When you have essential tremor, everyday tasks that others take for granted can seem like insurmountable hurdles you're being asked to leap over throughout the day. Activities like pouring a cup of coffee or tying your shoelaces can leave you feeling defeated and exhausted.
Maybe you've tried medication to treat your essential tremor, but haven't seen any progress. Or maybe your neurologist has suggested you consider surgical treatment, but you aren't sure if that's the right option for you.
Fortunately, there is an option — called MR-guided focused ultrasound — that is offered only in the region by Penn Medicine.
Casey H. Halpern, MD, a Penn Medicine neurosurgeon and Chief of Stereotactic and Functional Neurosurgery, answers questions below about essential tremor and the hope that focused ultrasound treatment offers to people whose shaky extremities might otherwise seem untreatable.
Q&A about essential tremor
What is essential tremor?
Dr. Halpern: Essential tremor is an involuntary movement of the upper extremities, and sometimes the head and jaws. This tremor doesn't really exist when you're at rest, but when you try to do something, you start shaking.
Most people with essential tremor are otherwise healthy. Sometimes it runs in families, but other times it's sporadic.
When patients are diagnosed with essential tremor, where are they referred for treatment?
Dr. Halpern: Neurologists are generally the first specialists you'll see for essential tremor treatment. This is because treatment typically involves medications, such as a series of pills.
However, some people try several different medications and still have a disabling tremor that interferes with daily living. They have trouble picking up utensils, writing, getting dressed, working on a computer. This can be very tiring over time.
Those are the patients who are usually referred to a neurosurgeon, like me, for other treatment options.
What treatments are available for patients whose essential tremor cannot be controlled using medication?
Dr. Halpern: The surgical standard of care for essential tremor in this country has been what's called deep brain stimulation. This procedure involves putting electrodes in a patient's brain and attaching these electrodes to a pacemaker using wires. The wires run a current into the brain to suppress the tremor.
But there is also a nonsurgical treatment called MR-guided focused ultrasound that received approval from the US Food & Drug Administration. During the procedure, a focused beam ultrasound is delivered in an MRI machine to make a lesion in the brain.
This process — called ablation — is done on the thalamus, which is the same portion of the brain where the electrodes would be implanted during deep brain stimulation though it is currently limited to one side of the brain.
How is MR-guided focused ultrasound treatment different from deep brain stimulation?
Dr. Halpern: There are a few differences between MR-guided focused ultrasound and deep brain stimulation. First, focused ultrasound is nonsurgical, which means no holes are made in the skull and no hardware, like a pacemaker, is needed. Second, focused ultrasound makes a lesion on the brain, which means the treatment should last long term. At Penn Medicine, we offer both technologies and help guide patients and their families towards the best treatment for them.
What sets Penn Medicine's MR-guided focused ultrasound system apart?
Dr. Halpern: At Penn Medicine, we are the only ones in the region with the MR-guided focused ultrasound system as well as procedural alternatives including radiosurgery and deep brain stimulation. We believe any patient with disabling tremor should be counseled by experts that can offer all options for this condition. This procedure can be transformative for patients with essential tremor. And that is our goal: complete suppression of essential tremor with focused ultrasound.