Essential Tremor
Essential tremor is a neurological disorder that causes involuntary and rhythmic shaking, most often in the hands.
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What Is Essential Tremor?
Essential tremor is one of the most common neurological movement disorders, causing rhythmic, involuntary shaking — most often in the hands, but sometimes in the head or voice. Over time, these tremors can worsen and begin to interfere with everyday activities like eating, writing, or drinking from a cup.
Signs and Symptoms
Symptoms of essential tremor develop over time and usually begin with the hands. The tremor may include a nodding or shaking head motion. It tends to appear more on one side of the body. It worsens with movement and can be triggered by stress, fatigue, caffeine intake and temperature changes.
Diagnosis
Diagnosis of essential tremor starts with a physical exam and medical history. Other procedures and tests may be needed to diagnose, including a detailed neurological exam, blood and urine tests to rule out other causes, and performance tests to evaluate your tremor. This may include drawing a spiral or holding your arms out in front of you.
When Should You See an Essential Tremor Specialist?
If your tremor is beginning to interfere with daily activities or your quality of life, it’s time to discuss treatment with your primary care physician or a neurologist who provides essential tremor treatment in Indianapolis. Many patients achieve good symptom control with medication, but if tremor remains bothersome despite medical therapy — or if you’re unable to tolerate medication — a movement disorder specialist or neurosurgeon can evaluate whether advanced treatments such as deep brain stimulation (DBS) or focused ultrasound may be appropriate.
What Are the Surgical Treatment Options for Essential Tremor?
For patients whose tremor is no longer adequately controlled with medication, advanced therapies can provide meaningful symptom relief. Two established treatment options are deep brain stimulation (DBS) and MRI-guided focused ultrasound (FUS). DBS uses implanted electrodes to regulate abnormal brain activity, while focused ultrasound is an incisionless procedure that uses precisely targeted ultrasound energy to treat the brain region responsible for tremor.
Choosing between deep brain stimulation (DBS) and focused ultrasound is a shared decision. Our functional neurosurgery team works with each patient to review the benefits and considerations of each option and develop a treatment plan that aligns with their symptoms, overall health, anatomy, and personal preferences.
Treatment Options
There are different treatment options, depending on the severity of your symptoms:
- Medication to help reduce or control tremors.
- Physical or occupational therapy to condition your muscles for control and coordination improvement, and to help you adapt to living with essential tremor.
- Deep brain stimulation This procedure can be recommended because, over time, medications for treating this disease become less effective. We recommend surgery for select patients to improve their quality of life before it declines significantly. You will have a special
MRI
of your brain 1-2 weeks before your surgery along with an appointment to make sure you can safely go to sleep with anesthesia for the surgeries.
Once asleep, you will have two very thin electrodes placed in your brain. There will be a CT scan done before you wake up to confirm the accuracy of the leads, and then your first surgery will finish. You will stay in the hospital one night and go home the next day.
One week later, you will have outpatient surgery while asleep, in which the generator, also known as “battery,” will be placed below your collar bone (where a pacemaker goes) through two incisions. You will go home the same day, and the battery will be turned on in your neurologist’s office. You should ask your doctor about your specific surgery. - Stereotactic ablation The goal of this surgery is to create a “lesion” in the brain with energy in the form of heat (either electricity, laser, radio wave or ultrasound). The surgery can be done with or without a “frame,” which is a device that is fixed onto your head before you obtain an MRI of your brain. This defines the “frame based stereotactic” surgery versus the “frameless stereotactic” surgery.
In both types of operations, a special high-resolution MRI will be needed shortly before your surgery to help target the exact part of your brain (in millimeters) that needs to be treated. You will be brought into the operating room and typically given conscious sedation with medications given through your IV to make you feel comfortable without going to sleep completely. During the procedure, you may be asked to give feedback on what you are feeling. After the procedure is complete, you will typically spend one night in the hospital and likely go home the next day.
Frequently Asked Questions
Deep brain stimulation (DBS) involves placing thin electrodes in a precise area of the brain that controls movement (typically the thalamus). These electrodes connect to a small device implanted near the collarbone that delivers gentle electrical signals to interrupt the abnormal activity causing tremor.
One key advantage of DBS is that it is adjustable over time, allowing treatment to be refined as your condition changes and making it an effective long-term option. Advances in computer-guided surgical technology also allow DBS to be performed routinely with patients fully asleep under anesthesia — an important benefit for those concerned about being awake during the procedure.
MRI-guided focused ultrasound (FUS) is an incisionless procedure that uses highly focused ultrasound energy to create a small, precise lesion in the thalamus — the area of the brain involved in tremor. During treatment, MRI provides real-time imaging and temperature monitoring, allowing the neurosurgeon to accurately target the brain region responsible for the tremor while preserving surrounding tissue.
One key advantage of focused ultrasound is that it does not require an incision or implanted hardware, allowing many patients to return home the same day. Because treatment is performed while the patient is awake, the care team can assess tremor improvement throughout the procedure to help optimize results.
Most candidates have a confirmed diagnosis of essential tremor and symptoms that significantly interfere with daily life. If medications are no longer providing adequate relief — or you cannot tolerate their side effects — and simple tasks such as eating, writing, or drinking from a cup have become difficult, you may be a candidate for advanced treatments such as deep brain stimulation (DBS) or MRI-guided focused ultrasound (FUS).
We encourage patients to treat our presurgical evaluation process as an open conversation. During these appointments, we thoroughly explain a patient’s different options to determine whether DBS is appropriate.
Yes. Unlike deep brain stimulation (DBS), MRI-guided focused ultrasound (FUS) is performed while you are awake. This allows your neurosurgical team to monitor your tremor throughout the procedure and make real-time adjustments to optimize treatment while minimizing the risk of side effects.
During the procedure, you will lie comfortably in an MRI scanner while focused ultrasound energy is precisely directed to the targeted area of the brain. Because there are no incisions or implanted devices, most patients return home the same day after a period of observation.
This is one of the most common concerns we hear, and the answer is no. Our surgeon performs DBS with patients fully asleep under general anesthesia, using advanced imaging and computer-guided technology to ensure precise placement without requiring you to be awake.
A specialized MRI is completed one to two weeks before surgery for planning, and a CT scan is performed during the procedure to confirm accuracy before you wake. Most patients stay in the hospital for one to two nights before returning home.
MRI-guided focused ultrasound (FUS) is an incisionless procedure, but like any medical treatment, it carries potential risks. Temporary side effects may include numbness or tingling, balance difficulties, headache, or dizziness. Although uncommon, some side effects can persist after treatment.
One advantage of focused ultrasound is that it does not require an incision or implanted hardware, reducing the risk of infection or device-related complications. Our team reviews the potential benefits and risks of focused ultrasound in detail during your evaluation so you can make a confident, informed decision. Our physicians continually refine their techniques through ongoing research and clinical training to provide safe, effective, and evidence-based care.
Recovery depends on the type of procedure performed. After deep brain stimulation (DBS), most patients return home within one to two days. After MRI-guided focused ultrasound (FUS), many patients go home the same day following a short observation period.
After DBS, light daily activities are typically resumed within a few weeks, with gradual improvement as the device is programmed and stimulation settings are adjusted over time during follow-up visits. After FUS, improvement in tremor is often noticeable immediately, with continued adjustment to daily function over the following days to weeks as the brain adapts.
Physical and occupational therapy may be recommended after either treatment to help improve coordination, rebuild confidence in daily activities, and maximize functional benefit as tremor control improves. Our team provides ongoing follow-up care to ensure the best possible long-term outcomes.
DBS and FUS are FDA-approved procedures and are covered by most major private insurance plans when clinical criteria are met. Coverage details vary, but our team helps guide you through the process, helping you to make sure that all your documentation is in place.
If you have questions, we encourage you to call our office or visit our Insurance and Billing page so we can help confirm your benefits before your consultation.
Do I Need a Referral To See an Essential Tremor Specialist in Indianapolis?
In many cases, you can schedule directly with our team without a referral, though some insurance plans may require one. We can help you determine what your specific plan needs. Referring physicians, including neurologists, primary care providers, and movement disorder specialists, can also submit referrals directly through our provider portal for streamlined coordination.
If a patient comes to us without a prior neurological evaluation, our team coordinates any necessary diagnostic workup as part of the presurgical process to ensure a comprehensive assessment. When you’re ready to take the next step, you can request an appointment through our appointment page or call our office to speak directly with our team.
Why Choose a Neurosurgeon for Essential Tremor Treatment?
At Goodman Campbell, we are a global leader in neurosurgical care and one of the most active centers for training and clinical research in the United States, with experience treating both straightforward and highly complex movement disorder cases. Patients benefit from a team that publishes outcomes data, trains future neurosurgeons, applies the latest evidence to every decision, and provides direct access to care throughout the process.
Request an appointment online and we will guide you through the next steps.