This chapter discusses the evaluation for and management of Vim deep brain stimulation (DBS) in the essential tremor (ET) patient. It is important to document the tasks that are of particular importance to the patient, such as writing, and putting on make-up. The majority of DBS clinicians initiate programming two to four weeks after Vim DBS lead implantation. Prior to initiating DBS programming, electrode impedance measurements should be performed to confirm integrity of the DBS system and its connections, and also to document a baseline measurement for future reference during troubleshooting. Stimulation-related adverse effects for DBS in the region of the Vim include paresthesia, dysarthria, incoordination, pain, asthenia, abnormal thinking, and headache. Often, stimulation parameters remain remarkably stable over time and provide excellent tremor suppression for many years. The neurostimulator can be turned off by the patient using the patient programmer.