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

Sophia Peschke¹, Jing Dong¹, Angelina Kirschner¹

¹Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.

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Summary

Patient feedback using the Visual Analogue Scale (VAS) can guide deep brain stimulation (DBS) programming for essential tremor (ET). This patient-centered approach optimizes tremor control with reduced energy use, identifying personalized stimulation "sweet spots".

Keywords:

Visual Analogue Scale (VAS)connectomics deep brain stimulation (DBS)essential tremor

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Area of Science:

Neuroscience
Neurosurgery
Neurology

Background:

Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) is a key therapy for essential tremor (ET).
Optimizing DBS requires precise electrode placement and stimulation parameters to balance tremor suppression and side effects.
Current methods lack systematic integration of patient-reported feedback for programming.

Purpose of the Study:

To evaluate if subjective patient feedback, quantified by the Visual Analogue Scale (VAS), can effectively guide DBS programming for essential tremor.
To determine if VAS-guided programming improves tremor control compared to standard-of-care (SoC).

Main Methods:

Collected and analyzed 1253 unique stimulation settings in 15 VIM-DBS patients, with each setting rated using a VAS.
Mapped and analyzed volumes of tissue activated (VTA) for each setting.
Compared VAS-optimized settings against SoC programming, using voxel-wise statistics and connectivity analyses to identify optimal stimulation regions and neural correlates.

Main Results:

VAS-optimized DBS achieved tremor suppression comparable to SoC but with significantly lower energy consumption.
Identified stimulation 'sweet spots' (high VAS ratings) in the dorsal VIM and 'sour spots' (low ratings) ventrally.
Positive correlations found between connectivity of sweet spots and prefrontal, frontal, and insular regions with perceived clinical benefit.

Conclusions:

Integrating patient-reported feedback via VAS provides a structured, individualized approach to DBS optimization for essential tremor.
VAS-guided programming successfully identifies patient-specific optimal stimulation regions ('sweet spots') and their associated connectivity profiles.
The study highlights that optimal stimulation targets may be more dorsal than previously suggested, emphasizing the value of subjective feedback in refining DBS therapy.