Botulinum injection
When medications do not control the tremor or the person does not tolerate medication, C. botulinum toxin, deep brain stimulation, or occupational therapy can be helpful. The electrodes for deep brain stimulation are usually placed in the  "tremor center" of the brain, the ventral intermediate nucleus of the thalamus. Ultrasound
Additionally, MRI-guided high-intensity focused ultrasound is a nonsurgical treatment option for people with essential tremor who are medication refractory. MRI-guided high-intensity focused ultrasound does not achieve healing, but can improve the quality of life. While its long-term effects are not yet established, the improvement in tremor score from baseline was durable at 1 year and 2 years following the treatment. To date, reported adverse events and side effects have been mild to moderate. Possible adverse events include gait difficulties, balance disturbances, paresthesias, headache, skin burns with ulcerations, skin retraction, scars, and blood clots. This procedure is contraindicated in pregnant women, persons who have non-MRI compatible implanted metallic devices, allergy to MR contrast agents, cerebrovascular disease, abnormal bleeding, hemorrhage and/or blood clotting disorders, advanced kidney disease or on dialysis, heart conditions, severe hypertension, and ethanol or substance abuse, among others. The US Food and Drug Administration (FDA) approved Insightecs Exablate Neuro system to treat essential tremor in 2016.Another treatment for essential tremor is a surgical option; deep brain stimulation is used. Prognosis
Although essential tremor is often mild, people with severe tremor have difficulty performing many of their routine activities of daily living.
This unique topography allows for frequent collisions of warm and cold air, the conditions that breed strong, long-lived storms throughout the year. A large portion of these tornadoes form in an area of the central United States known as Tornado Alley. This area extends into Canada, particularly Ontario and the Prairie Provinces, although southeast Quebec, the interior of British Columbia, and western New Brunswick are also tornado-prone. Tornadoes also occur across northeastern Mexico.The United States averages about 1,200 tornadoes per year, followed by Canada, averaging 62 reported per year. NOAAs has a higher average 100 per year in Canada. The Netherlands has the highest average number of recorded tornadoes per area of any country (more than 20, or 0.00048/km2, 0.0012/sq mi annually), followed by the UK (around 33, 0.00013/km2, 0.00034/sq mi per year), although those are of lower intensity, briefer and cause minor damage. Tornadoes kill an average of 179 people per year in Bangladesh, the most in the world. Reasons for this include the regions high population density, poor construction quality, and lack of tornado safety knowledge. Other areas of the world that have frequent tornadoes include South Africa, the La Plata Basin area, portions of Europe, Australia and New Zealand, and far eastern Asia.Tornadoes are most common in spring and least common in winter, but tornadoes can occur any time of year that favorable conditions occur. Spring and fall experience peaks of activity as those are the seasons when stronger winds, wind shear, and atmospheric instability are present.