Comment on: “A Transatlantic Viewpoint on the Role of Pallidal Stimulation for Parkinson's Disease”
Bibliographic record
Abstract
We read the viewpoint by Drs. Boogers and Fasano with interest.1 We agree that the target globus pallidus internus (GPi) could have been underused compared with subthalamic nucleus (STN) in deep brain stimulation (DBS) practice for patients with Parkinson's disease (PD), as the published data so far has been largely on STN DBS. Besides the many reasons to endorse a more frequent use of GPi in the future as mentioned in the article,1 there is also a potential benefit of using GPi for the important and challenging axial symptoms as we would like to emphasize here. The symptoms of postural instability and gait disability (PIGD) were analyzed in a meta-analysis article comparing GPi with STN DBS at medication off and on status over time.2 It was found that GPi is superior to STN DBS on PIGD in the long term use of DBS at medication on status.2 Swallowing function is another major axial symptom (although much less studied than gait and balance) where GPi DBS has demonstrated superiority to STN, as reflected in a relatively large size study and a more recent systematic review on the effect of DBS on swallowing function,3, 4 particularly at medication on status,3, 4 which is also strikingly similar to the conclusion on the effect of GPi compared with STN DBS on PIGD.2 Axial symptoms are major causes of morbidity and mortality and poor quality of life in patients with PD, particularly in the advanced disease stage or after long-term DBS therapy,2, 4, 5 when they become more and more prominent, but less and less responsive to the dopaminergic medications and DBS therapy, likely because they are largely due to deficits caused by non-dopaminergic mechanisms.6 It is hard to tell whether the worsening of axial symptoms is because of disease progression, DBS stimulation related side effects (possibly less so in GPi given its much larger size than STN), medication changes (given the significant reduction of the dopaminergic medications post-surgically in patients with STN, but not much in GPi DBS), or the combination of all. This, along with the favorable effect of GPi DBS on mood, cognitive function, and dyskinesia compared with STN DBS,1, 7 would further suggest that GPi should be more frequently used, particularly also as mentioned that the journey post implantation could be different or more challenging for STN, and that we need to make our decision based on real world data, which can also be affected by the currently implicit selection bias of the targets.1 The possible superiority of GPi DBS on the important challenging axial symptoms of gait, balance, and swallowing function here could possibly further motivate an increased use of GPi,2-4 which will help us to gather more information on the use of GPi and yield a better assessment and selection of the targets for DBS in the future. We thank all patients and families for their engagement in our studies. (1) Research Project: A. Conception, B. Organization, C. Execution; (2) Statistical Analysis: A. Design, B. Execution, C. Review and Critique; (3) Manuscript: A. Writing of the First Draft, B. Review and Critique. T.X.: 1A, 1B, 1C, 3A, 3B P.C.W.: 1B, 1C, 3B T.X. has received Consultancies from CVS Caremark; is employed by The University of Chicago Medicine; has received honoraria from the Parkinson's Foundation and CVS Caremark; and has received grants from The Michael J. Fox Foundation for Parkinson's Research, American Parkinson's Disease Association, and the National Institutes of Health. P.C.W. is employed by the University of Chicago Medicine. Data sharing not applicable – no new data generated.
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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 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| 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".