Focused Ultrasound for Essential Tremor: Key Q&A Insights

Focused ultrasound is emerging as a significant treatment option for people with Essential Tremor. Ultrasound energy is used to heat a small portion of the brain associated with the tremor circuit. The heat destroys a ~4 mm region of the pathway, resulting in a substantial reduction in tremor. The FDA approved the incisionless procedure in 2016. At UF Health, we recently treated our 100th patient as we continue our goal to reduce tremor and improve the quality of life in our patients.

The following Q&A, based on insights from Justin Hilliard, MD, an Associate Professor of Neurosurgery at the University of Florida, addresses common questions, misconceptions and practical considerations related to the procedure.

Q. How severe does a tremor need to be for focused ultrasound?

A. Your essential tremor needs to be impacting your quality of life in a significant way. Focused ultrasound carries risks, but the benefits are substantial. A typical candidate would be experiencing tremors that are severe enough to disrupt daily tasks, such as eating, drinking or writing.

If your tremor hasn’t reached this level of severity, Dr. Hilliard may advise continuing medical management.

Q. How does age affect the ability to do this treatment or therapy?

A. Focused ultrasound is appropriate for older adults, with those in their 70s and 80s often being ideal candidates. There is no strict age limit for the procedure. Ultimately, determining if focused ultrasound is right for you depends on a thorough evaluation of your tremor, previous treatments and risk factors like pre-existing balance or speech concerns.

Q. I have tremor in both hands. Is it possible to treat both sides?

A. Yes. It is possible to treat both sides, but only one side can be treated at at ime. FDA labeling requires nine months between treatments to allow a full recovery prior to influencing the other side of the brain. Treating both sides simultaneously could severely affect your speech and mobility. No center in the United States treats both sides of the brain simultaneously.

Q. Will my doctor treat the worst side first?

A. You can choose which side you want to treat first. Dr. Hilliard typically advises treating your dominant hand first.. Our team will help guide that decision during your evaluation.

Q. What are the common side effects associated with the procedure?

A. The four common areas influenced are speech, balance, coordination and sensation. There are also rare side effects, such as changes in taste or tinnitus.. These side effects typically result from swelling around the region of the tremor circuit that is permanently impacted. Side effects peak within the first week of the procedure,, but as swelling dissipates, the side effects tend to diminish.

Approximately 20% of patients may experience mild to moderate long-term side effects. Typical tremor reduction is in the range of 70-80%. . Long-term, serious side effects are rare, but may occur. Dr. Hilliard’s goal is to provide functional improvement in your tremoring extremity while avoiding permanent side effects.

Q. I am over 60 years old, and my tremor is getting worse. What procedure would you recommend for someone of my age?

A. Your age and medical history play a role in determining the best possible options. Dr. Hilliard suggests scheduling an evaluation at UF Health, where he and our clinicians can assess whether focused ultrasound or an alternative therapy called deep brain stimulation is better suited to your needs. We perform both procedures at UF Health.

Q. Do I need to be off my medication before my evaluation?

A. Ideally, you would wean your medications a few days prior to yoru evaluation in order to allow Dr. Hilliard to fully assess the severity of your tremor.

Q. Does facial hair have to be removed before surgery?

A. No. You don’t have to remove facial hair before the procedure. However, your head will be shaved beforehand as scalp hair can interfere with the ultrasound.

Q. Does stress or lack of self-confidence trigger tremors?

A. Everyone has tremor to some extent. Those with essential tremor can have a worsened tremor due to anxiety or stress (as adrenaline is released). Stress can exacerbate tremor, but low self-confidence does not directly trigger tremors.

Q. If someone has had Botox injections for essential tremor, would that eliminate them as a candidate for focused ultrasound?

A. No. Botox injections would not disqualify a patient for focused ultrasound treatment.

Q. What research advances do you expect in the next five years?

A. Over the next five years, Dr. Hilliard believes focused ultrasound and deep brain stimulation outcomes will improve with advances in imaging technology allowing even more precise targeting of the tremor circuit.

Q. Is focused ultrasound covered by insurance?

A. Yes. Focused ultrasound is an FDA approved procedure and is covered by Medicare and commercial insurers. It is not experimental. Once the UF Health team determines you’re an appropriate candidate, the procedure will be submitted to your insurance. Our clinical staff at UF Health will work with you to find the best ways to support your needs.

Learn more about focused ultrasound treatment and Dr. Hilliard. To schedule an appointment, call (352) 273-9000.