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Background: Deep brain stimulation (DBS) is the clinical standard surgical treatment for pharmacoresistant essential tremor (ET). The most common target for stimulation in ET patients is the ventral intermediate nucleus (Vim) of the thalamus. However, deep brain stimulation is limited in its use by the occurrence of adverse effects with increasing stimulation and the decay of beneficial effects over time. Not many recent formal guidelines on reprogramming for adverse effects are available. Objective/hypothesis: Our goal was to give an overview of the most frequently encountered adverse effects during the programming of Vim-DBS and present different strategies proposed in the medical literature to minimize them. Methods: We searched Medline for relevant articles published before December of 2022, prioritizing studies of high quality but accepting case reports if no other evidence was available. Results: Based on our findings, we were able to give an overview of troubleshooting techniques for stimulation-induced dysarthria, gait disturbance and ataxia under stimulation, habituation to stimulation, and the occurrence of paresthesia, dysgeusia, and dysphagia. Conclusion: Strategies like directional stimulation, reduced pulse width, interleaving stimulation, and alternating group programming have shown significant results and we encourage their implementation to combat frequently occurring adverse effects in deep brain stimulation. We encourage further research into these strategies and the underlining mechanisms that lead to adverse effects and habituation in DBS.