# Comparative evaluation of standardized imaging-guided contact selection for subthalamic deep brain stimulation in Parkinson’s disease: study protocol for a randomized double-blind crossover trial

## TL;DR

This study compares a new imaging-guided method for selecting brain stimulation contacts in Parkinson's patients to traditional methods, aiming to improve treatment outcomes.

## Contribution

The study introduces a standardized imaging-guided protocol for subthalamic deep brain stimulation contact selection in Parkinson’s disease.

## Key findings

- The trial will assess patient preference between imaging-guided and conventional stimulation methods.
- Motor function and quality of life will be evaluated using standardized assessments and accelerometric monitoring.
- The crossover design allows direct comparison of both approaches within the same patients.

## Abstract

Subthalamic deep brain stimulation (STN-DBS) effectively treats motor symptoms in appropriately selected patients with Parkinson’s disease, but individual responses vary. Despite modern directional leads allowing more precise stimulation, optimal contact selection strategies have not yet been standardized. This study compares a standardized imaging-guided contact selection protocol to conventional clinical programming.

We designed a monocentric, randomized, double-blind crossover trial enrolling 30 people with Parkinson’s disease with bilateral directional STN-DBS. Participants will undergo both programming approaches: standardized imaging-guided contact selection targeting the dorsolateral STN and conventional contact selection through clinical test stimulations. Each configuration will be applied for 1 week. The primary outcome is patient preference after both treatments. Secondary outcomes include motor assessments (MDS-UPDRS III), accelerometric monitoring, and questionnaire-based quality of life measures (e.g., PDQ-39).

This study addresses a critical gap in standardization of imaging-guided DBS programming. By using patient preference as the primary outcome, we aim to capture clinically meaningful differences that may not be detected with traditional motor scales. The crossover design balances statistical power with clinical feasibility in specialized care settings.

Deutsches Register für Klinische Studien DRKS00034229. Registered on May 27, 2024.