Early in the morning of June 16, inside the MRI suite at Marcus Neuroscience Institute, June Montagne held a pen and tried to draw a circle.

For most people, it would have been a simple request. For Ms. Montagne, 68, whose hands had shaken since childhood, it was a test of whether six decades of essential tremor (ET) could be quieted without an incision, anesthesia or a hospital stay.

After each round of focused ultrasound treatment, she tried again: circles, lines, her signature. And each time, the page told the story before she could.

“It’s an incredible feeling. It’s like a miracle,” she says. “Going from shaking to hardly shaking at all. Now I’m pretty solid.”

Timothy Miller, M.D

Her case also marked a milestone for Marcus Neuroscience Institute, part of Baptist Health, at Boca Raton Regional Hospital: Ms. Montagne was the 100th patient treated there with high-intensity focused ultrasound (HIFU) for ET, a neurological condition that causes uncontrolled shaking, most often in the hands.

Six Decades of Shaking

Ms. Montagne has built a remarkable life on the water. A Boca Raton-based yacht charter broker and proud member of the Charter Yacht Brokers Association Hall of Fame, she came alive at sea long before she settled in South Florida.

“I started sailing off the coast of South Africa in my 20s,” she recalls. Eventually, she found work as a crew member aboard a yacht in Cape Town. “We crossed the ocean in six weeks and ended up in the Caribbean.”

Ms. Montagne’s career has been built around confidence, conversation and connection — hosting clients, attending international boat shows and traveling to Italy, Greece, Turkey and beyond. But through all of it, she carried something else: the physical, emotional and social burdens of ET.

“I was a child when I discovered that I had essential tremor,” she recalls. “I remember quite vividly being about 5 or 6 years old in the physician’s office. He asked me to put my hands out, and then he put a piece of paper on my hands. I was shaking so much that it just floated off.”

Four generations of her family have lived with the same condition.

“My father had essential tremor, and his father, too,” she says. Her son, Jake, also shows early signs of ET.

When Everyday Life Becomes a Struggle

For Ms. Montagne, the tremor was not painful but it was always present — shaping how she brushed her teeth, applied makeup, held a glass, signed her name and worked at a keyboard.

“You find that you compensate,” she says. “You support your arm against something, and I was using props to help me get through different times.”

Her career made the challenge harder. In a business built on luncheons, dinners and cocktail parties, a shaking hand could draw unwanted attention.

“Having a cocktail in your hand and not being able to hold it correctly, or spilling a glass of wine unintentionally, it’s embarrassing,” she admits. “I felt that I always had to explain why I was shaking.”

Work at the computer became a daily battle, too.

“My typing was so bad that I couldn’t control my left hand, so I would hold on to the side of the keyboard and type with my thumb,” she says.

Even signing Christmas cards to her clients left her feeling embarrassed.

“It looked like a child’s handwriting,” she says.

Over the past decade, her tremor grew worse. And as her left hand became harder to control, the condition began to affect not just her confidence, but her productivity.

“My left-hand typing was really affecting my speed and how productive I could be,” she says.

Understanding Essential Tremor

Essential tremor is often confused with Parkinson’s disease, but the two conditions are quite different, says Timothy Miller, M.D., director of functional neurosurgery at Marcus Neuroscience Institute.

“It’s very important to pick up these differences in clinic, because they’re treated very differently,” Dr. Miller says.

Parkinson’s disease often brings gait changes, slowed movements and changes in voice and facial expression. Essential tremor, by contrast, most often causes shaking during movement, such as writing, eating, drinking or reaching for an object.

Essential tremor is considered benign in the sense that it is not life-threatening, Dr. Miller explains. But for many patients, it can still be life-limiting.

“Essential tremor often runs in families, whereas Parkinson’s disease does not,” Dr. Miller says. “Nailing the diagnosis up front is very important to determine treatment options.”

At Marcus Neuroscience Institute, patients are evaluated through a multidisciplinary process that includes functional neurosurgery and movement disorders neurology. Dr. Miller works closely with movement disorder neurologist Sameea Husain, D.O., to help confirm the diagnosis and determine whether a patient may be a candidate for focused ultrasound, medication, deep brain stimulation or another treatment approach.

A Treatment That Sounded Like a Miracle

About five years ago, a friend sent Ms. Montagne an article about HIFU as a treatment for essential tremor.

“It was like my prayers had been answered,” she says.

She chose to treat her right hand first, three years ago, and saw significant improvement. But as her left hand worsened, she began looking at treatment again.

“That is why I decided to have HIFU on my left hand,” she says.

The procedure uses MRI-guided ultrasound energy to target a tiny area of the brain involved in tremor. Unlike traditional surgery, it does not require an incision.

“High-intensity focused ultrasound uses about 1,000 ultrasound arrays to focus beams of ultrasonic energy at a very small area of the brain,” Dr. Miller says. “When all of those beams intersect, they heat up the brain tissue and interrupt part of the pathway that’s known to be responsible for essential tremor.”

The target is a small structure called the VIM nucleus of the thalamus. The team uses MRI imaging in real time, allowing physicians to carefully monitor the target and the patient’s response during the procedure.

Safety comes first. Doctors test the target at a lower energy level, watching carefully for both improvement and possible side effects before delivering the final treatment.

“Before we ever create a permanent lesion, we create a subthreshold lesion that allows us to check for side effects and also efficacy,” Dr. Miller says. “There’s no incision, no anesthesia and no hospital stay.”

Ms. Montagne was a strong candidate, he says, in part because her skull density allowed the ultrasound energy to reach the target effectively.

Treatment Day, Step by Step

On the morning of her procedure, Ms. Montagne was greeted by the Institute’s nurse navigator, Talia Adoni, BSN, RN, CNRN, who walked her through each step.

Her head was shaved, and a lightweight frame was fitted to keep her head motionless during the MRI. The only pain she experienced was from the initial numbing injections given before securing the frame.

“Quite honestly, I think the injections to numb your scalp before they put the frame on are the most painful part,” she says.

Music helped her stay calm during the procedure.

“You get earplugs because the MRI machine is loud,” she says. “It does help to choose your favorite music.”

Between each treatment round, Ms. Montagne came out of the scanner and performed simple tasks: drawing circles, drawing lines and signing her name. The change was visible almost immediately.

“It’s quite remarkable because you can already see some difference,” she says.

After several rounds, each lasting roughly eight minutes, the final signature looked nothing like the first.

For someone who had spent much of her life compensating for a shaking hand, the stillness felt almost unbelievable.

“It’s an incredible feeling,” she says. “It’s like a miracle.”

Home the Same Day

HIFU is an outpatient procedure and Ms. Montagne went home the same day with her son, Jake. Her entire visit lasted about three and a half hours.

Dr. Miller says most side effects are mild and temporary.

“There are some expected side effects that can include some numbness of the fingertips, a bit of discoordination with the treated arm and some balance difficulties,” he says. “We are usually seeing good resolution within a month and near-complete resolution within six months.”

Study data show that fewer than four percent of patients report any lasting effects beyond two years, and those are typically minor, he says.

Ms. Montagne’s recovery went smoothly.

“I never felt dizzy or that I lost my balance. I felt fine,” she says.

Six days after treatment, she was walking, working and celebrating small victories.

Life, Regained

For Ms. Montagne, the results have been life changing.

Before treatment, she had to hold the side of her keyboard and type with her thumb. After treatment, she could use her left hand again.

“The typing side is incredible,” she says. “Being able to use my left hand to type on my phone, filling up a glass of water, carrying things with my left hand where I couldn’t before, putting toothpaste on the toothbrush, eating with a knife and fork — those are just some of the things I can do now without shaking.”

The change has given her a new appreciation for daily life.

“I have a much deeper appreciation for all those little things that we do every day,” she says.

For Dr. Miller, that kind of immediate improvement is one of the most meaningful parts of his work.

“This is probably one of the most meaningful immediate responses, when I can see a patient go from very tremulous to immediately improved,” he says. “There’s not much else in the world of neurosurgery where we can see that sort of immediate result.”

A Milestone Worth Celebrating

As the 100th HIFU patient at Marcus Neuroscience Institute, Ms. Montagne became part of a growing program that offers advanced treatment for patients with essential tremor and other movement disorders.

“It feels wonderful,” she says. “The attention that I got was quite amazing.”

Dr. Miller credits the milestone to a coordinated team that includes neurosurgery, movement disorders neurology, imaging specialists and patient navigation. He says that team-based approach is essential to selecting the right patients and providing the right treatment.

“What makes us special is a multidisciplinary team approach,” he says.

That approach has helped the program complete more than 100 HIFU procedures, all with successful outcomes, Dr. Miller adds.

A Message of Hope

Both patient and physician share the same advice: Don’t wait to ask questions.

“If you’re concerned that you have essential tremor, ask for a referral to a neurologist for a definitive diagnosis, and start looking into interventions early,” Dr. Miller says.

For anyone living with a tremor that is interfering with work, meals, writing or confidence in social situations, Ms. Montagne’s advice is simple: find out what options are available.

“Take the chance to do it,” she says. “It can only be better than what it was, and it will change your life.”

Click here for more information about movement disorder treatments and specialists at Marcus Neuroscience Institute at Boca Raton Regional Hospital.