BACKGROUND

Perampanel is an antagonist of the a-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor. It is currently FDA-approved to treat focal and generalized tonic-clonic seizures in epilepsy, but recent evidence suggests its potential in treating severe and refractory tremors.

To determine the safety and efficacy of perampanel in treating tremors via a systematic review of existing literature. 

We performed a literature search on five large databases (PubMed, Cochrane, Google Scholar, HERDIN, and Scopus) for clinical studies within the last 10 years and screened a total of 1,539 unique articles for full assessment. We filtered out papers on epilepsy as well as hypokinetic diseases and assessed nine articles for quality assessment and review.

A total of four case reports/series, four open-label trials, and one randomized controlled trial were assessed to be of fair to good quality. All trials showed that low-dose perampanel (2-4 mg/day) was safe and well-tolerated with minor adverse events reported by participants. A net benefit from baseline was observed in patients with essential and primary orthostatic tremors. However, current evidence is weak because the trials employed a non-randomized before-after study design with a small sample size and significant dropout rates.

Low-dose perampanel at 2-4 mg/day shows promising potential in treating refractory tremors and myoclonus in recent clinical studies, but current evidence is weak or anecdotal. Additional randomized controlled trials are needed to determine the conclusive benefit of perampanel for hyperkinesia.

BACKGROUND

Perampanel is an antagonist of the a-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor. It is currently FDA-approved to treat focal and generalized tonic-clonic seizures in epilepsy, but recent evidence suggests its potential in treating severe and refractory tremors.

To determine the safety and efficacy of perampanel in treating tremors via a systematic review of existing literature. 

We performed a literature search on five large databases (PubMed, Cochrane, Google Scholar, HERDIN, and Scopus) for clinical studies within the last 10 years and screened a total of 1,539 unique articles for full assessment. We filtered out papers on epilepsy as well as hypokinetic diseases and assessed nine articles for quality assessment and review.

A total of four case reports/series, four open-label trials, and one randomized controlled trial were assessed to be of fair to good quality. All trials showed that low-dose perampanel (2-4 mg/day) was safe and well-tolerated with minor adverse events reported by participants. A net benefit from baseline was observed in patients with essential and primary orthostatic tremors. However, current evidence is weak because the trials employed a non-randomized before-after study design with a small sample size and significant dropout rates.

Low-dose perampanel at 2-4 mg/day shows promising potential in treating refractory tremors and myoclonus in recent clinical studies, but current evidence is weak or anecdotal. Additional randomized controlled trials are needed to determine the conclusive benefit of perampanel for hyperkinesia.

Health Policy ; Health ; Policy

OBJECTIVES

During the early COVID-19 pandemic (2020 to mid-2021), the Philippine government relied on nonpharmaceutical interventions such as lockdowns and Enhanced Community Quarantine (ECQ). With the emergency use authorization of vaccines, assessing their potential impact became essential. This study develops a Philippine model to evaluate the epidemiologic and economic effects of COVID-19 vaccination, estimating its impact on mortality, hospitalization, and mild/asymptomatic cases under various prioritization strategies, including booster doses and the presence of variants of concern.

A dynamic transmission model (DTM) with an SEIR (Susceptible-Exposed-Infected-Recovered) structure was calibrated using local data, including case numbers, deaths, seroprevalence, vaccination coverage, and intervention costs. The model’s outputs informed a cost-effectiveness analysis (CEA) from health system and societal perspectives over a two-year horizon. Incremental Cost-Effectiveness Ratios (ICERs) were calculated, with costs adjusted to 2020 prices and discount rates of 3%-10% applied. Sensitivity analyses, including one-way and probabilistic approaches, assessed robustness, while a budget impact analysis (BIA) estimated government expenditures in 2020 and 2021.

Without vaccination, daily cases could have peaked at 400,000 between February and May 2021. A vaccination campaign was projected to reduce cases to around 20,000, significantly lowering mortality.  

From the health system perspective, the estimated cost without vaccination was PhP 14.46 trillion, with 93.83 million QALYs. With vaccination, costs dropped to PhP 2.36 trillion, while QALYs increased to 101.79 million. From the societal perspective, costs were PhP 14.68 trillion without vaccination and PhP 2.38 trillion with vaccination, with the same QALY outcomes.

CEA results confirmed that vaccination was cost-saving, with ICERs of -PhP 1,520,727.28 per QALY (health system) and -PhP 1,546,171.63 per QALY (societal). Sensitivity analyses supported these findings, with oneway sensitivity analysis showing minimal impact from parameter changes and probabilistic sensitivity analysis confirming cost-saving outcomes. The BIA estimated government expenditures of PhP 983.45 billion in 2020 and PhP 1.47 trillion in 2021 for the vaccine scenario, lower than the no-vaccine scenario.

Indeed, our modeling has shown that COVID-19 vaccines could mitigate the spread of COVID-19 and provide good value for money.

Background and Introduction. The RxBox is a telemedicine device that measures and transmits vital signs to remote experts. It has been deployed to primary care health centers (PCHC) in the Philippines serving disadvantaged populations, to decrease morbidity and mortality due to common diseases and poor access to care. Factors affecting its adoption by healthcare workers is unknown.

Materials and Methods. The study determined social and behavioral factors that affect adoption of a telemedicine device into the clinical workflow using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. This is a mixed methods research using review of records, survey and focused group discussions.

Results and Discussion. RxBox telemedicine devices were installed in 79 primary care health centers (PCHC) and were used a total of 15,705 times within the study period. An ordinary least squares regression analysis using the combined site and individual-level data showed that among the UTAUT parameters, only compatibility, facilitating conditions, and social factors have significant relationships with intent-to-use of the RxBox. The innovation assisted primary care health workers in their clinical responsibilities, improved the stature of their PCHC in the community, and helped in the care for patients. Training and technology support after deployment as well as encouragement by peer and champions (the PCHC physician, local government leaders) reinforced continuous use after training. Users described the experienced improvements in quality of services provided by the PCHC and the consequent benefits to their patients.

Conclusions. These factors should be accounted for in designing strategies to reinforce health workers' attitudes and enhance support towards acceptance and use of novel telemedicine devices into clinical routine in local health centers. Lessons are immediately useful for local leaders in low- and lower middle-income countries that suffer disproportionately from unnecessary maternal deaths and mortality due to non-communicable diseases. This contributes to the body of knowledge and should bolster national-level advocacy to institute an enabling policy on telehealth Information Communication Technology (ICT) and use of Filipino innovations towards health systems strengthening. Results can be used by implementers, evaluators, and regulators of health ICT, especially in resource-poor settings. Likewise, the study can encourage more research in the field to spur more dynamic local health ICT and biomedical device industries.

INTRODUCTION: Seizures are the most common neurologic emergency in the neonatal period. Phenobarbital and levetiracetam are the most commonly used anti-epileptic agents. However, there is conflicting evidence regarding their efficacy and safety. This review aims to synthesize data from randomized trials evaluating levetiracetam versus phenobarbital as a first-line antiepileptic drug for seizures in the newborn. METHODS: A systematic review and meta-analysis following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was performed. The review considered randomized clinical trials (RCTs) providing information about the efficacy and safety of levetiracetam vs phenobarbital as first line treatment of neonatal seizures. Medline by PubMed, CENTRAL by Cochrane, Embase, Google Scholar, and grey literature for RCTs were searched. RESULTS: Four randomized controlled trials met the criteria for inclusion. A total of 312 neonates (levetiracetam n=167, phenobarbital n=145) comprised the pooled sample. Seizure freedom did not significantly favour one particular drug. This was also seen throughout subgroup analysis comprising clinical determination of seizure onset and cessation and neonates with hypoxic-ischemic encephalopathy. Significant heterogeniety was seen throughout the analyses. Hypotension was seen more in patients given phenobarbital. No significant association of either drug was seen for respiratory abnormalities and requirement for ventilation. Mortality was not significantly associated with either drug. CONCLUSION This meta-analysis combined and synthesized data from four randomized controlled trials comparing levetiracetam and phenobarbital in efficacy and safety for neonatal seizures. The statistical analysis did not lend evidence to support the use of one drug over the over. More studies that employ stringent techniques to minimize bias are needed for a more robust conclusion.

OBJECTIVE: X-linked dystonia parkinsonism (XDP) is an adult-onset, progressive and debilitating movement disorder described among Filipino males from Panay Island. The available oral medications have been ineffective. While chemodenervation with botulinum toxin A works and deep brain stimulation surgery is promising, these are not affordable for the vast majority of patients. Thus, we decided to look into the efficacy, safety and tolerability of levodopa+carbidopa (levodopa) versus placebo among patients with XDP.

METHODS: This was a double blind, randomized, placebo-controlled clinical trial. Patients were randomized to receive levodopa or placebo for 6 months. The dose was increased gradually until 1000 mg levodopa/day is reached or until side effects appear.

RESULTS: A total of 86 out of 94 randomized patients (91.5%) were included in the intention-to-treat cohort for the primary efficacy analysis. Nineteen patients (9 in levodopa, 10 in placebo) dropped out or were lost to follow up. There was no significant difference in the baseline and last visit Burke Fahn Marsden Dystonia Rating Scale and the part III of the Unified Parkinson's Disease Rating Scale scores between levodopa and placebo. The most common adverse events in the levodopa group were increased movements, pain and nausea/ vomiting.

CONCLUSION: While levodopa is safe and well-tolerated, it does not have any effect in alleviating the dystonia or parkinsonism in XDP.

BACKGROUND: Locally, understanding and communicating sensory neuropathy may be confounded by a "comprehension gap" during consults and limited "nerve literacy" or knowledge of patients about nerves. This may affect the effectiveness of healthcare.
OBJECTIVE: The study aims to describe the Filipino patients' experience of sensory neuropathy in local terms and their understanding of its causation.
METHODS: A cross-sectional, descriptive study among 24 patients with sensory neuropathy was done using semi-structured individual interviews. The first part elicited Filipino terms and descriptions used to explain their experience. The second part elicited perceived cause pre- and post- consult and perceived body part affected.
RESULTS: The most common descriptors of sensory neuropathy include "manhid", "kuryente", "tinutusuk-tusok", "ngalay", "kirot", and "naninigas". Many would initially identify "pasma" as a cause. Post-consult, many would cease to see it as part of natural ageing and would identify structural explanations such as impingement. They would however attribute it to an affectation of "ugat" which most defined as blood vessels.
CONCLUSION: The abovementioned terms are commonly used to describe sensory neuropathy and can be clinically useful in eliciting symptoms. There is existing confusion with regards to the nerve as a structure involved even after consultation.

BACKGROUND: Medication errors are preventable events that can cause or lead to inappropriate drug use. Knowing the prevalence and types of errors can help us institute corrective measures and avoid adverse drug events.
OBJECTIVE: This study determined the prevalence of medication errors and its specific types in the four main service wards of a tertiary government training medical center.
METHODS: This is a retrospective, descriptive chart review study. From the master list of admissions, systematic sampling was done to retrieve the required number of charts. Relevant pages such as order sheets, nurses' notes, therapeutic sheets were photographed. For prolonged admissions, only the first 7 days were reviewed. Each chart was evaluated by two people who then met and agreed on the errors identified.
RESULTS: The overall prevalence of medication errors is 97.8%. Pediatrics had the most (63.3/chart), followed by Medicine, OB-Gynecology, and Surgery (7.3/chart). The most common type of errors identified were prescribing, followed by compliance, then administration errors.
CONCLUSION: Medication errors are present in the four main wards in our hospital. We recommend orientation of all incoming first year residents on proper ordering and prescribing of drugs, as well as a prospective observational study to determine true prevalence of all types of medication errors.

BACKGROUND: Migraine is a highly common disorder that can cause significant disability on an individual, which collectively may lead to a substantial burden for the society. Various expert societies have recommended Acetaminophen/Aspirin/Caffeine (AAC) combination regimen as the first-line drug treatment for migraine attacks; however, there were no pooled evidences summarizing the effectiveness and tolerability of this regimen.
OBJECTIVE: To determine the effectiveness and tolerability assessment of oral AAC combination regimen as an acute treatment for migraine in adults.
METHODS: Relevant studies from inception to March 2014 were searched in Cochrane CENTRAL, MEDLINE, LILACS, Scopus and metaRegister of Controlled Trials. The Cochrane Collaboration's tool for the assessment of risk of bias was employed. Trials that were randomized, double-blind, parallel-group, placebo and active-controlled were included and the data were employed for meta-analysis. To evaluate the quality of evidence, the GRADE approach was utilized for outcomes with sufficient studies and data.
RESULTS: From 225 records identified, 4 trials were included in this review, with a total of 3,608 participants with recorded baseline characteristics. Patient-reported migraine intensity was moderate-severe and the AAC dose used was at 500/500/130 mg. At 2 hours, AAC regimen was statistically different and found to be superior to placebo in terms of pain-free, headache relief, nausea-free, photophobia-free, phonophobia-free and functional disability reduction rates using intension-to-treat analysis. Missing data did not alter the outcome measures generating robust results. Sumatriptan 100 mg was found to be better than AAC in pain-free rate, and phonophobia-free rates at 2 hours. Statistically more patients in the AAC arm experienced "any adverse event" compared to placebo and complaints were commonly nausea and nervousness.
CONCLUSION: For adult individuals with moderate-severe migraine, a fixed oral dose of Acetaminophen/Aspirin/Caffeine (AAC 500/500/130 mg) may be used as first-line therapy for the acute treatment of migraine and is only associated with mild, infrequent adverse events.