ABSTRACT
The novel coronavirus disease 2019 (COVID-19) has created a global health impact to millions of people. There have been studies of COVID-19 patients manifesting with neurologic symptoms. Although the number of adult COVID-19 infections diagnosed with Guillain-Barré Syndrome (GBS) is increasing, the occurrence of cases in pediatric population remains limited or perhaps underreported. We report a rare case of an asymptomatic COVID-19 infection manifesting as acute progressive ascending polyneuropathy and hyporeflexia in a 16-year-old teen. The diagnosis of COVID-19 infection was confirmed by reverse transcription polymerase chain reaction for SARS-CoV-2 of oropharyngeal and nasopharyngeal swab specimens. Magnetic resonance imaging of the spine revealed abnormal enhancement of the cauda equina, including the dorsal and ventral roots. Electromyography and nerve conduction studies were compatible with an acute inflammatory demyelinating polyneuropathy subtype of GBS. Although lumbar puncture was not done, the clinical findings and electrodiagnostic tests were both consistent with GBS. The patient had improvement of both motor and sensory functions after completing the treatment of intravenous immunoglobulins. Neurologic manifestations of systemic illness especially in children during this time of pandemic warrants scrutiny, as these may mask a potentially dangerous and infectious ongoing COVID infection. © 2022 University of the Philippines Manila. All rights reserved.
ABSTRACT
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, prerecorded 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. © 2022 University of the Philippines Manila. All rights reserved.
ABSTRACT
Objective: To determine the risk factors of stroke among COVID 19 patients and analyze if there is an association between these factors and the incidence of stroke, and between mortality and stroke, in this cohort. Background: While most large studies about the possible association of COVID 19 and stroke were done in rich countries, only few small studies have been done in low to mid income countries like the Philippines. Design/Methods: This is an observational study done in 37 referral hospitals for COVID-19 all over the country. RT-PCR confirmed adult COVID-19 patients more than 18 years of age were included in the study. For those who consented, a pre-made detailed ion form containing the variables of interest is filled up by the field neurologist by clinical observation, chart review and interview of the relatives or the patient. Results: The incidence of stroke among COVID-19 patients was 3.4% (n=367). More died among patients with stroke than those without (42.2% vs 14.7%, p<0.01). In addition, more patients were admitted in the ICU (43.3% vs 15.0%, p<0.01) regardless of causes in the same cohort. Smoking (95% CI: 0.27 to 0.53, p<0.0001), hypertension (95% CI:0.43 to 0.68, p<0.0001), presence of heart failure (95% CI: 0.07 to 0.62, p=0.01), presence of any past neurologic co-morbidities (95% CI:0.34 to 0.10, p=0.004) and past history of stroke (95% CI:0.60 to 1.09, p<0.0001) had positive while being a health care worker (95% CI: -1.12 to -0.35, p<0.0004) had negative significant associations with stroke. Conclusions: COVID 19 stroke patients in LMIC have higher mortality and ICU admission rates than patients with COVID 19 alone or COVID 19 stroke patients from developed countries.
ABSTRACT
Objective: We aimed to investigate the associations between new-onset neurological symptoms (NNS) and mortality, respiratory failure, intensive care unit (ICU) admission, duration of ventilator dependence, length of ICU and hospital stay among COVID-19 patients. Background: Current reports of neurological symptoms/signs, complications, and outcomes of COVID-19 infection are limited due to the small number of included patients and relatively short duration of data collection which could hinder more precise estimates and detection of rarer manifestations. Design/Methods: We conducted a nationwide, comparative, retrospective, cohort study among adult, hospitalized COVID-19 patients involving 37 hospital sites from various regions in the Philippines. Results: We included a total of 10,881 patients with confirmed COVID-19 infection (2,008 had NNS;8,873 did not have NNS). The most common NNS were headache (n = 607, 5.58%), anosmia/hyposmia (n = 544, 5.0%), and altered sensorium (n = 479, 4.4%). The adjusted hazard ratios (aHRs) for mortality among the mild and severe cases were significantly higher by 1.660 (95% CI 1.132-2.435) and by 1.352 (95% CI 1.042-1.752), respectively, in the NNS group compared to those in the non-NNS group. The aHRs for respiratory failure in the NNS group were significantly increased by 1.914 (95% CI 1.346-2.722), by 1.614 (95% CI 1.260-2.068), and by 1.234 (95% CI 1.089-1.398) among the mild, severe, and critical cases, respectively. The aHRs for ICU admission in the NNS group were still significantly higher by 1.973 (95% CI 1.457-2.673) and by 1.831 (95% CI 1.506-2.226) among the mild and severe cases, respectively. Patients who had NNS were not significantly associated with a longer duration of ventilator dependence (adjusted odds ratio (aOR) 0.954, 95% CI 0.772-1.179), longer ICU stay (aOR 0.983, 95% CI 0.772-1.252) and longer hospital admission (aOR 1.045, 95% CI 0.947-1.153). Conclusions: The presence of NNS significantly increases the risk of mortality, respiratory failure and ICU admission among COVID-19 patients.
ABSTRACT
Objective: This review aimed to examine the treatment gaps and challenges that burden Philippine epilepsy care. Background: Epilepsy is a neurologic disease that carries a high disease burden and, likely, a huge treatment gap, especially in low-to-middle income countries such as the Philippines. Design/Methods: Pertinent data on epidemiology, research, health systems and financing, pharmacologic and surgical treatment options, cost of care, and workforce were obtained through a literature search and review of relevant Philippine government websites. Results: The estimated prevalence of epilepsy in the Philippines is 0.9%. Epilepsy research in the Philippines is low in quantity compared to the rest of Southeast Asia. Inequities in healthcare services delivered to local government units have arisen due to devolution. Programs for epilepsy care by both government and non-government institutions have been implemented. Healthcare expenditure in the Philippines is largely out-of-pocket, with only partial coverage from the public sector. There is limited access to antiseizure medications, mainly due to cost. Epilepsy surgery is an underutilized treatment option. There are only twenty epileptologists in the Philippines, with one epileptologist for every 45,000 epilepsy patients. Epilepsy care delivery has been further impeded by the coronavirus disease of 2019 pandemic. Conclusions: There is a large treatment gap in epilepsy care in the Philippines due to high disease burden, sparse research, inadequate public support, inaccessibility of healthcare services and pharmacotherapy, underutilization of surgical options, and low specialist density. Addressing the treatment gap is expected to improve the overall survival and quality of life of epilepsy patients in the Philippines.