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Background: Amyotrophic lateral sclerosis (ALS) is a fatal and incurable neurodegenerative disease. There is still no established cost-effective treatment that can improve functional status and survival of ALS patients. Perampanel, by inhibiting neuronal calcium ion influx and preventing dyslocalization of nuclear proteins, has the potential to ameliorate ALS neurodegeneration.Objectives: This study aims to determine the efficacy and safety of perampanel among ALS patients in terms of improvement in functional status using a review of relevant studies.Methods: MedLine, Cochrane Central Register for Controlled Trials, Scopus, Embase, Literatura Latino-Americana e do Caribe em Ciências da Saúde, ClinicalTrials.gov website, and HERDIN databases were searched from inception to August 2021 for relevant studies.Results: The search yielded 132 articles; 3 studies were included in the analysis. Pooled evidence shows that perampanel compared to placebo significantly improves cortical motor hyperexcitability but not the ALS functional rating scale-revised score. Perampanel is associated with adverse events such as aggression, somnolence, anger, and dysarthria.Conclusion: There is no sufficient evidence to support the role of perampanel in improving functional status of ALS patients. Although it can ameliorate motor cortical hyperexcitability, its clinical benefit has not yet been elucidated. Perampanel is not well tolerated among ALS patients as it is associated with adverse events such as aggression, somnolence, anger, and dysarthria. Further studies investigating the role of perampanel early in the ALS disease course, excluding ALS patients with frontotemporal lobe degeneration features and C9ORF72 repeat expansion, and using gradual drug titration schedule are needed to evaluate the potential benefit of perampanel in ALS. [ABSTRACT FROM AUTHOR]

Background: Despite being known abroad as a viable alternative to face-to-face consultation and therapy, telerehabilitation has not fully emerged in developing countries like the Philippines. In the midst of the coronavirus disease 2019 (COVID-19) pandemic, wherein social distancing disrupted the in-clinic delivery of rehabilitation services, Filipinos attempted to explore telerehabilitation. However, several hindrances were observed especially during the pre-implementation phase of telerehabilitation, necessitating a review of existing local evidences. Objective: We aimed to determine the challenges faced by telerehabilitation in the Philippines. Method: We searched until March 2020 through PubMed, Scopus, Embase, Cochrane Library, and HeRDIN for telerehabilitation-related publications wherein Filipinos were involved as investigator or population. Because of the hypothesized low number of scientific outputs on telerehabilitation locally, we performed handsearching through gray literature and included relevant papers from different rehabilitation-related professional organizations in the Philippines. We analyzed the papers and extracted the human, organizational, and technical challenges to telerehabilitation or telehealth in general. Results: We analyzed 21 published and 4 unpublished papers, which were mostly reviews (8), feasibility studies (6), or case reports/series (4). Twelve out of 25 studies engaged patients and physicians in remote teleconsultation, teletherapy, telementoring, or telemonitoring. Patients sought telemedicine or telerehabilitation for general medical conditions (in 3 studies), chronic diseases (2), mental health issues (2), orthopedic problems (2), neurologic conditions (1), communication disorders (1), and cardiac conditions (1). Outcomes in aforementioned studies mostly included telehealth acceptance, facilitators, barriers, and satisfaction. Other studies were related to telehealth governance, legalities, and ethical issues. We identified 18 human, 17 organizational, and 18 technical unique challenges related to telerehabilitation in the Philippines. The most common challenges were slow internet speed (in 10 studies), legal concerns (9), and skepticism (9). Conclusion: There is paucity of data on telerehabilitation in the Philippines. Local efforts can focus on exploring or addressing the most pressing human, organizational, and technical challenges to the emergence of telerehabilitation in the country. [ABSTRACT FROM AUTHOR]

Background: A critical strategy in the management of Alzheimer's disease (AD) is optimizing the effects of currently available pharmacologic therapies such as citicoline (CC).Objective: The purpose of this study was to determine the effects of CC as adjunct therapy to cholinesterase inhibitors (AChEI) in the treatment of AD.Methods: We identified relevant studies by electronic search until April 2020. We considered studies with a comparator group that enrolled elderly patients with a diagnosis of AD and employed CC as an adjunct therapy to AChEIs compared to AChEI monotherapy or comparisons of different AChEIs combined with CC. Methodological quality assessment was done using the Newcastle-Ottawa Scale.Results: Out of 149 articles identified, two retrospective cohort studies involving 563 elderly patients affected with AD were included. After 3 months and 9 months, better Mini-Mental Status Examination scores were observed in the "AChEIs + CC" group versus "AChEIs alone" group. CC combined with donepezil may be better in improving cognition than when combined with rivastigmine. No significant difference was noted in terms of activities of daily living (ADL) and instrumental-ADL. Neuropsychiatric Inventory and Geriatric Depression Scale-short form scores appeared to be lower in the combination treatment versus monotherapy. The adverse events of combined treatment were self-limiting and included occasional excitability, gastric intolerance, and headache.Conclusion: Limited evidence from pooled data of two observational studies suggests that CC used in adjunct with AChEIs in the treatment of AD was well-tolerated and showed improvement in cognition, mood, and behavioral symptoms compared to treating with AChEIs alone. [ABSTRACT FROM AUTHOR]

Congenital glioblastoma multiforme (cGBM) is an infrequent primary central nervous system tumor occurring within the first few months of life with a reported poor overall prognosis. Our objective was to describe our own clinical case of cGBM and review the literature of cGBM cases with prolonged survival. We report a case of cGBM with prolonged survival at 4 years. A systematic review was conducted on cases of cGBM with long-term childhood survival. We searched online databases until August 2019 for relevant articles. The patient underwent an emergency right hemicraniectomy with excision and biopsy of the right cerebral hemisphere mass and insertion of a ventriculoperitoneal shunt. At present, she is a 52-month-old child with good speech and minimal left hemiparesis and able to ambulate, with a Functional Independence Measure for Children score of 109. Out of 160 articles screened, there were 10 articles included. A total of 15 patients, including the present case, were analyzed qualitatively. The age at presentation ranged from 30 weeks' gestation to 35 days. Most patients underwent surgical excision (n = 13, 86.7%) and adjuvant chemotherapy (n = 10, 66.7%). The reported range of survival of these patients was from 27 to 110 months. Limited evidence from 15 cases of cGBM suggests that surgical excision and/or chemotherapy may prolong the survival of patients. Therefore, these interventions may be offered and performed to patients with cGBM on a case-by-case basis. Larger clinical studies or registry-based information are necessary to substantiate the implications of our review. [ABSTRACT FROM AUTHOR]

The review assessed the efficacy and tolerability of mitoxantrone in patients with neuromyelitis optica spectrum disorder (NMOSD). Eight articles were reviewed with a total of 117 patients. Annualized relapse rate and progression of disability dramatically decreased post-treatment in most studies. Mitoxantrone was generally tolerated. Only one patient developed acute myeloid leukemia, which lead to septicemia and death. No serious cardiotoxicity was reported. Mitoxantrone may be effective in reducing the frequency of relapse and slowing down the progression of disability in patients with NMOSD. The risk of cardiotoxicity and leukemia detains it as a second-line agent for NMOSD. Unlabelled Image • Mitoxantrone may be effective in reducing the frequency of relapse in NMOSD. • It also slows down the progression of disability in NMOSD. • It is generally safe and tolerable for patients with NMOSD. [ABSTRACT FROM AUTHOR]

Status epilepticus (SE) is an emergent neurologic condition that carries a high risk of morbidity and mortality. Intravenous brivaracetam (IV BRV) may be an alternative anticonvulsant against status epilepticus, although the sparseness of controlled studies on the topic limits its recommendation for this indication. This systematic review aimed to determine the efficacy and safety of IV BRV in the treatment of status epilepticus. A comprehensive literature search was conducted until December 2019 through several electronic databases (PubMed, Google Scholar, Scopus, OpenGrey, ScienceDirect, HERDIN, Epistemonikos, CENTRAL, ClinicalTrials.gov) to identify relevant studies. Studies that involved adult patients with SE who were given IV BRV were considered for inclusion in this review. From a total of 34 studies identified, 5 uncontrolled studies with 77 patients were included in this review. Thirty-seven out of 77 patients (48%) with SE responded to IV BRV. Reported time to seizure cessation may be immediate from a few minutes to several hours after IV BRV treatment. Patients manifested with significant disability on Glasgow outcome scale (Median: 3) and modified Rankin scale (Mode: 5). Six patients [somnolence (5), worsening seizures (1)] had treatment emergent adverse events. Limited evidence from 5 uncontrolled studies involving a limited number of patients suggests that IV BRV may be efficacious and safe in terminating seizures among patients with SE or refractory SE. Further studies employing either prospective, controlled trials or registry-based study designs are essential to determine the definitive role of IV BRV in patients with SE. • Intravenous brivaracetam (IV BRV) is an emerging drug used for status epilepticus (SE). • Five uncontrolled studies with 77 patients were included in this review. • 37 out of 77 patients (48%) with SE responded to IV BRV. • Few patients reported adverse events (somnolence and worsening seizures). • Limited evidence suggests that IV BRV may be efficacious and safe for SE. [ABSTRACT FROM AUTHOR]