Long-term effects of directional deep brain stimulation in Parkinson’s disease: a randomized clinical trial on motor and non-motor symptoms
Bibliographic record
Abstract
Abstract Background Deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson’s disease (PD) that is more precisely focused to the desired target structure may avoid nearby structures that are responsible for undesired side effects. Objective Comparing the long-term effects of STN-DBS with segmented or ring contacts on motor and non-motor symptoms in akinetic-rigid PD patients. Methods This study was a prospective randomized clinical trial. At 6-months postoperatively, the optimal omnidirectional (OS) and directional (DS) stimulation contacts were compared in MedOFF within a double-blind cross-over design, both acutely (within one day) and chronically, i.e., after 3-week stimulation blocks of each condition. The examination included motor and non-motor evaluations (e.g., cognition, mood and quality of life). Importantly, the stimulation intensity of the optimal DS was adjusted such that the total electrical energy delivered (TEED) was equivalent to the TEED of the optimal OS. Results There were no significant differences between OS and DS with regard to all outcome parameters, with 30% less stimulation intensity of the latter. Notably, OS scored (non-significantly) better than DS in all motor and non-motor measures apart from the cognitive evaluation, where OS led to a deterioration of executive functions. However, in 3 of 19 patients, the stimulation intensity of DS needed to be increased above the TEED-estimated values to reach the motor benefits of OS. Conclusions Reliable comparisons between OS and DS require long-term clinical evaluations. A potential differential influence on motor and non-motor symptoms needs to be investigated in future confirmatory studies. Registration: ClinicalTrials.gov: NCT03548506
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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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 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".