Advances in Clinical Medical Research

The Non-Motor Burden of Parkinson’s Disease: Experience from an Eastern Indian Tertiary Center

Nihar Ranjan Biswal, Rashmi Rekha Mallick, Chinmayee swain — Mon, 29 Sep 2025 00:00:00 +0000

Background: Parkinson’s disease (PD) is defined by motor signs, but non‑motor symptoms (NMS) – neuropsychiatric, autonomic, sleep, sensory, and cognitive – often arise early, drive disability, and reduce health‑related quality of life (HRQoL). Regional NMS profiles can inform screening and management.
Methods: We conducted a cross‑sectional study at a tertiary hospital in Eastern India. Consecutive adults with idiopathic PD (Hoehn & Yahr stages 1–4) underwent structured assessment using validated instruments: NMS questionnaire, NMS scale (NMSS), Montreal Cognitive Assessment (MoCA), Beck Depression Inventory (BDI‑II), Beck Anxiety Inventory, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), PD Questionnaire‑39 (PDQ‑39), Visual Analog Scale for pain, and King’s PD pain scale. Demographic and clinical data were recorded. Descriptive statistics summarized prevalence and severity; comparative analyses explored associations between NMS burden and patient characteristics.
Results: A total of 150 patients (mean age ~63 years; male ≈ two‑thirds; disease duration ~7 years) were included. The NMS burden was high: Depression affected approximately half, insomnia about one‑third, and cognitive impairment around two‑fifths. Constipation and orthostatic hypotension were frequent autonomic problems, whereas olfactory dysfunction and pain were also common. Mean PSQI scores reflected poor sleep quality. Higher NMS burden correlated with worse HRQoL.
Conclusion: NMS are ubiquitous in this Eastern Indian PD cohort and substantially impact HRQoL. Routine, structured NMS screening alongside motor evaluation should be the standard of care. Region‑aware, multidisciplinary strategies addressing mood, sleep, cognition, autonomic dysfunction, and pain are essential.

Clinical Spectrum of Primary Headache Disorders at a Tertiary-Care Hospital in Eastern India: A Prospective Observational Study

Nihar Ranjan Biswal, Rashmi Rekha Mallick, Chinmayee Swain — Mon, 29 Sep 2025 00:00:00 +0000

Background: Primary headache disorders are leading contributors to disability worldwide, but prospective regional data from Eastern India remain limited. Our objective was to describe the sociodemographic profile, clinical characteristics, triggers, disability, and treatment patterns; and to explore factors associated with moderate to severe disability.
Methods: A Prospective, observational study was conducted in a tertiary-care teaching hospital over 12 months. Consecutive adults (18–65 years) meeting International Classification of Headache Disorders, 3rd Edition primary-headache criteria were included, and patients who refused to give consent were excluded. Case-record form captured demographics, phenotype, monthly headache days (MHDs), intensity (visual analogue scale), triggers, and disability (Migraine Disability Assessment [MIDAS]/Headache Impact Test-6 [HIT-6]). Analyses included descriptive summaries, group comparisons, and multivariable logistic regression for predictors of moderate-severe disability (MIDAS III-IV).
Results: We enrolled 420 adults, of whom 286 (68.1%) were female; the mean age was 33 ± 11 years. The phenotype distribution was migraine in 269 (64.0%) – including 210 without aura, 59 with aura, and 32 chronic – tension-type headache in 134 (31.9%) – 110 episodic and 24 chronic – and cluster headache in 17 (4.0%). Common features included unilateral pain in 298 (71.0%), throbbing quality in 290 (69.0%), nausea/vomiting in 244 (58.1%), photophobia in 260 (61.9%), phonophobia in 239 (56.9%), and aura in 59 (14.0%). Frequently reported triggers were stress 260 (62.0%), sleep loss 206 (49.0%), fasting 130 (31.0%), menstruation 132/286 (46.2% of women), weather change 118 (28.1%), caffeine withdrawal 67 (16.0%), and screen exposure 155 (36.9%). Disability was substantial with MIDAS 12 (IQR 6–25), Grade III–IV in 193 (46.0%), and HIT-6 severe in 172 (41.0%), while medication-overuse headache affected 50 (12.0%). In multivariable analysis, higher MHDs (adjusted odds ratio 1.45 per 5-day increase), medication overuse (2.10), anxiety/depression (1.82), and female sex (1.39) independently predicted moderate–severe disability, all P ≤ 0.045.
Conclusions: Migraine predominated and conferred substantial disability. Addressing modifiable triggers and MOH, routine disability screening, and timely preventive therapy may reduce burden.

Trigeminal Neuralgia Treated with Percutaneous Balloon Compression: A Case Series

Kruti Sundar Mandal, Jagannath Tripathy — Mon, 29 Sep 2025 00:00:00 +0000

Background: Trigeminal neuralgia (TN) produces sudden, repeated, electric-shock-like face pain with significant functional impairment. Percutaneous balloon compression (PBC) of the trigeminal (Gasserian) ganglion is a less invasive alternative to medication-refractory TN or patients not suitable for extensive surgery.
Case Summary: Three adults with refractory TN received fluoroscopy-guided PBC. Case 1: A 54-year-old female with left V1–V3 pain, refractory to carbamazepine/gabapentin, experienced ≈75% immediate relief and complete analgesia at 1 and 6 months. Case 2: A 28-year-old female with left V1–V3 TN following unsuccessful radiofrequency ablations and microvascular decompression experienced a mild post-procedure headache with minor magnetic resonance imaging-detectable bleed treated conservatively; pain-free at day 7 and 6 months. Case 3: A 64-year-old male with right V1–V2 TN had total relief within 1 h; temporary facial numbness/dry eye settled by 2 months, pain-free at 7 months.
Conclusions: PBC provided prompt, long-lasting analgesia with acceptable, predominantly reversible sensory effects. Selective, “pear-shaped” balloon confirmation, and uniform compression durations favor PBC as an efficacious interventional treatment for TN.