Our study aimed to determine the effects of new-onset neurological symptoms (NNS) on clinically relevant outcomes in hospitalized patients with COVID-19 infection. We conducted a nationwide, comparative, retrospective, cohort study among adult, hospitalized COVID-19 patients involving 37 hospital sites from various regions in the Philippines. We included a total of 10,881 patients with confirmed COVID-19 infection (2008 had NNS while 8873 did not have NNS). 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). The presence of NNS significantly increases the risk of mortality, respiratory failure and ICU admission among COVID-19 patients. Registration and associated protocol publication: ClinicalTrials.gov website (NCT04386083); Espiritu AI, Sy MCC, Anlacan VMM, Jamora RDG. The Philippine COVID-19 Outcomes: a Retrospective study Of Neurological manifestations and Associated symptoms (The Philippine CORONA study): a protocol study. BMJ Open. 2020;10:e040944.

BACKGROUND AND PURPOSE: The coronavirus 2019 (COVID-19) pandemic has been continuing its global spread ever since it’s onset and efforts to curb the infection in multiple reports have contrasting effects on stroke severity, admissions and outcomes. In the Philippines, where the COVID-19 pandemic shows no signs of slowing down and has been in the world’s longest lockdown, we investigated the effect of the pandemic in the stroke admissions and outcomes in one of the largest tertiary hospitals in the Philippines. METHODS: This is a retrospective, comparative study of all adult stroke patients admitted between Pre-COVID (February 2019-January 2020) and COVID period (February 2020-January 2021). The differences of stroke types, severity, classification, and discharge outcomes between pre-COVID and during COVID was analyzed in the study. RESULTS: There is a decrease in total number of stroke admissions from 597 in the pre-COVID period to 487 during the pandemic. Stroke patients take significantly longer time to seek hospital consultation from onset of stroke symptoms and significantly higher proportion of patients have moderate and severe stroke. The discharge outcome showed significantly higher proportions of dependency upon discharge (13%) and higher proportion of death in stroke patients from 7% pre-COVID19 pandemic to 13% during the pandemic. CONCLUSIONS: There was reduction in total stroke admissions, mild and transient stroke during the pandemic. There was significantly higher proportion of stroke patients having moderate and severe stroke. The discharge outcome of stroke patients is functionally poorer during the pandemic and more stroke patients have died compared to before COVID-19 pandemic. keywords: Stroke, Philippines, COVID-19, acute stroke

Objective To determine the current availability of care for headaches, in particular migraine in the Asian Oceanian region. Method A questionnaire-based, cross-sectional study from August 2020 to February 2021, surveyed country representatives from the member countries of the Asian Oceanian Association of Neurology. The items of the survey were influenced by the findings and recommendations of the 2011 Atlas of Headache by Lifting the Burden and the World Health Organization. Results Respondents from all of the 21 member countries of the Asian Oceanian Association of Neurology and 3 other Asian countries participated in this survey. All countries have an established neurological association except for Brunei where there are only 6 neurologists. Thirteen countries (54%) have a dedicated council for headaches. The majority have no subspecialty training program for headaches (75%). Prevalence studies are available in 14 countries while 10 out of the 24 have clinical practice guidelines. Among the 6 countries who offer subspecialty training for headache, only 3 countries cater foreign neurologists. Most of the countries have a wide selection of non-specific migraine drugs. All countries except for Mongolia have at least 1 triptan but non-oral forms for triptans are only available in 8 countries. Monoclonal antibody for migraine prophylaxis is available in 12 out of 24 countries (50%). The majority of respondents agree that migraine is under-diagnosed and under-treated by non-neurologists and that more time should be allotted for lectures dedicated to primary headaches in medical schools. Conclusion The survey showed the scarcity of clinical guidelines, subspecialty training, dedicated headache clinics, and patient advocacy organization for the care of headache patients in the participating countries. Acute and prophylactic medications approved for migraine are available in most countries but approved non-pharmacologic devices are lacking. The recommendations in the 2011 Atlas of Headache Disorders are still to be achieved.

Objectives: We aimed to describe the current preferences of Filipino neurologists in the diagnosis and management of migraine. Methods: This is an observational descriptive study using a web-based survey done from November 2019 to June 2020 among certified locally practicing neurologists belonging to the Philippine Neurological Association. Results: A total of 259 (56.67%) from the 2018 roster of 457 neurologists participated in the survey. The prevalence of migraine in the respondents was 49.81% with a F:M ratio of 3.3:1. The majority (78%) based their diagnosis on established international criteria for migraine. Many (77%) would request neuroimaging for their patients with a history of more than 3 years of recurrent severe migraine. The most preferred class of drugs for acute migraine was NSAIDs (48.26%). One-third of respondents would give anti-nausea medications for moderate to severe attacks of migraine. About half would not consider using triptans for their patients with moderate to severe episodic migraine attacks. The top three drugs used for migraine prophylaxis were topiramate (80.69%) followed by flunarizine (73.36%) and propranolol (49.03%). Among patients with two or more headaches per week, 74.13% would prescribe prophylactic drugs. The use of a headache diary and the Migraine Disability Assessment Scale (MIDAS) was advised by 62.16% and 14.67% of respondents respectively, while cautioning about medication overuse headache was done by 68.34%. Conclusions: We have described the preferred practice of Filipino neurologists in diagnosing and treating migraine patients with locally available resources. The use of measurement tools (specifically MIDAS scoring to assess migraine disability), triptans, and anti-nausea drugs are not popular practices among Filipino neurologists The survey shows the need to promote the use of prophylactic drugs, counselling for medication overuse and more teaching about primary headaches in medical school.

Background Months after the initial report of an unknown cause of pneumonia outbreak in Wuhan, China, the SARS-COV-2 continues its rampant spread globally. This novel corona virus has been known to cause severe respiratory illness. It is important to be wary of the complications that would soon present at the Out-patient centers after being cured from the infection. Case This is a case of a 59-year-old, female who came in at the Out-Patient Clinic with progressive bilateral pins and needles sensation of the feet after recovering from COVID-19 infection followed by a sensory level on T7-T10. Case Report Here we present a case of transverse myelitis as a complication of COVID-19 infection, the first to have occurred after recovery from the virus. With the success of treatments and recoveries, possible post infectious sequelae could be the next wave that could come into the present picture of the pandemic. Conclusion Post infectious transverse myelitis after recovering from COVID is a possibility and that documentation of such cases and other complications must be reported.