Essential Tremor (ET) is the most common movement disorder, affecting nearly 1% of the adult population. It is characterized by involuntary, rhythmic tremors—primarily in the hands—during voluntary movement or when maintaining a posture. Though not life-threatening, essential tremor can significantly impair daily functioning, fine motor skills, and quality of life. Traditional treatments such as beta-blockers, primidone, and surgical options (e.g., deep brain stimulation or thalamotomy) provide benefit, but many patients experience limited relief or are not candidates for invasive procedures. In this context, Repetitive Transcranial Magnetic Stimulation (rTMS) offers a non-invasive, safe, and promising therapeutic alternative.

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive neuromodulation technique that uses magnetic pulses to stimulate specific areas of the brain. For essential tremor, low-frequency rTMS (typically 1 Hz) is targeted over the cerebellum, which plays a central role in the cerebello-thalamo-cortical (CTC) pathway—a network crucial in the genesis and regulation of tremor.

A growing body of clinical trials and pilot studies supports the potential efficacy of cerebellar Repetitive Transcranial Magnetic Stimulation (rTMS) in Essential Tremor:

• A 2024 randomized, sham-controlled trial involving 45 patients found that 12 sessions of 1-Hz cerebellar rTMS over 4 weeks led to significant reductions in tremor severity measured by the Fahn-Tolosa-Marin (FTM) tremor-rating scale. These improvements persisted for up to 3 months, with no serious side effects reported.
• Other studies assessed cerebellar rTMS as an “add-on” therapy in patients already on medications. Though both real and sham groups improved, the real-rTMS group showed greater tremor reduction, supporting the notion of synergistic benefit when rTMS is used alongside pharmacotherapy.
• Resting-state fMRI and motor evoked potential (MEP) assessments revealed neurophysiological changes after rTMS, suggesting improved functional connectivity within motor control circuits. This underlines the mechanistic basis for sustained benefit in Essential Tremor patients.

Repetitive Transcranial Magnetic Stimulation is well-tolerated and no serious adverse events were reported across studies.The most common side effects were mild scalp discomfort or temporary fatigue. Repetitive Transcranial Magnetic Stimulation (rTMS) sessions typically last 20–30 minutes, performed 3 times per week over 2–4 weeks.

Repetitive Transcranial Magnetic Stimulation (rTMS) may be particularly suitable for:

• Patients with treatment-resistant essential tremor
• Individuals not eligible for surgery
• Patients seeking non-pharmacological options
• Those with bilateral tremor not adequately controlled by medication

Repetitive Transcranial Magnetic Stimulation (rTMS) is emerging as a safe, effective, and non-invasive therapy for patients with essential tremor, especially those who have not achieved adequate relief with medications. By targeting cerebellar circuits involved in tremor regulation, rTMS offers lasting symptom reduction and improved quality of life. As evidence continues to grow, rTMS is establishing itself as a key option in the modern, personalized treatment of Essential Tremor.