Spinal Cord Stimulation Therapy for Gait Dysfunction in Two Corticobasal Syndrome Patients
Bibliographic record
Abstract
dysfunction, Neuromodulation, Spinal cord stimulationGait impairments such as freezing of gait (FOG) and postural instability are frequently described in corticobasal syndrome (CBS) patients.1 CBS parkinsonism is typically levodopa resistant, and there are currently no effective treatments or any disease-modifying therapies.1 Thus, there is a significant unmet need for an effective gait therapy.Tonic spinal cord stimulation (SCS) has shown significant promise for improving gait impairments and reducing FOG episodes in advanced Parkinson's disease patients with levodopa-resistant gait difficulties.2,3 As these axial gait features are also observed in CBS, the effect of SCS was investigated over 12 months in a convenience sampling of two CBS participants (~3 years with disease) who had significant gait impairment while OFF-and ON-levodopa medication.This monocentric, investigational, pilot study was approved by the Western University Research Ethics Board (REB#107451) and registered at ClinicalTrials.gov(NCT03079310).Participants recruited from the London Movement Disorders Centre provided signed informed consent.Due to the limited availability of SCS devices allocated for off-label use in our center, we explored the use of SCS in two participants with clinically certain CBS that met international criteria, 4 resistant gait disorder, and significant FOG.Neither participants had a history of stroke, spinal disorders nor any other neurological diseases, significant cognitive impairment, chronic back and/or lower limb pain and were not on unstable pharmacological treatment.Although physiotherapy (PT) regimes were not part of the study protocol, PT was not effective for gait in either participants.However, prior to study recruitment, Case I continued in-home PT for home safety and range of motion exercises.Endpoints were assessed before surgery and at 3, 6, and 12 months of SCS use while OFF (≥12 h) and ON (150% of usual morning dose) levodopa.Primary endpoint was the change in spatiotemporal parameters (STPs) during self-paced walking on the ProtoKinetics Walkway.Sensors embedded in the walkway detect footfalls in real time which are captured by the Protokinetics Movement Analysis Software (PKMAS) program.PKMAS provides accurate and validated measurements of various gait parameters.Gait asymmetry and variability (CV%) values were calculated by averaging step length and stride velocity measures.FOG episodes were analyzed using foot pressure changes as previously described.2 Secondary endpoints were MDS-UPDRS part III, comprehensive apraxia upper limb assessment, 5 freezing of gait questionnaire (FOG-Q), and activities-specific balance confidence scale (ABC). 2 Two electrodes with eight contacts/lead (Boston Scientific ® Precision Novi) were implanted in the medial, epidural space of T8-T10 spinal segments.2 Electrode localization was confirmed by paresthesias fully covering the lower trunk, both lower extremities and feet.
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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) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".