EMBRACE Tremor BiFUS

Inclusion Criteria:

1. Men and women with an age of 18 years or older.

2. Willing to participate in the study (i.e., signed ICF). (Willing to be randomized).

3. Patient is able to undergo a high-resolution Computerized Tomography (CT) scan.

4. Patient is able to fit into MRI unit and comply with all contraindications for thespecific magnetic resonance (MR) system including and limited to contrast mediumshould there be needed.

5. The thalamus, sub-thalamus and the pallidum must be apparent on MR imaging.

6. Patient is able to communicate sensations to the physician during the procedure;Procedure does not require general anesthesia.

7. Patient must be able to use the Stop Sonication button freely.

8. Patient willing to have their head shaved prior to the actual treatment.

9. Patient has no history for claustrophobia which is not responding to medications.

10. ET patients who are eligible for second side staged bilateral Exablate thalamotomytreatment. Time since first intervention is at least 9 months.

11. Available tremor assessment prior to the unilateral Exablate thalamotomy.

12. Patients randomized to the study, irrespective of group allocation should be willingand able to remain in the study for at least 6 months and able to complete therequired assessments.

Exclusion Criteria:

1. Subject experienced any non-transient neurological event or worsening following theprevious Exablate procedure.

2. Patients with MRI related contraindications (e.g. presence of metallic implantsincompatibility with MRI, severe claustrophobia, reaction to contrast medium).

3. Patients in whom it is not possible to avoid energy absorbing structures orsensitive tissues (e.g., skull implants, surgical clips, shunts, electrodes, durapatch, skull patch, electrodes, etc.) from the path of the ultrasound beam.

4. Patients with concurrent active infections disease and/or severe allergies withfever.

5. Patients that have been diagnosed with brain tumors or a vascular anomaly.

6. Patients with a history of seizures, brain hemorrhages, stroke within the past year,or any coagulopathy.

7. Patients under anticoagulants and/or anti-platelets drugs known to increase bleedingrisk within the duration defined by the half-life of the specific drugs.

8. Patient that has been given any contrast agent (e.g., CT, MRI), within 24 hoursbefore treatment

9. Severe unstable hypertension that cannot be controlled by medications (diastolicBlood Pressure > 100 on medication).

10. Patients with unstable cardiac status.

11. Patients exhibiting any behavior(s) consistent with ethanol or substance abuse.

12. Cerebrovascular disease (multiple CVA or CVA within 6 months).

13. Patients with risk factors for intraoperative or postoperative bleeding.

14. Imaging shows abnormal finding in CT or/and MRI (e.g., brain tumor, brain vascularmalformation, shunt, etc.).

15. Patient has physical subscale score ≥ 16.5 on the Dysphagia Handicap Index or hasbeen diagnosed with dysphagia.

16. Patient with cognitive impairment.

17. Patient with clinically significant abnormal speech function as determined by aspeech pathologist.