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In routine clinical practice, it is difficult to predict which stimulation settings will provide optimal tremor control while avoiding disabling motor complications. We analysed long-term tremor and gait outcomes in 73 patients from two DBS centres with chronic bilateral (sub)thalamic DBS, assessed before surgery and at follow-up after 12 months using blinded ratings of standardized video recordings. We evaluated the influence of demographic, clinical, and stimulation parameters and applied voxel-wise probabilistic stimulation mapping to identify anatomical regions associated with tremor suppression and stimulation-induced gait ataxia. DBS produced a marked reduction in tremor (46.3% \u00b1 4.3), with 77% of patients free of functionally disabling tremor (&gt;\u20092\u00a0cm amplitude) at follow-up, but 44% exhibiting clinically relevant gait ataxia. No demographic, clinical, or stimulation parameter was independently associated with tremor improvement. However, probabilistic mapping revealed a tremor \u201csweet spot\u201d just superior to the medial subthalamic nucleus, and stimulation field\u2013based modelling predicted individual tremor outcome in leave-one-out cross-validation, explaining 21% of variance. In contrast, higher stimulation amplitudes and higher age at surgery were associated with greater stimulation-induced gait worsening, which localized to posterior\u2013inferior stimulation in the subthalamic area. Integrating these factors enabled leave-one-out cross-validated prediction of gait outcome, explaining 49% of variance. Together, these results show that the clinical variability of DBS in essential tremor reflects both spatial targeting and patient-specific susceptibility. Individualized prediction models based on probabilistic stimulation mapping can integrate these factors to estimate stimulation outcome.<\/jats:p>","DOI":"10.1007\/s00702-026-03137-9","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T08:58:42Z","timestamp":1774515522000},"page":"1963-1975","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Probabilistic mapping of tremor control and gait ataxia risk in deep brain stimulation"],"prefix":"10.1007","volume":"133","author":[{"given":"Benedikt","family":"Weigl","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina","family":"Pistorius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Roothans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicol\u00f2 G.","family":"Pozzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Paschen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcnther","family":"Deuschl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Volkmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin M.","family":"Reich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"issue":"4","key":"3137_CR1","doi-asserted-by":"publisher","first-page":"1040","DOI":"10.1016\/j.brs.2020.03.017","volume":"13","author":"CJ Anderson","year":"2020","unstructured":"Anderson CJ, Anderson DN, Pulst SM, Butson CR, Dorval AD (2020) Neural selectivity, efficiency, and dose equivalence in deep brain stimulation through pulse width tuning and segmented electrodes. 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