1.Time interval between first ever and recurrent stroke in a population hospitalized for second stroke: A retrospective study
Rong Zhu ; Ke Xu ; Jingpu Shi ; Qi Yan
Neurology Asia 2016;21(3):209-216
Objectives: The survivors of first-ever stroke are at a high risk of recurrent stroke. The time interval
between first-ever stroke and first recurrence of stroke, however, have not been well studied. The aim
of the present study was to evaluate the time interval between first-ever and first recurrence of stroke
and the risk factors of stroke that were related to the length of time interval. Methods: Patients admitted
in our hospitals during 2014 with first recurrence of stroke were included in the study. A total of 377
patients were enrolled and a standardized questionnaire was used to collect data in this retrospective
study. Results: The mean time interval among all the subjects was 58.42 months (median, 36.01 months;
range 0.16months to 455.98months). The mean time interval was shorter in hemorrhagic stroke group
(56.78 months) than in ischemic stroke group (58.75 months), but the difference was not significant
(p=0.819). The median of time interval was similar in the two groups. The associated risk factors to
the length of time interval were age over 60 years, subtype of first-ever stroke, the length of history
of hypertension. Age was the only associated risk factor to the time interval among patients with first
recurrence of hemorrhagic stroke.
Conclusion: Factors associated with the time interval are different among different types of recurrent
stroke. This provides the basis for preventive treatment for recurrent stroke after their first-ever stroke
Stroke
2.Ankle-brachial index as a predictor of one-year prognosis in ischemic stroke patients
Hyun Goo Kang ; In Sung Choo ; Bum Joon Kim ; Seong Hwan Ahn
Neurology Asia 2016;21(3):217-224
Objective: Peripheral arterial disease (PAD) reduces functional activity and increases the rate of
cardiovascular death in the elderly. Our study aimed to determine whether the presence of PAD in
stroke patients affected the progression of disability or death one year after discharge. Methods: From
April 2012 to March 2013, consecutive first stroke patients above 50 years of age without known PAD
were enrolled. PAD was defined as a low ankle-brachial index (less than 0.9) measured by an automatic
device. Clinical data associated with the stroke were collected from medical records. Disability in stroke
patients was evaluated with the modified Rankin scale (mRS) on discharge day and one year after the
index stroke. Progression of disability was defined as an increase in mRS more than one level at one
year. Results: Among the 526 patients, 238 had ischemic strokes and underwent ankle-brachial index
(ABI) measurement. Of them, 192 patients were included. In univariate analysis, age, dyslipidemia,
discharge mRS, low-density lipoprotein cholesterol, D-dimer, homocysteine, internal carotid artery
stenosis, posterior cerebral artery stenosis, and PAD were factors associated with worsening mRS.
After adjustment for these factors in the logistic regression analysis, PAD was an independent factor
associated with worsening mRS. In the analysis of one-year mortality, patients with PAD had a higher
death rate, but PAD was not an independent factor after adjusting for other variables.
Conclusions: The presence of PAD in stroke patients suggests a chance of disability progression, but
may not be a predictor of death after one year.
Atherosclerosis
;
Peripheral arterial disease
;
Stroke
3.Efficacy of repetitive transcranial magnetic stimulation on refractory epilepsy in Malaysia
Sherrini Bazir Ahmad ; Kheng Seang Lim ; Hui Ting Goh ; Chen Mun Wo ; SiewYong Low ; Chong Tin Tan
Neurology Asia 2016;21(3):225-233
Background & Objective: Modulation of cortical excitability by low frequency repetitive transcranial
magnetic stimulation (rTMS) has demonstrated therapeutic use in epilepsy. This study aimed to evaluate
the efficacy of low-frequency rTMS on refractory epilepsy in a group of Malaysian subjects. Methods:
Nine patients with refractory epilepsy completed the study. All patients received 10 sessions of 1Hz
rTMS (1000 pulses per session) at 90% of resting motor threshold. Outcome measures included seizure
frequency, Symptom Checklist-90 (SCL-90), Beck Depression Inventory II (BDI II) and Quality of
Life in Epilepsy-31 (QOLIE-31). Responders were defined as having ≥ 50% seizure reduction. Results:
The mean age was 33.8 years (SD 11.7), with 4 male. Three patients had mesial temporal sclerosis
(MTS); 4 with focal cortical dysplasia (FCD) and two lesion-negative. Three patients achieved >50%
seizure reduction at 8 weeks post-treatment, with 2 of them had improvement in the number of IED.
All of the responders had FCD. The responders were younger (mean 24.7 vs. 38.3 years old), had
shorter duration of illness (mean 15.7 vs. 30.5 years) and had less frequent seizure frequency prior to
treatment (mean 5.5 vs. 10.8 attacks per week), as compared to the non-responders. Six patients had
improvement in BDI-II scores, two in QOLIE-31 and four in SCL-90 post treatment, irrespective of
seizure control. The mean scores in BDI-II improved significantly with treatment (p<0.01).
Conclusion: rTMS is a potentially promising treatment for epilepsy, esp
Transcranial Magnetic Stimulation
;
Epilepsy
4.Validity and reliability of the Chinese parent proxy and child self-report health related quality of life measure for children with epilepsy (CHEQOL-25) in Malaysia
Su Woan Wo ; Pauline Siew Mei Lai ; Lai Choo Ong ; Wah Yun Low ; Kheng Seang Lim ; Chee Geap Tay ; Chee Piau Wong ; Ranjini Sivanesom
Neurology Asia 2016;21(3):235-245
Objective: To determine the validity and reliability of the Chinese parent proxy and child self-report
health related quality of life measure for children with epilepsy (CHEQOL-25) in Malaysia. Methods:
Face and content validity of the Chinese parent proxy and child self-report CHEQOL-25 was verified
by an expert panel, and piloted in five children with epilepsy (CWE). The Chinese CHEQOL-25 was
then administered to 40 parent proxies and their CWE (aged 8-18 years), from two tertiary hospitals,
at baseline and 2 weeks later. Results: Forty parents and their CWE were recruited. Cronbach’s alpha
for each subscale ranged from 0.56-0.83. At test-retest, the interclass correlation for all items ranged
from 0.68-0.97. Items 8 and 25 were removed as their corrected item-total correlation values were
<0.3. Epilepsy severity, the number of anti-epileptic drugs taken daily, number of close friends and
number of time spent with friends were found to be associated with the parent proxy CHEQOL-25
score. Duration of epilepsy, child’s cognitive ability, number of close friends and number of time spent
with friends were associated with child self-report CHEQOL-25. The parent proxy and the child selfreport
showed high to fair agreement on the “interpersonal/social” [Intraclass correlation coefficient
(ICC)=0.670, p<0.001] and “epilepsy secrecy” subscale (ICC=0.417, p=0.048).
Conclusions: Our small study found that the Chinese CHEQOL-25 was a valid and reliable questionnaire
to assess the quality of life of children with epilepsy from the parent prospective and child self-report
when items 8 and 25 were removed.
Epilepsy
5.Hypometabolism based on a cutoff point on the mini-mental state examination in Parkinson’s disease
Eun Joo Chung ; Yong Hee Han ; Chi WoongMun ; Sang Kyun Bae ; Seok Mo Lee ; Hae Woong Jeong MD, Sang Jin Kim
Neurology Asia 2016;21(3):247-253
Objective: The aim of the present study was to evaluate cortical hypometabolism of the F-18-
fluorodeoxyglucose positron emission tomography (FDG-PET) based on a diagnostic cutoff point of
the mini-mental state examination (MMSE) in de novo PD.Methods: We recruited 24 PD patients and
15 healthy controls to analyze FDG-PET. We divided the patients into two groups by the diagnostic
cutoff point of MMSE for diagnosing dementia, with scores of>25 vs. < 25. FDG-PET was processed
using statistical parametric mapping (SPM) 8 running on Matlab 11. Results: Patients with a MMSE <
25 presented lower score in time orientation, serial sevens, language and pentagon copying of MMSE
compared to patients with a MMSE >25. Compared to healthy controls, patients with a MMSE> 25
and < 25 showed a fronto-temporo-parietal hypometabolism, which was more extended in patients
with a MMSE < 25. Difference in cortical hypometabolism between patients with a MMSE >25 and
< 25 was found in the right inferior parietal lobule.
Conclusions: In the comparison by cutoff point of MMSE (25/24), hypometabolism in the right
inferior parietal lobule suggests that the posterior cortical deficit is the main region ofde novo PD
with cognitive impairment. Hypometabolism of right inferior parietal lobule is related to the damage
of cerebral networkin de novo PD.
Parkinson Disease
6.Effects of age, sex, and body mass index on sudomotor and cardiovagal functions in a healthy Korean population
Heejeong Jeong ; Ki-Jong Park ; Heeyoung Kang ; Nack-Cheon Choi ; Oh-Young Kwon ; ByeongHoon Lim
Neurology Asia 2016;21(3):255-260
Background: Hypertension results from an impaired baroreceptor reflex and enhanced sympathetic
activity. The prevalence of hypertension differs among ethnicities and is more frequent in South Asians
than in Caucasians, suggesting that baseline autonomic nervous system functions and their regulation
may also differ among ethnic groups. In most studies, the reference values for clinical autonomic
function tests are obtained from heterogeneous ethnic populations, or ethnic factors are not considered
in the study design. Obtaining reference data in a homogenous ethnic group and comparing them within
various ethnic groups could be helpful to detect ethnic differences in autonomic functions. The aim of
this study was to identify normative reference values for standard autonomic reflex measurements in
a homogeneous Korean population. Methods: A total of 181 healthy Korean volunteers (age, 20–74
years) underwent standard autonomic function tests: heart rate difference during deep breathing,
Valsalva maneuver, and the quantitative sudomotor axon-reflex test. Mean and 5th and 95th percentile
values were obtained for each age group. We also analyzed factors (age, sex, and body mass index)
that can influence autonomic functions. Results: The heart rate difference during deep breathing and
expiratory-inspiratory ratio were higher in males than in females and were inversely related to age.
The Valsalva ratio was inversely related to age. Males had higher sweat volumes at all body areas
evaluated than those of females, and only forearm sweat volume was significantly different between
the age groups.
Conclusions: Cardiovagal function was affected by age and sex in Koreans. Sudomotor function was
affected by sex, and only forearm sweat volume was affected by age and sex. These results represent
preliminary normative clinical autonomic data in a Korean population comprised of a single ethnicity
Hypertension
7.Sarcocystis nesbitti related autoimmune diffuse alopecia
Chin Chwen Ch’ng ; Su-Ming Wong ; Chong Tin Tan
Neurology Asia 2016;21(3):261-264
Background & Objective: Symptomatic sarcocystosis has been said to be rare until recent years, when
there were reports of outbreaks of febrile myositis for travellers returning from the Malaysian island
resorts. In 2012, an outbreak of Sarcocystis nesbitti infection involving 92 college students and staff
occurred after returning from Pangkor Island, Malaysia. A few months after recovering from the
febrile illness, some patients complained of hair loss. This study aimed to determine the prevalence,
clinical features and outcome of this disorder. Methods: All patients who became sick in the outbreak
were asked whether they had the hair loss. For those who had, they were interviewed with standard
questionnaires, examined and investigated. Patients were followed-up via an online survey 2 years
later. Results: Out of 89 patients who were ill, 19 patients (21.4%) complained of alopecia. The mean
peak onset was 4 months after the initial illness. Eleven patients (57.9%) reported the hair fall of more
than 100 per day. The other symptoms were itch 10 (52.6%), scaling 10 (52.6%), erythema 4 (21.1%),
none had scarring. Eleven patients (57.8%) had positive antinuclear factor with high titre (speckled or
nucleolar pattern). Two years after the event, 10 had complete or near complete spontaneous recovery,
1 had partial response and 1 had no improvement.
Conclusions: A delayed transient diffuse alopecia is seen in close to half of patients with Sarcocystis
nesbittiinfection. This high frequency of positive ANF suggested an immune-mediated mechanism.
Sarcocystosis
8.Sleep quality and psychosocial correlates among elderly attendees of an urban primary care centre in Malaysia
Rosdinom Razali ; Julianita Ariffin ; Aznida Firzah Abdul Aziz ; Sharifah Ezat Wan Puteh ; Suzaily Wahab ; Tuti Iryani Mohd Daud
Neurology Asia 2016;21(3):265-273
Sleep quality can vary in relation to one’s general well-being and in the elderly, it is often affected
by the presence of medical or psychological conditions. This study aims to determine the frequency
of different components of sleep quality in the elderly, and their relationships with psychosocial
and medical attributes. A cross-sectional study was conducted on 123 attendees aged 60 years and
above at Pusat Perubatan Primer Universiti Kebangsaan Malaysia. Sleep quality and psychological
distress were assessed using the validated Malay versions of Pittsburgh sleep quality index (PSQI) and
Hamilton anxiety depression scale (HADS) respectively. Information on medical comorbidities and
medications were obtained from the participants, their doctors and medical notes. Almost half of the
patients experienced poor sleep quality (47.2%) which was significantly associated with older mean age
(69.5 ±4.55). There was no statistical significance between sleep quality and other sociodemographic
characteristics (gender, ethnicity and living arrangement). Most patients described their sleep quality
as subjectively generally “fairly good” (69.1%) despite PSQI scores indicating poor sleep quality. A
majority of the patients (59.3%) were on follow-up for 3 or more medical illnesses, with heart disease
as the only medical comorbidity significantly associated with poor sleep quality. Most of them also
complained of only “mild difficulty” with their sleep. Among the 7 sleep components of PSQI, “sleep
disturbance” was the most frequent experience. Most experienced mild sleep disturbance (87.8%)
and usage of hypnotic agents was low (6.5%). Only 23.6% of patients had significant psychological
distress (HADS scores ≥ 8), with positive correlation with sleep quality.
Sleep
;
Polysomnography
9.An occult cause of infantile spasms: Vitamin B12 deficiency. A case report and review of literature
Pinar Arican ; Nihal Olgac Dundar ; Dilek Cavusoglu ; Gizem Gungor ; Pinar Gencpinar
Neurology Asia 2016;21(3):275-278
Vitamin B12 deficiency in exclusively breastfed infants is an important problem in developing countries.
Vitamin B12 deficiency is associated with a wide spectrum of clinical manifestations. Few cases of
vitamin B12 deficiency have been reported as the cause of infantile spasms. We report the case of a
6-month-old boy diagnosed with infantile spasms associated with vitamin B12 deficiency caused by
nutritional inadequacy in the mother. He was observed to have head nods and flexor limbs spasms
which appeared in clusters. Psychomotor development was normal. The serum vitamin B12 level was
low and results of electroencephalography (EEG) indicated modified hypsarrhythmia. His symptoms
resolved after synthetic adrenocorticotropic hormone (ACTH) and vitamin B12 treatment. The EEG
was completely normal after the first month and sixth month of treatment. In addition to ACTH and
vitamin B12 treatment, following antiepileptic drug treatment was not initiated. During 21 months’
follow up he is seizure-free and his neurological development is age-appropriate.
This case of a 6 month-old infant with infantile spasms due to vitamin B12 deficiency seems to be
a striking because of only with vitamin B12 and ACTH treatment the patient became seizure-free.
Vitamin B12 deficiency may be a treatable cause of infantile spasms and should be considered in the
associated cause of infantile spasms especially if nutritional inadequacy in the mother.
Vitamin B 12 Deficiency
;
Infants
10.Central median nerve injury secondary to carpal tunnel steroid injection followed up with serial ultrasonography and electrophysiology
SJ Sebastin ; RS Yak ; EP Wilder-Smith
Neurology Asia 2016;21(3):279-280
Intra-neural injection is a rare but serious complication of carpal tunnel steroid injection. We present
a case of central median nerve injury following injection where nerve ultrasound identified the lesion
within the substance of the median nerve. Most needle injuries will respond to conservative treatment,
and can be conveniently assessed, monitored and potentially prevented by using ultrasound.