Probabilistic characterisation of deep brain stimulation in patients with tardive syndromes
Bibliographic record
Abstract
Tardive syndromes (TS) are characterised by hyperkinetic motor signs that commonly develop after using antidopaminergics. Deep brain stimulation (DBS) of the globus pallidus interna (GPi) has been successful in treating refractory TS, although a minority of patients have minimal response.1 The location of active contacts or volume of tissue activated (VTA) by DBS or stimulation of adjacent tracts may explain some of this outcome variability. Group-level neuroimaging analyses can demonstrate optimal stimulation areas, tracts and functional networks associated with maximal clinical benefits during DBS. To our knowledge, this approach has not yet been applied to TS. The objectives of this study were to (1) retrospectively examine clinical outcomes from seven patients with TS GPi-DBS and (2) use neuroimaging analysis to investigate brain circuits possibly related to efficacy. This retrospective study followed the Helsinki Declaration. ### Clinical treatment Seven patients (five men and two women) with medication-refractory TS underwent bilateral DBS surgery between 1999 and 2017 at Toronto Western Hospital. GPi electrodes (model 3387; Medtronic, Minneapolis, Minnesota) were implanted based on routine stereotactic targeting methods. Microelectrode recordings and postoperative MRI was used to verify accurate placement. Initial programming was performed on average 8 weeks after implantation with weekly or biweekly adjustments in the early postoperative phase. Abnormal movements were graded using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) for cases with predominant tardive dystonia and the Abnormal Involuntary Movement Scale (AIMS) for cases showing predominant classic tardive dyskinesia. Scores were recorded at preoperative baseline (ie, the last evaluation before surgery: B) and at various postoperative time points. The postoperative time of the maximum benefit/side effect ratio was defined as ‘time of maximal benefit’ (TMB). The percentage change in BFMDRS or AIMS from B to TMB was calculated. ### Neuroimaging analysis Full details are available in online supplemental methods. Briefly, DBS electrodes were localised on postoperative MRI …
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| 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".