<h3>Objective:</h3> To describe clinical outcomes of severe tremor-predominant Parkinson’s Disease (PD) patients who underwent single trajectory dual targeting of the subthalamic nucleus (STN) and ventral intermedius nucleus of the thalamus (VIM). <h3>Background:</h3> Some patients with tremor-predominant PD have a sub-optimal response to STN-DBS, whereas those that undergo VIM-DBS may have inadequate improvement of rigidity or bradykinesia. Reports on the efficacy and safety of dual target STN-VIM DBS using single trajectory are scarce. <h3>Design/Methods:</h3> We retrospectively reviewed the charts of all PD patients who underwent dual target STN-VIM DBS from 2012–2022 in one center. All patients were implanted bilaterally with the Boston Scientific 8-contact 15.5mm electrodes under general anesthesia using the parietal approach. Primary outcome measure was reduction in motor Unified Parkinson’s Disease Rating Scale (m-UPDRS). Secondary outcome measures include change in levodopa equivalent daily dose (LEDD) post-DBS, and time to reaching the minimum LEDD post-DBS. <h3>Results:</h3> 12 patients (7 men) were identified. Mean age at time of surgery was 71.58±5.21 years. Mean duration of PD was 28.50±14.84 years. Mean m-UPDRS was 30.83±34.15 preDBS and 14.91±18.26 post-DBS (p<0.00000006). Mean % reduction in m-UPDRS was 50.94±0.08 %. Mean pre-DBS LEDD was 792.85±458.64, whereas post-DBS LEDD was 14.28±37.79 (p= 0.004). 7/12 were on PD medications pre-DBS: 6/7 completely weaned off medications post-DBS, and 1/7 had 89% reduction in LEDD post-DBS. The mean time to reach minimum LEDD was 33±22.87 days. Transient side effects included dysarthria (4/12), imbalance (4/12), and headaches (2/12) which improved spontaneously. 2/12 had persistent headaches which were effectively controlled with opiates. 8/12 had neuropsychological testing (NPT) pre- and post-DBS: 4/8 had no change post-DBS, 2/8 had mild worsening and 2/8 had improvement. <h3>Conclusions:</h3> Dual target STN-VIM DBS is very effective in treating tremor/parkinsonism in tremor-predominant PD, allowing the majority of patients to wean off PD medications. Side effects are mostly transient. <b>Disclosure:</b> Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Adamas. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Revance. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kyowa Kirin. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amneal. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Adamas. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sunovion. Dr. Evidente has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Teva. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB. Dr. Evidente has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Ipsen. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medtronic. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Neurocrine. The institution of Dr. Evidente has received research support from Sunovion. The institution of Dr. Evidente has received research support from Pharma 2B. The institution of Dr. Evidente has received research support from Neuraly. The institution of Dr. Evidente has received research support from Revance. The institution of Dr. Evidente has received research support from CND. The institution of Dr. Evidente has received research support from Lundbeck. The institution of Dr. Evidente has received research support from Abbvie. The institution of Dr. Evidente has received research support from Acadia. The institution of Dr. Evidente has received research support from Aptinyx. Dr. Ponce has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston Scientific. Dr. Ponce has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott. Dr. Ponce has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Miss Evidente has nothing to disclose. Dr. Garrett has nothing to disclose. Miss Evidente has nothing to disclose.