In this randomized, sham-controlled trial, MRI-guided focused ultrasound thalamotomy reduced hand tremor in patients with essential tremor who had not had a response to medication. Adverse effects of the procedure included sensory deficits and gait disturbances. Essential tremor, the most common movement disorder, 1 is characterized by a distinctive postural and intention tremor typically affecting the hands more than the legs, trunk, head, or voice. 2 , 3 Essential tremor does not shorten life expectancy, but it can affect quality of life, functional activities, mood, and socialization. 4 – 6 Class I evidence exists for propranolol and primidone as first-line medications that reduce tremor by approximately 60% in 50% of patients. 7 – 11 If resistance to medications develops or side effects are unacceptable, neurosurgical intervention is considered, primarily targeting the nucleus ventralis intermedius of the thalamus, a component of tremor circuitry that . . .