We describe an unusual case of hypoxic ischemic encephalopathy in a preterm female of 36 weeks who presented with status epilepticus and atypical abdominal myoclonus. The seizures were confirmed electrographically using video electroencephalography (EEG), while the abdominal myoclonus was demonstrated to be nonepileptic, as it had no EEG correlate. Other possible causes of neonatal seizures were excluded. The infant then responded to a gamut of antiseizure medications but the myoclonus persisted. To the best of our knowledge, this is the first report of atypical myoclonus in a preterm baby caused by hypoxic ischemic encephalopathy.

Pediatric intracerebral hemorrhage is a rare condition among children. We discuss the case of a 7-year-old Filipino male with generalized tonic seizures and diagnosed to have both SARS-CoV-2 infection and hypertension secondary to renal arterial stenosis. The occurrence of intracerebral hemorrhage in children, though commonly caused by arteriovenous malformations, may be secondary to an acute hypertensive episode. In this case, the presence of COVID-19 in the patient may have been contributory to the development of spontaneous intracerebral hemorrhage due to its direct endothelial effects, as well as its dysregulatory action on the renin-angiotensin-aldosterone system.
COVID-19 ; Hypertensive Crisis ; Renal Artery Obstruction

Background. Subacute sclerosing panencephalitis (SSPE) is a fatal neurodegenerative disease caused by prolonged persistent infection of the central nervous system with a measles virus mutant. Though various treatment modalities have been tried, there is no effective treatment to completely cure SSPE and new therapeutic strategies are needed.

Objective. This is a prospective uncontrolled observational open label trial to describe the short-term outcomes and safety of intraventricular ribavirin in combination with oral isoprinosine in Filipino SSPE patients.

Methods. Sixteen (16) unrelated SSPE patients between ages 3-26 years and in various clinical stages were included in this study. Demographic data were described. Intraventricular instillation of ribavirin (1-3 mg/kg/dose) through an Ommaya reservoir was given for a duration of 3-6 months in 13 patients. The duration of follow-up was 48 weeks. The clinical outcome was assessed before, during, and after treatment using the Neurological Disability Index (NDI), Brief Assessment Examination (BAE), and clinical staging using the Jabbour Classification. Adverse side effects from intraventricular ribavirin were enumerated.

Results. Six of 13 (46.15%) patients mostly in Stage III illness had clinical improvement showing decreasing NDI and BAE scores during treatment and the clinical improvement was maintained or improved further during the 48-week follow-up period. Clinical improvement manifested as improved mental alertness, decrease in spasticity and reduction of seizures. The clinical staging of those who improved remained stable during and after treatment was discontinued. Five (38.46%) patients in Stage II disease worsened and progressed to Stage III despite ribavirin therapy including 1 (7.6%) patient who died after the treatment phase due to pneumonia and brainstem failure. The clinical course of two (15.38%) patients remained unchanged. Minor adverse side effects of ribavirin included transient fever, rash, oral sores, seizure episodes, drowsiness, bladder retention and mild increase in transaminases. Ommaya reservoir infection was a serious adverse event in 5 (31.25%) patients.

Conclusion. There is still no definitive cure for SSPE. Although ribavirin may help alleviate some of the symptoms of SSPE and prolong life, it may not reverse or halt the progression of the disease. Long term follow-up of these patients and continuous use of intraventricular ribavirin will better clarify its role in modifying the fatal course of SSPE. The role of ribavirin in Stage I patients and a controlled clinical trial in Stage II SSPE needs further studies.

OBJECTIVE

The aim of this study was to compare the outcomes of the shunted and non shunted group of children with tuberculous meningitis hydrocephalus. Another objective is to determine the applicability of the Palur classification and treatment algorithm in managing Filipino children with TBM hydrocephalus.

Forty nine children that satisfied the criteria for a probable TB meningitis with hydrocephalus in a tertiary hospital were reviewed. Frequency statistics, Chi square and Fischer Exact Test were used
to describe the data collected.

There were 24 males and 25 were female chi ldren. The average age on admission was 9 months. Thirty-one patients were managed medically and eighteen underwent neurosurgical intervention. Of the 31 medically managed, 26 were on stage II and 5 were on stage Ill. Eighty percent of these
medically managed patients survived and six children died. There were 8 children who underwent serial lumbar tap in combination with acetazolamide. Eighty seven per cent of these patients improved as compared to 78% among those on oral acetazolamide alone. Of the 18 children managed surgically, 7 were on stage II and 11 were in stage Ill. Eighty eight percent of these shunted patients survived and 2 children did not improve. Outright VP shunting showed more improvement compared to TV prior to VPS. Early or delayed timing in shunting did not affect outcome on discharge.

Medical management still plays a role in treating stage II patients using the BMRC classification and a much higher percentage of survival was noted among patients falling under grade II TBM according to Palur grading. Despite the clarity of the protocol recommended by Palur, treatment and classification should be individualized and based on the local experience of each setting.

INTRODUCTION AND PURPOSE

Gangliogliomas are rare benign tumors, with only one percent (1 %) occurring in the central nervous system. Intracranially it occurs most commonly in the temporal area with seizures as its primary symptom. Neuroimaging has nonspecific findings. On MRI, it has low intensity on T1 and high intensity on T2-weighted images6. It may show a well-defined cystic mass with a solid mural nodule and may have calcifications in 30%. Management would include total resection of the tumor but prognosis would be greatly influenced by the tumor grade, location and margination. It is generally indolent and associated with a favorable prognosis. The purpose of this case report is to document this rare brain tumor with an atypical presentation.

We report the case of a 3 Y2 year old boy who manifests with intermittent upward ocular bobbing since 2 years of age, associated with intention tremor and frequent falls to the left. Neuroimaging revealed a solid mass involving the left cerebellar hemisphere, vermis, superior and middle cerebellar peduncles, partially extending to the left dorsal pons and midbrain with mild obstructive hydrocephalus. He then underwent ventriculoperitoneal shunting and biopsy revealed ganglioglioma,
WHO grade I.

BACKGROUND AND OBJECTIVE: Japanese Encephalitis (JE) is an acute encephalomyelitis characterized by abrupt fulminant illness with fever, convulsions, signs of increased intracranial pressure and focal neurologic sings. It is major cause of viral encephalitis in Asia. The exact prevalence is difficult to determine especially in a developing country like the Philippines where specific tests like the Japanese Encephalitis Virus IgM, is costly and not readily available in all medical center laboratories.

CASE SERIES: The 4 pediatric confirmed cases of Japanese Encephalitis who all initially presented with fever, seizures and behavioral changes. All of them had a history of travel to endemic areas of JE in the Philippines. Japanese virus ELISA test IgM showed positive results in all patients. Cranial CT scans showed predilection of involvement in the areas of the thalamus, basal ganglia and the brainstem. All of the patients survived but had significant neurologic deficits on discharge.

OBJECTIVE

The aim of this study was to compare the outcomes of the shunted and non shunted group of children with tuberculous meningitis hydrocephalus. Another objective is to determine the applicability of the Palur classification and treatment algorithm in managing Filipino children with TBM hydrocephalus.

Forty nine children that satisfied the criteria for a probable TB meningitis with hydrocephalus in a tertiary hospital were reviewed. Frequency statistics, Chi square and Fischer Exact Test were used
to describe the data collected.

There were 24 males and 25 were female chi ldren. The average age on admission was 9 months. Thirty-one patients were managed medically and eighteen underwent neurosurgical intervention. Of the 31 medically managed, 26 were on stage II and 5 were on stage Ill. Eighty percent of these
medically managed patients survived and six children died. There were 8 children who underwent serial lumbar tap in combination with acetazolamide. Eighty seven per cent of these patients improved as compared to 78% among those on oral acetazolamide alone. Of the 18 children managed surgically, 7 were on stage II and 11 were in stage Ill. Eighty eight percent of these shunted patients survived and 2 children did not improve. Outright VP shunting showed more improvement compared to TV prior to VPS. Early or delayed timing in shunting did not affect outcome on discharge.

Medical management still plays a role in treating stage II patients using the BMRC classification and a much higher percentage of survival was noted among patients falling under grade II TBM according to Palur grading. Despite the clarity of the protocol recommended by Palur, treatment and classification should be individualized and based on the local experience of each setting.

OBJECTIVE

To compare intravenous, buccal midazolam & rectal diazepam in abating seizures in an emergency setting. Study design: Prospective, non-blinded, Randomized Controlled research.

Children aged 1 month -18 years who presented and developed active seizures in the emergency room in a tertiary hospital from May 1, 2006 -April 30, 2007 were included. Those who have received rescue treatment at home or pre- hospital, with known allergic reaction to either midazolam or diazepam were excluded. Daily randomization sequence was done by drawlots. The dose of buccal/ intravenous midazolam and rectal diazepam administered was designed to give about 0.5mg/kg. Standardized data form was used to record demographic data, adverse effects, seizure type, duration, time to terminate and seizure recurrence. The primary outcome measure was the cessation of clinical seizures within 10 minutes of administration of the randomized drug. If the child was still seizing despite the 1^st treatment line, additional medication was based upon the seizure management protocol of the section.

Pearson correlation coefficient, Chi square, Kruskal Wallis Test.

A total of 34 patients were enrolled in the study. Six were randomized under the rectal gtoup while 15 & 13 children were assigned to the intravenous & buccal Midazolam group respectively. There were l O (29%) females & 24 (71 %) males with age range from 1 month up to 15 years. The top 3 etiologies of the seizures included epilepsy 35%, CNS infections 23% & hyperi:ensive encephalopathy 1 8%. With rectal Diazepam, the mean time to control seizure was 5 minutes & was effective in all (1 00%) patients. With intravenous Midazolam, the mean rime to control seizures was recorded at 7 minutes & 33 seconds & was effective in 14 of 1 5 (93%) subjects. The patients under the buccal route responded similarly with the intravenous Midazolam group with cessation of seizures in 12 of 13 (92%) children. Comparing the three-treatment group using Kruskall Wallis, KW value of0.619 is not significant at 0.05 levels. The seizures of32 (94%) of the subjects were controlled within 10 minutes. Comparing seizure duration with rime to control the attack using the Pearson Correlation, this yielded a coefficient of 0.203 and found to be not significant at 0.05 levels. Comparing the seizure recurrence of the three treatment arms using Chi-square, it showed x2 value of 24.824, which is significant at 0.05 levels. There were no adverse effects reported in chis study.

Buccal Midazolam is safe & effective in cessation of seizures in all age groups irrespective of the type and etiology of seizures. There was no statistical significance in time to terminate seizures between the three treatment groups. It has the additional advantage of ease in administration and less seizure recurrence.