Cost-Analysis of the Different Treatment Modalities in X-Linked Dystonia–Parkinsonism

Background: X-linked dystonia-parkinsonism (XDP) is a debilitating disease endemic in the Philippines. Several oral medications as well as botulinum toxin A (BoNT-A) injection and deep brain stimulation (DBS) surgery appear to be the cornerstone of treatment in XDP, which are commonly used in combination. Being a chronic progressive disease, it is an economic burden to the patient and their families. Thus, we aim to perform a comparative analysis of the associated healthcare costs for the therapeutic options used in XDP.Methodology: A questionnaire assessing the healthcare costs in the management of XDP was designed and administered through an interview with the XDP patients or their caregivers. We analyzed the data and a bootstrap analysis was also done to obtain a more generalizable estimation of the costs.Results: A total of 110 gene-positive XDP patients were included in this study. The mean total annual cost per patient was USD 4,861.23 (USD:PHP 1:50, as of January 8, 2018). More than half of the patients (n = 61, 55.5%) received both oral medications and BoNT-A injection while 42 patients (38.2%) received oral medications alone. Only seven patients underwent DBS with a reported estimated cost of USD 50,931.43. The bootstrap analysis confirmed the estimates done in this study.Conclusion: The estimated costs in the management of XDP was shown to be 30 times the average annual health expenditure of an average Filipino. This calls for more government effort to provide comprehensive care for chronic and debilitating diseases such as XDP

How Effective and Safe is Botulinum Toxin Therapy in Cervical Dystonia: The Current Stand

Cervical dystonia (CD) is the most common focal dystonia that is characterized by involuntary contraction of cervical muscles causing abnormal head movements and postures. The treatment for CD was previously limited to oral medications, however, with consequent systemic side effects. In recent years, botulinum toxin (BoNT) has demonstrated efficacy in several studies and thus has received level A recommendation from both the American Academy of Neurology and the European Federation of Neurological Sciences in the treatment of dystonia. In many countries, it is the first‐line treatment for CD. There are four types of toxin approved for the use in CD, three type A [OnabotulinumtoxinA (OnaBoNTA), AbobotulinumtoxinA (AboBoNTA), and Incobotulinumtoxin A (IncoBoNTA)] and one type B [RimabotulinumtoxinB (RimaBoNTB)]. Proper selection of affected muscles and dose of toxin are important parameters in successfully providing symptomatic treatment. Good response rate is defined as improvement of more than 25 % from baseline using the Toronto Western Torticollis Rating Scale. The most common side effect of chemodenervation with BoNT for CD is dysphagia

Cerebral Vasculitis in a COVID-19 Confirmed Postpartum Patient: A Case Report

COVID-19 has primarily been reported as a respiratory illness, but involvement of other organ systems has been reported. We describe a case of a postpartum with COVID-19 who had cerebral vasculitis. The patient presented with headache, blurring of vision, right-sided body weakness, and incoordination. Cranial magnetic resonance imaging (MRI) and angiography (MRA) showed a small acute hemorrhage on the left occipital lobe with associated acute subarachnoid hemorrhage along the parietal and occipital convexities and bilateral moderate to severe narrowing of the cerebral vessels. The patient was discharged asymptomatic. On follow-up, patient had no residual neurologic deficits, and repeat cranial MRI/MRA showed complete resolution of the vasculitis. This report was compatible with the pattern of viral-induced vasculitis and provides support to the mechanism of COVID-19-associated neurologic manifestation

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Research Productivity among Filipino Neurologists Associated with Socioeconomic, Healthcare, and Disease Burden Factors: A Bibliometric Analysis

Philippine research productivity in neurology has not been fully characterized. We investigated the research output of adult and child neurologists in the Philippines and correlated this to the Philippine socioeconomic and healthcare indices among different regions. We used electronic databases to retrieve studies published by Filipino neurologists using the 2022 Philippine Neurological Association website as reference. We included all studies published until December 2021. Official government region-specific socioeconomic indices were used. Correlational analysis was completed on bibliometric indices and collected data. We retrieved 746 articles from 274 of 526 Filipino neurologists which were published in 245 publications over 45 years with 12,409 citations. The National Capital Region (NCR) had the most publications (n = 662, 88.7%) and citations (n = 10,377, 83.6%). Research productivity was positively correlated with population, gross domestic product (GDP), health expenditure, number of healthcare establishments, neurologists, and research personnel. The Philippine research landscape is dominated by articles of neurologists belonging to institutions in the NCR, which has the greatest number of neurologists, training institutions, and highest GDP. There is a need to address the disparity seen in other regions to bridge gaps in healthcare, health human resources, and health information through research

Googling Alzheimer Disease: An Infodemiological and Ecological Study

Introduction: Understanding the emergent role of the internet on the health-seeking behavior of people is critical not only in the areas of medicine and public health but also in the field of infodemiology. Methods: Using Google Trends, data on global search queries for Alzheimer disease (AD) between January 2004 and April 2021 were analyzed. The relationship between online interest, as reflected by search volume index (SVI), and measures of disease burden, namely prevalence, deaths, and disability-adjusted life years, was evaluated. Results: There was a reduction in the tendency to search for AD during the past two decades. SVI peaks corresponded to news of famous people with AD and awareness months. Symptoms, causes, and differences with the term dementia were central queries for persons interested in AD. No notable overall correlation between SVI and measures of disease burden was found due to competing results. Sub-group analyses, however, showed that these correlations may be influenced by socioeconomic development, with strong negative significant associations observed in lower middle-income countries. Conclusion: Online interest in AD may represent a more complex metric influenced by socioeconomic factors. Awareness of the impact of celebrity diagnosis and awareness months on online search behavior may prove useful in the planning of public health campaigns for AD

Quality of life and Parkinson\u27s disease: Philippine translation and validation of the Parkinson\u27s disease questionnaire

The 39-item Parkinson\u27s Disease Quality of Life Questionnaire (PDQ-39) is the most widely used self-administered questionnaire assessing the quality of life of Parkinson\u27s disease (PD) patients. We translated the PDQ-39 into the Filipino language as the Philippine-PDQ-39 (P-PDQ-39) and used it to assess the quality of life of Filipino patients with PD. The original PDQ-39 was translated into Filipino using forward and backward translation by independent bilingual translators and used among 100 consecutively sampled PD patients. Baseline demographic data, disease duration and levodopa equivalent dose were collected. Internal consistency was measured using Chronbach\u27s α. The following rating scales and questionnaires were correlated with P-PDQ-39 through Pearson\u27s correlation coefficient to assess construct validity: modified Hoehn & Yahr Stage, Hospital Anxiety and Depression Scale-Pilipino (HADS-P), Unified Parkinson\u27s Disease Rating Scale (UPDRS) Parts I-III, and Non-motor symptom Assessment Scale for Parkinson\u27s Disease (NMSS). The mobility and activities of daily living domains of the P-PDQ-39 were well correlated with the Hoehn & Yahr stage of the patients and the UPDRS II and III scores emphasizing the value of motor symptoms in quality of life. Non motor symptoms in PD were also important determinants of quality of life as demonstrated in the correlation of HADS-P and NMSS Total scores with the P-PDQ 39 domains. The P-PDQ-39 is a valid assessment tool for assessing the quality of life of Filipino-speaking PD patients. © 2018 Elsevier Lt

Transcranial magnetic resonance-guided focused ultrasound pallidothalamic tractotomy for patients with X-linked dystonia-parkinsonism: a study protocol

Abstract Transcranial magnetic resonance-guided focused ultrasound (MRgFUS) is a noninvasive method for controlling tremor and has recently been used in patients with X-linked dystonia-parkinsonism (XDP). This study aims to determine the improvement in dystonia and parkinsonism in patients with XDP after MRgFUS pallidothalamic tractotomy. This prospective study will be conducted at the Philippine General Hospital, University of the Philippines Manila. The primary outcome measure is the change in the pre- and post-treatment XDP-Movement Disorder Society of the Philippines Scale scores. In addition, demographic and clinical data will be collected, including the Burke-Fahn-Marsden Dystonia Rating Scale, Part III of the Movement Disorder Society-Unified Parkinson’s disease Rating Scale score, XDP clinical and functional stage, the five-level EuroQol five-dimensional questionnaire, Montreal Cognitive Assessment scores, MRgFUS treatment parameters, and adverse events. Patients will be assessed within 24 hours of treatment, then at 2 weeks, 3 months, 6 months, 9 months, and 12 months post-treatment. This protocol was approved by the University of the Philippines Manila Research Ethics Board (UPMREB 2022-0271-01). Data collection began in January 2023. This protocol has been registered with ClinicalTrials.gov: Trial Registration number: NCT05592028

Clinical outcomes in COVID-19 among patients with hypertension in the Philippine CORONA Study

Abstract Objective To describe the association between hypertension and clinical outcomes in a cohort of patients with coronavirus disease 2019 (COVID-19). Design Retrospective cohort study. Setting Thirty-seven (37) hospitals in the Philippines. Patients 10,881 patients admitted for COVID-19 from February to December 2020. Measurements and main results Among the 10,881 patients included in the Philippine CORONA Study, 3647 (33.5%) had hypertension. On regression analysis adjusted for confounders (age group, sex, smoking history, diabetes, chronic cardiac disease, chronic kidney disease, chronic respiratory disease, chronic neurologic disease, chronic liver disease, HIV/AIDS, and malignancy), patients with hypertension had significantly greater odds of in-hospital mortality (OR 1.33, 95% CI 1.17–1.52), respiratory failure (OR 1.99, 95% CI 1.75–2.28), ICU admission (OR 2.16, 95% CI 1.90–2.45) and severe/critical disease (OR 1.57, 95% CI 1.41–1.75), compared to patients without hypertension. The time-to-event analysis with confounder adjustment also showed that hypertension was significantly associated with shorter time-to-event outcomes of in-hospital mortality (HR 1.13, 95% CI 1.01–1.26), respiratory failure (HR 1.86, 95% CI 1.65–2.10), and ICU admission (HR 1.99, 95% CI 1.76–2.23). Conclusions Our analysis of nationwide data confirmed previous findings that hypertension is an independent risk factor for worse clinical outcomes among patients hospitalized for COVID-19, with increased odds of in-hospital mortality, respiratory failure, ICU admission, and severe/critical COVID-19. More specific studies should be done to elucidate the impact of hypertension characteristics, such as chronicity, severity, drug therapy, and level of control on these clinical outcomes

Clinical Outcomes of COVID-19 Infection in Pregnant and Nonpregnant Women: Results from The Philippine CORONA Study

Objective: Our study determined the association of pregnancy with various clinical outcomes among women with COVID-19 infection. Methods: We conducted a retrospective, cohort, subgroup analysis of the Philippine CORONA Study datasets comparing the clinical/neurological manifestations and outcomes of pregnant and nonpregnant women admitted in 37 Philippine hospitals for COVID-19 infection. Results: We included 2448 women in the analyses (322 pregnant and 2.126 nonpregnant). Logistic regression models showed that crude odds ratio (OR) for mortality (OR 0.26 [95% CI 0.11, 0.66]), respiratory failure [OR 0.37 [95% CI 0.17, 0.80]), need for intensive care (OR 0.39 [95% CI 0.19, 0.80]), and prolonged length of hospital stay (OR 1.73 [95% CI 1.36, 2.19]) among pregnant women were significant. After adjusting for age, disease severity, and new-onset neurological symptoms, only the length of hospital stay remained significant (adjusted OR 1.99 [95% CI 1.56,2.54]). Cox regression models revealed that the unadjusted hazard ratio (HR) for mortality (HR 0.22 [95% CI 0.09, 0.55]) among pregnant women was statistically significant; however, after adjustment, the HR for mortality became nonsignificant. Conclusion: We did not find a significantly increased risk of mortality, respiratory failure, and need for ICU admission in pregnant women compared with nonpregnant women with COVID-19. However, the likelihood of hospital confinement beyond 14 days was twice more likely among pregnant women than nonpregnant women with COVID-19