# Efficacy and safety of single-trajectory posterior subthalamic area and subthalamic nucleus deep brain stimulation for dystonic tremor: a retrospective pilot study

## TL;DR

A new deep brain stimulation method targeting two brain areas at once shows promise for treating dystonic tremor with high safety and effectiveness.

## Contribution

A novel single-lead, dual-target DBS approach for dystonic tremor is introduced and evaluated.

## Key findings

- Combined PSA and STN stimulation was preferred by 83.3% of patients and showed greater efficacy than single-target stimulation.
- Mean tremor scores improved by 78.1% and 87.1% on two clinical scales after 6–12 months of treatment.
- No serious adverse events were reported, indicating the approach is safe.

## Abstract

To evaluate the feasibility, safety, and preliminary efficacy of a novel single-lead, dual-target deep brain stimulation (DBS) approach targeting the posterior subthalamic area (PSA) and subthalamic nucleus (STN) for dystonic tremor.

This retrospective pilot study reviewed outcomes of six consecutive patients with medically refractory dystonic tremor who underwent single-lead PSA-STN DBS at our center (June–December 2024). Clinical outcomes were assessed using the BFMDRS and FTMTRS scales. A formal blinded crossover assessment was performed in three patients to compare PSA-only, STN-only, and combined stimulation. Chronic settings were selected via patient-directed optimization.

All six patients completed follow-up (100% retention) and achieved stable chronic stimulation programs. Five patients (83.3%) independently selected combined PSA + STN stimulation; one preferred STN-only. At LFU (6–12 months postoperatively), the mean BFMDRS-Motor score decreased by 78.1% and FTMTRS by 87.1%. The crossover assessment (n = 3) showed that combined stimulation outperformed single-target stimulation. No serious adverse events occurred. All efficacy analyses are exploratory.

This single-lead, dual-target PSA-STN DBS approach demonstrates feasibility and preliminary efficacy for dystonic tremor. Prospective controlled trials are warranted.

The online version contains supplementary material available at 10.1007/s00415-025-13569-0.