Objective: To assess longitudinal tremor outcomes with ventral intermediate nucleus deep brain stimulation (VIM DBS) in patients with dystonic tremor (DT) and to draw comparisons with DBS outcomes in essential tremor (ET). Methods: We retrospectively investigated VIM DBS outcomes for 163 patients followed at our center diagnosed with either DT or ET. The Fahn-Tolosa-Marin tremor rating scale (TRS) was used to assess change in tremor and activities of daily living (ADL) at 6 months, 1 year, 2–3 years, 4–5 years, and ≥ 6 years after surgery. Results: Twenty-six DT and 97 ET patients were analyzed. Compared to preoperative baseline, there were significant improvements in TRS motor up to 4–5 years (52.2%; p = 0.032) and a tendency to improve at ≥ 6 years (46.0%, p = 0.063) in DT which was comparable to the outcomes in ET. While the improvements in the upper extremity tremor, head tremor, and axial tremor were also comparable between DT and ET throughout the follow-up, the ADL improvements in DT were lost at 2-3 years follow-up. Conclusion: Overall, tremor control with VIM DBS in DT and ET was comparable and remained sustained at long-term likely related to intervention at the final common node in the pathological tremor network. However, the long-term ADL improvements in DT did not remain sustained possibly due to inadequate control of concomitant dystonia symptoms. These findings from a large cohort of DT indicate that VIM targeting is reasonable if the tremor is considerably more disabling than the dystonic features.