A non-invasive treatment gives a steady outlook

Small business owner Scott Slate built a career on his handiwork. As an RV park owner and manager, electrical and plumbing maintenance are part of his everyday life. The central Texas business owner never could have imagined his life’s work would be threatened by the very tools that helped build his business – his hands.

Fortunately, a non-invasive therapy performed by Dr. Ashwin Viswanathan, director of stereotactic and functional neurosurgery at Baylor Medicine, helped Slate manage his essential tremor and regain control of his hands and his life.

Slate, who turns 60 later this year, first developed a tremor in his 30s. “At first, it was just an annoyance. I could work around it, and if I focused really hard, I could get rid of it.” However, that changed 15-20 years ago. “I could no longer will it away. That was when my primary care provider officially diagnosed me with an essential tremor. He prescribed me medications that worked well for about a decade.”

Eventually, Slate’s tremor stopped responding to medication. “We tried a handful of medications, but after about 5 years, it got to a point where my tremor was affecting my ability to do my job. Maintaining electrical and plumbing at my RV Park, a tremor not only makes working with my hands difficult, but also dangerous. You do not want shaky hands in an electrical box.” As a result, Slate would hire contract workers to assist with his company, which impacted his earnings as a small business owner.

Around that time, his primary care physician referred him to a neurologist. In a twist of fate, his new specialist had recently attended a national conference, where he sat in on a panel about an at-the-time novel therapy called MR-guided focused ultrasound (MRgFUS), which uses focused beams of ultrasonic energy guided by MRI to target areas deep in the brain with no incisions or permanent implants.

“He shared that his nurse practitioner had an essential tremor. She also attended this conference and had decided that focused ultrasound was a good option for her. After speaking with my neurologist, we decided it was an option I should also consider.”

After working with his insurance provider, Slate was connected with Viswanathan’s office.

“My first appointment with Dr. Viswanathan was a video visit. I showed him my tremor, and we discussed my medication regimen. After talking through the pros, the cons and the possible side effects, we decided to move forward with the procedure for treatment of my right hand, which is my dominant hand. I went into the appointment ready to do it, but Dr. Viswanathan is a good doctor and still took the time to explain everything in a way I could understand.”

In November 2025, Slate traveled to Houston with his wife for his treatment. Baylor College of Medicine, in partnership with Texas Children’s Hospital, is one of a few selected centers in the country with the expertise and technology to perform MRgFUS.

He recounts the day. “The procedure itself, there was no discomfort, no pain. The worst part was when they placed the halo device (a ring attached to the skull with four steel pins) to prevent neck movement and keep my head in place, and even that was very manageable.” After just a few passes through the MRI machine, the difference in Slate’s tremor was night and day. “I could see the difference in the steadiness of my handwriting immediately. In real time, it was 100 times better than it used to be.”

Viswanathan explains the mechanics of the procedure. “The focused ultrasound energy interrupts a small cluster of neurons in the ventral intermediate nucleus of the thalamus, a key relay point in the tremor circuit. Because this happens in real time, we are often able to see the symptoms improve in real time.”

Slate was able to go home that same day. While he experienced some of the temporary side effects Viswanathan discussed with him, he made a full recovery. “Dr. Viswanathan told me that I might have a change in taste and that I could have some balance or gait issues. When I woke up the day after the treatment, my sensation of taste was off. I also noticed my walking was not quite right, like I lost track of where my right foot was. However, these both resolved within a couple of weeks. In fact, the gait thing did not even last a week.”

For Slate, the benefits of the treatment far outweighed the minor side effects. “My daughter is 31, and she cried the first time she saw me after the procedure. She said, ‘Dad, I have never seen you with a stable hand.’ My wife also sleeps so much better now because my tremor is not waking her up throughout the night.”

He also regained a sense of ownership over his business. “Prior to the focused ultrasound, I would have to walk an employee through a job. I have always been an educator, but it was frustrating to know that the only thing preventing me from doing my work was the tremor. I now feel like I have my life and my business back, and I am so thankful for Dr. Viswanathan and the entire team. The quality of care – the empathy and concern for my well-being – has probably been some of the best healthcare I have had in my entire life.”

To learn more about MR-focused ultrasound at Baylor Medicine, call the Department of Neurosurgery at 713-798-4696. More information is also available here.

By Cristina Flores, senior communications associate in the Department of Neurosurgery