Deep Brain Stimulation Placement Using Intraoperative MRI for Dystonia: One Year Clinical Outcomes (S30.003)
Bibliographic record
Abstract
OBJECTIVE: To evaluate clinical outcome in patients with dystonia who underwent deep brain stimulation (DBS) placement using intraoperative MRI (ClearPoint®, MRI interventions). BACKGROUND: DBS lead placement using intraoperative MRI (iMRI) is an alternative surgical technique utilizing real-time intraoperative neuroimaging to guide electrode placement. Unlike the traditional awake procedure, iMRI DBS is done under general anesthesia without microelectrode recording (MER) and electrical stimulation. However, there is limited literature on clinical outcomes. METHODS: Twenty-two consecutive dystonia patients underwent DBS surgery using iMRI. Of these, 13 patients (idiopathic, n=11; genetic, n=1, tardive n=1) were included in our analysis. Patients with secondary dystonia (n=7) and those with prior DBS placement using MER (n=2) were excluded. Pre- and post-DBS Burke-Fahn-Marsden dystonia rating scale (BFMDRS) movement scores and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity scores were obtained at 6 and 12 months. RESULTS: The mean age of patients (M=6, F=7) was 55 years. Distribution of dystonia was variable with cervical dystonia as predominant component in 12 patients. All patients underwent bilateral GPi DBS placement. The mean BFMDRS and TWSTRS scores before DBS were 20 (95[percnt] CI: 12-28[percnt]) and 17.5 (95[percnt] CI: 14.7-20.2[percnt]) respectively and after DBS were 4.92 (95[percnt] CI: 3.2-6.7[percnt]) and 8.2 (95[percnt] CI: 4-12.5[percnt]) respectively at 12 months. There was a mean improvement in BFMDRS of 70.7[percnt] (95[percnt] CI: 63.8-79.5[percnt], p<0.01) and in TWSTRS of 56.4[percnt] (95[percnt] CI: 34.2 -78.6[percnt], p<0.01) at 12 months. Two patients had asymptomatic small intracranial hemorrhage, 1 had technical complications causing symptomatic intracranial hemorrhage/capsular infarct with partial hemiparesis and 1 had unilateral hardware infection/ lead fracture requiring revision. CONCLUSIONS: iMRI-guided DBS in dystonia patients showed improvement in clinical outcomes comparable to previously reported results using awake MER-guided DBS placement. This technique is particularly appropriate for children and patients where dystonia interferes with head fixation during wakefulness.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".