The FDA has approved the first focused ultrasound device to treat essential tremor in patients who have not responded to medication. ExAblate Neuro (InSightec, Dallas, TX; www.insightec.com/clinical/neurosurgery/) uses magnetic resonance (MR) images to deliver focused ultrasound that destroys brain tissue in a tiny area thought to be responsible for causing tremors.

Indications: To determine if ExAblate Neuro treatment is appropriate, patients should first have MR and computerized tomography (CT) scans.

Dosage/administration: Those undergoing treatment lie in an MRI scanner that takes images to help a doctor identify the targeted area in the brain’s thalamus. Treatment with the transcranial focused ultrasound energy is administered with incremental increases in energy until patients achieve a reduction of tremor. Patients are awake and responsive during the entire treatment.

Adverse reactions: Adverse events for the ExAblate Neuro are consistent with those reported for thalamotomy surgery, including numbness/tingling of the fingers, headache, imbalance/unsteadiness, and loss of body control movements (ataxia) or gait disturbance.