PURPOSE: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children which persists into adulthood. Evidence suggests that the condition is etiologically related to delayed brain maturation. Detection of the presence of neurological soft signs can be a means to assess neuromaturation. The objective of this study was to assess the prevalence of neurological soft signs in ADHD patients and to determine any correlation between the presence of neurological soft signs with age, gender, severity, and type of ADHD which could give further insights into this disorder. METHODS: A Cross-sectional study was conducted at the Child Neurology and Developmental Pediatrics outpatient clinic which included patients 6-18 years old diagnosed with ADHD as well as healthy controls. Patients with other neurodevelopmental conditions (intellectual disability, metabolic disorder, cerebral palsy, abnormal MRI findings), or any condition that may lead to failure to complete the given tasks such as physical handicap were excluded. Neurological soft signs were measured by utilizing the Physical and Neurological Evaluation for Soft Signs (PANESS) scale. KEY FINDINGS: A total of 48 patients between 6 and 18 years of age (24 ADHD patients and 24 healthy control) were examined. Neurological soft signs were significantly higher in patients with ADHD and were present regardless of gender, type, and severity of ADHD. ADHD patients performed worse on given tasks as evidenced by higher PANESS scores. There was a weak negative correlation between neurological soft signs and age, indicating that soft sign scores decrease with increasing age. There was no statistically significant difference in neurological soft signs scores between those with medication versus without treatment, except for the dysrhythmia which was significantly higher in the drug-naive group. SIGNIFICANCE Neurological soft signs are common in patients with ADHD and add scientific evidence to the predictive value of neurological soft signs as indicators of the severity of functional impairment in ADHD. The prevalence of neurological soft signs is much higher in children with ADHD than in controls which may have the potential to improve sensitivity in the diagnosis of ADHD.

Introduction: Leigh disease and Leigh-like syndrome are a heterogenous group of neurodegenerative disorders involving any level of the neuraxis and may present with a variety of clinical presentations, prominent among them is psychomotor regression. Despite the remarkable number of established disease genes and novel mutations being discovered, many cases of Leigh syndrome remain without a genetic diagnosis, indicating that there are still more disease genes to be identified. Case: Here we present a case of a two and a half-year-old girl who presented with delayed acquisition of developmental milestones with subsequent regression, ataxia, and dyskinesia. Her work-up showed raised blood lactate levels and lactate peak in MR spectroscopy. Mitochondria genome showed absence of mitochondrial DNA mutation, while whole exome sequence analysis revealed a novel dynein gene variant, p.A1577S. Her parents underwent genetic testing as well, and her father also had the same dynein mutation, however, is non-symptomatic. She had an older brother who initially presented with ophthalmoplegia and eventually developed psychomotor regression. He subsequently expired from respiratory failure after almost 2 years from initial presentation. Both siblings were diagnosed with Leigh syndrome. Conclusion The diagnosis of Leigh syndrome remains based on characteristic clinical and radiologic findings. However, a specific defect must be identified if reliable genetic counseling is to be provided.
Neurodegenerative Diseases|leigh Disease

Background and objective : Neurodevelopmental disabilities in adolescents have signifi cant effects on medical and social function. One of these challenges is their transition into adult care. Parental involvement is critical because these young adults may have more diffi culties in making informed decisions independently. Thus, the transition process involves not only the direct health care needs of the young adult, but the needs and concerns of the parents or carers who are instrumental in guiding that process. This study aims to explore the expectations and experiences of family carers of youths with chronic neurodevelopmental disorders who have undergone or are about to undergo transition into adult healthcare in a Filipino-based health care system. Methods: A descriptive phenomenology was used to gain an in-depth understanding of parents’ perceptions and experiences of their youths’ transition process from a pediatric to an adult health care setting. The results were analyzed manually using Colaizzi’s method, which involves integrating both the destructured and restructured analysis principles of phenomenology. Purposive sampling was used to interview 13 family carers of 13 youths with various neurodevelopmental disorders using a semi-structured interview questionnaire. Results : Despite the lack of information on the transition process, our study found that carers did not have a strong inclination to resist the transition event. Most of the carers treat the health care provider as a major decision maker in determining the timing and manner of transition, adopting a “doctor knows best” attitude. Several other hindrances and facilitators to successful transition were also identifi ed and are similar to the current literature. Conclusion This study provides a greater understanding of carers’ perceptions and experiences of transition care for youths with neurodevelopmental disorders in the local setting. They exhibited trust and confi dence in the medical profession as a whole, and had a “doctor knows best” attitude that may enable successful transitioning.
Transitional Care ; Neurology ; Neurodevelopmental Disorders ; Caregivers

Purpose: Attention defi cit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children persisting into adulthood. Evidence suggests that the condition is etiologically related to delayed brain maturation. The detection of the presence of neurological soft signs can be a means to assess neuromaturation. The objective of this study was to assess the prevalence of neurological soft signs in ADHD patients and determine any correlation between the presence of neurological soft signs with age, gender, severity and type of ADHD which could give further insights into this disorder. Methods: A cross-sectional study was conducted at the Child Neurology and Developmental Pediatrics outpatient clinic which included patients 6-18 years old diagnosed with ADHD as well as healthy controls. Patients with other neurodevelopmental conditions (intellectual disability, metabolic disorder, cerebral palsy, abnormal MRI fi ndings), or any condition that may lead to failure to complete the given tasks such as physical handicaps were excluded. Neurological soft signs were measured by utilizing the Physical and Neurological Evaluation for Soft Signs (PANESS) scale. Key Findings: A total of 48 patients between 6 and 18 years of age (24 ADHD patients and 24 healthy controls) were examined. Neurological soft signs were signifi cantly higher in patients with ADHD and were present regardless of gender, type and severity of ADHD. ADHD patients performed worse on the given tasks as evidenced by higher PANESS scores. There was a weak negative correlation between neurological soft signs and age indicating that soft sign scores decrease with increasing age. There was no statistically signifi cant difference in neurological soft sign scores between those with medication versus without treatment, except for dysrhythmia which was signifi cantly higher in the drug-naive group. Significance Neurological soft signs are common in patients with ADHD and add scientifi c evidence to the predictive value of neurological soft signs as indicators of the severity of functional impairment in ADHD. The prevalence of neurological soft signs is much higher in children with ADHD than in controls which may have the potential to improve sensitivity in the diagnosis of ADHD.
Attention Deficit Disorder with Hyperactivity

Background : Caregiver burden and its impact on the quality of life is as important as determining the quality of life of children with epilepsy as these factors inl uence each other as well as the outcome of these children. Objectives : The primary objective of the study was to determine the association between caregiver burden and quality of life as well as anxiety and depressive symptoms among caregivers of Filipino children with epilepsy. Also, the study aimed to determine the prevalence rate of caregiver burden, impaired quality of life, anxiety, and depressive symptoms in an ambulatory care setting. Methodology : In this cross-sectional survey, adult caregivers accompanying their pediatric patients with epilepsy at a single tertiary center were recruited. Sociodemographic and clinical data were collected. The participants completed questionnaires for caregiver burden, quality of life, anxiety, and depressive symptoms. Results : Fifty-three caregivers participated with a mean age of 38 years. Most of them were females, married, unemployed, and at least college level. The mean age of their patients was 9.4 years and 71.7% of patients were on a single anti-epileptic drug. Lower educational level was less likely associated with caregiver burden. Although impaired quality of life and depressive symptoms were more likely associated with caregiver burden, this association did not reach statistical signii cance. Conclusion The prevalence rate of caregiver burden, impaired quality of life, anxiety, and depressive symptoms were 24.5%, 22.6%, 28.3%, and 9.4% respectively, among caregivers of Filipino children with epilepsy at a single tertiary center. Lower educational level was the only characteristic signii cantly associated with lesser odds of having caregiver burden
Caregiver Burden ; Quality of Life ; Anxiety ; Depression

Spinal muscular atrophy (SMA) is the most common inherited lethal disease in children. Confirmatory diagnosis is based on molecular genetic testing of survival motor neuron (SMN) genes. We aimed to describe the phenotypic presentation of Filipino infants and children with SMA based on the copy number analysis of SMN genes. Medical records of 17 Filipino children were reviewed from January 2017 to December 2019. De-identified clinical data fulfilled the diagnostic criteria defined by the International SMA Consortium. Among Filipino children, the predominant SMA type by copy number was type I having two copies of SMN2 gene. The clinical severity based on symptom onset and highest functional motor capacity attained correlated with SMN2 copy number congruent with existing data. A significant time lag between symptom onset to confirmation of genetic diagnosis was noted. Nine out of the 17 (52%) children did not have a family history of the disease, raising the possibility of mutation carriers in these families since the incidence of de novo mutations in literature is about 2%. These data offered the first epidemiological pattern of genetically confirmed SMA among Filipino children; provided additional information for genetic counselling; and an avenue to consider pre-symptomatic newborn screening and carrier testing that would change proactive measures and opportunities for therapy. These measures unavoidably will decrease the incidence and prevalence of disease in the future.
Muscular Atrophy, Spinal

Gastroenterology ; Endoscopy, Gastrointestinal ; Consensus ; Colorectal Neoplasms ; Survival Rate ; Incidence ; Philippines ; Colonic Polyps ; Adenoma

Objectives: While many healthcare workers (HCWs) contracted COVID-19 during the pandemic, more information is needed to fully understand the potential for adverse health effects in this population segment. The aim of the present study is to examine the association between healthcare worker status and neurologic and clinical outcomes in COVID-19 infected inpatients. Methods: Using the nationwide database provided by the retrospective cohort Philippine CORONA study, we extracted relevant data and performed a secondary analysis primarily focusing on the presentation and outcomes of healthcare workers. Propensity score matching in a 3:1 ratio was performed to match HCWs and non-HCWs. We performed multiple logistic and Cox regression analyses to determine the relationship between HCWs and COVID-19 clinical outcomes. Results: We included 3,362 patients infected with COVID-19; of which, 854 were HCWs. Among the HCWs, a total of 31 (3.63%) and 45 (5.27%) had the primary outcomes of in-hospital mortality and respiratory failure, respectively. For both overall and 3:1 propensity-matched cohorts, being an HCW significantly decreased the odds of the following outcomes: severe/critical COVID-19 at nadir; in-hospital mortality; respiratory failure; intensive care unit admission; and hospital stay >14 days. Conclusion We found that being an HCW is not associated with worse neurologic and clinical outcomes among patients hospitalized for COVID-19.
Health Personnel ; COVID-19 ; SARS-CoV-2 ; Cohort Studies