Julian Fellowes, the 76-year-old screenwriter best known for Downton Abbey and The Gilded Age, has significantly reduced his essential tremor and regained the ability to write by hand after undergoing a non-invasive treatment called MR-guided focused ultrasound (Magnetic Resonance -guided focused ultrasound thalamotomy). The procedure, performed in May 2025 at Imperial College Healthcare NHS Trust in the U.K., targeted a region of his brain called the thalamus and yielded a clear reduction in tremor in his right hand.
Essential tremor (ET) is a neurological movement disorder characterized by involuntary, rhythmic shaking, especially during purposeful movements such as writing, eating, or drinking. It is more common in older adults and often worsens over time. 2
Fellowes said that over the past decade essential tremor severely limited his ability to write, hold a cup steady, or perform other tasks needing precision. He tried medications, which are common first-line treatments, but they failed to provide sufficient relief. He was talking in a video released by Insightec in YouTube after the recovery.
The procedure uses MRI imaging to guide focused ultrasound beams through the skull to reach a precise target in the thalamus without making incisions. 3
While Fellowes remained awake during the surgery, doctors monitored his responses so they could adjust targeting in real time. The goal is to ablate (destroy) a small region of brain tissue to interrupt the tremor signals.
After the procedure, Fellowes reported acute improvements: he could draw steady spirals, drink from a cup without spill, and soon after felt confident enough to resume writing. 3
Clinical studies of MR-guided focused ultrasound thalamotomy have shown durable benefits. A five-year follow-up of patients treated with this method reported an average tremor severity reduction of about 73% from baseline. 1
Participants in those studies also reported stable quality of life and minimal delayed complications between one year and five years post-treatment. 1,2
The treatment is most useful for people whose tremor is persistent and unresponsive to medication. As with any medical procedure, it carries risks. Although major adverse effects are uncommon, temporary side effects may occur (e.g. discomfort, tingling, balance issues).
The procedure typically treats one side of the brain to diminish tremor in the arm on the opposite side. In Fellowes’s case, the right hand was treated by targeting the left thalamus. 3
It does not guarantee a complete cure: tremor may recur or persist in different degrees, depending on individual brain anatomy, disease duration, and other health factors.
“Focused Ultrasound for Essential Tremor: Five-Year Results,” Focused Ultrasound Foundation, 24 August 2022. https://www.fusfoundation.org/posts/focused-ultrasound-for-essential-tremor-five-year-results/
Cosgrove, G. R., et al. “Magnetic resonance imaging–guided focused ultrasound thalamotomy for essential tremor: Sustained tremor improvement at 5 years.” PMC, 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC10193464/
Insightec. “Downton Abbey Creator Lord Julian Fellowes Successfully Treated for Essential Tremor with Insightec’s Incisionless Focused Ultrasound Therapy.” Insightec, September 16, 2025. https://insightec.com/news/downton-abbey-creator-lord-julian-fellowes-successfully-treated-for-essential-tremor-with-insightecs-incisionless-focused-ultrasound-therapy/.
(Rh/Eth/TL)