Do you suffer from shaky hands? Neurosurgery has long been thought the only solution to hand tremors. But now scientists have discovered a new, less invasive treatment that could offer fresh hope

Sarah Couldwell was shocked when a customer mistook her shaking hands as a sign that she was angry.

‘I’d given her some information and afterwards she told my colleague I was so angry my hands were shaking with rage,’ recalls Sarah, 52, a personal banker at a High Street bank.

‘Nothing could’ve been further from the truth as I enjoy helping customers. I was horrified.’

In fact, since she was 15, Sarah has suffered from involuntary shaking in her hands and arms.

‘Over the years I simply accepted it – I didn’t know anything could be done about it,’ she says.

‘I actually have an aunt who’s affectionately known in our family as “Shakin’ Stevens” [the 80s pop singer] because her hands shake so much, so it does run in my family.’

Sarah put up with the tremors until three years ago, when another bank customer apologised for his own shaking hands. She confided she had the same issue – and after they chatted, Sarah decided it was time to see her GP.

In 2024, she underwent tests to rule out other causes such as Parkinson’s disease, and was diagnosed with essential tremor. ‘It didn’t come as a huge shock,’ says Sarah, who lives in Gosport, Hampshire, with her husband Simon, 51, a retail manager, and their two children.

‘It was a clarification that I had a clinical problem and it wasn’t all in my head. I’ve always struggled carrying drinks without spilling them, or fitting a key into a lock. I find fiddly jobs which require fine motor skills difficult.’

Essential tremor is the most common neurological movement disorder in the UK, affecting around 600,000 people. It’s more common in those aged over 50 and slightly more in men, although it’s not clear why. Likewise, it’s not known why it can run in families.

The involuntary shaking of the body – particularly the hands and arms – is thought to be caused by a dysfunction of a network of brain cells that control movement. Symptoms are worsened by stress, caffeine, lack of sleep and ageing.

Everyday tasks such as eating and using a keyboard can become difficult.

Treatment usually starts with drugs such as propranolol, which suppresses the release of the hormone adrenaline that increases tremors. Anti-seizure drugs, including primidone and topiramate, which calm overactive nerve signals triggering the tremors, can sometimes help.

More severe cases are treated with MRI-guided ultrasound, which targets the ventral intermediate nucleus (VIM) – a pea-sized area deep in the brain where the tremor is generated. The high-energy waves produce heat that destroy this tissue, leaving a lesion.

A 2022 study in the Journal of Neurosurgery found 73 per cent of 45 patients who had this treatment still had reduced tremors five years later. But it can cause walking or balance problems.

Deep brain stimulation (DBS) – where electrodes are implanted into each side of the brain to target the VIM area – is also used in severe cases.

It is effective but the surgery can last six hours or more.

Now there is a new, less invasive treatment: transcranial ultrasound stimulation (TUS) involves directing soundwaves through a patient’s skull into the brain, to calm the overactive signals driving the tremor.

These soundwaves are much less intense than MRI-guided ultrasound and do not destroy tissue. A clinical trial is now under way at University College London Hospitals NHS Foundation Trust, where ten patients will receive a real stimulation and a ‘sham’ version (where no soundwaves are transmitted) so researchers can compare the two in the same person.

Dr Bradley Treeby, a former professor of biomedical ultrasound at University College London and co-founder of NeuroHarmonics, a spin-out of University College London which developed TUS, says: ‘If drugs fail to work, the problem with the existing options is that they are all surgical, and many patients are hesitant to undergo neurosurgery – or worry about it leaving permanent lesions on their brain – even though it works very well for many people.’

He says another issue is access to these procedures. Only around 200 people a year out of the thousands with essential tremor receive either treatment, due to a limited number of specialist centres, long waiting lists and tough eligibility criteria.

The new therapy could be much more accessible as it can be done in an outpatient setting while the patient is awake.

The patient first undergoes an MRI to pinpoint the exact location of the VIM in their brain.

Then during the 40-minute procedure they wear a special helmet that fires soundwaves painlessly through the skull, with motion sensors attached to their hands and arms.

As Dr Treeby explains: ‘The patient holds their arms outstretched in front of them so any change in the tremor should be visible with the naked eye – but the sensors will also precisely measure it.’

As TUS doesn’t create a lesion, any side-effects are expected to be mild, such as possibly a headache or sleepiness, which would soon pass. It’s likely the treatment will have to be regularly repeated. But what concerns experts is that people don’t realise there is help for essential tremor.

‘Most people with mild tremors don’t go to their GP unless they’re very disabling,’ says Dr Sharon Muzerengi, a consultant neurologist at University Hospitals Birmingham NHS Trust and the private Priory Hospital in Birmingham.

‘In clinic I see patients who’ve become socially isolated. If you’re spilling your beer walking back from the bar, for instance, you may avoid going to the pub and stay indoors.

‘Often people with essential tremor also suffer with anxiety and depression.’

After her diagnosis, Sarah was prescribed propranolol, but it made her feel faint, and she was switched to primidone, then to the anti-seizure drug trihexyphenidyl. But both caused side-effects so for the last year she’s not taken any medication.

Her tremors have got worse, making work tasks – such as counting bank notes or placing forms into envelopes – tricky.

‘My colleagues knew about my issue, so helped me but I was aware of customers noticing my hands shaking,’ she says. ‘I also stopped eating out as so many things were hard to eat, like cutting up a steak. Simon does most of the cooking as I can’t safely chop vegetables or hold a hot pan.’

She adds: ‘When our son was younger, I loved drawing with him – but as my hand shook more, I couldn’t do anything like that, which was sad.’

Sarah was assessed and found suitable for DBS and had the first stage of the procedure, to insert the electrodes, earlier this month. She’ll have the operation to connect these to a power-pack implanted just below her collarbone in three weeks’ time. This will be switched on in eight weeks.

‘My consultant told me it will be life-changing for me, especially as I’m relatively young,’ she says. ‘I’m hopeful it will make a huge difference.’