Inclusion Criteria:  Adult patients with a diagnosis of ET, refractory to pharmacotherapy referred for DBS consideration. Informed consent signed by the subject. DBS candidate per FDA guidelines. Primary language - English Physically and cognitively capable of completing evaluations and consent Medically cleared for surgery and anesthesia Negative pregnancy test prior to surgery for female subjects of child-bearing potential.  Exclusion Criteria:  Any individuals with contraindication to bilateral DBS lead placement, history of dementia per DSM-V criteria, intracranial hemorrhage, or psychiatric illness. Conditions precluding MRI. History of supraspinal disease. Subjects with a history of seizure disorder. Subjects who have made a suicide attempt within the prior year, Subjects with any medical contraindications to undergoing DBS surgery (eg, infection, coagulopathy, or significant cardiac or other medical risk factors for surgery) Subjects with an implanted stimulator such as a cardiac pacemaker, defibrillator, neurostimulator and cochlear implant Subjects who are pregnant or nursing. Patient that is unwilling or unable to comply with the requirements of this protocol, including the presence of any condition (physical, mental, or social) that is likely to affect the subject's ability to comply with the protocol. Any other reasons that, in the opinion of the investigator, the candidate is determined to be unsuitable for entry into the study.