I was excited when my editor asked me to cover brain surgery that offers relief for patients with a debilitating neurological condition: essential tremor.
“Am I going actually going to peer inside a human skull?” I wondered. Then, I learned that the procedure didn’t involve any cutting, which sounded even more incredible.
There’s another reason it piqued my interest: One of my children was diagnosed with a neurological condition at age 4. Since then, I’ve learned that these conditions can affect your entire life: daily activities, independence, career options, sense of self.
There is currently no cure for my daughter’s condition; we just live life with it. While I love her exactly as she is, I imagine she would love a choice to “opt out” of its effects on her life. What would it mean for an adult, I wondered, to all but reverse a condition midlife? I’d soon find out …
A week before surgery, I asked patient Brandon DeJames to share what had brought him to this moment.
Holistic care for movement disorders.
How it began
In third grade, DeJames was playing a game with his classmates when his teacher asked, “Why is your hand shaking?”
He didn’t have an answer for her. It just shook sometimes.
He kept busy swimming and playing kickball with his two brothers and a neighborhood full of friends in North Miami, Florida. He didn’t have time to worry about his hand. Of course, his brothers tagged him with the nickname “Shakes,” but he just laughed it off.
Classmates also teased him from time to time. “I was made fun of, but you let it roll off you,” said DeJames, 46.
His family wasn't too concerned, especially since his grandfather's hand also shook. But over time, DeJames's symptoms began to increase. One shaking hand turned into two shaking hands. His head began to shake, too.
A name for the shaking – but no solution
At 16, DeJames was diagnosed with essential tremor, a neurological condition that causes a person’s body parts to shake involuntarily and rhythmically. Almost any body part can be affected, although hands are the most common. To the casual eye, the tremor resembles Parkinson’s disease.
Over the years, neurologists prescribed more than a dozen medications, but “they never got rid of the tremor,” DeJames said. He didn’t like the side effects, so he discontinued them. (My daughter actually takes one of the medications DeJames discontinued, and he's right. The side effects can be challenging.)
Another option was an invasive surgery that would require putting a probe into his brain and a pacemaker-like device into his chest. “I didn’t like the idea of it, something in my head, permanently,” DeJames said.
Since medication didn’t work, and surgery was not appealing, DeJames adapted to life with essential tremor.
‘Just dealing with it’
“Through the years I learned to do things with it – not hiding it, just dealing with it,” DeJames said.
In high school, he played the saxophone in marching band. This instrument was a strategic choice: he could hold it close to his body, aided by the strap around his neck.
“If someone hands me a full cup of a drink, it’s a mess,” DeJames said. “I will go to restaurants, but I order … things I know I can do. Eating soup, or spoon-to-mouth, can be hard.”
And high-stress situations would only crank it up higher. “I've been in job interviews where I'm like, ‘Oh God, I'm shaking all over and these people think I'm a freak now,’” DeJames said. “I feel judged. I try to keep my hands down. I hold them together in my lap, but it's kind of hard (to hide it) when the head starts going.”
Harder changes
One of the disheartening adaptations DeJames has had to make was changing his job.
After completing a health occupational program in high school, DeJames knew he wanted to pursue a medical career. He was trained and licensed as a CT technologist, but in recent years has had to switch focus due to his tremor.
“I don’t work in CT full time because you have to start IVs and things like that,” he said. His shaking made these fine motor tasks challenging – and he felt it increased patients’ anxiety too.
“People notice it, and they’ll point it out,” he said. “I’ve had, ‘Are you an alcoholic? Are you on drugs? Are you on Adderall?’”
As a result, DeJames primarily performs X-rays in his role at Novant Health Clemmons Medical Center, and helps with CT scans. “I would ideally like to be doing CTs full time,” DeJames said.
A new hope
He moved to North Carolina in 2008. While he enjoyed working with patients and found happiness with his partner of 15 years, he still wanted to experience life without shaking.
When he learned about a newer procedure called MR-guided focused ultrasound – that suppresses tremor without incisions or permanent implanted devices – DeJames decided to give it a try.
On a warm January day, he traveled from his home in Winston-Salem to Novant Health Mint Hill Medical Center in Charlotte, NC.
And then he went through a procedure that didn’t exist when his hand began shaking 37 years ago.
Procedure day: A shaved head, a few clicks, and ‘instant gratification’
Then: nothing.
At least, nothing that I could tell. The control room was silent, and I didn’t want to disrupt what is essentially incisionless brain surgery with my amateur questions. I stared at the computer monitors, trying to figure out what was going on. I watched Munyon outline specific parts of DeJames's brain on the MRI. I heard him click a computer mouse. And then – quietly, quickly – there it was: a 15-second treatment.
The team pulled DeJames out of the tube to assess how it had worked. He held a cup of water, drew a picture, wrote his name. He held his arms out straight in front of him, and you could tell he already felt and saw a change.
He slid back into the MRI machine for his next treatment with a smile on his face.
Over 45 minutes, DeJames had four short treatments. Then he completed his final task, writing the phrase: “This is a sample of my best handwriting.”
He held the pen up with a flourish – and no tremor.
Nurse Christy Moore was ready, passing DeJames a box of tissues for the tears of joy that she has learned "almost always" come. “I told you, it's instant gratification,” Moore said.
“I love instant gratification,” DeJames said, wiping his eyes.
The recovery room – and the rest of his life
Still shaking from emotion, DeJames walked to the recovery room, where he and his mother embraced, crying.
“It’s been a long time trying to get to this spot, to this time. I don't have words,” Roxanne DeJames said. “What an amazing thing that you can do that through the skull. Sound waves can do that. I can’t even conceive of it.”
Brandon DeJames, on the other hand, had plenty of words – and a scheduling request. Under current FDA regulations, only one side of the body can be treated at a time, with a required nine-month wait between procedures. DeJames doesn't want to wait a day longer than necessary to have the procedure on his other side.
“Can I make my next appointment? Can I sign up now?” DeJames asked. “Come on, September!”
500 lives changed – including Brandon's
After spending a few minutes recovering, DeJames walked out to applause, balloons, and cake. He was Novant Health's 500th patient to go through this procedure, and the team was ready to celebrate. No hospital in the U.S. has done more than Mint Hill Medical Center.
DeJames cut the cake – ta-da! – with a steady hand. And then he devoured it, in public.
“It will make life so much easier,” DeJames texted me later that day. “I don’t think I’ve stopped smiling.”
I hadn’t either.
You’ll recall DeJames was in third grade – the same grade my daughter is in now – when he began experiencing the symptoms of essential tremor. As I watched his procedure, I wondered: what else will be possible someday for my daughter, that I can’t even dream of today?
A mom’s journey for answers
About eight years ago, Brandon DeJames’s mom, Roxanne DeJames, was browsing medical news when she read an interesting blurb: a company named Insightec had developed a new incisionless procedure to treat the effects of essential tremor.
The technology, called “MR-guided focused ultrasound,” uses sound waves, guided by MR imaging, to create an ablation (a small change) in the part of the brain responsible for tremor – reducing the tremor’s effects.
“I said, ‘Oh my gosh, this sounds interesting,’” Roxanne, an infusion nurse, said.
She eventually tried to enroll Brandon in the clinical trials (although they were too late to sign up). The procedure earned FDA approval in the United States in 2016, and in 2020, the procedure became fully covered by Medicare in all 50 states.
Then Brandon learned that a neurosurgeon in his own health care system had partnered with Insightec to provide the procedure. In January 2024, Dr. Charles Munyon performed the procedure on Brandon.
Roxanne was there to hug her son afterward.
I caught up with Roxanne a month later to ask her how Brandon was doing. After all, she has watched his journey from its beginning. She said that for a while, as he cycled through different drugs to try to treat his tremor, he was “dulled.” But now, after the procedure? “He's a different man. He's brighter, he's happier. He's still walking around on cloud nine."
In fact, she said, the next week, they were were getting together to practice placing IVs. Brandon is getting ready to perform CTs again.
