{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T12:47:26Z","timestamp":1791722846701,"version":"4.3.4"},"reference-count":28,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Deep brain stimulation (DBS) has traditionally followed diagnosis-driven, nucleus-centered targeting paradigms. Increasing evidence supports a circuit-based framework in which clinical outcomes depend on modulation of symptom-relevant networks rather than diagnostic labels alone. This approach is particularly relevant in mixed movement disorder phenotypes such as dystonic tremor, where the most disabling symptom may not align with the conventional surgical target. Methods: We report a clinically illustrative single case treated using a symptom-oriented, connectome-informed DBS strategy. Clinical phenotype, tremor severity, functional impairment, prior medical and botulinum toxin treatments, and longitudinal outcomes were systematically reviewed. DBS target selection prioritized the dominant, treatment-refractory symptom rather than the underlying dystonia diagnosis. Surgical planning incorporated high-resolution MRI with patient-specific thalamic segmentation using Brainlab Brain Elements\u00ae, followed by postoperative lead localization and volume of tissue activated visualization with the SureTune\u2122 platform. Results: A 54-year-old left-handed woman with long-standing cervical dystonia developed a severe, markedly asymmetric dystonic tremor predominantly affecting the left upper limb, resulting in profound functional disability. Instead of conventional bilateral globus pallidus internus DBS, unilateral right ventral intermediate nucleus (VIM) DBS was selected to engage tremor-related cerebellothalamic circuits. Rapid and marked improvement was observed, with tremor severity reduced to mild levels within 15 days after stimulation onset. At 6-month follow-up, overall tremor severity improved from 49 to 13 points on the Fahn\u2013Tolosa\u2013Marin Tremor Rating Scale, corresponding to a 73.5% reduction. This improvement was associated with restoration of legible handwriting, independent feeding and drinking, and recovery of bimanual fine motor function. Clinical benefit remained stable throughout follow-up, without stimulation-related adverse effects. Conclusions: This case illustrates the feasibility of a symptom-oriented, connectome-informed DBS strategy in selected patients with dystonic tremor. When symptom expression and network involvement are markedly asymmetric, selective unilateral modulation of the tremor-dominant circuit may achieve meaningful and durable functional improvement. Further studies are needed to assess the generalizability of this approach.<\/jats:p>","DOI":"10.3390\/jcm15041666","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T11:39:10Z","timestamp":1771846750000},"page":"1666","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Symptom-Oriented, Connectome-Informed Deep Brain Stimulation for Asymmetric Dystonic Tremor: Unilateral Ventral Intermediate Nucleus (VIM) DBS Targeting a Tremor-Dominant Network"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7313-040X","authenticated-orcid":false,"given":"Olga","family":"Mateo-Sierra","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Gregorio Mara\u00f1\u00f3n University Hospital, C\/Dr Esquerdo 46, 28007 Madrid, Spain"},{"name":"Gregorio Mara\u00f1\u00f3n Research Institute, Gregorio Mara\u00f1\u00f3n University General Hospital, C\/Dr Esquerdo 46, 28007 Madrid, Spain"},{"name":"Department of Surgery, Medicine School, Complutense University of Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9292-9471","authenticated-orcid":false,"given":"Javier Ricardo","family":"P\u00e9rez-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Gregorio Mara\u00f1\u00f3n Research Institute, Gregorio Mara\u00f1\u00f3n University General Hospital, C\/Dr Esquerdo 46, 28007 Madrid, Spain"},{"name":"Movement Disorders Unit, Department of Neurology, Gregorio Mara\u00f1\u00f3n University Hospital, C\/Dr Esquerdo 46, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"De la Casa-Fages","sequence":"additional","affiliation":[{"name":"Gregorio Mara\u00f1\u00f3n Research Institute, Gregorio Mara\u00f1\u00f3n University General Hospital, C\/Dr Esquerdo 46, 28007 Madrid, Spain"},{"name":"Movement Disorders Unit, Department of Neurology, Gregorio Mara\u00f1\u00f3n University Hospital, C\/Dr Esquerdo 46, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Teresa","family":"Del Castillo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Gregorio Mara\u00f1\u00f3n University Hospital, C\/Dr Esquerdo 46, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7810-6719","authenticated-orcid":false,"given":"Pilar","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Radiology, Gregorio Mara\u00f1\u00f3n University Hospital, C\/Dr Esquerdo 46, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascual","family":"Elvira","sequence":"additional","affiliation":[{"name":"Department of Radiology, Gregorio Mara\u00f1\u00f3n University Hospital, C\/Dr Esquerdo 46, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Paz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medicine School, Complutense University of Madrid, 28040 Madrid, Spain"},{"name":"Department of Anesthesiology, Dr Balmis University General Hospital, Av. Pintor Baeza 12, 03010 Alicante, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Grandas","sequence":"additional","affiliation":[{"name":"Gregorio Mara\u00f1\u00f3n Research Institute, Gregorio Mara\u00f1\u00f3n University General Hospital, C\/Dr Esquerdo 46, 28007 Madrid, Spain"},{"name":"Movement Disorders Unit, Department of Neurology, Gregorio Mara\u00f1\u00f3n University Hospital, C\/Dr Esquerdo 46, 28007 Madrid, Spain"},{"name":"Department of Medicine, Medicine School, Complutense University of Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/0140-6736(91)91175-T","article-title":"Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus","volume":"337","author":"Benabid","year":"1991","journal-title":"Lancet"},{"key":"ref_2","first-page":"499","article-title":"Deep brain stimulation for movement disorders: Long-term outcomes","volume":"11","author":"Fasano","year":"2015","journal-title":"Nat. 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