Living with hand tremor can make everyday tasks hard. Eating, writing, getting dressed or even holding a phone may take extra effort and patience. Tremors can also cause embarrassment and result in social isolation.

For some people with tremors, medications may not help enough, or they may cause unwanted side effects. Surgery may also feel like a big step.

An incisionless procedure called magnetic resonance-guided focused ultrasound (MRgFUS) offers another treatment option. Joshua M. Rosenow, MD, a neurosurgeon and director of Functional Neurosurgery at Northwestern Medicine, and Leonard Verhagen Metman, MD, PhD, a movement disorders neurologist and director of the Northwestern Medicine Department of Neurology’s Deep Brain Stimulation and Advanced Therapeutics Program, answer common questions asked about this approach.

What Is Magnetic Resonance-Guided Focused Ultrasound?

MRgFUS uses ultrasonic waves focused on a single target in the brain guided by MRI imaging to treat tremors without open surgery.

Instead of making an incision, physicians use focused ultrasound waves to target and interrupt the abnormal activity of a small area of the brain responsible for tremor. MRI technology helps medical professionals see exactly where to aim and to monitor treatment in real time.

Because there is no cutting or implanted hardware, MRgFUS is considered a minimally invasive treatment.

What Conditions Can MRgFUS Treat?

This type of treatment is used to help manage tremors caused by:

• Essential tremor
• Tremor‑dominant Parkinson’s disease

Both conditions can cause shaking, often in the hands. Over time, tremors can worsen and begin to interfere with everyday activities and independence.

How Can This Treatment Help?

People notice improvement right away.

Benefits may include:

• Less shaking in the treated hand
• Easier performance of everyday activities like eating or writing
• Reduced reliance on medications
• Long‑lasting symptom improvement for most people

Results vary, but for the right patient, MRgFUS can be life‑changing.

What Happens During the Procedure?

The procedure is performed while you are awake so your care team can watch how your tremor responds during treatment. Here’s a general idea of what to expect:

• You’ll lie on an MRI table while wearing a special head frame.
• MRI scans guide the treatment and help doctors target the correct area in the brain.
• The surgeon will test your movement and tremor while identifying the best target. As a safety measure, the surgeon will first use low‑power ultrasound, which has only a temporary effect. This helps confirm that the tremor improves at the chosen target and that no side effects occur. At this stage, the surgeon can still adjust the focus.
• Once the best target is located, higher power ultrasound will be used to create a permanent lesion and treat the tremor.
• The anti-tremor effect is immediate.

Because there are no incisions, stitches, implanted devices or anesthesia, people go home the same day. The surgery may be performed in an outpatient center instead of a hospital.

Second-Side MRgFUS Treatment for Essential Tremor

If essential tremor affects both sides of your body, MRgFUS may help. After your initial (first-side) treatment, you may be eligible to have the other hand treated. Treating both sides may further reduce tremors.

You may be eligible for second-side MRgFUS if all of these apply:

• Your first treatment was at least nine months ago, which is the time frame recommended by the U.S. Food & Drug Administration (FDA).
• You have not experienced persistent side effects after your first treatment.
• You experience tremors in both hands.

How Long Do the Effects of Treatment Last?

Studies show that many people who have MRgFUS maintain improvement in hand tremors for at least three to five years after treatment. However, tremor is a progressive neurologic disorder, and MRgFUS does not treat the underlying disease process or stop disease progression. Consequently, over time, tremor may return to some degree.

What Are the Potential Side Effects?

MRgFUS can cause side effects. The most commonly reported include:

• Imbalance
• Numbness or tingling
• Headache or head discomfort during the procedure

For most people, these side effects are mild and gradually improve on their own. While many times they resolve within about 30 days, some side effects can take several months to fully improve.

When Is MRgFUS an Option?

MRgFUS may be considered if you:

• Have a confirmed diagnosis of essential tremor or tremor‑dominant Parkinson’s disease
• Continue to have disabling symptoms despite medication
• Have tremors that interfere with your daily activities
• Want a less invasive alternative to open brain surgery

When Is This Treatment Not Recommended?

MRgFUS may not be right for everyone. It may not be recommended if you:

• Are pregnant
• Have certain heart conditions or unmanaged high blood pressure
• Have implanted metal devices that are not MRI‑safe
• Cannot lie flat for 60 to 90 minutes
• Cannot tolerate more than 15 minutes in an MRI machine without requiring sedation

Your care team will review your full medical history before recommending MRgFUS.

MRgFUS is typically provided by a multidisciplinary team, which may include:

• Movement disorders neurologists
• Functional neurosurgeons
• Neuropsychologists
• Advanced practice providers (APPs)
• A patient coordinator to help guide scheduling and next steps, including physical therapy.

This team‑based approach helps ensure care is personalized and supportive throughout the process.

Is Magnetic Resonance‑Guided Focused Ultrasound Right for You?

If tremors are affecting your quality of life and other treatments haven’t helped, MRgFUS may be worth exploring. A consultation with a movement disorders neurologist is usually the first step. During this visit, they will review your medical history, neurologic exam and goals to help decide what’s best for you.

Learn more or schedule a consultation with a Northwestern Medicine specialist.