1.High prevalence of diabetes in stroke patients and its association with lacunar infarction
Zhe Kang Law ; Wan Nur Nafisah ; Ramesh Sahathevan ; Jee Yong Hing ; Mohd Firdaus Zakaria ; Nurul Munirah Mohd Shuhari ; Nur Fathihah Ahmad ; Teong Kui Ting ; Hui Jan Tan ; Shahrul Azmin ; Rabani Remli ; Azmawati Mohammed Nawi ; Norlinah Mohamed Ibrahim
Neurology Asia 2015;20(2):121-127
Background & Objectives: The burden of stroke is increasing, in part due to increasing prevalence of
diabetes mellitus. Given the high prevalence of diabetes in the Malaysian population (22.6%), we aimed
to determine the prevalence of diabetes in our stroke population. We also aimed to study the stroke
subtype associated with diabetes. We hypothesized that lacunar infarction would be more prevalent
in diabetics. Methods: We retrospectively reviewed data of consecutive patients with acute ischaemic
stroke admitted from October 2004 to December 2010 from our stroke registry. Demographic data, risk
factors profile and stroke subtypes were reviewed and analyzed. Results: Eight hundred and fifty eight
patients were identified from the registry. As high as 59.3% (n=509) of our patients were diabetics,
of which 49.2% (n=422) had pre-existing diabetes and 10.1% (n=87) were newly diagnosed. Lacunar
infarction was the commonest stroke subtype, comprising 60.6% (n=519) of all strokes. Diabetes was
significantly associated with lacunar infarction (OR 1.5, CI 95% 1.16-2.01, p=0.003), particularly in
those aged ≤ 55 years (OR 2.29, 95% CI 1.12-4.67) and HbA1C ≥ 6.5% (χ²=8.77, p=0.003).
Conclusions: The prevalence of diabetes in our stroke patients is amongst the highest reported.
Diabetes mellitus, particularly those with poor glycaemic control is strongly associated with lacunar
infarction.
Diabetes Mellitus
;
Stroke
2.Validation study of the Malay version of the Myasthenia Gravis Quality of Life (MGQOL)15 and Myasthenia Gravis Activities of Daily Living (MGADL) questionnaires
Alif Adlan Mohd Thabit ; Nor Azman Rosli ; Hana Maizuliana Solehan ; Zahariah Pilus ; Maskanah Mohammad Lotfie ; Ramesh Sahathevan ; Norlinah Mohamed Ibrahim ; Hui Jan Tan ; Wan Nur Nafisah Wan Yahya ; Hazlina Mahadzir ; Shahrul Azmin Md Rani ; Zhe Kang Law ; Rabani Remli
Neurology Asia 2016;21(1):33-39
Myasthenia gravis (MG) is an immune mediated neuromuscular disease causing fatiguability, which can
influence quality of life (QOL). MG disease status can be established with Myasthenia Gravis Quality
of Life (MGQOL) 15 and Myasthenia Gravis Activities of Daily Living (MGADL) questionnaires to
measure patients’ perception of MG-related dysfunction. This study aims to validate the translated
Malay versions of the MGQOL15 and MGADL for use in Malay-speaking MG patients. By using
the cross cultural adaptation process, both questionnaires were translated into Malay language. Two
sets of MGQOL15 Malay version and MGADL Malay version were distributed to MG patients during
their routine follow-up to be filled up one week apart. A total of 38 patients were recruited during this
study comprising predominantly females compared to males (71% vs 29%) and Malays compared to
non-Malays (60% vs 40%). The mean age was 52.5 years; with most of the patients in the 60-69 years
old category (37%).The Spearman’s correlation coefficient was 0.987 for MGQOL-15 Malay version
and 0.976 for MGADL Malay version, while the internal consistency for MGQOL15 Malay version
was 0.952-0.957, and 0.677-0.694 for MGADL Malay version. The MGQOL15 Malay version and
MGADL Malay version are reliable and valid instruments for the measurement of quality of life in
MG patients in the local setting.
Myasthenia Gravis
;
Quality of Life
3.Impulse control behaviours in a Malaysian Parkinson’s disease population
Shahrul Azmin ; Eng Liang Tan ; Nik Jaafar Nik Ruzyanei ; Zakaria Hazli ; Azmawati Mohammed Nawi ; Zhe Kang Law ; Remli Rabani ; Wan Yahya Nafisah ; Ramesh Sahathevan ; Hui Jan Tan ; Nur Fadhlina M. Pakarul Razy ; Nor Azian Abdul Murad ; King-Hwa Ling ; Mohamed Ibrahim
Neurology Asia 2016;21(2):137-143
Background: Impulse control behaviours are repetitive and excessive activities that may be subsyndromal
and not fulfil the criteria for impulse control disorder. These activities have potential to
negatively impact on the daily lives of sufferers. We conducted a study to investigate the prevalence
of impulse control behaviours and its associated features in Parkinson’s disease in our population.
Methods: We conducted a prospective cross-sectional study on consecutive patients attending neurology
clinic. Inclusion criteria include idiopathic Parkinson’s disease patients with Hoehn & Yahr stage I-IV.
Eighty patients were enrolled and screened for impulse control behaviours using the Questionnaire
for Impulsive-Compulsive Disorder for Parkinson’s disease (QUIP). Results: Prevalence of impulse
control behaviours among our cohort was 11.3%; the features significantly associated with it were
higher level of education (p=0.02), advanced stage of disease (p=0.03) and higher levodopa dosage
(p= 0.01). The commonest impulse control behaviour in our cohort was compulsive medication use
(7.5%), followed by hobbyism (6.3%), hypersexuality (5%), compulsive buying (3.75%), punding
(2.5%), walkabout (2.5%), compulsive eating (1.25%) and pathological gambling (1.3%).
Conclusions: There is an association between impulse control behaviour and higher levodopa dosage
in a study on patients with Parkinson’s disease in Malaysia. We also found a low prevalence of
pathological gambling as compared to studies performed in the West.
Disruptive, Impulse Control, and Conduct Disorders
;
Parkinson Disease
4.A validation study of the Bahasa Malaysia version of the National Institute of Health Stroke Scale
Najma Kori ; Wan Asyraf Wan Zaidi ; Rabani Remli ; Azman Ali Raymond ; Norlinah Mohamed Ibrahim ; Hui Jan Tan ; Syed Zulkifli Syed Zakaria ; Zhe Kang Law ; Kartini Ahmad ; Wan Nafisah Wan Yahya ; Ramesh Sahathevan
Neurology Asia 2018;23(3):225-232
Background & Objectives: The National Institute of Health Stroke Scale (NIHSS) provides a valid
and quick assessment of stroke severity in hyperacute stroke management. Stroke patients who are
eligible for reperfusion therapy require prompt assessment. There is no validated Bahasa Malaysia
(BM) version of the NIHSS that allows easier assessment by BM-speaking health professionals.
This study aimed to translate and validate a BM version of the NIHSS. Methods: The English NIHSS
was translated to BM, then back translated to ensure linguistic accuracy. We also adapted the language
assessment of the NIHSS to be more culturally appropriate. Training and certification videos were
downloaded from the NIH website and dubbed into BM. We determined intra-class correlation and
unweighted kappa as the best measure of reliability. Median scores were used in the analysis for
language items. Results: One hundred and one raters participated in the test-retest reliability study.
Agreement between the original NIHSS and our translated version of the BM-NIHSS was good (ICC
= 0.738, 95% CI: 0.611 to 0.823). Fair to moderate agreement was found on item-by-item analysis
(unweighted κ=0.20-0.50) despite high observed agreement. Fifty patients participated in the language
assessment arm. Scores were better in BM for reading, naming objects and repetition (Mdn = 100, p
< 0.001). There was no difference in the median scores for the description component.
Conclusions: The BM-NIHSS is a valid translation of the NIHSS, and may be used in clinical practice
by BM-speaking healthcare professionals.
5.Incidence and risk factors of delirium in patients with acute ischaemic stroke
Boon Hau Ng ; Zhe Kang Law ; Rabani Remli ; Hui Jan Tan ; Norlinah Mohamed Ibrahim ; Azman Ali Raymond ; Wan Asyraf Wan Zaidi ; Syed Zulkifli Syed Zakaria ; Nafisah Wan Yahya ; Ramesh Sahathevan
Neurology Asia 2019;24(4):295-302
Background & Objectives: The reported incidence of post-stroke delirium varies substantially in current
medical literature. The impact of delirium on mortality and morbidity is significant and there is need
for sustained research on the topic. We aimed to determine the incidence, risk factors and outcome of
delirium in acute ischaemic stroke. Methods: We conducted a cross-sectional observational study on
consecutive patients with ischaemic stroke. The Confusion Assessment Method was used to diagnose
delirium within seven days of stroke onset. Results: Two hundred and eighty patients were recruited
(mean age 63.6 years) and 36 (12.9%) developed delirium. After adjustments for covariates, age >65
years (odds ratio, OR 5.2; 95% confidence interval 1.6-17.5); pre-existing dementia (6.5; 1.1-38.2);
TACI (7.2; 1.5-35); and a National Institute of Health Stroke Scale of ≥10 (6.8; 1.7-26.4), were
independently associated with a risk of developing delirium. Lacunar infarcts were not associated with
delirium (0.07; 0.03-0.16). The majority of patients with delirium were cared for in a dedicated stroke
unit but this proportion was not significant compared to those without delirium (69.4% vs 58.2%,
p=0.20). Delirious patients had significantly higher in-patient mortality (8.3% vs 0%, p=0.002) and
longer length of hospital stay (6.94 vs 3.98 days, p< 0.001).
Conclusions: One in 8 patients with ischaemic stroke in our centre developed delirium. Older age,
pre-existing dementia and severe stroke were independent predictors of delirium. Patients with lacunar
infarcts did not develop delirium as often as those with other stroke types. Delirium significantly
increased in-patient mortality and length of hospital stay.