Benefits of Physical Activity in PD, Neonatal Seizures Increased During Rewarming, Cluster Headache Characterized by Creaky Voice

This week Neurology News Network covered a study that identified a dose-dependent association between physical activity and all-cause morality in Parkinson disease, seizure rates in neonates before and after hypothermia therapy, and why patients with cluster headache may be characterized by "creaky voice."

Welcome to this special edition of Neurology News Network. I’m Marco Meglio. Please excuse our appearance this week as a majority of the US workforce, including the NeurologyLive team, moves to working remote as we come together to help reduce the spread of the novel coronavirus.

An analysis featuring more than 10,000 individuals with Parkinson disease (PD) found an inverse association between physical activity (PA) and all-cause mortality as well as an inverse dose-response association between the total PA amount and mortality. In this nationwide population-based cohort study, 10,699 individuals with PD who were at least 40 years old were asked to self-report on PA levels using structured questionnaires. Among the total cohort followed up for 8 years, there were 1823 deaths (mortality rate, 17%). For individuals who were physically active, investigators observed a significantly reduced morality risk. After adjusting for confounding variables, Cox proportional hazard regression models for morality showed HRs of 0.80 for vigorous-intensity PA, 0.66 for moderate-intensity PA, and 0.81 for light-intensity PA. "Activity modification to increase and maintain PA would be beneficial for PD management, and future prospective randomized clinical trials to elucidate causal associations between PA and mortality in PA are warranted," the study authors wrote.

Neonates with hypoxic ischemic encephalopathy who underwent hypothermia demonstrated higher odds of developing electrographic seizures during the rewarming epoch compared with the preceding epoch. These seizures were thus associated with an increased risk for death or disability at ages 18-22 months. a total of 120 newborns were randomized to either 72 hours of cooling (group A; n = 66) or 120 hours (group B; n = 54) and were followed for 2 years. Serial amplitude EEG was recorded during hypothermia rewarming and focused on 4, 12-hour epochs before and after the initiation of rewarming. In total, 23% (n = 28) had electrographic seizures at rewarming, 6 of which had clinical manifestations that required phenobarbital treatment. Within each group, more infants had seizures during the rewarming epoch compared with its immediately preceding epoch. According to the investigators, this was the largest study to date to systematically assess electrographic seizures during preceding and rewarming phases in hypothermia therapy for asphyxiated neonates.

Using a digital voice analysis, investigators found patients with cluster headache (CH) to have significantly lower second harmonic values compared to healthy controls (HC), suggesting they can be characterized by a creaky voice phonation. This type of “creaky voice” was associated with vocal cord edema underlined by laryngopharyngeal (laringofaringeal) reflux.Patients had voice quality examined using traditional measures of fundamental frequency, calculations of jitter and shimmer, and noise-to-harmonics ratios as well as quantities related to the spectral tilt. These measures were calculated based on the production of stressed vowels extracted from digitally recorded reading tasks done inside of a soundproof insulated cabin in the laboratory of the Audiology Department at the University of Campania.At the conclusion of the study, patients with CH showed a significantly lower difference between the amplitude of the first harmonic (H1) and the amplitude of the second harmonic (H2) compared with HC. Even after using age and smoking status as covariates, Quade’s rank analysis confirmed the pattern seen in these patients

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