BACKGROUND

Patients with severe nontraumatic brain injuries often present with disorders of unconsciousness. Immediate neurologic care, neuroprotection, and early neurorehabilitation are core principles for better outcomes. Neurorehabilitation, through both pharmacological and non-pharmacological strategies, aims to enhance neuroplasticity for faster recovery. Amantadine, primarily known as an antiviral and used in Parkinson’s treatment, has shown a potential role for accelerating neuronal recovery and neurorehabilitation.

OBJECTIVE

Available literature on the use of amantadine for nontraumatic brain injury patients is limited. This scoping review aims to identify the potential benefits and limitations of amantadine in neurorehabilitation.

METHODOLOGY

In the literature review, the keywords "Amantadine" AND "Neurorehabilitation" were used to search PubMed, EBSCO, and the Cochrane Library for articles published between January 1, 2003, and August 2024. Inclusion criteria required that articles have clear research objectives, strict subject eligibility criteria, a detailed methodology, and the administration of amantadine for nontraumatic brain injuries. Out of 57 identified articles, only 7 were included in the study.

RESULTS AND DISCUSSION

Its benefits include improving the level of consciousness, accelerating recovery, decreasing mortality, managing delayed post-hypoxic encephalopathy, and improving verbal fluency in nonfluent speech. Its adverse effects and the paucity of available literature recommending amantadine for neurorehabilitation are the possible limitations.

CONCLUSION

Amantadine accelerates the neurologic recovery of patients with disorders of unconsciousness secondary to nontraumatic brain injuries.

RECOMMENDATION

Future studies may conduct meta-analyses, systematic reviews, and randomized controlled trials of amantadine in patients with nontraumatic brain injury to further strengthen its promising role in neurorehabilitation.

Human ; Amantadine ; Neurological Rehabilitation ; Neurorehabilitation

Cortical blindness, a consequence of bilateral occipital lobe lesions, typically manifests with partial or complete visual loss. It is often associated with the intriguing phenomenon of visual anosognosia, wherein patients paradoxically deny their profound visual loss, which would often lead to confabulation. This constellation of clinical findings points to Anton’s Syndrome. Bilateral occipital infarcts are the most common cause of cortical blindness, and the cooccurrence of visual anosognosia is frequently reported in these cases. We present a unique case of a 65-year-old right- handed Filipino male who experienced sudden, acute cortical blindness resulting from simultaneous bilateral occipital infarcts of likely cardioembolic origin secondary to atrial fibrillation. Despite the cortical blindness, the patient explicitly acknowledged his blindness and was not demonstrating signs of denial or confabulation. The patient’s neurological examination was otherwise notable only for the visual impairment, without other focal deficits. This clinical presentation stands in contrast to the typical features of Anton's syndrome. Cranial magnetic resonance imaging revealed acute infarcts in both occipital lobes and the right pons. This unusual presentation underscores the heterogeneity in the clinical expression of posterior circulation strokes. This case contributes valuable insights into the complex neural pathways involved between visual information processing, its awareness, and speech production following bilateral occipital infarction. This is the Philippines’ unprecedented case of bilateral visual loss after simultaneous acute bilateral occipital infarcts occurring without accompanying visual anosognosia.

Human ; Male ; Aged: 65-79 Yrs Old ; Cardioembolic Stroke ; Embolic Stroke ; Stroke

METHODOLOGY

A descriptive, cross-sectional design was utilized, involving the translation of the SS-QOL from English to Filipino through Collaborative Translation Protocols, which centered on group consensus. Three Filipino language experts rigorously evaluated the initial translation for linguistic and cultural appropriateness. To assess content and face validity, an expert committee of three neurology consultants provided ratings, which were analyzed using the item-level content validity index (i-CVI). Subsequently, a pilot testing phase was conducted with 10 stroke survivors recruited via purposeful sampling in Metro Manila to evaluate the SS-QOL-Filipino’s clarity, layout, understandability and answerability, while also measuring the intraclass correlation coefficient (ICC) to assess consistency and agreement among items

RESULTS

This study successfully developed a stroke-specific HRQOL tool for the Philippines, addressing a critical need for objective measures in patient-centered care. The use of Collaborative Translation Protocols ensured the questionnaire’s conceptual, linguistic and cultural equivalence, incorporating nuances specific to the Filipino context in areas like eating habits, emotional expressions and technological terms. The high face and content validity, coupled with strong consistency and high understandability observed during pilot testing underscore the SS-QOL-Filipino’s suitability for the target population, positioning it as a valuable instrument for both clinical practice and research.

CONCLUSION

The SS-QOL scale was successfully translated into Filipino using Collaborative Translation Protocols and rigorously validated. The SS-QOL-Filipino version demonstrates high content and face validity, strong consistency and excellent understandability and answerability, affirming its status as a reliable and appropriate outcome measure for assessing the QOL among stroke patients in Metro Manila.

Human ; Male ; Female ; Middle Aged: 45-64 Yrs Old ; Aged: 65-79 Yrs Old ; Adult: 25-44 Yrs Old ; Life ; Quality Of Life ; Stroke ; Survivors

BACKGROUND: Critical illness neuropathy (CINP) is defined as an acute and primary axonal motor and sensory neural disease occurring in critically ill patients leading to severe limb weakness as well as difficulty in weaning. It could co-exist with myopathy hence the term critical illness polyneuropathy and myopathy (CIPNM). The clinical presentation of critical illness polyneuropathy includes flaccid quadriplegia without affecting cranial nerves. It usually complicates the clinical course of a patient on mechanical ventilation with severe sepsis and MODS. The cornerstone in the diagnosis of neuromuscular disorders in the critically ill is the electrophysiological evaluation. Until recently the only possible way to affect the incidence was to reduce the risk factors. Hyperglycemia is associated with adverse outcomes, including increased mortality and CIPNM, in acutely ill patients.

OBJECTIVES: To evaluate the relevant literature and determine the effect of intensive insulin therapy (ITT) versus conventional insulin therapy (ITT) in preventing the occurrence of critical illness polyneuropathy and myopathy among critically ill patients.

SEARCH STRATEGY: The search was performed by means of MEDLINE, PUBMED, Ovid SP, Science Direct, and Cochrane library database limited to studies written in English using the words "randomized clinical trial", "intensive insulin therapy", "intensive insulin therapy in critical illness", "critical illness", "critical illness polyneuropathy", "critical illness myopathy", and "critical illness polyneuropathy and myopathy". The title and abstract of the studies were evaluated. The references of each study selected were screened to identify studies that were not included on electronic search. Key journals and textbooks were also searched. References mentioned in the textbooks were likewise reviewed.

SELECTION CRITERIA: Studies were chosen if they met the following inclusion criteria: the study was a randomized controlled trial; the study participants were adults; a critical care setting used; the intensive insulin therapy was defined by a target blood glucose concentration of 80-110mg/dl; the conventional insulin therapy was defined by a target blood glucose concentration 210mg/dl; studies that documented critical illness polyneuropathy and myopathy (CIPNM).

DATA COLLECTION & ANALYSIS: Two reviewers independently did validity assessment. Analysis of data was done by statistical packs Revman 5.0 from the Cochrane Collaboration.

MAIN RESULTS: The search resulted in recovery of 3 trials met the inclusion criteria. A total of 1,188 patients from the 3 randomized trials were evaluated. Five hundred forty six (546) to received intensive insulin therapy (ITT) in contrast the six hundred forty two (642) who received conventional insulin therapy (CIT). The analysis using the presence of electrophysiological evidence of CIP/CIM showed that the IIT group had a lower event rate (151/546 or 28%) as compared to the CIT group (263/642 or 41%). This resulted to a total odds ratio (OR) of 0.51 with the confidence interval fixed at 95%. The relative risk (RR) was computed at 0.68 with a number needed to treat (NNT) of 7.8

REVIEWERS' CONCLUSIONS: IIT is an effective therapy that could actually decrease the incidence of critical illness polyneuropathy and myopathy among critically ill patients.

Human ; Humans ; Adult ; Critical Illness ; Odds Ratio ; Risk Factors ; Incidence ; Medline ; Insulin ; Blood Glucose ; Respiration, Artificial ; Confidence Intervals ; Quadriplegia ; Patient Selection ; Multiple Organ Failure ; Polyneuropathies ; Neuromuscular Diseases ; Muscular Diseases ; Critical Care ; Hyperglycemia ; Sepsis ; Cranial Nerves

Background and Objective: The prevalence of aspirin resistance amongst patients with cardiovascular disease and in the healthy population has been reported to range from 5% to 45%. Lately, rapid platelet function analyzer (RPFA) a point-of-care determination of platelet aggregability has been introduced for rapid determination of aspirin resistant patients. The purpose of this paper is to report the prevalence of aspirin resistance among patients with recurrent non cardioembolic ischemic stroke as detected by RPFA (Ultegra®). Methods: Seventy-seven patients with mean age of 61.2 + 10.4 (range 33-87 years) who developed recurrent non-cardioembolic ischemic stroke were consecutively included in the study. Fifty-seven (74%) were males. Aspirin resistance was determined using the RPFA (Ultegra®) machine. Patients with an aspirin reaction unit (ARU) value above 550 were identified as aspirin resistant. Results: Following this method, the prevalence of aspirin resistance was determined to be 10.4% (95% CI: 1% to17%). Comparison of baseline characteristics between aspirin resistant and aspirin responsive patients did not show any significant difference. Conclusion: The prevalence of aspirin resistance in this study was 10.4% amongst patients with recurrent non-cardioembolic ischemic stroke. The study has shown the feasibility of utilizing RPFA (Ultegra®) machine in detecting aspirin resistance.