Human ; Research

Multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) is a variant of chronic inflammatory demyelinating polyneuropathy (CIDP). It presents as a chronic, asymmetrical sensory-motor polyneuropathy with features of demyelination on nerve conduction studies. Management options include intravenous immunoglobulin and corticosteroid infusions. Prognosis is generally favorable but there have been reports of variable response to treatment. This condition is rare and local data on CIDP and its variants is limited, hence we report a case of a 64-year-old male presenting with 3 year history of progressive asymmetric numbness and weakness of all limbs. Sensory deficits began on the left hand and had progressed to involve the distal portions of all limbs, eventually developing weakness as well. The patient underwent multiple nerve-conduction studies, all of which showed findings congruent with MADSAM. He was given intravenous high dose methylprednisolone and was maintained on mycophenolate mofetil.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Methylprednisolone ; Mycophenolate Mofetil ; Mycophenolic Acid

This is a case of a 44 year old single, Filipino, female who presented with dysarthria, left central facial paresis, left hemianopsia and left hemiparesis. Magnetic Resonance Imaging showed an acute infarction of the right posterior cerebral artery territory. 2d echo and transesophageal echocardiography were done and vegetations were observed on the mitral, aortic and tricuspid valves giving a diagnosis of endocarditis. With the absence of fever and negative blood cultures, infective endocarditis was less likely. On further workup, computed tomography scan of the abdomen showed a probable malignant ovarian mass. This finding led to a diagnosis of nonbacterial thrombotic endocarditis as the cause of the stroke. Endocarditis as a cause of an embolic event in the brain is uncommon and nonbacterial thromobotic endocarditis is rare. It commonly affects the left sided heart valves. Multivalvular involvement which includes the right sided heart valves are rarely reported. Nonbacterial thrombotic endocarditis has a high mortality so therefore early detection and management is crucial and can be life-saving.

Human ; Female ; Adult: 25-44 Yrs Old ; Endocarditis ; Tricuspid Valve ; Stroke

BACKGROUND

Acute migraine can be treated with rimegepant, an antagonist of the calcitonin gene-related peptide (CGRP) receptor. With a focus on the Asian population as a subgroup, this metaanalysis attempts to investigate the effectiveness and safety of rimegepant for individuals suffering from severe migraines.

METHODS

PubMed, MEDLINE database and Cochrane Library were used to identify valid randomized controlled trials for this study. The primary endpoint investigated was freedom from pain and freedom from the most bothersome symptom 2 hours post dose. RevMan 5.4.1 software was used to perform a meta-analysis on each outcome measure.

RESULTS

A total of five randomized controlled trials were incorporated, with two of them being conducted on Asian populations and published between 2014 and 2024. There were 2,516 cases in the rimegepant group and 2,668 cases in the placebo group out of the total 5,184 patients that were included. Rimegepant was found to significantly reduce the primary endpoints in acute migraine patients (RR 1.58, 95% CI 1.42-1.75, P-value 0.0001; RR 1.34, 95% CI 1.08-1.66, P- value 0.0001), and in the acute migraine Asian patients (RR 1.79, 95% CI 1.47-2.19, P-value < 0.00001; RR 1.45, 95% CI 1.31-1.60, P-value < 0.00001) but showed no significant difference in the risk reduction of any adverse event, nausea and urinary tract infection among acute migraine patients (RR 1.06; 95% CI, 0.93-1.21; RR 0.88; 95% CI, 0.57-1.35; RR 1.08; 95% CI, 0.64-1.84;).

CONCLUSION

The use of rimegepant is effective and safe for acute migraine patients, including the Asian subgroup.

Human ; Calcitonin Gene-related Peptide ; Rimegepant Sulfate

BACKGROUND

Polypharmacy in patients with chronic disease such as Migraine Headache poses potential harm in patients such that psychological distress may come in. In relation to psychological distress, Migraine Headache patients with multiple drug use are at increased risk of anxiety and depression.

OBJECTIVES

The main objective of the study is to determine the association between anxiety and depression to polypharmacy in migraine headache patients by using the data in the PNA One Headache Database.

METHODOLOGY

We utilized the data obtained from the Philippine Neurological Association One (PNA-1) Headache Database from 2021 to 2024 and determine the association between Anxiety and Depression to Polypharmacy in patients with Migraine.

RESULTS AND DISCUSSION

The number of medications taken by patients does not significantly differ across depression and anxiety levels, indicating that polypharmacy has no impact on patient’s depression and anxiety. However, the study found that patients with anxiety have more tendency to report more severe headache.

CONCLUSION

The study highlights that participants, primarily middle-aged women, experience chronic headaches with high pain severity, often lasting for hours. Educational attainment may influence headache management compliance with a large proportion having only elementary education. Headache onset typically begins in early adulthood, and medication effectiveness often diminishes over time suggesting potential tolerance issues. Anxiety is associated with reporting of increased headache severity while depression does not significantly impact headache characteristics or polypharmacy. The findings emphasize the need for targeted interventions and revised treatment strategies to improve headache management outcomes.

Human ; Anxiety ; Depression ; Headache ; Migraine Disorders ; Polypharmacy

BACKGROUND

There is growing interest in gender differences in acute stroke worldwide. However, no known studies have been published on the differences in prognosis of hyperacute intracerebral hemorrhage between genders among Asians, particularly Filipinos.

OBJECTIVES

Compare gender differences in the prognosis of hyperacute intracerebral hemorrhage in terms of baseline demographic and radiologic profile, as well as, clinical outcomes.

METHODS

This is a retrospective cohort study involving a chart review of all patients diagnosed with hyperacute Intracerebral Hemorrhage admitted at a tertiary hospital from January 2021 to May 2023. Patients were grouped according to their gender and baseline demographic, radiologic and clinical outcomes were assessed and compared between two groups.

RESULTS

No statistical difference was found between stroke risk factors between the two groups. However, males tend to have higher percentages of intraventricular extension (29.2 %. (n=28) vs 30.6% (n=11) and increased hematoma volume compared to their female counterparts (n=39, 83% vs n=11, 68%). In addition, males had a higher number of ICU admissions (42.7% (n= 41) vs. 33.3% (n= 12) and mortality (46.9%( n=45) vs. 30.6% (n=11), though the results were not statistically significant.

CONCLUSION

In patients with hyperacute intracerebral hemorrhage, gender does not influence on its radiologic and clinical outcome.

Human ; Stroke ; Gender Identity ; Gender Differences ; Sex Characteristics

BACKGROUND

Endovascular thrombectomy (EVT) is the gold standard of care for large vessel occlusion strokes, but is underutilized in developing countries.

METHODOLOGY

This single-center retrospective study included patients who underwent EVT during the period of September 2018 to April 2023. Data collected were demographics, underlying co-morbidities, use of anti-thrombotics/coagulants, CT or MR ASPECTS, thrombolysis prior to EVT, technique, timing, TICI score, occlusion site, discharge and 90-day MRS.

RESULTS

Of the 1,595 stroke patients, 57 (3%) cases underwent EVT. The mean age was 65 with a male to female ratio of 6:5. Hypertension, atrial fibrillation, and diabetes were the common comorbidities. Majority of patients (90%, n=54) presented with moderate to severe disability (MRS 3-5). Majority were in the anterior circulation (89%, n=51). Stentriever technique was mostly used (59% n=34) with a 77% (n=44) recanalization rate. Early neurologic improvement (ENI) was seen in 7% (n=4), 2 of which translated to a favorable outcome after 90-days. Mortality occurred in 24% (n=14) of cases, mostly from neurological complications. 24% (n=14) had favorable outcome of MRS 0-2 after 90 days. Among those grouped in the unfavorable outcome, 53% (n=23) were MRS 3, still showing marked improvement of quality of life.

CONCLUSION

EVT outcomes in this study is aligned with the landmark trials which exhibited a number needed to treat of 2.8-7.4. This local data highlights that EVT is a possible and effective treatment for large vessel strokes despite wide gap in accessibility and use in the country.

Human ; Thrombectomy

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.

X

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