Interleaving Deep Brain Stimulation (DBS) in Parkinson’s Disease (PD): A Retrospective Review on Rational, Management, and Outcomes (P1.010)
Bibliographic record
Abstract
Objective: To review the practical applications of interleaving stimulation in a DBS referral center. Background: Conventional DBS programming involves monopolar or bipolar stimulation; however, with the advancement of technology new stimulation parameters are now available. Interleaving stimulation provides alternating sequences of stimulation on the same electrode and may reduce adverse effects and deliver added therapeutic benefit. This is because it may stimulate two regions each with benefit at different voltages or by directing stimulation away from unintended regions. Programming is a time intensive process and no clear guidelines on the utility of interleaving stimulation exist. Methods: We performed a retrospective chart review of all patients with Parkinson’s disease (PD) who have had DBS interleaving at Toronto Western Hospital. Results: Twenty-seven PD patients with STN DBS (24 bilateral) had interleaving performed and 48[percnt] continued on interleaving at last evaluation. Sub analysis demonstrates 4 main categories for performing interleaving: management of dyskinesias (N=11), adverse effects (N=11), parkinsonism (N=4), and battery consumption (N=1). All patients with dyskinesias had benefit; however, 36[percnt] discontinued interleaving stimulation due to waning of benefit (N=1), worsened parkinsonism (N=1), worsened pain (N=1), and exacerbated impulsive behavior (N=1). Adverse effects that were attempted to be improved with interleaving included speech difficulty (N=7), dystonia (N=1), pain (N=1), diplopia (N=1), and behavioral problems specifically impulsivity (N=1). In this subgroup of adverse effects, only 3 patients with speech difficulty benefited from interleaving. Parkinsonism (specifically gait impairment and tremor associated with a narrow therapeutic window) was improved with interleaving in all patients although one discontinued due to stimulation induced facial contractions. Finally, battery consumption was attempted to be reduced in a patient with double monopolar stimulation but was not successful. Conclusion: Interleaving stimulation was most beneficial for the treatment of dyskinesias and parkinsonism. Some benefit was demonstrated for stimulation induced speech difficulty.
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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 | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.006 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| 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".