Neurologist Kelly Mills describes the case of an 80-year-old patient with long-standing essential tremor that resulted in difficulty independently performing activities of daily living and was refractory to multiple medications. The patient’s medical comorbidities, including diabetes that might complicate wound healing, affected his candidacy for surgical interventions. He underwent treatment of the Vim thalamus with MRI-guided, high-intensity focused ultrasound. Following treatment, the patient reported substantial functional improvement at 22 days and at six months. #essentialtremor #johnshopkinsmedicine #clinicalconnection