Abstract: Repetitive Transcranial Magnetic Stimulation is a non-invasive brain stimulation process popularly used to treat psychiatric disorders. Multiple evidence shows effectiveness of rTMS in treating addiction, particularly in tobacco or cigarette users. This study consisted of review of current published literatures on repetitive transcranial magnetic stimulation following predefined eligibility criteria. The studies included evaluated at least one of the epidemiological parameters: (i) the meaning of repetitive transcranial magnetic stimulation (ii) Effectiveness of the Repetitive Transcranial Magnetic Simulation Over Behavioral therapy (iii) rTMS-associated adverse events among tobacco users Methodology: We included published studies discussing rTMS in smoking cessation which examined if these interventions were effective and identified whether it has a severe negative effect on the patients. A total of 104 related studies were identified through database searches (Pubmed, Elsevier, Cochrane). Of which, 53 duplicate studies were removed. Five studies were then excluded with more than 10 years in publication. A total of 28 papers were then included in the study. Conclusion We conclude that rTMS is more effective in treating addiction in terms of smoking compared to behavioral therapy and rTMS affects triggered desired circuit which may be crucial among tobacco users. Individual neuronal excitability in the specific region’s subsequent induction may impact the therapeutic outcomes. With this, the high-frequency rTMS sequentially applied to the left superior medial frontal cortex and dorsolateral prefrontal cortex may be an effective tool for improving the cessation rate.
Transcranial Magnetic Stimulation ; Smoking Cessation

Subependymal giant cell astrocytoma is a rare tumor that occurs in the walls of the lateral ventricles, foramen of Monro, and less frequently, in the third ventricle. It is one of the intracranial lesions found in tuberous sclerosis complex (TSC) ─ a rare multisystem genetic disease. We present a rare case of an adult Filipino with cutaneous signs of TSC, who initially presented with signs of increased intracranial pressure. The patient underwent right frontal craniotomy, endoport-assisted excision of the tumor with insertion of a ventriculoperitoneal (VP) shunt. Histopathology was consistent with a subependymal giant-cell astrocytoma WHO grade 1. The general status of the patient improved thereafter – there was the relief of headache and improvement in vision and gross hearing. Subependymal giant cell astrocytoma is a rare tumor of the central nervous system especially in adults, whose diagnosis is based on clinical, radiological, and histological, and immunohistochemical stains. It should be included in the differential diagnosis of a mass near the foramen of Monro. Given the hereditary nature of the disease, genetic counseling is essential when encountering patients with this condition.
Astrocytoma ; Tuberous Sclerosis ; Adult ; Case report

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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Targeted for relief of spasms, posturing, pain, impaired function and disfigurement, botulinum toxin type-A (BoNT-A) was injected in dystonias of X-linked dystonia-parkinsonism (XDP). From 1992-2012, focal/ multifocal dystonia combinations were injected in XDP at the following regions: Peri-ocular (21 cases), oromandibular (50 cases), ligual (35 cases), laryngeal (5 cases), cervical (56 cases), truncalaxil (24 cases) upper limbs (13 cases) and lower limbs (18 cases). Pain was frequently reported in 40/50 cases with oromandibular dystonia, 28/56 cases with cervical dystonia, 18/24 cases with truncal-axil dystonia and 16/31 cases with limb dystonia. Outcomes were assessment through the global dystonia rating scale (DRS) at week 4, VAS pain reduction at week 4, duration of BoNT-A effects and safety. Cranial, laryngeal and cervical dystonia showed substantial improvement (DRS median score of 3-4), whereas truncal-axil and limb dystonias showed moderate improvement (DRS median score of 2), following BoNT-A. Pain reduction ranged from 30-100% (VAS), for those dystonias that reported co-morbid pain. BoNT-A effects had a duration ranging from 8-20 weeks. Procedures were generally well tolerated, and the adverse events were most significant in laryngeal injections (voice breathiness, but was eventually followed by a strong voice). The other events were mouth dryness, dysphagia and weekness in oromandibular, cervical and limb dystonias, respectively. Therefore, BoNT-A is a safe and valuable therapeutic option for the dystonias of XDP, especially the disabling and painful dystonias. BoNT-A injection working protocols could be adopted in dystonia that adheres to cost minimization (e.g. lower dose end per selected muscles), yet achieving a substantial benefit, and a reduced adverse event profile. Futhermore, this present study allowed us to recommend a "high potency, low dillution" of BoNT-A in oromandibular, linual, laryngeal, cervical and distal limb dystonias. In dystonias of the abdominal, paraspinal and proximal limb muscles, the "low potency, high dilution" BoNT-A injection protocol could be adopted.

Human ; Botulinum Toxins, Type A ; Deglutition Disorders ; Dystonic Disorders ; Genetic Diseases, X-linked ; Lower Extremity ; Pain ; Spasm ; Torticollis ; Xerostomia

OBJECTIVE: To determine the prevalence of anxiety and its correlation with the quality of life among cognitively-intact, community dwelling Filipino patients with idiopathic Parkinson disease (PD) seen at the Movement Disorders Clinic of a tertiary hospital.
STUDY DESIGN: Prospective, cross-sectional study.
METHODS: Seventy six (76) Filipino outpatients fulfilling the United Kingdom Parkinson Disease Society Brain Bank Clinical Diagnostic Criteria for PD were included in the study. Demographic data were obtained including: age, sex, onset of disease, disease duration and medication intake. The Mini Mental State Examination (MMSE) was done to exclude significant cognitive impairment. The Hamilton Anxiety scale (HAM-A) was administered to quantify anxiety. The degree of anxiety was correlated with the quality of life instrument, Short form health survey (SF 36); and the functional and motor severity using the Unified Parkinson Disease Rating Scales (UPDRS).
FINDINGS: Our cohort of patients had a mean: age of 61 years (range: 42 - 81 years), and disease duration of 1.3 years (33 months). Out of the 76 patients, 37( 48.6%) probably had significant anxiety symptoms based on the the HAM A. Anxiety greatly impacts scores on SF 36.
CONCLUSION: The prevalence of anxiety among this Filipino cohort of patients is 48.6% which is higher than commonly reported worldwide. The presence of anxiety significantly correlated with poorer quality of life.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Anxiety ; Anxiety Disorders ; Brain ; Cognition Disorders ; Cognitive Dysfunction ; Parkinson Disease ; Quality Of Life

Amongst stroke patients, more than a third will develop spasticity, especially those that involve the paretic upper limbs. Despite establish intensive rehabilitaion programs in place, spasticity still affect a post-stroke patient's quality of life and create significant economic and caregiver burdens. The rationale for botulinum toxin type A (BoNT-A) use in spasticity is hinged on the toxin's ability to reduce muscle overactivity via a dual cholinergic blockede of extrafusal and intrafusal muscle. Efficacy and safety of BoNT-A in established post-stroke spasticity have been widely published, effectively establishing robustness of data and first line recommendation. Consensus guidelines and algorithms on the clinical use of BoNT-A for symptomatic upper limb spasticity are now also available. While BoNT-A has been universally shown to reduce muscle tone in spasticity, optimizing therapy requires judicious use of the toxin, while raising one's consciousness of adverse event, including muscle weakness, unwanted or desired in therapy. BoNT-A should not be administered alone in post-stroke spasticity, and its effects are best optimized in concert with a comprehensive neurorehabilitation program.

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OBJECTIVES: Transcranial sonography of the substantia nigra for diagnosing premotor stages of Parkinson disease has been attracting increasing interest. Standard reference values defining an abnormal increased echogenic size (hyperechogenicity) of the substantia nigra have been established in several populations using high-end stationary ultrasound systems. It is unknown whether a portable ultrasound system can be appropriately used and how the Filipino population would compare with the well-studied white population.
METHODS: We prospectively studied substantia nigra echogenic sizes and third ventricle widths in 71 healthy adult German participants and 30 age- and sex-matched Filipino participants using both a well-established stationary ultrasound system (in the German cohort) and a recently distributed portable ultrasound system (in both ethnic cohorts).
RESULTS: Mean substantia nigra echogenic sizes, cutoff values defining abnormal hyperechogenicity, and intra-rater reliability were similar with both systems and in both ethnic cohorts studied. The Filipino and German participants did not differ with respect to the frequency of insufficient insonation conditions (each 3%) and substantia nigra hyperechogenicity (10% versus 9%; P = .80). However, third ventricle widths were smaller in the Filipino than the German participants (mean ± SD, 1.6 ± 1.1 versus 2.4 ± 1.0 mm; P = .004).
CONCLUSIONS: The frequency of substantia nigra hyperechogenicity appears to be homogeneous in white and Asian populations. Screening for this feature may well be performed with a present-day portable ultrasound system.

Human ; Male ; Female ; Adult ; Asian Continental Ancestry Group ; High-energy Shock Waves ; Parkinson Disease ; Substantia Nigra ; Third Ventricle ; Ultrasonography

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

OBJECTIVE

To determine the prevalence and correlates of tardive dyskinesia among Filipino patients with Schizophrenia admitted at the National Center for Mental Health.

STUDY DESIGN

Case-control observational study

METHODS

Total study sample size was determined using the value of p (proportion of interest) equal to worldwide incidence of tardive dyskinesia that is 20%. A total of 227 (110 males and 117 females) our of the 917 Filipino patients fulfilling the DSM IV criteria for schizophrenia were randomly recruited in the study. Schooler and Kane's diagnosis of tardive dyskinesia using the Abnormal Involuntary Movement Scale was employed. Odds ratio was computed to show the odds of developing tardive dyskinesia in relation to the variables included. Correlation between variables and development of tardive dyskinesia was also evaluated using Pearson's coefficient.

FINDINGS

Among the 227 patients sampled, the prevalence rate was 20.26% (46 patients). Tardive dyskinesia was noted more in females and older age groups. Other risks factors significantly correlated with tardive dyskinesia include patients with a negative smoking history, those who underwent electroconvulsive therapy, with longer duration of illness and longer cumulative exposure to neuroleptic drugs. There was no association established with regard to the presence of diabetes mellitus and use of anticholinergic use due paucity of sample who had diabetes and due to irregular intake of the anticholinergics.

Human ; Schizophrenia ; Tardive Dyskinesia ; Dyskinesias ; Mental Health