George Vann once worked the beat as law enforcement for MTA Bridges and Tunnels with a side gig as a plumber — until an uncontrollable shake in both hands took those jobs away from him.
The tremors started around 2010. Vann, now 74, from Jamaica, Queens, struggled to grasp his firearm without shaking. He couldn’t hold steady a wand to test gas meters. He couldn’t carry a cup of coffee or use a spoon. To eat, Vann had to bring food right to his mouth. He never ate out at restaurants.
“No one should have to live like this,” said Vann, who in 2015 was diagnosed with essential tremor, the most common of all movement disorders. “No one.”
Now, after twice undergoing a non-invasive procedure that uses MRI-guided ultrasound to treat the tremors, Vann has regained control. “This is a gift from God,” said Vann, who first underwent the procedure for his dominant right hand in January 2022 and repeated it for his left hand in March 2023. “God, Jesus, the doctor — they gave me my life back. Make no mistake.”
Treatment for Essential Tremor Changing Lives
In 2016, the U.S. Food and Drug Administration approved the technique, called high-intensity focused ultrasound, for treatment of essential tremor in a patient’s dominant hand. The outpatient procedure uses MRI technology to determine the exact location in the brain where the tremors originate and once found, administers ultrasound to ablate the problematic tissue. While the procedure successfully treats tremors on the patients’ dominant side, they still often experience them on the untreated side, or have voice or head tremors that the unilateral procedure can’t fully treat. The safety and efficacy of repeating the treatment on the opposite region of the brain remained an open question.
Now, a study published July 29 in JAMA Neurology has revealed the answer: A multi-center clinical trial showed that second-side treatment is safe and effective in patients who previously underwent the procedure, with some mild to moderate side effects in a small number of participants.
“We knew there was strong demand for the procedure on the dominant side, since the improvement in quality of life is so dramatic,” said lead author Dr. Michael Kaplitt, a professor of neurological surgery at Weill Cornell Medicine and director of the Movement Disorders Program at NewYork-Presbyterian/Weill Cornell Medical Center, who in 2016 was the first physician in New York to perform the unilateral procedure experimentally before FDA approval. “Patients who had not been able to hold a pen or a glass, sometimes for decades, could walk out of the hospital after just a few hours with the use of their dominant hand restored.
“But in a world where holding a cellphone with one hand and touching the screen with the other is part of everyday life, and typing on a keyboard with two hands is an important skill,” he added, “the need for tremor control in both hands is more important today than ever before.”
To address this need, Dr. Kaplitt helped design and lead the clinical trial sponsored by Insightec—the manufacturer of the focused ultrasound machine. The trial took place from July 2020 to October 2021 at Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell Medical Center, along with six other academic medical centers in the United States.
FDA Approves Procedure for Non-Dominant Side
Of the 51 patients who participated in the trial, a small number experienced some adverse side effects. Eighty-five percent of these events were mild, and 13 percent were moderate, with the majority of these complications being numbness and tingling, speech difficulty, and gait/balance issues. Most had resolved after a year.
“While every procedure that changes the brain can have some risks, the low frequency of even relatively mild adverse events after this noninvasive procedure, which can be done in just a few hours, is quite remarkable,” Dr. Kaplitt said. “With such dramatic and immediate results, it allows patients to return home the same day.”
The investigators presented the findings to the FDA, which led to an additional approval in 2023 of the procedure on the second side, so that this is now available to any essential tremor patient.
That includes Robert Harris, 76, who first noticed his tremors in his late 20s. When he got a little nervous, he’d lose the ability to hold anything steady or use a pen to write. In his 30s, Harris started a plumbing business in New York City and would frequently participate in meetings with architects, construction managers and others.
“They’d have their plans laid out and my head would shake,” said Harris, from Brooklyn. “They’d look at me and think that I’m opposing something, that my head shaking meant we couldn’t do it, and then I’d have to explain.”
His shaking got progressively worse as he got older, making it nearly impossible to drink a cup of tea or write a check. He tried a few medications to control the tremors, but they instead made him lethargic and prevented him from playing tennis, lifting weights and tending to his garden.
Then he met Dr. Kaplitt. He underwent the procedure for his left hand in March 2023 and within a matter of hours, he got nearly full control of his hand back. He repeated the procedure for his right hand last January. And while he has had some minor balance issues, and the tremors have come back slightly in his left hand, he wouldn’t trade the experience for anything.
“I am so lucky to have had this procedure,” he said. “It feels like I’ve been given a new lease on life.”
Many Weill Cornell Medicine physicians and scientists maintain relationships and collaborate with external organizations to foster scientific innovation and provide expert guidance. The institution makes these disclosures public to ensure transparency. For this information, please see the profile for Dr. Kaplitt.