Focused Ultrasound Helps People with Essential Tremor
For people with essential tremor, the activities of daily life can be extremely difficult, if not impossible. Essential tremor is a medical movement disorder that causes people's arms, hands, and heads to shake uncontrollably, no matter how hard they try to be still. This condition is a common neurological disorder, estimated to affect 7-10 million people in the United States.
Increasingly, essential tremor patients are turning to a new non-invasive and painless treatment called focused ultrasound thalamotomy, which has the potential to eliminate their trembling. Columbia neurosurgeon Gordon Baltuch, MD, PhD, who specializes in the surgical treatment of movement disorders, started performing focused ultrasound in 2017 and has been one of the few surgeons in the United States experienced in the technique. A pioneer in this treatment for essential tremor, Dr. Baltuch performed his 500th focused ultrasound procedure in August.
“Essential tremor is a cause of significant disability,” says Dr. Baltuch. “Holding a spoon, drinking from a glass, writing, dressing, especially with buttons, putting on makeup. Those tasks sound mundane, but the mundane is important. If you're unable to put a shirt on, that can really impact your life in a very significant way.”
Dr. Baltuch explains the causes of essential tremor, the habits that make it worse, and how treatments like focused ultrasound can help.
What is essential tremor?
Essential tremor is a type of movement disorder, which is a medical condition controlled by the nervous system. Movement disorders cause abnormal movements and disrupt life to varying degrees, some extreme.
The shaking caused by essential tremor usually happens in the hands and arms but can also be in the head, eyelids, and other muscles. It may be heard in the voice. The movements may be on one side of the body or both.
A person with an essential tremor may have difficulty holding and using items such as forks, pens, tools, glasses, and mugs.
Essential tremor is not dangerous. Usually, it’s frustrating and sometimes embarrassing. In the most severe cases, it interferes with the ability to work and live.
Who gets essential tremor?
Everyone has a tremor from time to time, usually so slight it’s not noticed. Essential tremor is the most common type of tremor and is 10 times more common than Parkinson’s disease. It affects men and women, usually over age 65. If you live to your 70s and beyond, it is likely you will develop some degree of essential tremor. And for some people, it’s extreme.
What causes essential tremor?
The cause of essential tremor is unknown. Researchers have found the part of the brain that controls muscle movements does not work correctly in people who have essential tremor.
Genetics play a part. If one of your parents had essential tremor, you have a higher chance of developing it yourself.
How do you prevent essential tremor?
You cannot prevent essential tremor, but you may be able to minimize symptoms by limiting or avoiding triggers. Essential tremors can be worse when a person is experiencing stress or not sleeping enough, smoking, drinking caffeine and/or alcohol, and taking certain medications.
How do you treat essential tremor?
Unless the tremors significantly disrupt life or work, most people with essential tremors will be treated only for symptom relief.
In severe cases—meaning the person cannot eat or drink or perform usual duties—medications such as propranolol or primidone are the first option. If medication doesn’t help, surgery is an excellent second option.
The most common surgery is deep brain stimulation. A surgeon implants an electronic device in the thalamus, the part of the brain that controls movement and causes the tremors. The device is connected by a wire to a neurostimulator implanted in your chest. The neurostimulator sends pulses to your brain to stop the tremors.
A more recent surgical option—which doesn’t involve an incision—is focused ultrasound thalamotomy. A surgeon uses magnetic resonance imaging (MRI) to send sound waves through the skin and skull that target the thalamus. The sound waves generate heat that destroys the specific brain tissue that are causing the tremors.
What can a patient expect during a focused ultrasound procedure?
Focused ultrasound is a two-hour procedure during which a patient lies in an MRI machine. The patient remains awake, which helps the neurosurgeon control the intensity and location of the sound waves so the treatment can be customized to each person. By the time the person comes out of the MRI, the tremor has been suppressed. It’s very rare to see such immediate effects from a treatment.
What are the latest advances in focused ultrasound technology?
As of 2023, we expanded our focused ultrasound program to include staged bilateral procedures, allowing patients with tremor in both hands to be treated on each side of the brain, nine months apart per FDA guidelines. By 2026, we will begin to treat additional Parkinson’s symptoms beyond tremor using newly FDA-approved technology targeting the pallidothalamic tract.
When should you go to a doctor if you think you have essential tremor?
If your tremors are new or if they are interfering with your daily life, talk to your doctor.
Gordon Baltuch, MD, PhD, is professor of neurological surgery and co-chief of functional neurosurgery at Columbia University Vagelos College of Physicians and Surgeons. He specializes in the surgical treatment of movement disorders and is a pioneer in the use of focused ultrasound, a nonsurgical procedure approved in 2016 to treat essential tremor.