Stigma in epilepsy arises from the misconceptions and prejudices rooted in the patient’s culture and traditions. Upbringing also has an important impact on the quality of life of epilepsy patients. In Chinese tradition, the main purpose of life is to be a “gentleman” 君子, to fully express the true human nature. The essence of being a gentleman is “benevolence” and “virtue”. According to Zhuangzi’s concept of “virtue overcoming deformity” 德充符, virtue can prevail over physical deficiencies. Consistent with such a principle, a person with epilepsy should receive high honour if he can demonstrate the character of a “gentleman”. In - traditional Chinese culture, the sense of shame is the foundation of morality; “feeling shame” 知耻 and “being shameless” 无耻 are important moral concepts. A gentleman has a sense of shame, whereas a “petty person” 小人 is shameless. However, the ability to resist feeling inappropriate shame - “not feeling ashamed” 不耻 is also a trait of the gentleman. Thus, based on traditional Chinese philosophy, one should resist feeling ashamed for having epilepsy. Chinese culture emphasizes the importance of exerting vitality in the presence of adversity; people with epilepsy who do not feel ashamed of their deficiency is manifesting such a vitality. Traditional Chinese culture takes a positive attitude towards hardship and adversity, that it is essential for developing character and skills. Overcoming adversity requires responsibilities, the pre-requisite is personal freedom. Thus, allowing freedom and nurturing independence is consistent with traditional Chinese attitude to upbringing.

Background & Objective: The Indian data comparing the efficacy and safety outcomes of tenecteplase and alteplase in acute ischemic stroke is scarce. We aimed to compare the outcomes of two agents in an Indian population. Methods: TENVALT study was a single centre, retrospective study. Patients aged 18 years or older with acute ischemic stroke were included in this study if they presented within 3 hours of symptom onset and had a deficit with National Institute of Health Stroke Scale (NIHSS) score > 4, had a modified Rankin score (mRS) of 2 or less before the stroke onset and had no evidence of hemorrhage on non-contrast computed tomography of brain. A good functional recovery (mRS score of 0-2) at the end of three months was defined as the primary efficacy outcome. The development of symptomatic intracerebral hemorrhage was considered as the primary safety outcome. Results: A total of 120 patients (alteplase, n=65; tenecteplase, n=55) underwent stroke thrombolysis during this study. The mean age of the presentation in tenecteplase group was 66.6 years and in alteplase group was 62.5 years. Most of the study subjects were males in both the groups (tenecteplase, 78.2%; alteplase, 61.5%). Hypertension was the most common comorbidity in both the groups (tenecteplase, 67.3%; alteplase, 76.9%). Median mRS score at 3 months of follow up was 2 in tenecteplase and 1 in alteplase group; however, the difference between the total number of patients having good functional recovery (mRS 0-2) in the two groups was not statistically significant (tenecteplase 74.5 vs alteplase 87.7%, P=0.09). The total number of patients who had symptomatic intracranial hemorrhage was comparable between the two groups (tenecteplase, 5.5%; alteplase, 6.2%). Conclusion: Tenecteplase appears to be an efficacious alternative to alteplase for stroke thrombolysis and may be better suited to developing countries considering its low cost and ease of administration.

Recombinant tissue plasminogen activator (rt-PA) is the most effective treatment for acute ischemic stroke and the exclusion criteria of rt-PA has been revised to extend its application. However, in Taiwan, National Health Insurance (NHI) did not follow the latest international consensus due to safety concerns. The present study investigated whether extending the application of rt-PA in Taiwan was safe and effective. The medical records from the Shuang Ho hospital stroke registry between August 2009 and December 2016 were retrospectively reviewed. Post rt-PA intracranial hemorrhage (ICH) and modified Rankin Scale (mRS) score at 3-month after stroke were the primary and secondary outcomes, respectively. Differences were analyzed through Fisher’s exact test and Student’s t test. A p-value of <0.05 was considered statistically significant. Overall, there were 243 patients categorized into two groups: NHI exclusion criteria adherence (n = 160) and non-adherence (n = 83). There was no significant difference in the risk of post rt-PA ICH (12.50% in adherence group, 4.82% in non-adherence group, p=0.07). Among the non-adherence group, 10 patients breached the latest international exclusion criteria and none of them experienced post rt-PA ICH. However, among patients with moderately severe stroke, the odds of mRS < 2 at 3-month were significantly lower in non-adherence group. This study demonstrated that extending administration of rt-PA in Taiwan was safe but the functional outcome after moderate stroke was not as favorable as adherence group. Old age, long onset-to-treatment time and less efficacy of lower dose of rt-PA were the possible factors for the difference in outcome.

Post-stroke depression often seriously affects the prognosis and quality of life of patients and many clinical trials had shown that Chai Hu Shu Gan San (柴胡疏肝散) combined with selective serotonin reuptake inhibitors (SSRIs) had good efficacy and minor side effects. We aimed to conduct this metaanalysis to evaluate the efficacy and safety of Chai Hu Shu Gan San as an adjuvant drug for SSRI in treating post-stroke depression. We searched PubMed, EMBASE, Cochrane Library, Wanfang, China Biology Medicine disc (CBM), Chongqing VIP, and CNKI (China National Knowledge Infrastructure) from their date of foundation to December 15, 2018. Literature screening, data extraction and quality assessment were conducted by two authors independently. The data synthesis and analysis were performed by using Review Manager (RevMan) 5.3 software and sensitivity analysis was conducted to assess the robustness of the results. Finally, a total of 22 articles were included. The meta-analysis confirmed the advantages of the combination of SSRI and Chai Hu Shu Gan San, mainly from four aspects: the Hamilton Depression (HAMD) scale score (MD=3.66; 95% DI=2.33-4.98; p<0.001), the Modified Edinburgh Scandinavian Stroke Scale (MESSS) score (MD=4.87; 95% CI=2.32-7.43; p<0.001), the efficacy rate (OR=3.50; 95% CI =2.61-4.69; p<0.001) and the incidence of adverse reactions (OR=0.28; 95% CI=0.17-0.46; p<0.001). No significant publication bias was observed, and sensitivity analysis suggested a good stability of the results. According to the present evidence, we concluded that Chai Hu Shu Gan Sa

The Indian data comparing the efficacy and safety outcomes of tenecteplase and alteplase in acute ischemic stroke is scarce. We aimed to compare the outcomes of two agents in an Indian population. Methods: TENVALT study was a single centre, retrospective study. Patients aged 18 years or older with acute ischemic stroke were included in this study if they presented within 3 hours of symptom onset and had a deficit with National Institute of Health Stroke Scale (NIHSS) score > 4, had a modified Rankin score (mRS) of 2 or less before the stroke onset and had no evidence of hemorrhage on non-contrast computed tomography of brain. A good functional recovery (mRS score of 0-2) at the end of three months was defined as the primary efficacy outcome. The development of symptomatic intracerebral hemorrhage was considered as the primary safety outcome. Results: A total of 120 patients (alteplase, n=65; tenecteplase, n=55) underwent stroke thrombolysis during this study. The mean age of the presentation in tenecteplase group was 66.6 years and in alteplase group was 62.5 years. Most of the study subjects were males in both the groups (tenecteplase, 78.2%; alteplase, 61.5%). Hypertension was the most common comorbidity in both the groups (tenecteplase, 67.3%; alteplase, 76.9%). Median mRS score at 3 months of follow up was 2 in tenecteplase and 1 in alteplase group; however, the difference between the total number of patients having good functional recovery (mRS 0-2) in the two groups was not statistically significant (tenecteplase 74.5 vs alteplase 87.7%, P=0.09). The total number of patients who had symptomatic intracranial hemorrhage was comparable between the two groups (tenecteplase, 5.5%; alteplase, 6.2%).

Neurologic infections are related to chronic and life-long neurologic impairment. We aim to describe the outcomes of Filipino children with neurologic infections upon, and within one year from discharge. This data will be useful in developing programs for the prevention and improvement of outcomes in children with neurologic infections. Methods: This is a multicenter, cross-sectional, retrospective cohort study at six tertiary hospitals across the Philippines within four years (2007-2010). A standardized report form was used to collect clinical profile and outcome using inpatient and outpatient records. Neurologic outcome was classified and staged at 3-, 6-, 9- and 12-months postdischarge. Results: A total of 480 patients were included in the analysis (mean age 4.7 ± 5.3 y), most were bacterial in etiology (275 cases, or 57.3%). Severity of illness on admission (Stage 3, p <0.001) and etiologic agent (viral, p <0.001) were correlated with poor neurologic outcome on discharge. Of the 154 patients that had follow-up, 91 cases were observed to have neurologic deficits (severe, 50; moderate, 29; and mild 12). Twenty patients had improvement of neurologic impairment on subsequent follow-up. Motor deficits (64 cases), cognitive disorders (26 cases) and seizures (17 cases) are the most common neurologic sequela

Stooped posture, a forward trunk flexion, is a common clinical feature in patients with Parkinson’s disease (PD). However, the exact etiology and effects on gait and balance are not fully understood. In the present study we evaluated the effects of stooping on gait and balance using three-dimensional motion capture and clarified the relationship between the trunk angle and impaired motor function in patients with PD. Thirty-nine patients diagnosed with PD were enrolled in our study. All participants were asked to walk a 6-m tract at their preferred speed, gait parameters and trunk flexion angle were measured using a three-dimensional motion capture system. We analyzed the correlation between trunk angle and gait parameters including gait speed, length, and center of pressure distance for postural sway. Significantly negative correlations were observed between the trunk flexion angle and gait speed (r = -0.407, p = 0.010) and step length (r = -0.561, p < 0.001). Conversely, no correlation was found between trunk flexion angle and postural sway in static standing. We found that stooped posture destabilized gait pattern and did not affect postural sway in PD. Our result showed that stooped posture may not be a compensatory action for stabilizing gait and posture, but rather a symptom of PD.

Parkinson’s disease is a neurodegenerative disease characterized by motor and nonmotor symptoms. Skin manifestations may be seen in patients due to autonomic dysfunction or iatrogenic reasons. In this study, we aimed to identify various skin disorders and compare the skin sebum and moisture percent ages in patients with Parkinson’s disease with healthy controls. Methods: Forty patients with Parkinson’s disease and 40 healthy controls were included in the study. Dermatological history of the patients and dermatological examination were recorded. A portable pen-shaped LCD Display Digital Skin Moist Oil Analyzer (Reyoung-Beauty, Guangdong, China) was used to measure the sebum and the moisture in the skin. Results: In this study, the skin disorders consisted of acneiform and sebum related changes, seborrheic dermatitis, anterolateral leg alopecia, and angular cheilitis, bullous pemphigoid and melanoma. Increased sweating and seborrhea were frequent complaints. While skin sebum content was significantly higher in patients compared to the control group, skin moisture did not differ significantly between the groups. Cutaneous malignancy or iatrogenic skin disorders were not detected in any patient.

DYT1 and DYT6 dystonias are the two most common genetic primary dystonias. However, they are rare in the Asian population and have never been reported in Thailand. DYT6 dystonia typically presents with craniosegmental dystonia with speech involvement, whereas DYT1 dystonia typically presents with lower limb dystonia, which tends to become generalized over time. Methods: Blood samples were collected from 14 patients with primary dystonia evaluated in five tertiary hospitals in Thailand. Genotyping of the TOR1A and THAP1 gene was performed. Results: Two patients were found to have a missense mutation, p.M143V (c.427A>G), in exon 3 of the THAP1 gene confirming the diagnosis of DYT6 dystonia. One patient was a woman who developed blepharospasm and lower cranial dystonia at the age of 38 years. Her dystonia spread to the neck and arm six months later. The other patient developed focal hand dystonia at the age of 34 years. The TOR1A mutation was not identified in any of these 14 patients.

This is the report of an anterior communicating artery aneurysmal coil as the likely source of septic emboli resulting in bilateral hemispheric abscesses sparing the medial frontal, parietal and occipital lobes and brainstem. Cessation of antegrade anterior cerebral artery flow and resulting turbulent flow into the distal cortical arterial watershed of middle cerebral artery territory bilaterally is the probable mechanism for this unusual pattern.