Feasibility of speech telerehabilitation for a patient with Parkinson's Disease in a low-resource country during the pandemic: A case report

@#Parkinson’s disease (PD) is a chronic, neurodegenerative condition resulting in various motor impairments, including speech disorders. However, at the height of the coronavirus disease 2019 pandemic, a patient with PD could not access traditional in-person neurorehabilitation care. This case report highlights the feasibility of telerehabilitation to deliver speech therapy over a distance using available resources in a developing country. We describe a Filipino elderly woman, public speaker, and marriage counselor, seeking teleconsultation for her voice problems (slow and soft) attributed to PD. At that time, most center-based outpatient rehabilitation centers in Manila were closed due to the pandemic, and the patient preferred to stay at home for safety reasons. Hence, she was evaluated and managed remotely by an interdisciplinary team (neurologist, physiatrist, speech-language pathologist) through video calls. Since the ideal rehabilitation set up (in-person evaluation and therapy; use of Lee Silverman Voice Therapy) could not be done, the clinicians had to find practical alternatives, such as remotely administering subjective perceptual voice assessments, objective speech analysis using the Praat™ computer application, and speech teletherapy through synchronous (videocalls, phone calls) and asynchronous (e-mails, text messages, pre-recorded exercise videos) techniques. Notable speech improvements were observed by the clinicians, patient, and patient’s frequent communicative partners after at least four teletherapy sessions. However, the carry-over of the improvements was affected by the patient’s lack of compliance with the prescribed home exercise program. Telerehabilitation using synchronous and asynchronous techniques for speech disorders due to PD was found feasible, beneficial, safe, and practical amid social distancing and low resources in a developing country

Memantine for episodic migraine: A systematic review and meta-analysis

@#<p style="text-align: justify;"><strong>Introduction.</strong> Migraine is a common, debilitating primary headache. Memantine is a non-competitive N-methyl D-aspartate (NMDA) antagonist that lowers neuronal excitability that could prevent migraine attacks. This study aimed to determine the efficacy and safety of memantine in patients with episodic migraine attacks using a systematic review and meta-analysis.</p><p style="text-align: justify;"><strong>Methods.</strong> We searched CENTRAL, MEDLINE, Scopus, Cochrane, LILACS, ClinicalTrials.gov, HERDIN and Google Scholar for relevant studies until July 31, 2020. Prespecified screening and eligibility criteria for inclusion were applied. Included studies underwent methodological quality assessment. Study design, patient characteristics, interventions given, and relevant outcomes were extracted and synthesized.</p><p style="text-align: justify;"><strong>Results.</strong> This review included five relevant articles - two randomized controlled trials (RCT) and three non randomized studies (one retrospective records review and survey, two prospective open-label single-arm trials). There were 109 patients included in the RCTs and 197 patients reported in the non-randomized studies. Pooled data from the two RCTs showed that memantine at 10 mg/day significantly decreased the monthly number of migraine days at 12 weeks compared to placebo with a mean difference of -1.58 [95% confidence interval (CI) -1.84, -1.32]. Non-randomized studies also showed a decrease in migraine days per month with memantine (5 to 20 mg/day) after 12 weeks [95% CI]: -9.1 [-11, -7.23], -7.2 [-8.85, -5.55], and -4.9 [-6.29, -3.51]. Adverse drug events (ADE) did not differ significantly between patients treated with memantine compared to placebo.</p><p style="text-align: justify;"><strong>Conclusion.</strong> Memantine may be effective and well-tolerated as prophylaxis for episodic migraine.</p>

Botulinum toxin treatment practice recommendations for movement disorders clinics during the COVID-19 pandemic

Background: Due to the Coronavirus disease 2019 (COVID-19) pandemic, non-emergency services like botulinum toxin A (BoNT) injections were temporarily discontinued.Objective: We aimed to create standard practices that optimize the management of patients needing BoNT injections while ensuring both patients' and healthcare professionals' safety.Methods: We evaluated published guidelines and best practices to determine their applicability for BoNT injection during this pandemic. We then devised a decision tree algorithm for use in our hospital.Results: A decision tree algorithm has been formulated based on patient evaluation and risk stratification, triaging, the urgency of the procedure, and proper precautions on personal protective wear as appropriate for the procedure's risk stratification.Conclusion: The algorithm is in place to ensure the safety of both the patient and healthcare professional. It can be adopted and revised by other centers to suit their clinic needs.

Global online interest in telehealth, telemedicine, telerehabilitation, and related search terms amid the COVID-19 pandemic: An infodemiological study

Background@#Catalyzed by the coronavirus disease 2019 (COVID-19) pandemic that restricted non-essential travel, awareness of the value of telehealth increased among healthcare providers and consumers. Telerehabilitation, a subset of telehealth and telemedicine, refers explicitly to the remote provision of rehabilitation services. However, since the majority were new to the concept of telerehabilitation, which was commonly interchanged with other related terms (e.g., telehealth, telemedicine, teletherapy, telecare, telepractice, etc.), and relevant internationally recognized guidelines were not available pre-pandemic, many turned to online resources to learn more about it. However, such might create confusion with the terminologies. @*Objective@#This infodemiological study aimed to examine the trends of global online interest in telehealth, telemedicine, telerehabilitation, and related search terms. The authors hypothesized an abrupt rise in stakeholders' awareness regarding the virtual method of delivering or accessing healthcare, including rehabilitation services, during the pandemic. @*Method@#Using Google Trends™, we obtained and analyzed the trends of global online interest in telehealth, telemedicine, telerehabilitation, and other related search terms from 2004 to October 2020. @*Results@#The frequencies of searches for “telehealth,” “telemedicine,” and “telerehabilitation” peaked in March 2020, which coincided with the lockdown in many countries, including the Philippines. The term “telehealth” was more frequently searched in western countries, while “telemedicine” was relatively common in eastern countries. Among the terms synonymous with telerehabilitation, “teletherapy” was most commonly used worldwide, with “teletherapy speech” being the most searched related topic. The Philippines had the most significant number of times the term “telerehabilitation” was searched in the past decade. @*Conclusion@#During the COVID-19 pandemic, there is an overall global demand for the acquisition of knowledge related to telehealth, telemedicine, telerehabilitation, and related search terms. Of particular interest, tele rehabilitation, however, varied in terminologies across countries, with “teletherapy” mainly being used worldwide and “telerehabilitation” being primarily searched in the Philippines. Therefore, arriving at a consensus across professional societies and operationally defining different interrelated terms could help streamline our current or future guidelines and programs.

Botulinum toxin treatment practice recommendations for movement disorders clinics during the COVID-19 pandemic

Background@#Due to the Coronavirus disease 2019 (COVID-19) pandemic, non-emergency services like botulinum toxin A (BoNT) injections were temporarily discontinued. @*Objective@#We aimed to create standard practices that optimize the management of patients needing BoNT injections while ensuring both patients' and healthcare professionals' safety. @*Methods@#We evaluated published guidelines and best practices to determine their applicability for BoNT injection during this pandemic. We then devised a decision tree algorithm for use in our hospital. @*Results@#A decision tree algorithm has been formulated based on patient evaluation and risk stratification, triaging, the urgency of the procedure, and proper precautions on personal protective wear as appropriate for the procedure’s risk stratification. @*Conclusion@#The algorithm is in place to ensure the safety of both the patient and healthcare professional. It can be adopted and revised by other centers to suit their clinic needs.

The effectiveness and tolerability of the high dose Donepezil at 23 mg tablet per day for Alzheimer’s disease: A meta-analysis of randomized controlled trials

Objective@#To assess the effectiveness and tolerability of the 23 mg tablet donepezil in patients with Alzheimer’s disease (AD) using meta-analysis of randomized controlled trials.@*Methods@#Major healthcare databases were searched from May to September 2016. Evaluation of relevant trials, assessment of risk of bias, collection and analyses of data were performed.@*Results@#A total of 1,774 adult participants with AD were pooled from the two trials included. Pooled data showed that after 24 weeks of treatment, no significant difference was noted between Donepezil 23 mg/day and Donepezil 10 mg/day in terms of cognitive function (1.06 SIB points [-0.13, 2.26]; 1704 participants) and in terms of global clinical assessment (-0.02 CIBIC+ points [-0.13, 0.09]; 1705 participants). The participants who took the higher dose were at higher risk to experience “any adverse event” than those who received the lower dose (1.17 RR [1.09, 1.26]; 1785 participants).@*Conclusion@#Current evidences do not support the routine use of Donepezil 23 mg tablet for the improvement of cognitive function and global clinical status of patients with AD. The higher dose is also marked with an increased incidence of adverse events compared to the lower dose.

The effectiveness and tolerability of oral acetaminophen/aspirin/caffeine (AAC) combination regimen as an acute treatment for migraine in adults: A meta-analysis of randomized trials

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.

The effectiveness and tolerability of oral acetaminophen/aspirin/caffeine (AAC) combination regimen as an acute treatment for migraine in adults: A meta-analysis of randomized trials

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> 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.<br /><strong>OBJECTIVE:</strong> To determine the effectiveness and tolerability assessment of oral AAC combination regimen as an acute treatment for migraine in adults.<br /><strong>METHODS:</strong> 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.<br /><strong>RESULTS:</strong> 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.<br /><strong>CONCLUSION:</strong> 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.</p>