Imagine living your entire life unable to drink a glass of water in public without embarrassment. For Alexandra Lebenthal, this was reality—until she became one of the first Americans to undergo a revolutionary brain treatment that sounds like science fiction but delivers real-world miracles.
In this deeply personal episode of "This Is Your Brain," Dr. Phil Stieg shares Alexandra's remarkable journey with essential tremor and the breakthrough focused ultrasound treatment that transformed her life. Joined by Dr. Michael Kaplitt, Executive Vice Chair of Neurological Surgery and Director of Movement Disorders at Weill Cornell Medicine, the conversation reveals surprising truths about a condition affecting millions while offering hope through cutting-edge neuroscience.
Essential tremor affects over 10 million Americans—10 times more people than Parkinson's disease.
Despite its prevalence, essential tremor remains largely invisible because patients become experts at hiding their condition. Dr. Kaplitt explains that people adjust their entire lives to prevent others from noticing, avoiding social situations, business meetings, and public speaking opportunities.
Alexandra's experience illustrates this perfectly. As a Wall Street executive, she developed elaborate coping strategies: arriving early to meetings to drink wine for its calming effect, sitting on her hands, or holding them under tables. The constant vigilance required to hide the tremor often becomes as exhausting as the condition itself.
This hidden nature means many sufferers feel isolated and ashamed, unaware that millions of others share their struggle with hands that refuse to obey their brain's commands.
Essential tremor makes nearly every hand-based activity challenging or impossible. Dr. Kaplitt breaks down the extensive impact: "Think about everything we do in the modern world—shaving, brushing teeth, using a spoon, texting on phones. There's almost nothing in our life that is unaffected if your hands shake every time you try to move."
For Alexandra, the tremor affected her professional life dramatically. She couldn't pick up water during speeches, leading to dry mouth and increased anxiety. One particularly painful memory involved a business meeting where a colleague asked, "Is your health okay?" after noticing her shaking hands—exactly the kind of attention she spent decades trying to avoid.
The condition can derail entire career paths. Dr. Kaplitt mentions patients who wanted to be surgeons, dentists, electricians, or professional golfers—all requiring steady hands that essential tremor makes impossible.
Essential tremor originates in the thalamus, the brain's relay station that coordinates smooth movement. Dr. Kaplitt uses the analogy of Grand Central Station to explain how the thalamus works. Just as the train station has different tracks for different destinations, the thalamus has specialized regions that relay specific types of information—movement, sensation, mood, and more.
In essential tremor, the movement coordination area of the thalamus malfunctions, sending "bad information" to the rest of the brain. Instead of smooth, controlled movements, patients experience jerky, tremorous motion. The root cause remains mysterious, but understanding this faulty circuit has led to targeted treatments.
This insight explains why traditional approaches like meditation or relaxation techniques rarely help—the problem isn't anxiety or stress, but a fundamental miscommunication within the brain's movement network.
Focused ultrasound uses 1,000 precise beams to destroy the malfunctioning brain tissue without surgery. The treatment works like focusing sunlight through a magnifying glass. Dr. Kaplitt explains: "We have this helmet with a thousand different sources of ultrasound coming through the head from different angles that meet in the middle. Each beam is very low energy, but where these thousand beams converge, you can add up enough energy to heat and destroy the target spot."
What makes the procedure remarkable is its immediacy. Alexandra describes the real-time transformation: patients draw spirals and straight lines before treatment (which look like "seismographs of earthquakes" for tremor patients), then repeat the drawings after each ultrasound session, watching their hand control improve step by step.
The moment of truth comes with a simple paper cup of water. After 50 years of being unable to drink without shaking, Alexandra's first successful sip was "completely miraculous." The treatment literally rewires brain function in minutes, not months.
This "elective brain surgery" can prevent decades of hidden suffering and social withdrawal. Alexandra's story raises crucial questions about timing. She lived with essential tremor for 47 years before treatment, developing sophisticated coping mechanisms and experiencing countless embarrassing moments. Her advice to others? Don't wait.
The procedure's safety profile and immediate results suggest that earlier intervention could prevent the psychological toll of hiding a neurological condition for decades. Dr. Kaplitt emphasizes that the right patient needs not just medical suitability, but the psychological readiness to be a partner in the treatment process.
Recently, the FDA approved focused ultrasound for treating tremor on both sides of the brain in Parkinson's patients, expanding access to this transformative technology. For the 10 million Americans with essential tremor, this represents hope for reclaiming activities most people take for granted.
Perhaps the most powerful aspect of Alexandra's story isn't the technical achievement, but the emotional liberation. Dr. Kaplitt describes patients crying on the treatment table, overwhelmed by suddenly being able to do simple tasks they'd avoided for years.
There's even a psychological adjustment period—patients initially refuse to attempt drinking from a cup because they've been "trained emotionally" to avoid such situations. The trauma of decades spent hiding their condition doesn't disappear instantly, even when the physical symptoms do.
Alexandra's experience highlights how neurological conditions affect far more than just the body—they reshape entire identities and social interactions. The treatment doesn't just stop tremors; it returns people to themselves.
Today, Alexandra serves as an advocate for focused ultrasound treatment, helping others navigate the decision to undergo this life-changing procedure. Her message is clear: the technology exists to transform lives, and waiting only prolongs unnecessary suffering.
For anyone living with essential tremor, Alexandra's journey from a three-year-old with shaking hands to a confident advocate for revolutionary treatment proves that even lifelong neurological conditions can be overcome with the right technology and courage.
Ready to learn more about breakthrough neuroscience treatments? Listen to the full "This Is Your Brain" episode to hear Alexandra's complete story and Dr. Kaplitt's insights into the future of non-invasive brain interventions.
