Journal Article

DZNE-2026-00561

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Patient-Reported Feedback Suggests an Alternative Sweet Spot for Deep Brain Stimulation Programming in Essential Tremor.

Peschke, S. ; Dong, J. ; Kirschner, A. ; Off, J. ; Shaik, J. ; Palleis, C.Extern* ; Mehrkens, J. H. ; Kaufmann, E. ; Scherer, M. ; Koeglsperger, T. (Last author)DZNE*

2026
Wiley New York, NY

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Please use a persistent id in citations: doi:10.1002/mds.70228

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

Keyword(s): Humans (MeSH) ; Essential Tremor: therapy (MeSH) ; Essential Tremor: physiopathology (MeSH) ; Deep Brain Stimulation: methods (MeSH) ; Female (MeSH) ; Male (MeSH) ; Middle Aged (MeSH) ; Aged (MeSH) ; Patient Reported Outcome Measures (MeSH) ; Ventral Thalamic Nuclei: physiopathology (MeSH) ; Zona Incerta (MeSH) ; Visual Analogue Scale (VAS) ; connectomics ; deep brain stimulation (DBS) ; essential tremor

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Contributing Institute(s):

1. Clinical Research (Munich) (Clinical Research (Munich))

Research Program(s):

1. 353 - Clinical and Health Care Research (POF4-353) (POF4-353)

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Database coverage:
; Clarivate Analytics Master Journal List ; Current Contents - Clinical Medicine ; Current Contents - Life Sciences ; DEAL Wiley ; Ebsco Academic Search ; Essential Science Indicators ; IF >= 5 ; JCR ; Nationallizenz ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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