Better therapeutic efficiency of omnidirectional than directional subthalamic deep brain stimulation in Parkinson’s disease
Bibliographic record
Abstract
Abstract Background Deep brain stimulation (DBS) using segmented electrode contacts allows for directionally steered stimulation (DS), while the conventional ring mode provides omnidirectional stimulation (OS). However, with regard to achieving better effects with the same stimulation intensity or equivalent effects with lower intensity, the comparative therapeutic efficiency of these approaches remains unclear. Objective To compare the therapeutic efficiency of subthalamic DBS using segmented and ring contacts in Parkinson’s disease (PD) patients with akinetic-rigid symptoms. Methods A double-blind, randomized monopolar review was conducted with patients in the dopaminergic medication-off state at 10 weeks postoperatively on three upper ring contacts and three contacts of the upper segmented level. Impedance measurements were obtained, and the therapeutic threshold (current strength for complete biceps brachii muscle rigidity resolution) was estimated by increasing stimulation intensity in 0.2 mA increments. Results OS with ring contacts showed an improved therapeutic threshold compared to DS with segmented contacts. At 1.1 mA stimulation intensity, complete rigidity resolution was achieved in 90% of patients with the best ring contact, whereas only 40% achieved the same outcome with the best segmented contact. In addition, OS with ring contacts exhibited 50% lower impedance than DS with segmented contacts. Conclusions Incremental adjustments in current intensity during parameter titration generate valuable stimulus-response curves for assessing therapeutic efficiency. In clinical practice, the monopolar review should give priority to identifying the optimal ring level and therapeutic threshold. Segmented contacts should be carefully considered as a potential alternative when side effects limit the feasibility of other options.
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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 | 0.000 |
| 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) | 0.001 | 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".