{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T08:13:45Z","timestamp":1773389625625,"version":"3.50.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"\n Background<\/jats:title>\n Bradykinesia in Parkinson's disease (PD) involves reduced movement speed, amplitude, and rhythmicity. While the MDS-UPDRS Part III is the standard clinical tool for motor assessment, it has limited sensitivity to specific kinematic features. Levodopa and subthalamic nucleus deep brain stimulation (STN-DBS) are common treatments for PD, yet their differential effects across motor domains are not fully characterized. This study applies AI-based video analysis to evaluate the effects of levodopa and STN-DBS on limb bradykinesia.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This retrospective study assessed fifty-three patients with Parkinson's disease undergoing STN-DBS. Motor performance was video-recorded during Levodopa-off and Levodopa-on states (levodopa challenge test performed prior to surgery), as well as after DBS activation (OFF\n MED<\/jats:sub>\n \/OFF\n STIM<\/jats:sub>\n , OFF\n MED<\/jats:sub>\n \/ON\n STIM<\/jats:sub>\n , ON\n MED<\/jats:sub>\n \/ON\n STIM<\/jats:sub>\n ). Both clinical assessments and subsequent video-based analyses focused on the MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Part III, specifically evaluating items 3.4 Finger Tapping, 3.5 Fist-clenching test, 3.7 Toe Tapping, and 3.8 Leg Agility. Motor function was first evaluated using conventional UPDRS-III item scores rated by two experienced specialists, with the primary clinical comparison defined between the levodopa-on and OFF\n MED<\/jats:sub>\n \/ON\n STIM<\/jats:sub>\n states, to explore the differential therapeutic emphases of medication and DBS. Subsequently, AI-based video analysis was applied to quantify kinematic parameters, including amplitude, frequency, and coefficients of variation, using AI algorithms (NERVTEX Co. Ltd.). Comparisons were made for levodopa effects (Levodopa-off vs. Levodopa-on), DBS effects (OFF\n MED<\/jats:sub>\n \/OFF\n STIM<\/jats:sub>\n vs. OFF\n MED<\/jats:sub>\n \/ON\n STIM<\/jats:sub>\n ), and therapy-specific differences (Levodopa-on vs. OFF\n MED<\/jats:sub>\n \/ON\n STIM<\/jats:sub>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Conventional UPDRS-III item scores suggested that levodopa was more effective than DBS in improving upper-limb tasks (items 3.4 Finger Tapping and 3.5 Fist-clenching test), while lower-limb tasks (items 3.7 Toe Tapping and 3.8 Leg Agility) showed no significant changes. In contrast, AI-based kinematic analysis revealed more differentiated treatment effects. Levodopa was associated with improvements in movement speed, amplitude, and stability in the upper limbs, as well as a significant impact on lower-limb amplitude, both in toe tapping (item 3.7) and leg agility (item 3.8). DBS, by comparison, enhanced upper-limb motor output but had limited effects on the lower limbs, with improvements in speed and amplitude observed only in the toe tapping (item 3.7) task. Additionally, levodopa demonstrated superior improvements in lower-limb amplitude, both in toe tapping (item 3.7) and leg agility (item 3.8), compared to DBS.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This study demonstrates that AI-based kinematic analysis enables a nuanced and individualized characterization of motor responses to medication and STN-DBS in Parkinson's disease, complementing conventional clinical scoring. Although both therapies improve bradykinesia, they appear to preferentially modulate distinct motor domains across individuals, underscoring their complementary roles in treatment. These findings highlight the potential of AI-based motor assessment to support personalized symptom profiling and more individualized therapeutic decision-making in Parkinson's disease.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fneur.2026.1758218","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T05:26:08Z","timestamp":1773379568000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["AI-based retrospective analysis: differential improvement profiles of medication and deep brain stimulation in Parkinson's disease"],"prefix":"10.3389","volume":"17","author":[{"given":"Lu","family":"Su","sequence":"first","affiliation":[{"name":"Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Brain Function and Disorders, Huashan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aiwen","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Brain Function and Disorders, Huashan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhanxu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Brain Function and Disorders, Huashan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yilin","family":"Liu","sequence":"additional","affiliation":[{"name":"NERVTEX Co., Ltd","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geng","family":"Cheng","sequence":"additional","affiliation":[{"name":"NERVTEX Co., Ltd","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Brain Function and Disorders, Huashan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Brain Function and Disorders, Huashan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianjun","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Brain Function and Disorders, Huashan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"B1","first-page":"679","article-title":"Parkinson disease","volume":"102","author":"Halli-Tierney","year":"2020","journal-title":"Am Fam Physician"},{"key":"B2","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1002\/mds.21198","article-title":"Movement disorder society-sponsored revision of the unified Parkinson's disease rating scale (MDS-UPDRS): process, format, and clinimetric testing plan","volume":"22","author":"Goetz","year":"2007","journal-title":"Mov Disord"},{"key":"B3","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1002\/mds.10473","article-title":"The Unified Parkinson's Disease Rating Scale (UPDRS): status and recommendations","volume":"18","year":"2003","journal-title":"Mov Disord"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2297","DOI":"10.1093\/brain\/123.11.2297","article-title":"Dyskinesias and motor fluctuations in Parkinson's disease. A community-based study","volume":"123","author":"Schrag","year":"2000","journal-title":"Brain"},{"key":"B5","doi-asserted-by":"publisher","first-page":"693","DOI":"10.3390\/brainsci10100693","article-title":"Effects of subthalamic nucleus deep brain stimulation and levodopa on balance in people with Parkinson's disease: a cross sectional study","volume":"10","author":"May","year":"2020","journal-title":"Brain Sci"},{"key":"B6","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1056\/NEJMoa060281","article-title":"A randomized trial of deep-brain stimulation for Parkinson's disease","volume":"355","author":"Deuschl","year":"2006","journal-title":"N Engl J Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1001\/jama.2008.929","volume":"301","author":"Weaver","year":"2009","journal-title":"JAMA"},{"key":"B8","doi-asserted-by":"publisher","first-page":"6373","DOI":"10.3390\/s25206373","article-title":"AI video analysis in Parkinson's disease: a systematic review of the most accurate computer vision tools for diagnosis, symptom monitoring, and therapy management","volume":"25","author":"di Biase","year":"2025","journal-title":"Sensors (Basel)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1001\/jamaneurol.2024.5326","article-title":"Computer vision in clinical neurology: a review","volume":"82","author":"Friedrich","year":"2025","journal-title":"JAMA Neurol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1002\/mdc3.70123","article-title":"Computer vision technologies in movement disorders: a systematic review","volume":"12","author":"Pecoraro","year":"2025","journal-title":"Mov Disord Clin Pract"},{"key":"B11","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.parkreldis.2016.01.019","article-title":"Subjective perceived outcome of subthalamic deep brain stimulation in Parkinson's disease one year after surgery","volume":"24","author":"Maier","year":"2016","journal-title":"Parkinsonism Relat Disord"},{"key":"B12","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1177\/1877718X241312605","article-title":"Improving reliability of movement assessment in Parkinson's disease using computer vision-based automated severity estimation","volume":"15","author":"Xu","year":"2025","journal-title":"J Parkinsons Dis"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1859","DOI":"10.1002\/mds.23740","article-title":"The modified bradykinesia rating scale for Parkinson's disease: reliability and comparison with kinematic measures","volume":"26","author":"Heldman","year":"2011","journal-title":"Mov Disord"},{"key":"B14","doi-asserted-by":"publisher","first-page":"2131","DOI":"10.1093\/brain\/124.11.2131","article-title":"Pathophysiology of bradykinesia in Parkinson's disease","volume":"124","author":"Berardelli","year":"2001","journal-title":"Brain"},{"key":"B15","doi-asserted-by":"crossref","first-page":"44579","DOI":"10.1038\/s41598-025-28378-8","article-title":"Lower limb motor effects of DBS neurofeedback in Parkinson's disease assessed through IMU-based UPDRS movement quality metrics","volume":"15","author":"Salzmann","year":"2025","journal-title":"Sci Rep"},{"key":"B16","doi-asserted-by":"publisher","first-page":"6165","DOI":"10.1523\/JNEUROSCI.0282-08.2008","article-title":"High-frequency stimulation of the subthalamic nucleus suppresses oscillatory beta activity in patients with Parkinson's disease in parallel with improvement in motor performance","volume":"28","author":"K\u00fchn","year":"2008","journal-title":"J Neurosci"},{"key":"B17","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1007\/s00441-004-0936-0","article-title":"Deep brain stimulation","volume":"318","author":"Breit","year":"2004","journal-title":"Cell Tissue Res"},{"key":"B18","doi-asserted-by":"publisher","first-page":"19241","DOI":"10.1038\/s41598-020-74196-5","article-title":"Mapping of subthalamic nucleus using microelectrode recordings during deep brain stimulation","volume":"10","author":"Koirala","year":"2020","journal-title":"Sci Rep."},{"key":"B19","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1016\/j.clinph.2019.02.011","article-title":"Electrophysiological differences between upper and lower limb movements in the human subthalamic nucleus","volume":"130","author":"Tinkhauser","year":"2019","journal-title":"Clin Neurophysiol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1152\/physiol.00034.2015","article-title":"Neural control of walking in people with parkinsonism","volume":"31","author":"Peterson","year":"2016","journal-title":"Physiology (Bethesda)"},{"key":"B21","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1002\/mds.28883","article-title":"Discussion of research priorities for gait disorders in Parkinson's disease","volume":"37","author":"Bohnen","year":"2022","journal-title":"Mov Disord"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.1212\/01.wnl.0000310416.90757.85","article-title":"Effects of subthalamic nucleus stimulation and levodopa on freezing of gait in Parkinson disease","volume":"70","author":"Ferraye","year":"2008","journal-title":"Neurology"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1767","DOI":"10.1093\/brain\/123.9.1767","article-title":"The pedunculopontine nucleus and Parkinson's disease","volume":"123","author":"Pahapill","year":"2000","journal-title":"Brain"},{"key":"B24","doi-asserted-by":"publisher","first-page":"2664","DOI":"10.1093\/brain\/awq221","article-title":"Motor and cognitive outcome in patients with Parkinson's disease 8 years after subthalamic implants","volume":"133","author":"Fasano","year":"2010","journal-title":"Brain"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1007\/s00702-025-02931-1","article-title":"Ventral STN stimulation is associated with improved axial motor outcomes in Parkinson's disease","volume":"132","author":"Butler","year":"2025","journal-title":"J Neural Transm (Vienna)"},{"key":"B26","doi-asserted-by":"publisher","first-page":"100239","DOI":"10.1016\/j.dscb.2025.100239","article-title":"Comparing the impact of low frequency vs high frequency deep brain stimulation in Patient's with Parkinson's disease: a systematic review","volume":"19","author":"Mann","year":"2025","journal-title":"Brain Disord"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1758218\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T05:26:09Z","timestamp":1773379569000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1758218\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,13]]},"references-count":26,"alternative-id":["10.3389\/fneur.2026.1758218"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1758218","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,13]]},"article-number":"1758218"}}