Understanding the Role of TAPS Therapy in Essential Tremor Management: Stuart H. Isaacson, MD, FAAN

Nonsurgical therapy remains the mainstay of treatment for essential tremor (ET), yet traditional pharmacologic treatments provide variable tremor reduction and are limited by tolerability and high discontinuation rates.¹ Over time, adverse effects and reduced long-term efficacy can weigh on quality of life, leaving many patients with persistent tremor that interferes with daily tasks.²

For patients with medically refractory ET, deep brain stimulation and focused ultrasound targeting the ventral intermediate (VIM) nucleus of the thalamus offer comparable tremor suppression. However, these procedures carry hardware-related or sensory and gait risks and are not appropriate for every patient.^2,3 These gaps have driven interest in noninvasive options that can be used as needed.

Transcutaneous afferent patterned stimulation (TAPS) is a wrist-worn therapy that delivers alternating bursts of electrical stimulation to the median and radial nerves, with the frequency tailored to each patient’s tremor. Developed by Cala Health, the FDA-cleared therapy is indicated for essential tremor (ET), as well as postural and kinetic tremor associated with Parkinson disease. In April 2026, the FDA also cleared the company’s next-generation Cala kIQ Plus system, expanding its device portfolio.

Building on prior evidence of acute and short-term lasting benefit, a retrospective analysis of the multicenter PROSPECT trial (NCT03597100) assessed underlying tremor using TAPS therapy in patients with ET.⁴ Recently published in Tremor and Other Hyperkinetic Movements, the study defined underlying tremor as prestimulation tremor severity measured after a washout period averaging 16.2 hours.

Among 192 patients with ET, findings showed that prestimulation Bain & Findley Activities of Daily Living (BF-ADL) scores improved by 2.0 points at 1 month and 2.7 points at 3 months. Additionally, Essential Tremor Rating Assessment Scale (TETRAS) scores improved by 0.8 and 0.7 points at the same time points (all P <.001). Since the study was open-label without a control arm, the authors noted that placebo or learning effects may have contributed.

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“So we’re able to conclude that with consistent use of the [TAPS] device, there is improvement not only acutely with each stimulation session lasting hours, but also in underlying tremor between sessions that seems to improve progressively with ongoing and consistent use.”

To discuss these findings, NeurologyLive^® spoke with Stuart H. Isaacson, MD, FAAN, director of the Parkinson’s Disease and Movement Disorders Center of Boca Raton and lead author of the analysis. Isaacson began by providing background on PROSPECT and on how TAPS is delivered. He explained that each stimulation session lasts approximately 40 minutes, that tremor begins to improve after roughly 20 minutes, and that the benefit persists for several hours after the device is removed. He then described the rationale for the analysis, which set out to determine whether consistent TAPS use over time could reduce underlying tremor, as measured before a stimulation session.

Isaacson reviewed findings from 192 patients with available data, highlighting greater prestimulation improvement at 3 months than at 1 month and gains on the BF-ADL scale that may reflect improved daily functioning. He also discussed the proposed mechanism of TAPS, which involves peripheral nerve stimulation at the wrist to modulate activity in the contralateral VIM thalamus and cerebello-thalamo-cortical circuit. In clinical practice, Isaacson noted that he considers TAPS for patients with inadequate responses or adverse effects from oral therapies, as well as those hesitant about surgery or ineligible for surgical intervention. He emphasized its noninvasive nature, ability to be used before daily activities, and potential to avoid systemic adverse effects associated with oral medications.

Editor’s Note: In the paper publication, Isaacson has disclosed to serve as paid clinical advisor for Cala Health.

REFERENCES
1. AlMojel M, Fasano A. Non-surgical treatment of essential tremor: What's in store?. Parkinsonism Relat Disord. Published online September 3, 2026. doi:10.1016/j.parkreldis.2026.108967
2. Alharbi O, Albaibi SA, Almutairi AA, et al. The Pharmacological Management of Essential Tremor and Its Long-Term Effects on Patient Quality of Life: A Systematic Review. Cureus. 2024;16(12):e76016. Published 2024 Dec 19. doi:10.7759/cureus.76016
3. Venkatesan S, Sorrentino Z, Mampre D, Chandra V, Hilliard J. Contemporary and evolving perspectives on surgical therapies for essential tremor: deep brain stimulation and focused ultrasound. Expert Rev Neurother. 2026;26(5):443-460. doi:10.1080/14737175.2026.2642844
4. Isaacson SH, Peckham E, Tse W, et al. Underlying Tremor Improvement with Consistent Use of Transcutaneous Afferent Patterned Stimulation in Patients with Essential Tremor. Tremor Other Hyperkinet Mov (N Y). 2026;16:1. Published 2026 Jan 9. doi:10.5334/tohm.1091