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At the same time, the glycine group lost 27 percent less lean mass and had better preserved quadriceps muscle mass by 4 percent compared to controls

However, decreased responsiveness to VIM DBS by select body parts (possibly due to the somatotopic organization of the VIM nucleus) increased tolerance to VIM stimulation due to compensation or disease progression [176, 177], and the development of adverse side effects, such as dysarthia and dysphagia [174], in patients, has driven efforts to optimize DBS targeting

Site burden compounds this: as trials expand globally, particularly into Asia-Pacific and other emerging markets, sites increasingly switch between different sponsor-specific systems and processes, which industry commentary describes as a central operational risk in 2026 rather than a solved problem

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