Autoimmune Encephalitis in the Philippines: A Scoping Review on the Treatment Gaps, Challenges, and Current State of Care.

OBJECTIVES: We reviewed the current health service delivery for individuals with Autoimmune Encephalitis (AE) in the Philippines and to identify the gaps and challenges in its management. METHODOLOGY: We conducted a scoping review of pertinent literature AE in the Philippines using the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines. We extracted data on epidemiology, legislation, health financing, information systems, pharmacotherapy, and healthcare services related to the management of AE in the local setting. DISCUSSION: The epidemiology of AE is still unknown. Out-of-pocket expenses contribute to most of the healthcare expenditure despite government-led programs to reduce the financial burden. The access to diagnostic examinations such as magnetic resonance imaging, electroencephalogram, and antibody testing is limited by the geographic distribution of the facilities and costs. The acute and long-term management of AE are cost-prohibitive and are not readily available. There are significant treatment gaps in the care of individuals with AE in the Philippines in terms of disease recognition, resource allocation, access to satisfactory diagnostic evaluation, and provision of prognosis-changing therapeutics. We proposed core strategies that can address these treatment gaps such as increasing awareness, improving access to health resources, adequate healthcare financing, and availability of support systems.

The practice of teleneurology in the Philippines during the COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: The practice of teleneurology provided an accessible and safe method of consultation during the COVID-19 pandemic. We aimed to describe the practice of teleneurology among Filipino neurologists and determine the factors affecting its adoption using the unified theory of acceptance and use of technology (UTAUT) model and its constructs, namely performance expectancy, effort expectancy, social influence, and facilitating conditions. METHODS: This was a cross-sectional survey conducted online last October 2020 involving adult and pediatric neurologists in the Philippines. The internal consistency of the questionnaire adapted from UTAUT model was determined using Cronbach's alpha. We performed logistic regression analysis to determine which constructs of the UTAUT model were significant factors on the intent to practice teleneurology. RESULTS: The study yielded a 28.8% response rate. Among the respondents (n1 = 147), 95.2% (n2 = 140) practiced teleneurology during the pandemic, and 77.6% (n1 = 147) planned to continue it after the pandemic. Teleneurology was mostly done on an outpatient basis on social media platforms via videoconferencing due to easier access for both end-users. The UTAUT model explained 80.9% (95% CI 0.76, 0.86a) of the total variation. Performance expectancy and facilitating conditions affect the intent to use teleneurology. CONCLUSIONS: Due to the limited resources and knowledge of its practice, infrastructural support and benefit awareness campaigns would be beneficial to increase its adoption, especially in developing countries.

Wernicke-Korsakoff Syndrome in Hyperemesis Gravidarum: A Case Report and Literature Review.

BACKGROUND: Wernicke-Korsakoff syndrome (WKS) is a triad of ophthalmoplegia, ataxia and memory deficits due to thiamine insufficiency resulting from under- or untreated Wernicke's encephalopathy (WE), which may be associated with hyperemesis gravidarum (HEG). CASE PRESENTATION: We present a case of a 36-year-old Filipino woman in her first trimester with HEG, along with the WKS triad and abnormal hyperintense signals in the bilateral thalami and midbrain, left occipital lobe, periaqueductal gray matter and pontine periventricular areas. Neurologic deficits partially improved but persisted despite intravenous thiamine administration. EVIDENCE REVIEW: A review of current treatments for WE, and the prevention and neurocognitive recovery of WKS was done. The beneficial effects of thiamine for acute WKS are supported by several case reports and clinical experience. Evidence from one randomized controlled trial wherein thiamine was given in various doses for treating WE or preventing WKS in an alcohol-dependent population is limited by methodological issues. Rehabilitation and pharmacotherapy for neurocognitive recovery seems promising, but they have inadequate evidentiary support. More robust studies on multi-modal strategies are warranted to facilitate the neurocognitive recovery of patients with WKS.

Stroke Research Disparity in Southeast Asia: Socioeconomic Factors, Healthcare Delivery, and Stroke Disease Burden.

BACKGROUND: Cerebrovascular disease is the second leading cause of death worldwide and provides a heavy burden of disease in Southeast Asia (SEA). Contribution to the collective knowledge of this disease is necessary to address practice and treatment disparities. There is limited data on research productivity in the region. This study aimed to determine research productivity on stroke and other cerebral and spinal vascular diseases among the SEA countries and determine its relationship with bibliometrics, socioeconomic parameters, healthcare delivery indices, and burden of disease. METHODS: A comprehensive literature search was conducted using five major healthcare databases. We included studies published until June 2020 on cerebral and spinal vascular disease with at least one author from SEA. Country-specific socioeconomic parameters, the burden of disease, healthcare delivery indices, and the number of neurologists were collected from international databases and published data. Correlational analysis was done on bibliometric indices and collected data. RESULTS: A total of 2577 articles were included. Singapore had the most publications (n=1095, 42.5%) and citations (PlumX n=16,592, 55.2%; Scopus n=22,351, 56.7%). Gross domestic product per capita, percent gross domestic product for research and development, universal health care effective coverage index overall and for stroke treatment, and the number of neurologists had a positive correlation to bibliometric indices. CONCLUSIONS: There is a disparity in stroke research productivity among high-income and low-income countries in SEA. Priority must be given to scientific research output and its role in socioeconomic development and policy formulation.