Esteban García-Albea

Acoustic voice analysis in patients with Parkinson's disease treated with dopaminergic drugs

To quantify several acoustic features of the voice in patients with Parkinsons disease (PD), 41 patients and 28 age and sex-matched controls were studied. PD severity was assessed with the Unified PD Rating Scale (UPDRS) and the Hoehn and Yahr staging. The Computerized Speech Lab 4300 program (Kay Elemetrics) was used. Two seconds of a sustained /a/ and a sentence were captured with a microphone and laryngograph equipment. Measures included fundamental frequency (F0), frequency perturbation (jitter), intensity perturbation (shimmer), and harmonic/noise ratio (H/N) of the vowel /a/, and frequency and intensity variability of a sentence, phonational range, dynamic range at the natural frequency, maximum phonational time and s/z ratio. All subjects underwent indirect laryngoscopy and/or laryngeal fibroscopy. When compared with controls, PD patients showed higher jitter, lower H/N ratio, lower frequency and intensity variability of the sentence, and lower phonational range and reported a higher frequency of the presence of low voice-intensity, monopitch, voice arrests, and struggle. These features seem to be unaffected by the duration and severity of the disease.

Parkinsonism exacerbated by paroxetine

with surrounding edema. Four-vessel angiography showed occlusion of the right anterior cerebral and middle cerebral arteries. Discussion. This young man developed a cerebral infarct in association with use of shortterm, high-dosage anabolic steroids. Experimental evidence suggests that testosterone stimulates thrombus formation by suppressing prostacyclin production in arterial smooth muscle cells in rats.’ Nagelberg et aI3 reported another young man receiving testosterone for hypogonadism who developed a cerebral infarct. Shiozawa et a14 described three patients who developed superior sagittal sinus thrombosis after receiving androgen therapy for hypoplastic anemia. I t is unclear whether migraine added to the risk in these patients. With the more common use of anabolic steroids in the young, both users and their physicians should clearly be aware of this possible complication.

Acoustic voice analysis in patients with essential tremor

To quantify several acoustic features of the voice in patients with essential tremor (ET), 28 patients and 28 age- and sex-matched controls were studied. ET severity was assessed with the rating scale for tremor of Fahn, Tolosa, and Marín. The Computerized Speech Lab 4300 program (Kay Elemetrics) was used. Two-second samples of a sustained /a/ and a sentence were captured with a microphone and laryngograph equipment. Measures included fundamental frequency (F0), frequency perturbation (jitter, Koike algorithm), intensity perturbation (shimmer, Horii algorithm), and harmonic-to-noise ratio (H/N, Yumoto algorithm) of the vowel /a/, and the frequency and intensity variability of the sentence, phonational range, and dynamic range at the natural frequency, maximum phonational time, and s/z ratio. All subjects underwent indirect laryngoscopy and/or laryngeal fibroscopy. When compared with controls, ET patients showed higher jitter, lower H/N ratio (the last one only with laryngographic signal), of the vowel /a/, lower frequency variability in the microphonic signal, lower intensity variability in the laryngographic signal of the sentence, and significantly lower dynamic range at natural frequency of phonation. ET patients reported higher frequency of the presence of high voice intensity, tremor, and struggle. Several acoustic parameters were influenced by the severity of the disease, including shimmer, jitter, H/N ratio, frequency variability of the sentence, and s/z ratio, although neither of the acoustic analysis values or the phonetometric measurements were affected by the presence of voice tremor or by a successful pharmacological treatment of ET.

Acoustic voice analysis in untreated patients with Parkinson's disease.

To quantify several acoustic features of the voice in patients with Parkinsons disease (PD) not treated with dopaminergic drugs, 22 PD patients and 28 age and sex-matched controls were studied. The Computerized Speech Lab 4300 program (Kay Elemetrics) was used. Two seconds of a sustained /a/ and a sentence were captured with a microphone and laryngograph equipment. Measures included fundamental frequency (F(0)), frequency perturbation (jitter), intensity perturbation (shimmer), and harmonic/noise ratio (HIN) of the vowel /a/, and frequency and intensity variability of a sentence, phonational range, dynamic range at the natural frequency, maximum phonational time and s z ratio. All subjects underwent indirect laryngoscopy and/or laryngeal fibroscopy. When compared to controls, PD patients showed higher jitter and shimmer, lower H N ratio, and lower frequency variability of the sentence in the microphonic signal and reported a higher frequency of presence of low voice intensity, monopitch, harshness, voice arrests, and tremor.

Serum levels of β-carotene and other carotenoids in Parkinson's disease

Abstract To elucidate the possible role of carotenoids in the risk for developing Parkinsons disease (PD), we compared serum levels of β-carotene, α-carotene and lycopene, measured by high performance liquid chromatography, of 61 PD patients using their spouses as the control group. The serum levels of these 3 carotenoids did not differ significantly between PD patients and control groups. There was no influence of antiparkinsonian therapy on serum carotenoids levels, and these did not correlate with age, age at onset, scores of the Unified Parkinson Disease Rating Scale or the Hoehn and Yahr staging in the PD group. These results show that serum carotenoids concentrations are apparently unrelated to the risk for developing PD.

Drug-induced parkinsonism in a movement disorders unit: A four-year survey

UNLABELLED To establish the frequency of drug-induced parkinsonism (DIP) and the drugs responsible for this side-effect we reviewed the database of our Movement Disorders Unit during the first 4 years of its use. The diagnostic criteria for DIP included: (1) the presence of two or more cardinal symptoms of parkinsonism, (2) an absence of parkinsonian symptoms before the exposure to the offending drug, (3) a disappearance or significant improvement in parkinsonism after withdrawal of the offending drug, (4) no better explanation for the parkinsonism. One-hundred and five patients fulfilled the diagnostic criteria for DIP (16.3% of total patients referred and 33.8% of patients with parkinsonian syndromes). Drug-induced parkinsonism was related to 1, 2, 3, 4, 5 and 7 drugs in 62, 30, 9, 1, 2 and 1 patients, respectively. The most frequently offending drugs were: calcium-channel blockers (61 cases), antipsychotic drugs (29 cases), thiethylperazine (18 cases), clebopride (14 cases), and sulpiride (10 cases). When compared with idiopathic Parkinsons disease patients, DIP patients were predominantly female and showed an older age at the onset of parkinsonian signs. Parkinsonian signs only disappeared completely in 41 patients (39.0%). IN CONCLUSION (1) DIP was a frequent cause of parkinsonism in our Movement Disorder Unit, (2) calcium-channel blockers, and/or orthopramides and substituted benzamides were a frequent cause of DIP in our series, (3) old age and the female gender were frequent among DIP patients, (4) DIP is not always reversible.

Parkinsonism unmasked by verapamil.

We report the case of a 55-year-old man who had a parkinsonian syndrome unresponsive to levodopa for 5 years and had been taking verapamil during the past 8 years. Parkinsonian signs improved markedly after withdrawal of verapamil, suggesting its role in unmasking the parkinsonism. To our knowledge, this side effect of verapamil has not been described previously.

Heme Oxygenase-1 and 2 Common Genetic Variants and Risk for Restless Legs Syndrome.

AbstractSeveral neurochemical, neuropathological, neuroimaging, and experimental data, suggest that iron deficiency plays an important role in the pathophysiology of restless legs syndrome (RLS). Heme-oxygenases (HMOX) are an important defensive mechanism against oxidative stress, mainly through the degradation of heme to biliverdin, free iron, and carbon monoxide. We analyzed whether HMOX1 and HMOX2 genes are related with the risk to develop RLS.We analyzed the distribution of genotypes and allelic frequencies of the HMOX1 rs2071746, HMOX1 rs2071747, HMOX2 rs2270363, and HMOX2 rs1051308 SNPs, as well as the presence of Copy number variations (CNVs) of these genes in 205 subjects RLS and 445 healthy controls.The frequencies of rs2071746TT genotype and rs2071746T allelic variant were significantly lower in RLS patients than that in controls, although the other 3 studied SNPs did not differ between RLS patients and controls. None of the studied polymorphisms influenced the disease onset, severity of RLS, family history of RLS, serum ferritin levels, or response to dopaminergic agonist, clonazepam or GABAergic drugs.The present study suggests a weak association between HMOX1 rs2071746 polymorphism and the risk to develop RLS in the Spanish population.

Neuronal nitric oxide synthase (nNOS, NOS1) rs693534 and rs7977109 variants and risk for restless legs syndrome

Several biochemical, neuropathological, and experimental data suggest a possible role of nitric oxide (NO) in the pathophysiology of restless legs syndrome (RLS). Two single nucleotide polymorphisms (SNPs) neuronal nitric oxide synthase (nNOS or NOS1) gene (rs7977109 and rs693534) have been found to be associated with the risk for RLS in Germans, although only one of them (rs7977109) remained as significant after multiple comparison tests. The aim of our study was to replicate the possible association between these SNPs and risk for RLS in the Spanish population. We studied the allelic and genotype frequencies of the SNPs rs7977109 and rs693534 in 205 patients with RLS and 328 healthy controls using TaqMan genotyping. The rs7977109 and rs693534 genotypes and allelic frequencies did not significantly differ between patients with RLS and controls and were unrelated with the age at onset of RLS, gender, ferritin levels, and response to dopaminergic or gabaergic agents. The rs7999109GA genotype was overrepresented in RLS patients with positive family history of RLS, and in patients with symptomatic response to clonazepam. The results of our study suggest that these two NOS1 SNPs are not related to the overall risk for RLS in the Spanish population.

Association Between Vitamin D Receptor rs731236 (Taq1) Polymorphism and Risk for Restless Legs Syndrome in the Spanish Caucasian Population.

AbstractSeveral recent works suggest a possible role of vitamin D deficiency in the etiology or restless legs syndrome (RLS). We analyzed the possible relationship of 2 common single nucleotide polymorphisms (SNPs) in the vitamin D3 receptor (VDR) gene with the risk for RLS.We studied the genotype and allelic variant frequencies of VDR rs2228570 and VDR rs731236 SNPs in 205 RLS patients and 445 healthy controls using a TaqMan essay.The frequencies of the rs731236AA genotype and the allelic variant rs731236A were significantly lower in RLS patients than in controls (P < 0.005 and < 0.01, respectively). Restless legs syndrome patients carrying the allelic variant rs731236G had an earlier age at onset, and those carrying the rs731236GG genotype had higher severity of RLS, although these data disappeared after multivariate analyses. None of the SNPs studied was related with the positivity of family history of RLS.These results suggest a modest, but significant association between VDR rs731236 SNP and the risk for RLS.