The Incisionless Brain Procedure Giving Patients With Essential Tremor Their Lives Back

Dan Cooney had lived with tremors in both hands since he was 12 years old. For six decades, he adapted his life around a condition that made the simplest tasks unexpectedly difficult. His dream of actively restoring his prized 1969 silver Camaro stayed largely out of reach. He just dealt with it, the way most people with essential tremor do.

Then he met Hooman Azmi, M.D.

Now 73, Dan has had focused ultrasound surgery on both hands, performed by Azmi at Hackensack University Medical Center. His hands no longer shake the way they used to. His Camaro recently won best in show at an antique car and motorcycle show. And on a sunny fall day, he took Azmi for a gratitude ride.

What Essential Tremor Actually Is

Essential tremor is one of the most common movement disorders, and one of the most misunderstood. Unlike Parkinson’s disease, which causes tremors at rest, essential tremor appears during action, when someone reaches for something, tries to write or attempts any purposeful movement. It can affect the hands, voice or head, though hand tremors are by far the most common presentation.

The condition is often inherited, though it can also occur without a family history. Its severity ranges widely. At its worst, it is profoundly disabling, affecting virtually every activity of daily life. Yet because it is not life-threatening, many patients, like Dan, go years or even decades without pursuing treatment beyond medication, simply learning to manage.

Why Treatment Options Have Historically Fallen Short

Until recently, Azmi explains, patients with essential tremor faced a frustrating choice. Medications can offer mild to moderate relief but are often imperfect and come with side effects that compound over years of use. The surgical alternative, deep brain stimulation, involves implanting a pacemaker-like device in the brain. While effective, it is a significant surgical undertaking, and many patients choose to live with their tremors rather than pursue it.

Focused ultrasound changed that equation entirely.

What the Procedure Involves

Focused ultrasound, also known as MRI-guided focused ultrasound or HIFU, is incisionless. There are no cuts, no implants and no general anesthesia. On the day of the procedure, the patient's head is shaved to allow sound waves to pass cleanly through the scalp and skull, and a specialized frame is secured to the head using local anesthetic at four points to prevent any movement during the procedure. The patient then lies on an MRI table while the clinical team plans the treatment, takes precise measurements and sends test sound waves to confirm tremor relief and monitor for any side effects. Once the team is satisfied with the targeting, the power of the sound waves is increased to make the effect permanent. The entire process takes roughly two to two and a half hours, with about one hour on the MRI table.

Critically, the procedure works for hand tremors. It does not treat head or voice tremors, which require different approaches. That specificity matters in candidate selection; patients are evaluated carefully for the nature and location of their tremors, their response to medications and the anatomical characteristics of their skull, which must be compatible with safe sound wave penetration.

A Changing Landscape

Focused ultrasound received U.S. Food and Drug Administration (FDA) approval for essential tremor in 2016 and for tremor-dominant Parkinson’s disease in 2018. Hackensack Meridian Neuroscience Institute became the first hospital in New Jersey to offer the treatment in June 2021, and the program has since expanded to Jersey Shore University Medical Center and JFK University Medical Center, with hundreds of cases performed across those locations.

The indications are also expanding. Focused ultrasound is now being explored for nontremor symptoms of Parkinson’s disease, potentially opening the door for patients who are not good candidates for deep brain stimulation or who are not getting adequate relief from medication alone. Investigational efforts are underway across a range of other neurological conditions as well.

For patients who suspect they may be candidates, Azmi recommends seeking out a dedicated movement disorder team, exploring medication options thoroughly first and asking specifically about focused ultrasound as part of that conversation. The technology, he says, has a bright future, and for patients like Dan Cooney, it has already delivered on its promise.