“It was so embarrassing,” says Marilyn Berkoer of her condition. The otherwise healthy and active 81-year-old from Coconut Creek has suffered virtually her entire life from essential tremor (ET), a progressive neurological condition that causes uncontrollable shaking. It most often affects the hands but it can also affect the head, voice and legs, as was the case with Ms. Berkoer.

About 1% of all Americans have ET but for those over 60, the number jumps to 5%. The cause of the movement disorder is unknown but it is hereditary, experts say, with upwards of half of all patients reporting that they had a parent with the condition. It tends to start either in young adults in their 20s, or in older adults in over 60. It has even been reported in children as young as 10.

ET can be controlled with the right mix of medications – for a while – and although it’s not life-threatening, it is often extremely disabling. For the estimated 10 million Americans who have ET, many daily tasks are impossible and sometimes dangerous.

“I’m left-handed and if I needed to sign my name, I would have to steady my shaky left hand with my right hand. Holding a cup of hot coffee would take both hands, too, so I didn’t spill it all over myself,” says Ms. Berkoer. And the more she focused on her tremors, the worse they became, she says.

But thanks to specialists at Marcus Neuroscience Institute at Boca Raton Regional Hospital, part of Baptist Health, many patients like Ms. Berkoer who are no longer responding to their ET medications are benefiting from an innovative treatment that provides instant relief for their tremors.

Seeking Treatment for Essential Tremor (ET)

After moving to South Florida from New York 25 years ago, Ms. Berkoer noticed her ET symptoms were getting much worse, especially in her dominant left hand. In 2017, she finally decided to seek the care of a neurologist. She says she was fortunate to find Sameea Husain, D.O., director of movement disorder neurology at Marcus Neuroscience Institute.

“The goal with ET is to optimize the patient with oral medications. We can usually find some ‘cocktail’ of medications that works but they require constant tweaking to find the greatest benefit,” Dr. Husain explains. “Unfortunately, all of these medications come with side effects and they eventually lose their effectiveness, so we have to explore other options.”

Ms. Berkoer was more than ready to try something else. “I was taking up to nine pills a day for my ET and still had trouble eating and writing and holding beverages,” she says. She had heard about high-intensity focused ultrasound (HiFU) being approved to treat ET and was told by Dr. Husain that she would be a candidate for the procedure.

Dr. Husain referred her to her colleague, neurosurgeon Timothy Miller, M.D., director of functional neurosurgery at Marcus Neuroscience Institute. Dr. Miller was the first to perform HiFU at the Institute and has been finding great success using the innovative therapy to treat patients with ET and other movement disorders.

“Ms. Berkoer had already been diagnosed with essential tremor in her hands, legs and head when she was referred to me by Dr. Husain in 2023,” Dr. Miller recalls. “We discussed her options, which included deep brain stimulation (DBS) and high-intensity focused ultrasound (HiFU), both of which are highly effective in treating essential tremor. We discussed the risks and benefits of both and ultimately she opted for HiFU because it’s non-invasive, it can be done quickly with instant results, and it has long-term efficacy.”

What is High-Intensity Focused Ultrasound (HiFU)?

HiFU is an incisionless, painless outpatient procedure that sends more than 1,000 beams of ultrasound through the skull to target and destroy lesions that are disrupting the brain’s normal circuits. The procedure has been performed hundreds of times with excellent results by Dr. Miller at Marcus Neuroscience Institute as well as by neurosurgeons at Baptist Health Miami Neuroscience Institute.

The U.S. Food and Drug Administration (FDA) approved HiFU for essential tremor in 2016 and more recently approved its use in patients who suffer from tremors on both sides of their body, meaning that it can be performed twice – separately for each side of the body. HiFU is also used to treat other conditions and diseases, according to Dr. Miller.

“The benefits of HiFU compared to traditional surgery include little to no risk of infection, no hospitalization, no general anesthesia and no invasive burr holes into the skull or implants in the brain,” says Dr. Miller. And, he adds, the treatment is done in just one session.

What’s it Like Having High-Intensity Focused Ultrasound?

In June 2024, under Dr. Husain’s care, Ms. Berkoer underwent the HiFU procedure with Dr. Miller. After a lifetime of struggling with ET, she was excited to be the first patient to undergo the procedure at Marcus Neuroscience Institute.

“First, they shaved my head and put a halo on for stabilization and then they put me on the MRI table,” recalls Ms. Berkoer. At the controls and guided by the MRI, Dr. Miller focused the ultrasound’s energy on the pea-sized spot in the right thalamus of her brain that controlled the tremor in her left hand.

As he did so, he had her perform different tasks until he was able to find the exact spot that controlled her tremor. “He wanted me to squeeze his hand, draw a spiral and draw a straight line. At first, my line looked like an EKG,” she says, laughing.

Once Dr. Miller found the spot and delivered a burst of ultrasound energy, the results were instantaneous, says Ms. Berkoer. For the first time in her life, she was able to draw a perfectly straight line.

A 100% Improvement in Her Hand Tremor

“It was a miracle. I was screaming for joy in post-op. It’s like being born again. You’re given a renewed sense of normalcy, a chance to be like everybody else,” says Ms. Berkoer, choking back tears. “Being able to hold a cup of coffee. Being able to sign my name. Being able to eat without dropping it all over myself. It’s been a Godsend.”

“There’s very little that we do in the neurosurgery world where you see an immediate effect and this is one of those things,” Dr. Miller says. “Ms. Berkoer had an extremely successful outcome. She was reporting a 100% tremor improvement in her left-hand tremor, both at one month and six months post-operatively.”

Now that HiFU has been approved by the FDA for bilateral treatment – left-side and right-side tremors – Ms. Berkoer is scheduled to have her right-hand tremor treated in September after the required nine-month wait between treatments.

Mutual Trust Between Neurologist and Neurosurgeon

One of the advantages of being treated for ET at Marcus Neuroscience Institute is not just the technology and expertise that can be found, all under one roof. It’s also the trust doctors and surgeons have for each other, says Dr. Miller.

“When Dr. Husain sends me a patient and says she’s a candidate for HiFU, I trust that completely. I don’t have to confirm the diagnosis. I don’t have to rule out other conditions such as Parkinson’s disease, which is a mimicker of ET, because she’s already done that,” Dr. Miller says.

Dr. Husain says she is “over the moon” that Ms. Berkoer has been able to get her life back after suffering with ET for so many years. “Thanks to Dr. Miller, she’s finally able to do all the little things we take for granted every day. I’m still seeing her for head tremors that we’re treating with neurotoxin injections, which work by blocking signals from the nerves that make the muscles contract, causing them to relax.”

Impressed by Her Care Team’s Dedication, Caring and Empathy

Ms. Berkoer is more than pleased with the results of her HiFU treatment and can’t wait for her right hand to be treated. “You don’t find doctors like Husain and Miller – they’re the best. Everyone at Marcus Neuroscience Institute is there to help. It’s not just a job. It’s not just about providing great customer service. It's about dedication, caring, and empathy,” she says. “They are the most caring people in the world. I give them an A+++.”

For more information about high-intensity focused ultrasound (HiFU) at Baptist Health Brain & Spine Care, click here.