DBS for essential head tremor

Deep brain stimulation improves head tremor in most patients with essential tremor. In the largest clinical trial dataset of DBS for essential tremor, stimulation on one side significantly improved head and voice tremor, and adding the second side improved midline tremor further ^[1]. In a 2025 single-center analysis of 54 patients, 87% had a positive response in head tremor, sustained over a median of 14 months ^[2]. In our own case series of patients treated with DBS for head tremor, average improvement was 87%, and more than 70% of patients reached near-complete resolution (our case series; results vary).

Key facts

Thalamic DBS improves head tremor in most patients with essential tremor ^[1].
87% of 54 patients responded in a 2025 single-center analysis ^[2].
Bilateral stimulation adds further midline improvement ^[3].
We plan the trajectory through both the Vim and the PSA.
Hand, head and voice tremor are treated in the same operation.

**Head Tremor Before & 1 Year After DBS — Surgery Without Shaving Her Head** — A woman with constant head tremor, filmed before DBS and one year after surgery; her operation was performed without shaving her head. An example of “no-no” head tremor.
Shared with the patient’s written consent. Individual results vary.

**Head Tremor Before & After DBS: How DBS Gave Her Life Back** — A head tremor patient before and after DBS in Istanbul.
Shared with the patient’s written consent. Individual results vary.

**Essential Tremor Before & After DBS: Steady Again After 30 Years** — A patient with 30 years of essential tremor describes daily life after DBS.
Shared with the patient’s written consent. Individual results vary.

**A Story Worth Following: When Tremor No Longer Ran the Day** — A patient with essential tremor, before and after deep brain stimulation.
Shared with the patient’s written consent. Individual results vary.

Watch many more head tremor patientsOur YouTube playlist: many head tremor patients filmed before and after DBS

Open the head tremor video library on this site.

Why both sides are treated

When the main goal is a single dominant hand, one side may be enough. When head tremor is the main problem, both sides are treated: bilateral thalamic stimulation gives additional improvement in midline tremor ^[3],[1], and essential tremor tends to progress. Bilateral stimulation can increase speech and balance side effects, which is why careful targeting and programming matter ^[4].

Where the double-target technique fits

For patients in whom head tremor is the leading symptom, Prof. YILMAZ plans the trajectory so that both the Vim and the PSA can be stimulated. This allows the stimulation to be shared between the two sites at lower intensity and leaves a second target in reserve if the tremor progresses. See double-target DBS.

Are you a candidate?

Confirmed essential tremor with disabling head tremor
Insufficient response to, or side effects from, medication
Good general health; no significant memory problems
Realistic expectations about what DBS can and cannot do

What to expect

Switch-on the day after surgery; hand and head tremor usually respond immediately after a successful operation
Voice tremor often improves too, though less predictably ^[3]
Medication can often be reduced
Programming continues remotely after you return home

Side effects and how they are handled

Stimulation side effects usually appear when the stimulator is first switched on or when settings are increased, and most disappear when the settings are adjusted. In our published series ^[5]:

Tingling (paresthesia) was the most common effect when stimulation began; it faded within minutes without any change of settings.
Slurred speech appeared in one patient after the first electrode, lasted two weeks and resolved by itself; the second side was operated after it had settled.
Unsteadiness occurred in two patients: in one it resolved by itself, in the other after the active contact was moved slightly upward within the Vim and the PSA share was reduced.

Speech side effects were a known drawback when only the Vim was used. In our experience, the PSA is safer than the Vim with respect to speech, and because both targets sit on the same electrode, we can move stimulation away from a site that causes a problem. A well-placed electrode is the key: if an electrode lies too far to the side, speech effects can persist, which is why placement is checked by testing during surgery and by CT afterward ^[5].

Surgical complications are uncommon but real. In the published series, one electrode needed repositioning and two patients developed an infection requiring removal of an electrode, which was later re-implanted in one of them ^[5]. Your individual risk is discussed during the evaluation.

Your surgeon

Prof. Atilla YILMAZ, MD

Every operation is performed personally by Prof. YILMAZ, a stereotactic and functional neurosurgeon who has carried out 1,200+ neuromodulation procedures, including 800+ DBS surgeries, for patients from 60+ countries. He is the first author of the published double-target Vim+PSA series for rare tremor syndromes ^[5].

President, Middle-Eastern Society for Stereotactic and Functional Neurosurgery (MSSFN); Board of Directors, WSSFN and International Neuromodulation Society
Proctor for Medtronic, Abbott and Boston Scientific — the three leading DBS manufacturers appoint him to train other neurosurgeons on their systems
40+ neurosurgeons trained from 30 countries; first-ever DBS surgeries performed in six countries
Trained at the University of Florida (observership with Prof. Okun and Prof. Foote) and Umeå University Hospital, Sweden

Full profile and credentials

Questions to ask before choosing DBS

What type of tremor do I have, and how sure is the diagnosis?
Which target will be used, and why?
Will both sides be operated on?
Who will perform the operation, and how many tremor operations has the surgeon done?
When will the stimulator be switched on, and who will program it after I go home?
What happens if the effect lessens in the future?

Frequently asked questions

Will DBS also help my hand tremor?

Yes. Hand tremor is the symptom that responds most consistently to thalamic DBS in essential tremor ^[4].

Is there an age limit for DBS?

Age alone is not the deciding factor; general health and the type of symptoms matter more. Each patient is assessed individually.

Does the effect wear off?

Some studies report that the benefit of Vim-only stimulation can fade over years ^[5]. With double targeting, the second target can be added if this happens. Our longest-followed head tremor patient still has a tremor score of 0 six and a half years after double-target DBS; the score was 4 before surgery (our case series; results vary).

Sources

Mitchell KT, et al. Benefits and risks of unilateral and bilateral ventral intermediate nucleus deep brain stimulation for axial essential tremor symptoms. Parkinsonism Relat Disord 2019;60:126–132. scholars.duke.edu/publication/1349961
Anis S, et al. Efficacy of ventral intermediate nucleus deep brain stimulation for head tremors in essential tremor: a single-center retrospective analysis (54 patients). Mov Disord 2025;40(suppl 1) — congress abstract. www.mdsabstracts.org/abstract/efficacy-of-ventral-intermediate-nucleus-deep-brain-stimulation-for-head-tremors-in-essential-tremor-a-single-center-retrospective-analysis/
Putzke JD, Uitti RJ, Obwegeser AA, Wszolek ZK, Wharen RE. Bilateral thalamic deep brain stimulation: midline tremor control. J Neurol Neurosurg Psychiatry 2005;76(5):684–690. pmc.ncbi.nlm.nih.gov/articles/PMC1739619/
International Essential Tremor Foundation. Deep Brain Stimulation. essentialtremor.org/resource/deep-brain-stimulation/
Yilmaz A, Eray HA, Cakir M, Ceylan M, Blomstedt P. Deep Brain Stimulation with Double Targeting of the VIM and PSA for the Treatment of Rare Tremor Syndromes. Stereotact Funct Neurosurg 2024;102:224–239. DOI 10.1159/000539162. pubmed.ncbi.nlm.nih.gov/38934181/