BACKGROUND AND OBJECTIVES

Epilepsy is a very common pediatric neurologic disorder, and the mainstay of treatment is the use of anti-seizure medication. Several factors may cause inadequate adherence leading to uncontrolled seizures, lower quality of life, and neurodevelopmental consequences. This study aimed to determine medication adherence of adolescents with epilepsy and identify factors that may be associated in medication adherence.

This is a prospective cross-sectional study involving adolescents with epilepsy. A self-reported survey was used to measure adherence. Data on demographics and epilepsy were then assessed for presence of association with adherence.

Fifty-one participants were included. Of these, 19.6% were non-adherent, 35.3% had medium adherence, and 45.1% had high adherence. Simple logistic regression analysis showed that unemployed primary caregiver is associated with 7.0 times higher odds of having moderate-high adherence and consuming at least three drugs is associated with 0.3 lower odds of having moderate-high adherence.

As high as 80.4% of adolescents were adherent to their medications. The presence of a caregiver who can closely monitor the patient is associated with adherence while intake of several drugs is associated with nonadherence. Future studies may need larger sample size and explore knowledge, attitude, and other social factors that may influence medication adherence.

Objective: This study aimed to determine the incidence of encephalopathy among hospitalized patients with COVID-19. Methods: This was a retrospective observational study conducted in a tertiary hospital in Cebu City, Philippines. This study is a complete enumeration of all records of adult patients admitted for COVID-19 detected through polymerase chain reaction from March 1, 2020 to September 30, 2021. The cases were then classified as to the presence or absence of encephalopathy. Results: The study determined that 6 in every 1000 admitted COVID-19 patients developed encephalopathy. The clinico-demographic profile of patients with encephalopathy were mostly elderly with a mean age of 67, males (55.7%), and obese stage I (61.1%). Encephalopathy was more likely to develop in patients with type 2 diabetes mellitus (80.1%) and coronary artery disease (40.0%). Most patients who did not have encephalopathy however had a history of CVD. Most patients (66.7%) who developed encephalopathy were dyspneic on presentation. Laboratory examination results showed an increase in fasting blood sugar and elevated levels of LDH, CRP, serum ferritin, procalcitonin, and D-dimer. Majority of patients (66.7%) with encephalopathy were intubated. Taking into consideration the stage of infection and the incidence of encephalopathy, most patients (66.6%) were in the hyperinflammatory stage. The number of hospitalization days and severity of illness did not have any association with developing encephalopathy. Dichotomous categorization of outcomes into deceased and discharged showed that clinical outcomes and the development of encephalopathy were significantly associated, with 66.7% of patients with encephalopathy expiring during their course of hospitalization. Conclusion The incidence of encephalopathy among admitted COVID-19 patients was 6 in every 1000 patients. Encephalopathy was more common in elderly males who were obese with type 2 diabetes mellitus and coronary artery disease. The most common presentation of patients who developed encephalopathy was dyspnea. Collated laboratory results showed an increase in fasting blood sugar and elevated levels of LDH, CRP, serum ferritin, procalcitonin, and D-dimer. Majority of patients with encephalopathy were intubated and were in the hyperinflammatory stage of COVID-19 infection. Dichotomous categorization of outcomes into deceased and discharged showed that clinical outcomes and the development of encephalopathy were significantly associated, with most patients with encephalopathy expiring during their course of hospitalization.
COVID-19 ; BRAIN DISEASES ; BRAIN ; SARS-COV-2

Background and Objectives: Epilepsy is a very common pediatric neurologic disorder, and the mainstay of treatment is the use of anti-seizure medication. Several factors may cause inadequate adherence leading to uncontrolled seizures, lower quality of life, and neurodevelopmental consequences. This study aimed to determine medication adherence of adolescents with epilepsy and identify factors that may be associated in medication adherence. Methods: This is a prospective cross-sectional study involving adolescents with epilepsy. A self-reported survey was used to measure adherence. Data on demographics and epilepsy were then assessed for presence of association with adherence. Results: Fifty-one participants were included. Of these, 19.6% were non-adherent, 35.3% had medium adherence, and 45.1% had high adherence. Simple logistic regression analysis showed that unemployed primary caregiver is associated with 7.0 times higher odds of having moderate-high adherence and consuming at least three drugs is associated with 0.3 lower odds of having moderate-high adherence. Conclusion As high as 80.4% of adolescents were adherent to their medications. The presence of a caregiver who can closely monitor the patient is associated with adherence while intake of several drugs is associated with nonadherence. Future studies may need larger sample size and explore knowledge, attitude, and other social factors that may influence medication adherence.
adolescents ; epilepsy

The prefrontal cortex and hippocampus may support sequential working memory beyond episodic memory and spatial navigation. This stereoelectroencephalography (SEEG) study investigated how the dorsolateral prefrontal cortex (DLPFC) interacts with the hippocampus in the online processing of sequential information. Twenty patients with epilepsy (eight women, age 27.6 ± 8.2 years) completed a line ordering task with SEEG recordings over the DLPFC and the hippocampus. Participants showed longer thinking times and more recall errors when asked to arrange random lines clockwise (random trials) than to maintain ordered lines (ordered trials) before recalling the orientation of a particular line. First, the ordering-related increase in thinking time and recall error was associated with a transient theta power increase in the hippocampus and a sustained theta power increase in the DLPFC (3-10 Hz). In particular, the hippocampal theta power increase correlated with the memory precision of line orientation. Second, theta phase coherences between the DLPFC and hippocampus were enhanced for ordering, especially for more precisely memorized lines. Third, the theta band DLPFC → hippocampus influence was selectively enhanced for ordering, especially for more precisely memorized lines. This study suggests that theta oscillations may support DLPFC-hippocampal interactions in the online processing of sequential information.
Adult ; Female ; Humans ; Young Adult ; Epilepsy ; Hippocampus ; Memory, Short-Term ; Mental Recall ; Prefrontal Cortex ; Theta Rhythm ; Male

BACKGROUND

Newborns screened positive for Galactosemia through Expanded Newborn Screening (ENBS) with borderline levels undergo lactose challenge that requires interruption of breastfeeding temporarily then shifting to soy-based formula.

To determine the percentage of Classical Galactosemia (CGal), Non-classical Galactosemia (NCGal), probable mild variant form, and negative Galactosemia among newborns screened positive for Galactosemia who underwent lactose challenge.

This is a retrospective study. NBS records were reviewed and data were collected from January 2015 to December 2020.

Out of the 117 newborns screened positive for Galactosemia, 58 underwent lactose challenge. Majority were male, term with a birth weight of 2500-4000g and received a final disposition in 4-6 months. Fifteen patients underwent 1-week lactose challenge wherein six reached a resolution on first challenge. Majority, 35 (60.3%) were negative for Galactosemia, six (10.3%) probable mild variant Galactosemia, three (5.2%) NCGal, and no CGal were observed. Fourteen suspected cases (24.1%) are pending final disposition.

This study describes the demographics of newborns flagged for Galactosemia who underwent lactose challenge. A 1-week lactose challenge may be recommended to further detect patients who are negative for Galactosemia.

OBJECTIVE

This study aimed to determine the incidence of encephalopathy among hospitalized patients with COVID-19.

This was a retrospective observational study conducted in a tertiary hospital in Cebu City, Philippines. This study is a complete enumeration of all records of adult patients admitted for COVID-19 detected through polymerase chain reaction from March 1, 2020 to September 30, 2021. The cases were then classified as to the presence or absence of encephalopathy.

The study determined that 6 in every 1000 admitted COVID-19 patients developed encephalopathy. The clinico-demographic profile of patients with encephalopathy were mostly elderly with a mean age of 67, males (55.7%), and obese stage I (61.1%). Encephalopathy was more likely to develop in patients with type 2 diabetes mellitus (80.1%) and coronary artery disease (40.0%). Most patients who did not have encephalopathy however had a history of CVD. Most patients (66.7%) who developed encephalopathy were dyspneic on presentation. Laboratory examination results showed an increase in fasting blood sugar and elevated levels of LDH, CRP, serum ferritin, procalcitonin, and D-dimer. Majority of patients (66.7%) with encephalopathy were intubated. Taking into consideration the stage of infection and the incidence of encephalopathy, most patients (66.6%) were in the hyperinflammatory stage. The number of hospitalization days and severity of illness did not have any association with developing encephalopathy. Dichotomous categorization of outcomes into deceased and discharged showed that clinical outcomes and the development of encephalopathy were significantly associated, with 66.7% of patients with encephalopathy expiring during their course of hospitalization.

The incidence of encephalopathy among admitted COVID-19 patients was 6 in every 1000 patients. Encephalopathy was more common in elderly males who were obese with type 2 diabetes mellitus and coronary artery disease. The most common presentation of patients who developed encephalopathy was dyspnea. Collated laboratory results showed an increase in fasting blood sugar and elevated levels of LDH, CRP, serum ferritin, procalcitonin, and D-dimer. Majority of patients with encephalopathy were intubated and were in the hyperinflammatory stage of COVID-19 infection. Dichotomous categorization of outcomes into deceased and discharged showed that clinical outcomes and the development of encephalopathy were significantly associated, with most patients with encephalopathy expiring during their course of hospitalization.

Objectives: To perform a pilot study on the frequency of sleep-disturbance (Total sleep Disturbance Score (TSD) of > 41) in children diagnosed with Drug Resistant Epilepsy aged 4 to 12 years, using the Children’s Sleep Habits Questionnaire (CSHQ). Methodology: The Children’s Sleep Habits Questionnaire (CSHQ) was used to screen for sleep disturbances among 73 patients aged 4 to 12 years old with drug-resistant epilepsy seen at the Seizure Clinic of Philippine Children’s Medical Center. Descriptive statistics were used to characterize sociodemographic variables, and sleep and epilepsy-related variables. Continuous data were presented as mean ± standard deviation (SD), and categorical data as frequencies (percentages). Results: Sleep disturbances were common and severe in children with drug-resistant epilepsy. Out of the seventy-three participants, 61 patients had a TSD score of greater than 41 (84%) and 12 (16%) had TSD scores below 41 with a mean CSHQ score of 58. The most frequently occurring sleep disturbances involve the domains of bedtime resistance (29%), night wakings (28%), and daytime sleepiness (23%). Meanwhile, the least frequently occurring sleep disturbances involve the domains of sleep disordered breathing (76%), parasomnias (65%), and sleep anxiety (56%). Conclusion Majority of the children with drug-resistant epilepsy are sleep disturbed exhibiting high TSD scores (>41) using the Children’s Sleep Habits Questionnaire. We recommend to actively evaluate and screen for sleep and behavioral problems concurrently in children with epilepsy.
Epilepsy ; Pediatrics

Background: Creutzfeldt-Jakob disease is a rapidly progressive, fatal, transmissible neurodegenerative disorder caused by a prion protein. It is characterized by cognitive decline, motor dysfunction, and eventually, death. It occurs globally with 1 case per one million population/year. And It is still considered rare in countries like the Philippines due to challenges in its diagnosis and the under recognition of its clinical features. As of now, the local prevalence or incidence of this disease in our country remains unknown, as only a single case report has been documented. As of now, the local prevalence or incidence of this disease in our country remains unknown, as only a single case report has been documented. Objective: To report a series of patients with probable sporadic CJD from a tertiary hospital in the Philippines. Materials and Methods: Patients with rapidly developing dementia fulfilling the diagnostic criteria for sCJD were included. All were investigated in detail to find out any possible treatable cause, including electroencephalography (EEG), magnetic resonance imaging (MRI) of the brain, and cerebrospinal fluid analysis. Results: A total of 3 patients with probable sCJD were diagnosed using the European diagnostic criterion from January 2022 to April 2023. The clinical features are consistent with other reported series. All 3 patients had the classical EEG findings, typical MRI features, and positive for 14-3-3 assay, and one was positive for RT-QuIC. Two patients died within 13 months from the disease onset. Conclusion This is the first reported case series of probable sCJD in the Philippines from a tertiary hospital in Metro Manila. Like in our patients, this disease should be considered in individuals with rapidly progressive dementia associated with myoclonus, neuropsychiatric symptoms, akinetic mutism, visual abnormality, and ataxia with signs of pyramidal and extra-pyramidal dysfunction. Although a definitive diagnosis must be histopathological, there are ancillary tests that are currently available that allow us to make a probable diagnosis of sCJD possible. Our study raises question about the prevalence of this disease in the Philippines which needs more validated studies from other parts of the country.
Creutzfeldt-Jakob Syndrome ; Neurodegenerative Diseases

Background: Status epilepticus (SE) is a neurological emergency requiring prompt evaluation and management to prevent disease refractoriness associated with significant mortality and morbidity. Thus, estimating costs attributable to the treatment of SE is important because of the severity of this disease. In the Philippines, healthcare provisions are mostly out-of-pocket expenses; hence the cost of treatment is a critical determinant for disease management. Unfortunately, the availability of data regarding the cost of illness of SE in developing countries is limited. Objectives: To determine the frequently used anticonvulsant drug regimen and direct inpatient costs of acute treatment for status epilepticus within five years in a private tertiary hospital in the Philippines. Methods: Records from patients diagnosed with SE who were admitted under or referred to the Adult Neurology Service in a private tertiary hospital from January 2015 to December 2019 were retrospectively evaluated. The SE type was classified as non-refractory (NRSE), refractory (RSE), and super refractory (SRSE). Demographic data, clinical features, SE type, etiology, antiepileptic drugs (AEDs) and anesthetic drugs used, total cost of AEDs and anesthetic drugs, total cost of 5-day hospitalization, and total cost of entire length of stay were recorded. Results: We retrieved the records of 61 patients admitted for SE. Of these patients, 23 were classified as nonrefractory, 20 as refractory, and 18 as super refractory. Diazepam was given to all SE patients as first-line treatment. Valproic acid and levetiracetam were used as second-line treatments. The most frequently given anesthetic drug was midazolam. The mean hospitalization cost per patient was ₱52,0982.3 for SE, ₱659,638.7 for RSE, and ₱134,1451 for SRSE. The mean cost of 5-day hospitalization was ₱193,572.3 for NRSE, ₱358,808.5 for RSE, and ₱652,781 for SRSE. The mean cost of medications was ₱18,546 for NRSE, ₱30,780 for RSE, and ₱128,263 for SRSE. Conclusion The direct cost of SE varied depending on subtype and response to treatment. Costs increased with disease refractoriness. Direct inpatient treatment costs for SRSE were twice as high as that of NRSE and RSE.
epilepsy ; status epilepticus ; hospitalization

OBJECTIVE: To analyze the acupoint selection rules of acupuncture and moxibustion for post-stroke epilepsy by data mining technology. METHODS: The literature regarding acupuncture and moxibustion for post-stroke epilepsy included in CNKI, VIP, Wanfang, SinoMed and PubMed databases from the establishment of the database to August 1st 2022 was retrieved. Microsoft Excel 2019 software was used to establish a database to conduct the descriptive analysis of acupoints; SPSS Modeler 18.0 Apriori algorithm was used to conduct association rule analysis; high-frequency acupoint co-occurrence network diagrams were drawn by Cytoscape3.9.0 software; SPSS Statistics 25.0 software was used to perform hierarchical cluster analysis on high-frequency acupoints and a tree diagram was drawn. RESULTS: Totally 39 articles were included, and 63 prescriptions of acupuncture and moxibustion were extracted, involving 56 acupoints, with a total frequency of 516 times; the top three acupoints with the highest frequency of use were Baihui (GV 20), Fenglong (ST 40) and Neiguan (PC 6); the selected meridians were mainly the governor vessel, the hand and foot <i>yangmingi> meridians; the selection of acupoints were mostly in the head, neck and lower limbs; in terms of acupoint compatibility, Hegu (LI 4)-Shuigou (GV 26) and Neiguan (PC 6) had the highest confidence degree; The top 20 high-frequency acupoints could be divided into 4 effective clusters. CONCLUSION Modern acupuncture and moxibustion treatment for post-stroke epilepsy attaches great importance to the use of <i>yangi> meridians and meridians with enrich <i>qii> and blood; the core prescription is Shuigou (GV 26)-Neiguan (PC 6)-Hegu (LI 4)-Baihui (GV 20). In addition, the combination of distant and near acupoints is highly valued to improve clinical efficacy.
Humans ; Moxibustion ; Acupuncture Points ; Acupuncture Therapy ; Stroke/therapy* ; Data Mining ; Epilepsy