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Tiefenbach J, Yu JRT, Kondylis ED, Floden D, Baker KB, Fernandez HH, Machado AG. Loss of Efficacy in Ventral Intermediate Nucleus Stimulation for Essential Tremor. World Neurosurg 2024:S1878-8750(24)00430-3. [PMID: 38508382 DOI: 10.1016/j.wneu.2024.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The primary aim of this study is to report long-term outcomes associated with deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) performed at our institution. We further aimed to elicit the factors associated with loss of efficacy and to discuss the need for exploring and establishing reliable rescue targets. METHODS To study long-term outcomes, we performed a retrospective chart review and extracted tremor scores of 43 patients who underwent VIM DBS lead implantation for essential tremor at our center. We further evaluated factors that could influence outcomes over time, including demographics, body mass index, duration of follow-up, degree of parenchymal atrophy indexed by the global cortical atrophy scale, and third ventricular width. RESULTS In this cohort, tremor scores on the latest follow-up (median 52.7 months) were noted to be worse than initial postoperative scores in 56% of DBS leads. Furthermore, 14% of leads were associated with clinically significant loss of benefit. Factors including the length of time since the lead implantation, age at the time of surgery, sex, body mass index, preoperative atrophy, and third ventricular width were not predictive of long-term outcomes. CONCLUSIONS Our study identified a substantial subgroup of VIM-DBS patient who experienced a gradual decline in treatment efficacy over time. We propose that this phenomenon can be attributed primarily to habituation and disease progression. Furthermore, we discuss the need to establish reliable and effective rescue targets for this subpopulation of patients, with ventral-oralis complex and dentate nucleus emerging as potential candidates.
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Affiliation(s)
- Jakov Tiefenbach
- Department of Neuroscience, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Jeryl Ritzi T Yu
- St. Luke's Medical Center, Institute for Neurosciences, Quezon City, Philippines
| | - Efstathios D Kondylis
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Darlene Floden
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kenneth B Baker
- Department of Neuroscience, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hubert H Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Andre G Machado
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Yu JRT, Walker RH, Danek A, Westhoff C, Vege S, Itin I. Basal ganglia syndrome in a male with an XK gene variant but without XK disease (McLeod syndrome). J Mov Disord 2024:jmd.23196. [PMID: 38185097 DOI: 10.14802/jmd.23196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/05/2024] [Indexed: 01/09/2024] Open
Affiliation(s)
- Jeryl Ritzi T Yu
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City and Global City, Philippines
- University of the East, Ramon Magsaysay Memorial Medical Center, Philippines
| | - Ruth H Walker
- James J. Peters VA Medical Center, Bronx; Mount Sinai School of Medicine, New York, USA
| | - Adrian Danek
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | | | | | - Ilia Itin
- Center for Neurological Restoration, Cleveland Clinic, OH, USA
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Yu JRT, Sokola BS, Walter BL. Optimization of inpatient medication administration among persons with Parkinson's disease: recommendations on pharmacy technology and workflow. Front Pharmacol 2023; 14:1254757. [PMID: 38035015 PMCID: PMC10682362 DOI: 10.3389/fphar.2023.1254757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Abstract
Individuals with Parkinson's disease (PD) are vulnerable during hospitalizations due to the underlying complexities o1f symptoms, and acute illness or medication changes often lead to decompensation. Complications during hospitalizations are often due to worsening motor and nonmotor symptoms and commonly result from inaccurate medication regimens. Although the accuracy of medication administration relies on an interplay of factors, including patient status, transitions of care, coordination between the hospital prescriber and outpatient neurologist, etc., hospital pharmacists play an integral role in pharmacotherapy. The main aspects of pharmacy strategies aim to achieve timely administration of levodopa-containing medications, reduction of substitution and omissions of antiparkinsonian medications, and avoidance of antidopaminergic medications. This paper highlights critical areas for improvement and recommendations to minimize the impact of other factors from the pharmacy standpoint.
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Affiliation(s)
- Jeryl Ritzi T. Yu
- St. Luke’s Medical Center, Institute for Neurosciences, Quezon City, Philippines
- University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Brent S. Sokola
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, United States
| | - Benjamin L. Walter
- Center for Neurological Restoration, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
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Piccinin CC, Yu JRT, Brooks A, Clark P, Shaffer S, Sokola BS, Lewin K, Whitman JP, Sperling SA, Fernandez HH, Walter BL. Electronic health record tools as a potential resource for improving care among hospitalized people with Parkinson's disease. Parkinsonism Relat Disord 2023; 116:105896. [PMID: 37839911 DOI: 10.1016/j.parkreldis.2023.105896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Camila C Piccinin
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Jeryl Ritzi T Yu
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City and Global City, Philippines; University of the East Ramon Magsaysay Memorial Medical Center, 64 Aurora Boulevard, Quezon City, Philippines.
| | - Anne Brooks
- Parkinson's Foundation, 200 SE 1ST street, suite 800, Miami, FL, 33131, USA.
| | - Patricia Clark
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Shannon Shaffer
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Brent S Sokola
- Department of Pharmacy, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Kim Lewin
- Head and Neck Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44106, USA.
| | - John-Paul Whitman
- Center for General Neurology, Cleveland Clinic - Fairview Hospital, 18101 Lorain Ave, Cleveland, OH, 44111, USA.
| | - Scott A Sperling
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Hubert H Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Benjamin L Walter
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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Bhansali S, Assaedi E, Yu JRT, Mandava N, Sonneborn C, Hogue O, Walter BL, Samala RV, Margolius A. End of life care of hospitalized patients with Parkinson disease: a retrospective analysis and brief review. Front Aging Neurosci 2023; 15:1265156. [PMID: 37744391 PMCID: PMC10511646 DOI: 10.3389/fnagi.2023.1265156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Background Towards the end of life (EOL), persons with parkinsonism (PwP) have complex needs and can present with unique palliative care (PC) challenges. There are no widely accepted guidelines to aid neurologists, hospitalists, or PC clinicians in managing the symptoms of PwP at EOL. We examined a population of PwP at EOL, aiming to describe trends of in-hospital management and utilization of PC services. Methods All PwP admitted to two hospitals during 2018 (N = 727) were examined retrospectively, assessing those who died in hospital or were discharged with hospice (EOL group, N = 35) and comparing them to the main cohort. Their demographics, clinical data, engagement of multidisciplinary and palliative services, code status changes, invasive care, frequency of admissions, and medication administration were assessed. Results Among the EOL group, 8 expired in hospital, and 27 were discharged to hospice. Forty-six percent of EOL patients received a PC consultation during their admission. The median interval from admission to death was 37 days. Seventy-seven percent had a full code status on admission. Compared to hospice patients, those who expired in hospital had higher rates of invasive procedures and intensive care unit transfers (41% vs. 75%, in both variables), and lower rates of PC involvement (52% vs. 25%). The transition of code status change for the EOL group from Full code to Do Not Resuscitate (DNR) occurred at a median 4-5 days from admission. For patients that passed in the hospital, the median days from transition of code status to death was 0(IQR 0-1). Levodopa dose deviations were frequent in both EOL and non-EOL group, but contraindicated medications were infrequently administered (11% in EOL group vs. 9% in non-EOL group). Conclusion Our data suggest a low utilization of PC services and delayed discussions of goals of care. More work is needed to raise awareness of inpatient teams managing PwP regarding the unique but common challenges facing PwP with advanced disease. A brief narrative review summarizing the suggested management of symptoms common to hospitalized PwP near EOL is provided.
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Affiliation(s)
- Sakhi Bhansali
- Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Ekhlas Assaedi
- Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jeryl Ritzi T. Yu
- Institute for Neurosciences, St. Luke’s Medical Center, Quezon City, Philippines
- University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Nymisha Mandava
- Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Claire Sonneborn
- Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Olivia Hogue
- Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | | | - Renato V. Samala
- Department of Palliative and Supportive Care, Cleveland Clinic, Cleveland, OH, United States
| | - Adam Margolius
- Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
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Yu JRT, Sonneborn C, Hogue O, Ghosh D, Brooks A, Liao J, Fernandez HH, Shaffer S, Sperling SA, Walter BL. Establishing a framework for quality of inpatient care for Parkinson's disease: A study on inpatient medication administration. Parkinsonism Relat Disord 2023:105491. [PMID: 37495500 DOI: 10.1016/j.parkreldis.2023.105491] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND The complexity of antiparkinsonian medications makes patients vulnerable to medication deviations. This study examines the frequency and outcomes of deviations between outpatient and inpatient medication administrations in patients with Parkinson's disease (PD). METHODS We included hospital admissions of patients with PD during a 12-month period at the Cleveland Clinic Main and Fairview campuses. Outpatient regimens were compared with hospital medication administration records to establish rates of deviations in terms of levodopa equivalent daily dose (LEDD) difference, timing deviations/omissions of time-critical medications, substitution of levodopa compounds, and administration of antidopaminergic medications. Logistic regression analyses were used to investigate associations with length of stay (LOS), readmission rates, and mortality. RESULTS The study included 492 patients with 725 admissions. Of those on time-critical medications, 43% had a LEDD deviation and 19% had levodopa formulation substitutions. Of the admission days with known outpatient timing regimens, 47% had an average deviation of more than 30 min and 22% had at least one missed levodopa dose. LOS was longer with each additional day of over-dose (4%), under-dose (14%), missed dose (21%), timing deviation (15%) and substitution (19%), (all p < 0.0001). Administration of antidopaminergic medications (9.9% of admissions) was associated with increased 30-day readmission/death (OR 1.85, p = 0.041), 90-day mortality (OR 2.2, p = 0.018), and LOS (7.6 vs. 3.8 days, p < 0.0001). LEDD underdose was associated with 30-day readmission/death (OR 1.78, p = 0.025) and 90-day mortality (OR 1.14, CI 1.05-1.24, p = 0.002). CONCLUSIONS Deviations between outpatient and hospital regimens, and administration of antidopaminergic medications, were associated with poor outcomes.
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Affiliation(s)
- Jeryl Ritzi T Yu
- Center for Neurological Restoration, Department of Neurology, Neurological Institute, Cleveland Clinic, OH, United States; Institute for Neurosciences, St. Luke's Medical Center, Quezon City and Global City, Philippines; University of the East Ramon Magsaysay Memorial Medical Center, Philippines.
| | - Claire Sonneborn
- Center for Neurological Restoration, Department of Neurology, Neurological Institute, Cleveland Clinic, OH, United States; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, OH, United States.
| | - Olivia Hogue
- Center for Neurological Restoration, Department of Neurology, Neurological Institute, Cleveland Clinic, OH, United States; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, OH, United States.
| | - Debolina Ghosh
- Case Western Reserve University School of Medicine, Cleveland, OH, United States.
| | - Anne Brooks
- Parkinson's Foundation, Miami, FL, United States.
| | - James Liao
- Center for Neurological Restoration, Department of Neurology, Neurological Institute, Cleveland Clinic, OH, United States.
| | - Hubert H Fernandez
- Center for Neurological Restoration, Department of Neurology, Neurological Institute, Cleveland Clinic, OH, United States.
| | - Shannon Shaffer
- Center for Neurological Restoration, Department of Neurology, Neurological Institute, Cleveland Clinic, OH, United States.
| | - Scott A Sperling
- Center for Neurological Restoration, Department of Neurology, Neurological Institute, Cleveland Clinic, OH, United States.
| | - Benjamin L Walter
- Center for Neurological Restoration, Department of Neurology, Neurological Institute, Cleveland Clinic, OH, United States.
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Yu JRT, Shuaib U, Mate KKV, Kaur H, Sonneborn C, Hogue O, Morrison J, Yu XX. Identifying misconceptions and knowledge gaps in functional neurological disorders among emergency care providers. J Clin Neurosci 2023; 114:81-88. [PMID: 37329664 DOI: 10.1016/j.jocn.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Functional Neurologic Disorders (FND) are a common but heterogeneous group of disabling conditions. The Emergency Department (ED) is an important venue for care and referral as it is often the first point of contact when patients with FND are faced with a crisis or exacerbation of symptoms. METHODS ED providers (n = 273) practicing in the Cleveland Clinic Foundation Northeast Ohio network were invited to participate through secure web application electronic surveys. Data were collected on practice profiles, knowledge, attitudes, management of FND, and awareness of available resources for FND. RESULTS Sixty providers completed the survey (22% response rate; n = 50 ED physicians, 10 advanced care providers) with 95.0% (n = 57) reporting a lack of understanding about FND. The terms Psychogenic Nonepileptic Seizures and stress induced/stress related disease were used by 60.0% (n = 36) and 58.3% (n = 35) respectively. Ninety percent (n = 53) rated their experience with managing FND patients as at least more difficult. Eighty- five percent (n = 51) agreed with "rule out others" and 60% (n = 36) agreed with "caused by psych stress". Eighty six percent (n = 50) believe that there is a difference between FND from malingering. Only one respondent was familiar with any FND resources and 79% (n = 47) reported the need for FND specific educational materials. CONCLUSION This survey revealed major gaps in knowledge, inaccurate perceptions, and management that differs from the current standard of care among ED providers caring for patients with FND. Educational opportunities are needed to guide diagnosis and evidence-based treatment to optimize management of patients with FND.
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Affiliation(s)
- Jeryl Ritzi T Yu
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States
| | - Umar Shuaib
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States
| | - Kedar K V Mate
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Department of Musculoskeletal Oncology, Mayo Clinic, Arizona, United States
| | - Harpreet Kaur
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States
| | - Claire Sonneborn
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, OH, United States
| | - Olivia Hogue
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, OH, United States
| | - James Morrison
- Emergency Services Institute & Respiratory Institute, Cleveland Clinic, OH, United States
| | - Xin Xin Yu
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States.
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Caritativo ECA, Yu JRT, Bautista JMP, Nishioka K, Jamora RDG, Yalung PM, Ng AR, Hattori N. Genetic screening of Filipinos suspected with familial Parkinson's disease: A pilot study. Parkinsonism Relat Disord 2023; 108:105319. [PMID: 36774704 DOI: 10.1016/j.parkreldis.2023.105319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/27/2023] [Accepted: 02/05/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Although genetic factors are known to play a role in the pathogenesis of Parkinson's disease (PD), true prevalence of familial PD is unknown. We conducted this pilot study to identify genes implicated in familial Parkinson's disease among Filipinos. METHODS Eighteen Filipino patients belonging to 11 families with personal and family history of PD underwent thorough evaluation by movement disorders specialists. Samples were analyzed in Juntendo University, Tokyo, Japan. Sanger sequencing of polymerase chain reaction products was performed. Each sample was screened for 23 genes (SNCA, PARK 2, UCHL1, PINK 1, DJ-1, LRRK2, ATP13A2, GIGYF2, HTRA2, PLA266, FBX07, VPS35, EIF461, DNAJC13, CHCHD2, GCH1, MAPT, NR4A2, VPS13c, PSEN1, and GRN). RESULTS Out of 18 patients, six harbored Parkinson-related gene mutations. Five individuals from three families were positive for PINK1 c.10140T > C(p.L347P) mutation while one had heterozygous variant PRKN c.136G>T(p.A465) gene mutation. Three families displayed autosomal recessive pattern while one family with PINK1 mutation showed autosomal dominant mode of inheritance. Bradykinesia and tremor were predominant symptoms. Mean age at onset of symptoms was 40.4 years among those with PINK1 mutations. CONCLUSION In this study, we presented the clinical profiles and identified two genetic mutations among a small group of Filipino patients with familial PD. They were congruent with most studies showing these mutations as the most common causes of autosomal recessive early-onset PD. Preliminary data from this pilot study will guide planning for larger scale studies, such as collaborative projects including The Global Parkinson's Genetics Program (GP2).
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Affiliation(s)
| | - Jeryl Ritzi T Yu
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Global City, Philippines; Cleveland Clinic Center for Neurological Restoration, Neurological Institute, OH, USA
| | - Juan Miguel P Bautista
- Movement Disorders Service and Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Global City, Philippines.
| | - Kenya Nishioka
- Juntendo University School of Medicine, Department of Neurology, Tokyo, Japan
| | - Roland Dominic G Jamora
- Movement Disorders Service and Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Global City, Philippines; Department of Neurosciences, College of Medicine - Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Patrick M Yalung
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Global City, Philippines
| | - Arlene R Ng
- Movement Disorders Service and Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Global City, Philippines
| | - Nobutaka Hattori
- Juntendo University School of Medicine, Department of Neurology, Tokyo, Japan
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Yu JRT, Walter BL. Addressing critical care gaps in inpatient Parkinson's care - Minimizing the impact of comorbidities and developing new care delivery models. Parkinsonism Relat Disord 2022; 104:121-122. [PMID: 36335027 DOI: 10.1016/j.parkreldis.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jeryl Ritzi T Yu
- Center for Neurological Restoration, Department of Neurology, Neurological Institute, Cleveland Clinic, OH, United States
| | - Benjamin L Walter
- Center for Neurological Restoration, Department of Neurology, Neurological Institute, Cleveland Clinic, OH, United States.
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Yu JRT, Yu XX, Rajaram R, Fernandez HH, Siddiqui J. Burning mouth syndrome to oral cenesthopathy: A spectrum of neuropsychiatric and sensory complications in neurodegenerative parkinsonism? Parkinsonism Relat Disord 2022; 104:1-2. [PMID: 36182821 DOI: 10.1016/j.parkreldis.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/07/2022] [Accepted: 09/20/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Jeryl Ritzi T Yu
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States.
| | - Xin Xin Yu
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States
| | - Ryan Rajaram
- Department of Psychiatry, Cleveland Clinic, OH, United States
| | - Hubert H Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States
| | - Junaid Siddiqui
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States
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Yu JRT, Jamora RDG, Silverio EL, Bautista JMP, Luspian KJL, Tiongson RM, Ng AR. Spectrum of Movement Disorders in two Movement Disorders Centers in the Philippines. Acta Neurol Taiwan 2021; 30(3):94-101. [PMID: 34841504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Presently, there are no epidemiologic data on the prevalence of movement disorders in the Philippines. We aim to describe the most common phenomenologies and movement disorders in two specialty centers in Metro Manila dedicated to movement disorders. METHODS We investigated the clinical spectrum and etiologies of movement disorders referred to our centers from January 2007-December 2019 using a standardized collection form. RESULTS A total of 1438 patients presenting with complaints relating to movement disorders were evaluated between 2007 to 2019. There were 770 (53.5%) men. The mean age was 57.1 ± 17.9 years. The most common movement disorders were parkinsonism (n=677, 47.1%), myoclonus (n=212, 14.7%) and tremor (n=208, 14.5%). The least common was restless legs syndrome (n=4, 0.3%). There were 78 (37.7% of total dystonia cases) X-linked dystonia-parkinsonism patients referred to our clinic. Majority of the botulinum toxin injections were for hemifacial spasms (n=206). A small number of patients (n=41) were also seen at the center for deep brain stimulation programming. CONCLUSION The most common movement disorders managed were parkinsonism, myoclonus and tremor. The most common diagnoses were Parkinson's disease, hemifacial spasm and essential tremor. This study highlights the spectrum of movement disorders encountered in two specialty clinics in two Philippine tertiary hospitals. Given these varied cases, there is also a need for more movement specialists and centers dedicated to movement disorders to manage these cases.
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Affiliation(s)
- Jeryl Ritzi T Yu
- Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | - Roland Dominic G Jamora
- Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | - Estrela L Silverio
- Movement Disorders Service, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | - Juan Miguel P Bautista
- Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | - Kathleen Jaye L Luspian
- Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | - Rosemarie M Tiongson
- Movement Disorders Service, Institute for Neurosciences, St. Luke's Medical Center, Global City, Philippines
| | - Arlene R Ng
- Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
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Gutierrez SAS, Yu JRT, Yalung PM, Jamora RDG. Real-world experience with botulinum toxin A for the treatment of hemifacial spasm: A study of 1138 injections. Clin Neurol Neurosurg 2021; 205:106632. [PMID: 33865214 DOI: 10.1016/j.clineuro.2021.106632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/19/2021] [Accepted: 03/28/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hemifacial spasm (HFS) is a chronic, potentially disabling disorder that often requires long-term management with botulinum toxin (BoNT). In a country where healthcare costs limit compliance to medical follow-up and treatment, the study aims to provide a real-world experience on the use of BoNT for HFS among Filipinos. METHODS We retrospectively collected data from 162 HFS patients who received 1138 botulinum toxin (BoNT) injections from 2006 to 2019 in our movement disorders center in the Philippines. We described their clinical profile and treatment response. RESULTS The mean age at onset of disease was 47.7 ± 10.72 years. Majority of the patients reported a baseline moderate disease severity and disease frequency of >75% of waking time (59.8% and 46.9%, respectively). Most patients (61.73%) received 5 or less injections during the follow-up period. The mean duration of follow-up was 2.96 ± 4.28 years. The overall duration of treatment effect per injection was 3.6 ± 1.3 months while the mean interval between injections was 6 ± 5 months. There was no difference in the symptom improvement and duration between onabotulinumtoxinA and abobotulinumtoxinA. Side effects were infrequent. CONCLUSION This study supports existing evidence on the efficacy and safety of BoNT for the symptomatic relief of HFS. In the Philippines, long-term treatment with BoNT may be limited by the cost of the procedure as majority of our patients had a few injections with long treatment intervals.
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Affiliation(s)
- Samantha Anne S Gutierrez
- Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines.
| | - Jeryl Ritzi T Yu
- Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines.
| | - Patrick M Yalung
- Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines.
| | - Roland Dominic G Jamora
- Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines; Movement Disorders Service and Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines; Department of Neurosciences, College of Medicine - Philippine General Hospital, University of the Philippines Manila, Philippines; Movement Disorders Service and Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Global City, Philippines.
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13
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Co COC, Yu JRT, Macrohon-Valdez MC, Laxamana LC, De Guzman VPE, Berroya-Moreno RMM, Mariano MM, Rivera PPDP, Racpan-Cauntay JLM, Ilano KCS, Trias EC, Domingo AMC, Marcelo AVDB, Pineda-Franks MCC. Acute stroke care algorithm in a private tertiary hospital in the Philippines during the COVID-19 pandemic: A third world country experience. J Stroke Cerebrovasc Dis 2020; 29:105059. [PMID: 32807464 PMCID: PMC7305875 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Since the declaration of the Novel Coronavirus Disease (COVID-19) pandemic, ensuring the safety of our medical team while delivering timely management has been a challenge. Acute stroke patients continue to present to the emergency department and they may not have the usual symptoms of COVID-19 infection. Stroke team response and management must be done within the shortest possible time to minimize worsening of the functional outcome without compromising safety of the medical team. METHODS Infection control recommendations, emergency department protocols and stroke response pathways utilized prior to the COVID 19 pandemic within our institution were evaluated by our stroke team in collaboration with the multidisciplinary healthcare services. Challenges during the COVID-19 scenario were identified, from which a revised acute stroke care algorithm was formulated to adapt to this pandemic. RESULTS We formulated an algorithm that incorporates practices from internationally devised protocols while tailoring certain aspects to suit the available resources in our system locally. We highlighted the significance of the following: team role designation, coordination among different subspecialties and departments, proper use of personal protective equipment and resources, and telemedicine use during this pandemic. CONCLUSIONS This pandemic has shaped the stroke team's approach in the management of acute stroke patients. Our algorithm ensures proper resource management while optimizing acute stroke care during the COVID-19 pandemic in our local setting. This algorithm may be utilized and adapted for local practice and other third world countries who face similar constraints.
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Affiliation(s)
- Christian Oliver C Co
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines.
| | - Jeryl Ritzi T Yu
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines.
| | - Ma Cristina Macrohon-Valdez
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | - Lina C Laxamana
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | - Vincent Paul E De Guzman
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | | | - Manuel M Mariano
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | - Peter Paul Dela Paz Rivera
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | - Joana Lyn M Racpan-Cauntay
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines.
| | - Karen Czarina S Ilano
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines.
| | - Evita C Trias
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | - Alyssa Mae C Domingo
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines.
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14
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Laxamana LC, Co COC, Yu JRT, Mojica CV, Iboleon-Dy MAM, Domingo AMC, Ilano KCS, Macrohon-Valdez MCZ. Dabigatran Reversal With Idarucizumab Preceding Thrombolysis in an Octogenarian Patient with Chronic Kidney Disease and Acute Stroke: A Case Report. Clin Ther 2020; 42:1840-1845. [PMID: 32778345 DOI: 10.1016/j.clinthera.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/18/2020] [Accepted: 07/11/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Reversing the effect of dabigatran among patients with atrial fibrillation is important to normalize coagulation profile among patients who develop serious hemorrhage from any source. However, such intervention always has the potential to cause a prothrombotic state. Among patients suspected of ischemic stroke, Idarucizumab, may be administered preceding thrombolysis. This is a considerable option when given during the critical phase of revascularization. METHODS We report the case of an 84-year old, male, banker, known hypertensive with chronic renal disease. He has non valvular atrial fibrillation receiving Dabigatran at 75 mg twice daily and presented with symptoms of right-sided weakness, right hemisensory loss, facial asymmetry, and slurring of speech equating to National Institute of Health Stroke Scale (NIHSS) of 5. After coming into the hospital for a suspected stroke, 3 hours and 25 minutes after symptoms, complete reversal of Dabigatran with Idarucizumab was administered and intravenous thrombolysis was initiated 271 minutes post ictus. There was immediate improvement of the right upper extremity weakness and dysarthria 30 minutes post infusion. At 13 days post ictus, the patient was discharged with minimal right central facial palsy and right arm drift (NIHSS 2). Brain CT scan post revascularization did not reveal any hemorrhage and anticoagulant Apixaban 2.5 mg twice daily was started and maintained thereafter. Brain Magnetic Resonance Angiogram (MRA) showed complete recanalization of the left proximal MCA after 52 days. CONCLUSION Our case showed the effectiveness and safety of giving Idarucizumab followed by thrombolysis in Dabigatran-treated atrial fibrillation with ischemic stroke. Based on this case, the procedure can be performed in an elderly population with chronic kidney disease when administered close to the limit of threshold for thrombolysis.
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Affiliation(s)
- Lina C Laxamana
- Institute for Neurosciences, St. Luke's Medical Center- Global City, Manila, Philippines
| | - Christian Oliver C Co
- Institute for Neurosciences, St. Luke's Medical Center- Global City, Manila, Philippines.
| | - Jeryl Ritzi T Yu
- Institute for Neurosciences, St. Luke's Medical Center- Global City, Manila, Philippines
| | - Christianne V Mojica
- Institute for Neurosciences, St. Luke's Medical Center- Global City, Manila, Philippines
| | | | - Alyssa Mae C Domingo
- Institute for Neurosciences, St. Luke's Medical Center- Global City, Manila, Philippines
| | - Karen Czarina S Ilano
- Institute for Neurosciences, St. Luke's Medical Center- Global City, Manila, Philippines
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15
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Co COC, Yu JRT, Laxamana LC, David-Ona DIA. Intravenous Thrombolysis for Stroke in a COVID-19 Positive Filipino Patient, a Case Report. J Clin Neurosci 2020; 77:234-236. [PMID: 32414622 PMCID: PMC7211702 DOI: 10.1016/j.jocn.2020.05.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/01/2020] [Indexed: 01/15/2023]
Abstract
The 2019 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which was first reported in Wuhan, China last December 2019, has been declared an emergency by the World Health Organization but eventually progressed to become a Pandemic. To date, Coronavirus Disease 2019 (COVID-19) has affected at least 100,000 individuals worldwide, reaching thousands of mortalities (Zhou et al., 2020; World Health Organization, 2020). In the Philippines, the number of COVID-19 confirmed positive cases is over 636 and is expected to rise (Department of Health, 2020). Respiratory infections alongside their comorbidities can induce acute myocardial infarction and acute ischemic stroke (Warren-Gash et al., 2018) [3]. These may further bring challenges in the management and administration of Intravenous (IV) Alteplase in eligible patients. Currently, there are no case reports in the administration IV Altepase in ischemic stroke patients who are COVID-19 positive. We present a case of a 62-year old female who was admitted due to cough, colds and shortness of breath of 2 weeks duration and was tested to be COVD-19 positive. She suffered from an ischemic stroke while in the Medical Intensive Care Unit and was given Intravenous thrombolysis.
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Affiliation(s)
- Christian Oliver C Co
- Institute for Neurosciences, St. Lukes Medical Center - Global City, 5th Ave, Taguig, 1634 Manila, Philippines.
| | - Jeryl Ritzi T Yu
- Institute for Neurosciences, St. Lukes Medical Center - Global City, 5th Ave, Taguig, 1634 Manila, Philippines.
| | - Lina C Laxamana
- Institute for Neurosciences, St. Lukes Medical Center - Global City, 5th Ave, Taguig, 1634 Manila, Philippines.
| | - Deborah Ignacia A David-Ona
- Department of Internal Medicine, St. Lukes Medical Center - Global City, 5th Ave, Taguig, 1634 Manila, Philippines.
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