man who shakes holds soup spoon in both hands

Essential Tremor Affects Millions, But Few Know the Treatment Options

For people with essential tremor, the activities of daily life can be extremely difficult, if not impossible. Essential tremor, a medical movement disorder, causes people's arms, hands, and heads to shake uncontrollably, and no matter how hard people try, the tremor cannot be willed to stop.

Increasingly, essential tremor patients are turning to a noninvasive and painless new treatment—focused ultrasound—that has the potential to eliminate their trembling. For several years, Columbia neurosurgeon Gordon Baltuch, MD, PhD, who specializes in the surgical treatment of movement disorders, has been one of a few surgeons in the United States experienced in the technique.

Essential Tremor Treatment Options

“Essential tremor is a cause of significant disability,” says Baltuch, who has performed thousands of surgeries, helping thousands of people restore balance and control in their lives.

“Holding a spoon, drinking from a glass, writing, dressing, especially with buttons, putting on makeup. Those tasks sound mundane, but the mundane is important in our lives,” Baltuch says. “If you're unable to put a shirt on, that can really impact your life in a very significant way.”

We spoke with Baltuch to find out more about this common condition, estimated to affect 7 million to 10 million people in the United States, and how 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 hands and arms but can also be in the head, eyelids, and voice. People with essential tremor may experience rapid nodding, quivering, or shaking in the hands, arms, head, eyelids, and other muscles. The movements may be on one side of the body or both.

A person who has essential tremor may have a hard time holding and using items like 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 in 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?

Columbia neurosurgeon Dr. Gordon Baltuch

Gordon Baltuch

Unless the tremors significantly disrupt life or work, most people with essential tremor will be treated for symptom relief only.

In severe cases—the person cannot eat or drink or perform usual duties—medication (propranolol or primidone) is the first option. If medication is ineffective, 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.

Focused ultrasound thalamotomy is a more recent incisionless surgical option. 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 brain tissue that causes the tremors.

When should you go to a doctor if you think you have essential tremor?

If your tremors are new or are interfering with your life, talk to your doctor.


Read more about focused ultrasound in Columbia Medicine magazine.

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. Since 2017, he has successfully performed hundreds of these procedures.