An epileptic seizure can be induced by higher brain function or mental processes associated with emotion. The precipitation involves verbal, non-verbal and specific thinking with emotion. Some of these patients have symptomatic and focal epilepsies. Others were idiopathic epilepsies, where the hyperexcitable regions and systems provoked by some specific stimuli may produce epileptic seizures that results in symmetrical, asymmetrical, or even localized clinical manifestations. The understanding of precipitation of seizures by higher brain function may contribute to understanding of epileptogenesis and nosology of epilepsies.
brain function ; Seizures ; Comprehension ; Precipitation ; Epilepsy

Vasospasm has been known to cause permanent morbidity in 40-70% of survivors who suffered from subarachnoid hemorrhage (SAH). Early recognition of vasospasm is the key to better outcome of SAH. Cerebral angiography is expensive and impractical as a monitoring tool. Transcranial Doppler is operator dependent, and not readily available. The objective of this study is to devise a non invasive tool to screen for cerebral vasospasm following SAH. The proposed vasospasm score was based on clinical and cranial CT scan features. The features are hypertension, admission World Federation of Neurosurgeons Score (WFNS), amount of blood in the cisterns and subarachnoid space, intraventricular hemorrhage and hydrocephalus. Thirty six patients with aneurismal SAH were assessed retrospectively and correlated with the angiogram for vasospasm. The patients’ vasospasm score and their corresponding sensitivity and specificity were: 1 (100%, 0%), 2 (100%, 8%), 3 (100%, 8%), 4 (100%, 8%), 5 (91%, 46%), 6 (74%, 85%), 7 (48%, 85%), 8 (26%, 23%), 9 (3%, 100%), 10 (4%, 100%). A receiver operator characteristic curve was constructed that yielded a cut-off score of 6. The score of 6 was a good trade-off between sensitivity (74%) and specificity (85%). A clinical vasospasm score was proposed to screen for vasospasm after SAH. A score of 4 to 6 was found to correlate with angiographic vasospasm. Prospective study is required to validate the scoring system.
Vasospasm ; Subarachnoid Hemorrhage ; Clinical ; Vasospasm mechanism ; Scores

Various physiological parameters like blood pressure, temperature, blood sugar after onset of stroke have been proposed as possible marker of stroke prognosis to study the glycaemic status after acute stroke and assess the role of glycaemic status along with other clinical parameters in influencing stroke outcome. Forty-two confirmed stroke patients attending hospital within 6 hours of onset of stroke onset were included in the study. The time lag for hospitalization, blood pressure, blood sugar, HbA1c, stroke severity according to Toronto Scale, demographic factors, stroke onset type, type of stroke, past history of stroke, diabetes, and hypertension were recorded. The outcome was whether patient survived at the end of forth week. Twenty-one percent of patients who were not known diabetic found to be hyperglycemic though their HBA1C level was normal. Eighty-nine percent of such patients died. This rate was significantly higher than patients known to be diabetic with raised sugar and HBA1c level (26% patients, 12% mortality). There was strong and significant association between stroke severity and poor outcome. Strong and significant association was also found between stroke severity and blood sugar level. Modeling of stroke outcome using decision tree analysis (QUEST) found stroke severity as most important and significant predictor especially for severe stroke cases. In mild and moderately severe stroke, high sugar level was found to be a predictor, though not statistically significant.This study suggests that stroke severity is the most important predictor of stroke outcome, with high sugar level as a marker of stroke severity.
Cerebrovascular accident ; Biological Markers ; Sugars ; prognostic ; Blood Glucose

Although the surgical management of spontaneous intracerebral hematoma (SICH) is a controversial issue, it can be life saving in a deteriorating patient. Surgical techniques have varied from the open large craniotomy, burr hole and aspiration to the minimally invasive techniques like stereotactic aspiration of the SICH, endoscopic evacuation and stereotactic catheter drainage. The authors report their experience with a keyhole craniectomy for the surgical evacuation of SICH. Ninety-six cases of SICH were treated using the keyhole craniectomy technique. A small craniectomy of 2-2.5 cm diameter was made using a vertical incision over a relatively ‘silent area’ of the cortex closest to the clot. Using a small cortical incision the hematoma was evacuated and decompression was achieved. Hemostasis was achieved using standard microneurosurgical techniques. Good to excellent outcome was achieved in 55 cases. Mortality was noted in 23 patients. Blood loss was minimal during the procedure. Good evacuation of the clot was seen in all but 5 cases as judged by the postoperative CT scan. The keyhole craniectomy technique is minimally invasive, safe and can achieve good clot evacuation with excellent hemostasis. It can be combined with microscopic or endoscopic assistance to achieve the desired result.
Hematoma ; Methodology ; Good ; desires <1> ; Hemostasis procedure

A reappraisal was made with respect to a classical observation of the mode of instrumental phase reversals on inter-ictal EEG of seemingly bilateral synchronous spike-wave discharges in patients with either idiopathic generalized epilepsies (IGE) or symptomatic localization-related frontal lobe epilepsies (FLE). It was pointed out in the original observation by Tukel and Jasper that one phase reversal at midline or near the midline on the side of the parasagittal epileptogenic lesion designated as secondary bilateral synchrony (SBS) was found in patients with frontal lobe epilepsy (FLE), whereas a double phase reversal was found over the homologous frontal electrodes (F3 and F4) designated as primary bilateral synchrony (PBS) in patients with IGE. Twenty-three patients (IGE: 15, and FLE: 8) revealing bursts of seemingly bisynchronous spike-wave discharges in interictal EEGs were retrospectively studied. Discharge patterns were defined as stable phase reversal pattern if the site of phase-reversal was consistent, and as unstable pattern if the site of phase-reversal was not consistent but shifting in the same patient. Stable one phase-reversal pattern was found more frequently in FLE (50%) than in IGE patients (26.7%), and stable double phase-reversal pattern more frequently in the IGE (33.3%) than in the FLE group (12.5%). Notably, unstable pattern was found almost equally in both IGE and FLE patients (40% and 37.5%, respectively). Recognition of SBS or PBS in accordance with original observation was found not to clearly differentiate FLE from IGE in patients showing seemingly bisynchronous spike-wave complexes. The variability of instrumental phase-reversals can be accounted for by the fact that the localization of maxima of negative spike of the spike-and-wave complexes varies considerably.
IgE ; Pattern ; Right and left ; wave ; Patient observation

Pediatric-onset multiple sclerosis is underreported because of difficulty in diagnosis and assessment. In Western series, pediatric-onset disease showed significant differences from adult-onset disease with higher female preponderance, polysymptomatic in onset, frequent systemic manifestation in relapses, higher relapse rate, but less disability, and fewer lesions in brain magnetic resonance imaging. Multiple sclerosis manifests differently in Asians, yet there was no large series of pediatric-onset multiple sclerosis reported. We found that pediatric-onset disease in Asians showed greater similarity with adult-onset disease without the reported differences in female preponderance, relapse rate, and magnetic resonance imaging findings. There were also similar proportion and clinical features in optico-spinal form, and long spinal cord lesions were common in both groups. The significant difference was less disability among the pediatric-onset group. Thus, although multiple sclerosis in Asia is different from Western countries, there is greater similarity between the pediatric-onset and adult-onset group in Asia.
Multiple Sclerosis ; Adult ; Asia ; Pediatric ; Cancer Relapse

ASEAN Neurology Association (ASNA) consists of 9 member countries, Brunei, Indonesia, Lao, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam. Among them 2 countries are considered lower middle income, 4 as upper middle income, and 3 as high income by World Bank criteria. The life expectancy is above 75 years in Brunei and Singapore, below 60 years in Lao and Myanmar. There are a total of 1,871 neurologists in ASNA member countries which has a total of 540 million populations. This constitutes 2.2% of the world neurologists, although ASNA member countries accounts for 8.3% of the world population. Myanmar and Lao in particular, has lowest ratio of neurologist, with one neurologist serving 5 million populations in Myanmar, and 2 million populations in Lao.
Myanmar ; member ; Neurology ; Income ; Neurologist

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 ; Certification ; Asia, Southeastern ; Clinical ; Training Programs

Gaucher disease is the most common lysosomal storage disorder. Resveratrol is a natural polyphenol that possesses a wide range of beneficial effects, including anti-inflammatory, anti-oxidant, and neuroprotective activities. The aim of this study was to determine if resveratrol has a therapeutic effect on primary fibroblast cells derived from a patient with type III Gaucher disease. 3-(4,5- Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays were performed to determine the effect of resveratrol on cell survival. The expression levels of apoptosis-inducing factor (AIF), Bcl-2-associated X protein (Bax), caspase-3, acetyl-coenzyme A acetyltransferase 1 (ACAT1), E3- binding protein (E3BP), and citrate synthase (CS) were evaluated by western blotting to characterize the effect of resveratrol treatment on Gaucher disease cells. Thin-layer chromatography (TLC) was carried out to measure changes in glucosylceramide levels in resveratrol-treated patient cells. Resveratrol increased the viability of patient cells compared to that of untreated control cells. Resveratrol treatment dose-dependently decreased AIF, Bax, and cleaved caspase-3 levels, whereas ACAT1, E3BP, and CS expression dose-dependently increased. TLC analysis showed reduced levels of glucosylceramides in resveratrol-treated patient cells. These findings demonstrate that resveratrol can relieve cellular stress due to glucosylceramide accumulation, and suggest that it should be studied further as a new therapeutic approach for the treatment of Gaucher disease.
Gaucher Disease

Tuberculous meningitis is an important global medical problem which gives rise to high morbidity and mortality. It is the most severe form of extrapulmonary Mycobacterium tuberculosis. Comprehensive prevention effort, prompt diagnosis and rational treatment are all keys to improving treatment outcomes; yet many unsolved problems remain. On the other hand, the new problems, such as HIV co-infection and drug-resistance are posing important challenges. This review outlines the epidemiology, pathogenesis, diagnosis, management and prognosis of tuberculous meningitis. We mainly focus on research carried out in the recent decades, giving special attention to the work done among the Asian populations
Tuberculosis, Meningeal