{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T19:04:22Z","timestamp":1790795062206,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100023544","name":"National Taiwan University Hospital Hsin-Chu Branch","doi-asserted-by":"publisher","award":["109\u2010HCH092"],"award-info":[{"award-number":["109\u2010HCH092"]}],"id":[{"id":"10.13039\/501100023544","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100023544","name":"National Taiwan University Hospital Hsin-Chu Branch","doi-asserted-by":"publisher","award":["110\u2010HCH024"],"award-info":[{"award-number":["110\u2010HCH024"]}],"id":[{"id":"10.13039\/501100023544","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100023544","name":"National Taiwan University Hospital Hsin-Chu Branch","doi-asserted-by":"publisher","award":["National Science & Technology Council 114\u20102314\u2010B\u2010002\u2010120\u2010MY3"],"award-info":[{"award-number":["National Science & Technology Council 114\u20102314\u2010B\u2010002\u2010120\u2010MY3"]}],"id":[{"id":"10.13039\/501100023544","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disorders"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The long\u2010latency reflex (LLR), particularly LLR II elicited by peripheral stimulation, is considered a transcortical reflex and may reflect cortical\u2013subcortical excitability. Its relevance as a biomarker for subthalamic nucleus deep brain stimulation (STN\u2010DBS) optimization in Parkinson's disease remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine whether LLR II responses are modulated by STN\u2010DBS stimulation parameters and dopaminergic medication, and to explore the potential mechanisms underlying STN\u2010DBS\u2013related motor improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Thirteen Parkinson's disease patients with STN\u2010DBS underwent median nerve stimulation to assess LLR II, quantified as the peak abductor pollicis brevis electromyography (EMG) response at 50\u201370\u2009ms, normalized to prestimulus baseline EMG, across different stimulation intensities, contacts, and frequency conditions, including 60\u2009Hz, 130\u2009Hz, and an energy\u2010matched condition. A single DBS pulse was also paired with the cortical N20 response at N20\u2009\u2013\u20092\u2009ms (T1) or N20\u2009+\u200910\u2009ms (T2) to assess timing\u2010dependent effects. Sixteen Parkinson's disease patients without DBS were tested in medication\u2010\n                      <jats:italic>on<\/jats:italic>\n                      and \u2010\n                      <jats:italic>off<\/jats:italic>\n                      states. Motor severity was assessed using tested\u2010side Unified Parkinson's Rating Scale Part III (UPDRS III) subscores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      LLR II ratio was higher at 70% and 100% of clinical stimulation intensity than during DBS\u2010\n                      <jats:italic>off<\/jats:italic>\n                      (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0029 and\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.042, respectively). LLR II was higher at the most effective than at the least\u2010effective contact (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.042). The clinically most\u2010effective frequency showed higher LLR II than DBS\u2010\n                      <jats:italic>off<\/jats:italic>\n                      and the least\u2010effective frequency (both\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.048). In the single\u2010pulse DBS experiment, LLR II increased only at T2 compared to DBS\u2010\n                      <jats:italic>off<\/jats:italic>\n                      (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.047). No medication\u2010state difference was observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LLR II was modulated by clinically effective STN\u2010DBS parameters but was insensitive to dopaminergic medication, supporting its utility as a biomarker of DBS\u2010related sensorimotor circuit modulation, potentially involving the hyperdirect pathway. \u00a9 2026 International Parkinson and Movement Disorder Society.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mds.70508","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T01:42:14Z","timestamp":1786671734000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Subthalamic Nucleus Deep Brain Stimulation Enhanced Long\u2010Latency Reflex\n                    <scp>II<\/scp>\n                    in Parkinson's Disease Through Rapid Subthalamic\u2013Cortical Modulation"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9527-4084","authenticated-orcid":false,"given":"Kai\u2010Hsiang Stanley","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Neurology National Taiwan University Hospital Hsinchu Branch  Hsinchu Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yih\u2010Chih Jacinta","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Neurology National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7121-2463","authenticated-orcid":false,"given":"Chang\u2010Yu","family":"Jeng","sequence":"additional","affiliation":[{"name":"Department of Neurology National Taiwan University Hospital Hsinchu Branch  Hsinchu Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan\u2010Siou","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Neurology National Taiwan University Hospital Hsinchu Branch  Hsinchu Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun\u2010Hwei","family":"Tai","sequence":"additional","affiliation":[{"name":"Department of Neurology National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8371-8629","authenticated-orcid":false,"given":"Robert","family":"Chen","sequence":"additional","affiliation":[{"name":"Krembil Research Institute University Health Network  Toronto Ontario Canada"},{"name":"Division of Neurology, Department of Medicine University of Toronto  Toronto Ontario Canada"},{"name":"Edmond J. 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