1.Differences in epilepsy and seizures between Asia and the West
Neurology Asia 2007;12(1):59-60
There are some biological differences in epilepsy between the Asia and the West, mainly related to the
young average age and the smaller physique among Asians. The climatic differences partly account
for the higher prevalence of Japanese encephalitis and malaria, which remains important causes of
acute symptomatic seizures in parts of Asia. By comparison, psychosocial, cultural, economic, political
and organizational factors are much more important in influencing epilepsy causation, management
and outcome in the region. With limited resources, the later should be given priority in research to
improve epilepsy care in Asia.
2.Training and certification of neurologists in South East Asia.
Shih-Hui Lim ; Chong-Tin Tan *
Neurology Asia 2007;12(1):47-52
South East Asia has 8% of world population, but only has 2% of the total number of neurologists in the world. Seven of the 11 countries in South East Asia have training programmes in Neurology. Brunei, Laos, Malaysia, Myanmar and Singapore require prior training and certification in Internal Medicine before admission to training to Neurology. Most training programmes are 3 years in duration, inclusive of mandatory rotation to clinical neurophysiology. Assessment and certification processes are vigorous in most countries. Mature age, lack of funding, inadequate direct clinical responsibilities, and poor literacy in English are other issues in some of the countries. There is need to improve the quality as well as quantity in the training of neurologists in the region.
Training
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Asia, Southeastern
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Training Programs
3.Nipah Encephalitis – An Update
Sherrini Bazir Ahmad ; Chong Tin Tan
The Medical Journal of Malaysia 2014;69(Supplement A):103-111
Between September 1998 to May 1999, Malaysia and
Singapore were hit by an outbreak of fatal encephalitis caused
by a novel virus from the paramyxovirus family. This virus was
subsequently named as Nipah virus, after the Sungei Nipah
village in Negeri Sembilan, where the virus was first isolated.
The means of transmission was thought to be from bats-topigs
and subsequently pigs-to-human. Since 2001, almost
yearly outbreak of Nipah encephalitis has been reported from
Bangladesh and West Bengal, India. These outbreaks were
characterized by direct bats-to-human, and human-to-human
spread of infection. Nipah virus shares many similar
characteristics to Hendra virus, first isolated in an outbreak of
respiratory illness involving horses in Australia in 1994.
Because of their homology, a new genus called Henipavirus
(Hendra + Nipah) was introduced. Henipavirus infection is a
human disease manifesting most often as acute encephalitis
(which may be relapsing or late-onset) or pneumonia, with a
high mortality rate. Pteropus bats act as reservoir for the virus,
which subsequently lead to human spread. Transmission may
be from consumption of food contaminated by bats secretion,
contact with infected animals, or human-to-human spread.
With wide geographical distribution of Pteropus bats,
Henipavirus infection has become an important emerging
human infection with worldwide implication.
4.Diffusion and Perfusion MRI in Acute Cerebral Ischemia
Tchoyoson CC Lim ; Chong-Tin Tan
International Journal of Cerebrovascular Diseases 2001;9(2):67-69
Reeent advances in magnetic resonance imaging (MRI), in particular diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI), have allowed clinicians to have the ability to differentiate between irreversible cerebral infarction and the potentially reversible ischemic penumbra. This article examines the principles and practice of DWI and PWI. With continued advances in thrombolysis and other therapy for acute cerebral ischemia, neuroimaging is poised to play an increasingly important role in decisionmaking in aeute stroke.
5.Epilepsy stigma in Asia: the meaning and impact of stigma
Kheng-Seang Lim ; Chong-Tin Tan
Neurology Asia 2014;19(1):1-10
Stigma is conceptually broad and culturally variable. Understanding stigma from the conceptual
theories, culturally application based on the word stigma in other languages, the definition of stigma
and its synonyms, as well as the medical implications in other stigmatized disease such as AIDS,
will help us to understand the complexity of stigma in epilepsy. This review investigated the meaning
and types of stigma from different perspectives, leading to staging stigma into 5 levels, i.e. social
identity, stereotype, prejudice, discrimination and social disability. In addition to the conventional
categorization of stigma into social, felt, self-perceived or internalized stigma, new categories of
stigma i.e. personal and general attitudes towards epilepsy based on a newly developed Public
Attitudes Toward Epilepsy (PATE) scale was introduced. Courtesy stigma was further elaborated in
related to Asian culture. Based on well-established and recently developed theories, the causation and
impact of epilepsy stigma was discussed in an Asian context, especially from the aspects of language
and society values which are culturally specific. Integrating these theories of causation, illness and
stereotype perceptions were proposed to be the mediating mechanism of stigma, which led to the
development of a practical and multi-dimensional stigmatization model, aiming to guide, widen and
deepen the scope of future stigma research in epilepsy. Using the established model, together with
review of related studies, research priorities in epilepsy stigma research especially in Asia focusing on
five aspects, i.e. expanding population studies especially on significant others, understanding stigma
from personal attitude perspective, investigating the cultural and social causation of stigma, and the
impacts of stigma on patients as well as the family members, were proposed.
6.Tolosa-Hunt syndrome following recurrent facial palsies
Nortina Shahrizaila ; Norlisah Ramli ; Chong Tin Tan
Neurology Asia 2010;15(1):97-99
Tolosa-Hunt syndrome is typically associated with an infl ammatory lesion in the cavernous sinus or orbital
fi ssure, often requiring steroids for symptom resolution. In this report, we describe a case of Tolosa-Hunt
syndrome preceded by several years’ history of idiopathic recurrent facial palsies. The spontaneous
resolution of THS in our case as well as prior facial nerve involvement supports the hypothesis that
Tolosa-Hunt syndrome is part of a spectrum of idiopathic recurrent cranial neuropathy.
7.Nipah virus and bats
Heng Thay Chong ; Suhailah Abdullah ; Chong Tin Tan
Neurology Asia 2009;14(1):73-76
Since the initial outbreak in Malaysia, small outbreaks of Nipah encephalitis have been reported almost
annually in Bangladesh. Epidemiological studies have shown that the virus could be transmitted from
bat to human and from human to human. Wildlife studies have also shown that the virus was widely
distributed in at least 10 genera and 23 species of bats in a large part of Asia and Africa – a region
that stretches from Australia and southern China, and from Indonesia to as far west as Ghana, a region
with a total population of more than 1.4 billion people. As bats are long distant flying, gregarious
animals living in large colonies which could exchange novel viruses from one species to another, it
is not unexpected that the seroprevalence of Henipavirus among bat colonies are relatively high. The
widespread distribution of both the Henipavirus and its hosts also means that the virus will remain
an important cause of zoonotic disease.
8.Differences in epidemiologic and clinical features of Nipah virus encephalitis between the Malaysian and Bangladesh outbreaks
Heng Thay Chong ; M Jahangir Hossain ; Chong Tin Tan
Neurology Asia 2008;13(1):23-26
Since the initial outbreak of Nipah encephalitis in Malaysia in 1998, the virus has reemerged in
Bangladesh and the adjacent Indian state of West Bengal since 2001. To date more than 470 patients
have been affected with over 250 fatalities in total. Although the source of the virus is believed to be
the Pteropus fruit bats both in Malaysia and Bangladesh, there are also significant epidemiological
and clinical differences in the outbreaks occurring in these two regions. Epidemiologically, in the
Bangladesh and India outbreaks, bat-to-human transmission through food and animal and human-tohuman
transmissions were the predominant modes, the outbreaks were on a smaller scale and they
have recurred every year except 2002 and 2006. Clinically, the mortality was higher and respiratory
manifestation was more prominent in the Bangladeshi and Indian patients compared with their
Malaysian counterparts, which might reflect differences in care and medical practices. There remain
however, important differences in clinical manifestations which are likely to be due to some genetic
variations in the virus.
9.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
10.Attitudes toward epilepsy, a systematic review
Kheng Seang Lim ; Chin Hwan Lim ; Chong Tin Tan
Neurology Asia 2011;16(4):269-280
Surveys about attitudes towards those with epilepsy have been performed since 1949, in order to
understand the social stigma toward epilepsy. This review aims to demonstrate the variation in public
attitudes towards epilepsy and its associated factors, with a critical review of the methodology used
to examine attitudes towards epilepsy. There was marked variation of attitudes between Western and
non-Western populations, and these attitudes were positively correlated with the standard of living.
Besides the general public, studies were also performed within specifi c groups, particularly teachers
and students. However absence of a standardized questionnaire makes direct comparison diffi cult. A
few quantitative methods were developed but these were limited by cultural variations and thus lack
of global acceptance. Short-term intervention studies demonstrate an improvement of attitude with
knowledge. Nonetheless, the cultural and social reasons underlying the attitudes, and how this affects
the life of people with epilepsy, are understudied. Therefore, surveys on attitudes should continue to be
carried out, particularly in populations prone to have negative attitudes with emphasis on underlying
reasons, and such progress should be monitored longitudinally. Attitudes of people such as parents,
teachers, school counselors, health care professionals, and employers, which have a direct impact on
people with epilepsy, should be more extensively studied.