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

Gerald T Pagaling,Roland Dominic G Jamora,Christian Wilson R Turalde

doi:10.3389/fneur.2022.788309

Abstract

ObjectivesWe 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.MethodologyWe 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.DiscussionThe 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.

Highlights

Autoimmune encephalitis (AE) is a non-infectious or para-infectious immune-mediated inflammatory disorder of the brain parenchyma, leptomeninges, and cerebral vessels commonly presenting with subacute onset alteration in mental status, memory deficits, or psychiatric symptoms accompanied by a variety of neurologic findings [1,2,3,4]
We excluded 161 articles that were not related to AE in the Philippines
The rapid advances of AE research in the past 10 years led to its ever-changing practice in terms of diagnosis and management [1]

Summary

Introduction

Autoimmune encephalitis (AE) is a non-infectious or para-infectious immune-mediated inflammatory disorder of the brain parenchyma, leptomeninges, and cerebral vessels commonly presenting with subacute onset alteration in mental status, memory deficits, or psychiatric symptoms accompanied by a variety of neurologic findings [1,2,3,4]. Neurologic findings can be a focal central nervous system lesion, seizures, cerebrospinal fluid (CSF) pleocytosis, magnetic resonance imaging (MRI) features such as hyperintense T2-weighted fluid-attenuated inversion recovery signals in medial temporal lobes and multifocal inflammatory demyelinating areas of the gray and/or white matter [1, 2]. The diagnosis of autoimmune encephalitis necessitates diagnostic tests such as cranial magnetic resonance imaging (MRI), electroencephalogram (EEG), and cerebrospinal (CSF) studies that are not accessible [1, 2]. The advances in the diagnosis and treatment of AE are usually available in high-income countries. No comprehensive report has been made on the treatment gaps and challenges in AE care in the Philippines. We aimed to identify and evaluate the treatment gaps in the management of AE in the Philippines through systematic literature search and review of relevant Philippine websites

Objectives

Methods

Conclusion