Veterans with essential tremor can now get a nondrug wearable device through the VA

Encora Therapeutics' wearable device for adults with essential tremor is now available to order through the U.S. Department of Veterans Affairs, the company announced Oct. 15, expanding treatment options for veterans living with the condition.

The device, Encora X1, is FDA-cleared and delivers mechanical neurostimulation at the wrist to help manage hand tremor without medication or a procedure. VA facilities can purchase it through Lovell Government Services, a service-disabled veteran-owned small business certified by the Small Business Administration that is contracted to process Encora X1 orders. The device is available by prescription only, and the company said veterans can ask their VA care team whether it is appropriate for them.

The condition is common in the veteran population. More than 30,000 veterans receiving VA care had a recorded essential tremor diagnosis in a single year, according to a peer-reviewed national analysis of VA health records published in the journal Tremor and Other Hyperkinetic Movements.

Nationally, essential tremor is one of the most common movement disorders, affecting an estimated 7.6 million people in the United States, according to a separate analysis in the same journal. It causes involuntary, rhythmic shaking, most often in the hands, that typically occurs during movement and can worsen over time.

For many patients, tremor makes routine tasks such as holding a cup, eating, pouring a drink, writing or using a phone difficult. Medications are typically the first line of treatment, but they do not work for every patient, and side effects can limit their use, the company noted.

“Too many veterans with essential tremor have learned to adapt their lives around their tremor. They use two hands to hold a cup, avoid certain foods, or let someone else pour,” said Daniel Carballo, co-founder of Encora Therapeutics.

Carballo said VA availability gives veterans and their care teams another option “when medication isn't enough, isn't well tolerated, or simply isn't the right fit, and when they're looking for an option that isn't a drug and isn't a procedure.”

“We want veterans to be able to stay independent and keep doing the everyday things most of us take for granted,” he said.

How the device works

Encora X1 is a wrist-worn device about the size of a smartwatch. It delivers mechanical neurostimulation targeting the median, radial and ulnar peripheral nerve distributions at the wrist. According to the company, it can be used alongside medication or on its own, and it is designed to be worn throughout the day so patients can activate it when they want support with specific activities.

The company said the device may help fill a treatment gap for patients who need a nondrug option but have an implanted electrical device, such as a pacemaker. Because Encora X1 uses mechanical rather than electrical stimulation, it carries no electrical contraindications, giving physicians another option to weigh when selecting therapy, the company said.

Clinical data

In clinical studies, device effects were observed within about 15 minutes of use, according to Encora.

In a randomized, double-blind, sham-controlled study, 70% to 75% of participants achieved a one-point improvement in tremor-related disability during everyday tasks after 30 minutes of stimulation, compared with 48% of participants in the sham group, the company reported. In addition, 96% of study participants rated the therapy as “comfortable all of the time.” The company noted that individual results may vary.

Nondrug options gain attention in movement disorder care

The VA availability comes as interest grows in nondrug, noninvasive approaches to managing movement disorders, particularly for patients who have exhausted or cannot tolerate pharmacologic options.

For years, treatment for essential tremor has largely followed a stepwise path: medication first, followed by surgical or procedural options for patients with refractory, disabling tremor. That leaves a sizable middle group of patients whose tremor interferes with daily function but who are not candidates for, or are not interested in, invasive intervention. Older patients, those with multiple comorbidities and those already managing complex medication regimens may be especially reluctant to add another drug or undergo a procedure.

Wearable peripheral nerve stimulation devices have emerged as one response to that gap. Because they can be used on demand and removed when not needed, they allow patients to target therapy to the activities that matter most to them, such as meals or writing, rather than relying solely on continuous systemic treatment.

For primary care physicians, who often see essential tremor patients long before a neurology referral, these options may broaden early conversations about treatment goals and functional impact. Considerations such as implanted cardiac devices, medication burden and patient preference are increasingly part of those discussions.

Government health systems also play a role in adoption. When devices become available through federal procurement channels, clinicians in those systems gain a more straightforward path to prescribing them, which can shape how quickly new therapies reach patients in practice.