Essential tremor: incision-free neurosurgery using ultrasound

Drinking coffee without spilling it, signing a document without shaking, tying your shoelaces... these simple tasks are a daily challenge for millions of people around the world who suffer from essential tremor.

Essential tremor is a common neurological disorder characterised by involuntary rhythmic shaking, mainly of the hands. Although benign, it is highly debilitating. Pharmacological treatments, such as beta-blockers or anticonvulsants, often have limited effectiveness, prompting patients to consider more aggressive alternatives, such as surgery.

In recent years, a revolutionary technique has emerged that could change the game: magnetic resonance-guided focused ultrasound thalamotomy (MRgFUS).
With this technique, there are no incisions and no scars: the patient is placed in an MRI scanner. Hundreds of ultrasound beams pass through the skull and focus like a magnifying glass on a tiny area of the thalamus, the region of the brain involved in tremor. The heat produced creates a micro-lesion that stops the abnormal activity. The most spectacular thing? The effect is immediate. Many patients see their hands become stable again as soon as the procedure is over.

Published in September 2025 in the journal Expert Review of Medical Devices, an article co-authored by Emmanuel de Schlichting, a researcher at GIN, and his colleagues at the University of Toronto (Canada) reviews this technique by analysing studies published between January 2015 and March 2024 to evaluate its clinical efficacy, safety and procedural advances in the treatment of essential tremor. Key points such as patient selection, cranial density ratio, monitoring, thermal effects and tractography are discussed.

This review of the literature confirms the effectiveness of magnetic resonance-guided focused ultrasound thalamotomy:

• tremors are significantly reduced, sometimes after the first session,
• the benefits are maintained for several years,
• the risks are moderate, much lower than with traditional surgery.

In short: precise, incision-free neurosurgery and the promise of regained independence for patients. The only limitation is that effectiveness depends on the structure of the skull, which can slow down the spread of ultrasound waves.

Future improvements could further expand the use of this technique. With more precise targeting thanks to neural imaging, the possibility of treating both hemispheres of the brain, and new, even safer forms of ultrasound, by 2035 this technique could become a common outpatient procedure, not only for essential tremor, but also for other neurological diseases.

Reference : 
Magnetic resonance-guided ultrasound thalamotomy for essential tremor: a review.
De Schlichting E, Meng Y, Huang Y, Jones RM, Hynynen K, Hamani C, Abrahao A, Davidson B, Lipsman N.
Expert Rev Med Devices. 2025 Jul 11:1-9. 
doi: 10.1080/17434440.2025.2530765. Online ahead of print.