Deep brain stimulation improves symptoms of spasmodic dysphonia through targeting of thalamic sensorimotor connectivity
Bibliographic record
Abstract
ABSTRACT Background Spasmodic dysphonia is a dystonia of the vocal chords producing difficulty with speech. Current hypotheses are that this is a condition of dysregulated thalamic sensory-motor integration. A recent randomised controlled trial of thalamic deep brain stimulation (DBS) demonstrated its safety and efficacy. Our objective was to determine if the outcome could be predicted by stimulation of thalamic sensorimotor regions and adjacent white matter connectivity as assessed by diffusion tractography. Methods A cohort of six participants undergoing thalamic deep brain stimulation for adductor spasmodic dysphonia was studied. Electrodes were localised with the Lead-DBS toolbox. Group-based analyses were performed with atlases, co-ordinates, and using voxel-based symptom mapping. Diffusion tensor imaging (3 Tesla, 64 directions, 2mm isotropic) was used to perform individual probabilistic tractography (cerebellothalamic tract and pallidothalamic tract) and segmentation of the thalamus. Monopolar review was performed at 0.5V and binarised as effective or ineffective. Results Effective contacts stimulated more of thalamic regions connected to sensorimotor cortex than ineffective contacts (p<0.05, FDR corrected). This effect was consistent across analytical and statistical techniques. Group-level and tractography analyses did not identify a specific ‘sweet spot’ suggesting the benefit of DBS is derived from modulating individual thalamic sensorimotor connectivity. Stimulations at one year involved predicted thalamic sensorimotor regions with additional cerebellothalamic tract involvement. Conclusions Symptoms of spasmodic dysphonia are effectively treated by DBS. Stimulation of thalamic sensorimotor areas was associated with symptomatic improvement. These data are consistent with DBS acting upon pathophysiologically dysregulated thalamic sensorimotor integration in spasmodic dysphonia. What is known on this topic Spasmodic dysphonia is a dystonia affecting speech with few treatment options other than speech therapy and botulinum toxin. What this study adds Deep brain stimulation is demonstrated to be an effective therapy by targeting sensorimotor areas of the thalamus. How might this study affect research, practice or policy These data add to the evidence that spasmodic dysphonia is due to dysregulated thalamic sensorimotor integration, and also suggest novel targets for steering stimulation towards to maximise benefit.
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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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 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 | 0.001 |
| 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".