INTRODUCTION: Cavernomas in the brainstem and spinal cord are rare than their intracranial counterparts, and occurrences specifically at the cervicomedullary junction are infrequent. In this report, we present a case of a cervicomedullary cavernoma which manifested with spinal shock and dysfunction. CASE REPORT: We describe a patient who exhibited spinal shock syndrome and a stepwise decline in spinal cord function. A 33-year-old woman initially complained of right upper arm and occipital referred pain from the atlantoaxial region. Three days later, she experienced bowel and urinary incontinence. Subsequently, quadriparesis and numbness affecting all limbs developed after one week, followed by life-threatening respiratory depression after nine days. Magnetic resonance imaging revealed a lesion in the cervicomedullary junction, identified as a cavernous hemangioma. During the hospital stay, fragmented reflex activity gradually returned. Upon follow-up, the bowel and urinary incontinence, motor impairments, and sensory impairments showed improvement. CONCLUSION The proposed mechanism for the mass effect of this cavernous malformation on the spinal cord at the cervicomedullary junction was likely due to pressure effects caused by shifting dynamics. Understanding the natural history of cavernous malformations, regional neurovascular anatomy, safe entrance points to the brainstem, routes to the craniovertebral junction from the base of the skull, and specific microsurgical procedures for their removal are necessary for appropriate treatment. However, these considerations should be balanced against knowledge of the associated hazards and treatment recommendations.
Cavernoma

INTRODUCTION: Spontaneous regression of pituitary adenomas is a rare occurrence that is thought to be due to pituitary apoplexy. We would like to review the demograhic data, imaging findings, and neurologic, endocrinologic, and radiologic outcomes of patients who exhibited this unusual phenomenon. METHODS: We present a case of non-functioning pituitary adenoma (NFPA) in a 66-year-old man that underwent spontaneous regression. We also performed a systematic literature review on cases of pituitary adenomas that exhibited spontaneous regression, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: There have been only 27 reported cases of spontaneous regression observed in all pituitary adenomas, 16 of which are NFPAs. Headache was the most common symptom while decreased visual acuity and oculomotor nerve palsy were the most common sign. Pituitary hemorrhage was seen in two-thirds of cases, while findings suggestive of pituitary infarct, such as enhancement of the sphenoid sinus mucosa. were seen in one-third. Complete radiographic remission was observed in 62% of cases, with an 11% recurrence rate seen at least two years after the initial imaging. Neurologic recovery was reported in 88% and endocrinologic recovery from hypopituitarism was 40%. CONCLUSION Most patients exhibited neurologic and endocrinologic improvement concomitant with the regression of the pituitary adenoma. However, these tumors may recur; thus, regular and long- term neuro-ophthalmologic and radiologic follow-up is advised.
Pituitary adenoma ; spontaneous regression

Stroke is the most common neurologic admission in our Center. Healthcare needs to be sustainable, while maintaining the standard of care. Will codifying acute stroke care into a pre- written clinical pathway reduce mortality, lengths of hospital stay, and costs? We pilot-tested an Acute Stroke Clinical Pathway based on the Stroke Society of the Philippines, Department of Health, and other international guidelines. Mortality rate, lengths of hospital stay, excess hospital costs and complication rates were compared. Those enrolled into the Ischemic Stroke pathway stayed one day less compared to those who were not. The hospital share for mild hemorrhagic stroke, mortality rate for moderate hemorrhagic stroke, and length of stay and hospital share in severe hemorrhagic stroke patients enrolled into a Hemorrhagic Stroke pathway were statistically significantly less. The savings in some patient groups (e.g., in Mild Hemorrhagic strokes) were offset by losses in others (e.g., in Moderate to Severe Ischemic Strokes). Patients enrolled into a stroke pathway were recorded to have more nosocomial infections. The findings show that using a pre-written clinical pathway reduces stroke patient mortality, length of stay, and hospital cost, but only in specific patient groups. The increase in reported nosocomial infections in stroke-pathway-enrolled patients is hypothesized to be due to better reporting.

Tuberous Sclerosis Complex (TSC) is a genetic disorder that presents in a myriad of clinical manifestations affecting the different organ systems. These manifestations emerge at different times in a patient’s lifespan and diagnosis early in the disease can be challenging. Majority of patients with TSC develop epilepsy and is often one of the most difficult to manage. We report two neonates with drug resistant epilepsy with seizure onset on the first day of life and were subsequently diagnosed with Tuberous Sclerosis. These two neonates exemplified the diverse phenotypic expression of TSC.

Pooled systematic studies that compare treatment stragegies for post-stroke spasticity prove that Botulinum toxin-A (BoNT-A) has superior efficacy and safety and has become the first line management in tandem with physiotherapy. The natural evolution of spasticity show that, not only are neural mechanisms of muscle hypertonus come into play, but that biomechanical forces may likely set in 3 months after stroke. Uses of BoNT-A have been driven by pre-defined goals in the established stage of spasticity (i.E. > 6 months from onset of stroke), as well as the practice of repeat cycle injections to reduce muscle tone. About 19-33% of patients develop spasticity within 3 months after the ictus. Early intervention with BoNT-A (i.e. < 3 months from onser stroke spasticity) can be aimed at preventing the increasing severity of spasticity and the contracture development. There are two randomiaed double blind placebo-controlled trials, and a one single blind comparator trial with a non-injected group, that have recently been performed as early BoNT-A intervention, in tandem with rehabilitation. All the 3 trials showed benefit in terms of reduction in muscle tone with BoNT-A, and one study showed improvement in function, in subanalysis of severely weak muscles at baseline. In the large double blind placebo controlled study, pain reduction was achieved and muscle tone had sustained reduction over the longitudinal observation of 24 weeks, despite a single cycle injection of BoNT-A. The combination of early nrurorehabilitation and early BoNT-A application is an appealing therapeutic approach for upper limb post-stroke spasticity. Neurorehabilitation by constraint-induced movement therapy, in tandem with BoNT-A have been proven to reduce muscle overactivity and improve motor control, but remains to be established in a setting of early spasticity.

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The objective of the study is to monitor on a wide population base the safety and efficacy of zonisamide in patients with partial, generalized, and combined seizures. This is an open label, descriptive, post-marketing surveillance preliminary report that includes the data obtained from October 2008 to May 2010 of a four-year study. The study included 516 patients allocated to either zonisamide monotherapy or zonisamide add-on therapy, with efficacy and safety assessed monthly for three months. For adult patients, a maximum oral dose of 600 mg per day was allowed while a maximum dose of 12 mg/kg/day of zonisamide was allowed for pediatric patients. Efficacy measures were the proportion of responders and percentage change in seizure frequency from baseline. 321 of the 516 patients were included in the efficacy analysis. The responder rates were 53.27%, 80.37%, and 92.52% after the 1st month, 2nd month, and 3rd month of treatment respectively. The use of zonisamide led to seizure-reduction rates of 45.74%, 68.43%, & 82.85% during the 1st, 2nd, & 3rd month of use respectively. Safety analysis was done on all the 516 subjects. Adverse events were mostly mild and observed in 6.78% of patients. No serious adverse events were encountered. 7 subjects (1.4%) discontinued taking zonisamide because of increased seizure frequency in 4 patients, and 1 patient each due to absence of effect on seizure-control, rashes, and thrombocytopenia. All the rest continued taking zonisamide.

Human ; Male ; Female ; Seizures ; Zonisamide ; Isoxazoles ; Exanthema ; Marketing ; Thrombocytopenia ; Epilepsy

CONTEXT: Pregabalin has shown efficacy in the treatment of multiple chronic pain syndromes.
OBJECTIVES: The objective was to evaluate the overall safety and tolerability of pregabalin in the treatment of a several neuropathic pain syndromes in a naturalistic setting using a flexible dosage regimen.
METHODS: Patients aged >- 18 years with neuropathic pain of various etiologies participated in an open-label, non-comparative study at 95 sites in the Philippines. Treatment included pregabalin for 4 weeks, with upward dosage titration to 600 mg/day at investigator discretion. Efficacy was rated with an 11-point pain visual analog scale (VAS). Physicians and patients rated pregabalin on treatment satisfaction, efficacy and safety using a Clinical Global Impression (CGI) rating scale. Descriptive statistics were used for quantitative variables and categorical frequency counts for qualitative variables.
RESULTS: The efficacy analysis (intent-to-treat) included 1603 patients. Mean VAS pain score improved from baseline (7.2 +- 1.6) to 3.8 +- 1.8 at second visit and 2.3 +- 1.4 at last visit. Physicians' and patients' impression of pregabalin regarding treatment satisfaction, efficacy and safety using a CGI rating scale showed> 75% who gave a rating of excellent at second visit gave the same rating at final visit. Adverse events (AEs) were generally mild to moderate, with dizziness and somnolence most frequently reported.
DISCUSSION: Improvement in mean VAS pain scores as well as physicians' and patients' overall satisfaction with tolerability and efficacy support the usefulness of pregabalin in the treatment of various neuropathic pain syndromes in Asian patients.
WHAT'S KNOWN? Pregabalin is effective for the treatment of chronic pain syndromes, including painful diabetic peripheral neuropathy, postherpetic neuralgia, spinal cord injury and fibromyalgia.
WHAT'S NEW? This open-label, non-comparative study demonstrates safety, tolerability and efficacy for neuropathic pain syndromes in Asian patients.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Adolescent ; Neuralgia, Postherpetic ; Pregabalin ; Dizziness ; Fibromyalgia ; Chronic Pain ; Neuralgia ; Pain Measurement ; Diabetic Neuropathies ; Spinal Cord Injuries

Sulodexide was evaluated in an investigator-initiated, multi-center, randomized, controlled, open-labeled study to determine its safety and tolerability profile, and effect on the neurological recovery and functional outcome of patients with acute ischemic stroke. Sixty-five (65) patients were randomized to Standard care group and 46 to Standard care plus Sulodexide Treatment group. Sulodexide was observed to be safe and well-tolerated among patients included in this study. Although not statistically significant, Modified Rankin Scale Responder Analysis consistently showed higher proportions of functionally improved patients in the Sulodexide group than in the Standard Care group on treatment days 10, 30, and 90 respectively.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Glucuronyl Glucosamine Glycan Sulfate ; Research Personnel ; Stroke ; Glycosaminoglycans

Sex-linked dystonia parkinsonism (XDP, DYT3, "Lubag") is an adult-onset, progressive, debilitating movement disorder first described in Filipino males from Panay Island in 1975. XDP manifests predominantly as torsion dystonia, later combined with or sometimes replaced with parkinsonism. Within the Island of Panay, the preva-lence rate is highest in the province of Capiz, where 1:4000 men suffer from the disorder. There is a high degree of penetrance and generalization. While women often serve as carriers, XDP is not limited to men. An updated XDP Philippine registry (as of January 2010) has identified 505 cases, with 500 males and 5 females. While some report that females may carry a milder form of the disorder, in our experience, both sexes generally follow a similar progressive clinical course.

Human ; Male ; Female ; Aged ; Adult ; Dystonia ; Dystonia Musculorum Deformans ; Dystonic Disorders ; Genetic Diseases, X-linked ; Islands ; Parkinsonian Disorders ; Penetrance

It is now commonly accepted that non-motor symptoms of Parkinson's disease often outweigh and sometimes even antedate the development of motor symptoms of PD. It can prove to be more disabling and more challenging to treat and it clearly impacts quality of life in PD. This article provides a concise review of non-motor features in Parkinson's disease as well as the pathophysiological mechanisms underlying each complication. Currently available management strategies will be outlined as well.

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