Focused ultrasound (FUS) is beginning to fulfil its the potential as a therapy for a wide spectrum of neurologic conditions. Engineering advances allow sound waves to be targeted through the skull to a selected brain region, using an MRI guided array of focused emitters. High intensity focused ultrasound (HIFU) can create a coagulation lesion similar to that of radiofrequency stereotactic methods, but without opening the skull. This has led new treatments for medication resistant tremor, with promising clinical research to treat Parkinson’s disease, refractory chronic pain and psychiatric conditions. Moderate intensity FUS can safely open the blood-brain barrier for targeted delivery of molecular and cellular therapeutics without the need for brain injection with application to the treatment of brain tumors and neurogenerative diseases. Low levels of sonic energy can be used as a form of neuromodulation, with the potential to non-invasively modify abnormal neural activity as seen in epilepsy.