AUTHOR=Feldmann Lucia K. , Kaplan Jonathan , de Almeida Marcelino Ana Luisa , Schulze Daniel , Kühn Andrea A. 
  
TITLE=The chronical outcome monitoring in dystonia with deep brain stimulation (COMEDD) study protocol: a longitudinal evaluation of chronic electrophysiological biomarkers in patients with dystonia and deep brain stimulation therapy
  
JOURNAL=Dystonia
  
VOLUME=Volume 5 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/dystonia/articles/10.3389/dyst.2026.16304
  
DOI=10.3389/dyst.2026.16304
  
ISSN=2813-2106
  
ABSTRACT=IntroductionDeep brain stimulation is an effective therapy for patients with isolated dystonia. In pallidal local field potential recordings, theta was identified as a biomarker for symptom severity, and beta as a transdiagnostic biomarker for bradykinesia. However, challenges remain: 1) programming can be a lengthy process, and to date there is no guidance by electrophysiological biomarkers; 2) temporal dynamics of stimulation effects, but also of stimulation-induced side-effects are not understood; 3) electrophysiological characteristics for dystonia subtypes or non-responders are unknown.Materials and protocol outlineThis is the protocol for an observational, prospective, long-term study for the systematic identification of electrophysiological pallidal biomarkers in patients with dystonia and a newly implanted sensing-enabled deep brain stimulation system. We expect a recruitment of 25–30 patients to be sufficient to track changes in chronic biomarkers and symptom severity. The protocol consists of two strategies for data collection in the same patient cohort over 12 months after deep brain stimulation surgery: 1) continuously recorded chronic peak biomarker activity with weekly home monitoring; 2) monthly in-hospital recordings of local field potential data at 250 Hz sampling rate during rest and motor activity and during stimulation ON/OFF. Two patients have completed the study protocol with an appointment adherence of 92%, underlining the feasibility of the study protocol.DiscussionWe here present a feasible, systematic protocol for identification of electrophysiological biomarkers in dystonia to establish electrophysiology-based guidance of therapy optimization in dystonia. Progress of the study can be followed in the study registration log: NCT07244549.