Thalamic Deep Brain Stimulation Ameliorates Mixed and Abductor Spasmodic Dysphonia: Case Reports and Proof of Concept
Bibliographic record
Abstract
Abstract BACKGROUND AND IMPORTANCE Spasmodic dysphonia (SD) is a dystonia of the vocal folds causing difficulty with speech. A recent randomized controlled trial showed that thalamic deep brain stimulation (DBS) was safe and could improve this condition in the most common subtype—adductor SD. We investigated if thalamic DBS could also improve the other subtypes of abductor SD and mixed SD. These prospective blinded trials of 1 were designed to assess the safety of thalamic DBS in mixed and abductor SD and to quantify the magnitude of any benefit from unilateral or bilateral thalamic stimulation. CLINICAL PRESENTATION One patient with mixed SD and one patient with abductor SD received bilateral thalamic DBS. After optimizing their DBS settings for vocal improvement, they were blinded and prospectively randomized to receive 1 mo of left, right, both, or neither hemisphere stimulation. Outcome was assessed by a speech language pathologist, blinded to the settings, rating voice recordings with the Unified Spasmodic Dysphonia Rating Scale, and by patient self-reported quality-of-life questionnaires. Additional outcomes included scores of mood and cognition. There were no complications. Both patients reported a subjective improvement of their voice and quality of life with blinded left thalamic DBS. The quality of their voice was also objectively rated as improved with blinded left thalamic DBS. CONCLUSION This small proof-of-concept study suggests that left thalamic DBS can improve the quality of voice and quality of life of patients with mixed SD and abductor SD.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.006 |
| 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) | 0.000 | 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 teacher head, 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".