gholmali shahidi

One third of patients with Parkinson’s disease (PD) have mentioned “dysphonia” as their most debilitating communication deficit. Patient-based measurements, such as Voice Handicap Index (VHI) add necessary supplementary information to clinical and physiological assessment. There are a few studies about relation between VHI and disease severity in PD, although none of them showed any significant correlation. The goal of this study was to find correlation between these variables in Iranian PD patients. This cross-sectional, analytical and non-interventional study was done on 23 PD patients who reported a voice disorder related to their disease. They were selected from attendants of movement disorders clinic of Hazrat Rasool Akram Hospital. The relationship between disease severity (according to Hoehn and Yahr/H&Y and Unified Parkinson’s Disease Rating Scale-part3 /UPDRS-III) and VHI questionnaire (and its 3 domains) was investigated based on patients’ sex, UPDRS-III score H&Y and VHI. Total VHI and its 3 domains had no relationship with disease severity (H&Y) in all patients and by sex separation. However, there was a positive correlation between VHI and disease severity (UPDRS-III) (r=0.485). There was also a relation between physical and functional domains of VHI and UPDRS (rP=0.530, rF=0.479) while no relationship observed regarding sex differences. 9 out of 18 UPDRS-III items had strong relationship with VHI (total and 3subscales). Iranian PD patients feel handicap according to voice disorder caused by PD. Patient satisfaction of voice decreases with the disease severity and progression. A larger sample size is necessary to find relationship in genders. VHI is an important issue could be offered to be used in PD beside other assessments.

To improve the debilitating features of Parkinson disease (PD) different medical and surgical approaches are available. Subthalamic nucleus deep brain stimulation (STN-DBS) was appeared to be a promising method during last two decades. This study aimed to evaluate early motor outcomes of this procedure in first trial of Iranian patients.

Thirty-seven consecutive patients with advanced Parkinson disease with poor response to common medical agents underwent bilateral STN-DBS. For assessment of motor function parameters Unified Parkinson Disease Rating scale III (UPDRS III) was used. We compared total scores and subscores in three measurements performed as 1) preoperative off-medication, 2) preoperative on-medication and 3) six months postoperative on stimulation and on medication. Reduction in drug consumption was assessed with regard to administered doses of L-Dopa before and after surgery in stable states.

26 men and 10 women with mean age of 50 years were evaluated (one person expired before 6-month follow-up). Mean total scores of UPDRSIII were calculated as 5.2±54.52, 2.88±18.22 and 3±12.8 in three measurements, respectively (p=0.003). PostHoc analyses showed significant improvement among all measurements. Analysis of subscores also revealed significant amelioration in rigidity, resting tremor, hand movement, leg agility, finger tap and rapid alternating movement in on-medication phases of pre- and post-operation (all with p<0.01). The mean administered L-Dopa were224±1296 mg/d and 174±782 mg/d before and after surgery, with significant decline (p<0.001) in administered L-dopa dose.

The results indicate that bilateral STN-DBS can lead to significant short-term improvement of the motor symptoms especially in some debilitating symptoms such as rigidity and tremor in advanced PD. It also accompanies with remarkable reduction in needed doses of drugs. The findings support other studies with similar follow - up interval; however, continuous evaluations are needed for long-lasting effects.