Patient-Reported Feedback Suggests an Alternative Sweet Spot for Deep Brain Stimulation Programming in Essential Tremor.

BACKGROUND

Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) and caudal zona incerta is an established therapy for essential tremor (ET). Clinical outcomes depend on precise electrode placement and optimal stimulation parameters. Effective programming must balance tremor suppression with side-effect risk, yet systematic incorporation of patient-reported feedback remains limited.

OBJECTIVE

The aim was to assess whether subjective patient feedback, quantified via a Visual Analogue Scale (VAS), can guide DBS programming for effective tremor control.

METHODS

In 15 VIM-DBS patients, 1253 unique stimulation settings were collected, each rated using a VAS reflecting perceived clinical benefit. Associated volumes of tissue activated were mapped and analyzed. VAS-optimized settings were compared to standard-of-care (SoC) programming. Voxel-wise permutation statistics identified stimulation sweet and sour spots, whereas structural and functional connectivity analyses determined neural correlates of subjective benefit.

RESULTS

VAS-optimized stimulation achieved tremor suppression comparable to SoC settings but with lower energy consumption. Sweet spots correlated with high VAS ratings localized to the dorsal VIM, whereas sour spots were ventral. Connectivity between sweet spots and prefrontal, frontal, and insular regions positively correlated with perceived benefit.

CONCLUSIONS

Integrating patient-reported feedback offers a structured, individualized approach to DBS optimization in ET. VAS-guided programming identifies patient-specific sweet spots and delineates connectivity profiles associated with clinical benefit. Particularly, VAS-derived sweet spots were more dorsal than previously suggested targets, highlighting the importance of incorporating subjective feedback to refine optimal stimulation regions. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.