Subthalamic Nucleus Deep Brain Stimulation in Isolated Dystonia: A 3-Year Follow-Up Study (P1.008)
Bibliographic record
Abstract
Objective: To investigate long-term safety and efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) in a cohort of medically refractory isolated dystonia patients. Background:The STN is an alternative target for treating isolated dystonia with DBS. We previously reported excellent short-term outcomes of STN DBS in patients with isolated dystonia(1, 2). This extension study followed patients prospectively for three years post-surgery. Design/Methods:Twenty patients (12M, 8F; mean age 49+16.3 years) with medically refractory isolated dystonia enrolled in the long-term study. The primary endpoints were the change in Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) motor score and the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total score at 36 months compared to preoperative baseline. Additional secondary outcomes were also assessed. ClinicalTrials.gov (NCT00773604). Results:Fourteen patients were followed for 36 months. Using an intention-to-treat analysis (n=20) patients continued to show benefit in dystonia severity at 36 months compared to baseline. BFMDRS scores improved 73.83[percnt] from a mean 16.6+7.5 to 4.4+5.9(p<0.001) and total TWSTRS scores improved 66.12[percnt] from a mean 40.4+18.9 to 13.7+17.9(p < 0.001). Improvement at 36 months was equivalent to that seen at 6 months. Disability and quality of life measures were also improved. Three hardware and 17 stimulation related non-serious adverse events occurred between years 1 and 3 (including 3 patients with dyskinesia). One patient developed a device related infection requiring explantation at 15 months and exited the study. Conclusions: This study offers support for long-term tolerability and sustained effectiveness of STN DBS in the treatment of severe forms of isolated dystonia. 1. Ostrem JL, Racine CA, Glass GA, et al. Subthalamic nucleus deep brain stimulation in primary cervical dystonia. Neurology 2011;76(10):870-878. 2. Ostrem JL, Markun LC, Glass GA, et al. Effect of frequency on subthalamic nucleus deep brain stimulation in primary dystonia. Parkinsonism & related disorders 2014;20(4):432-438.
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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) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".