1.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.
2.Only certain aspects of knowledge have impact on attitudes toward epilepsy
Kheng Seang Lim ; Monica Chen Mun Wo ; Sherrini Ahmad Bazir Ahmad ; Chong Tin Tan
Neurology Asia 2013;18(4):361-368
Introduction: None of the identified studies employed quantitative scales correlating the knowledge and
attitudes toward epilepsy. Method: This study aimed to study the relationship between the knowledge
and attitudes toward epilepsy, using the Epilepsy Knowledge Questionnaire (EKQ) and the Public
Attitudes Toward Epilepsy (PATE) scale. Results: A total of 279 publics with a mean age of 36.6±14.7
years (ranged from 15-77 years), 50.8% female with majority (63.0%) Chinese, and 49.5% with
tertiary education level, were recruited. The mean score of epilepsy knowledge questionnaire (EKQ)
was 21.05±3.92 (95% CI: 20.57-21.48). Higher score in EKQ was associated with higher education
level (p<0.01). The total score in the EKQ correlated negatively with the mean scores in the PATE
scale, as well as the mean scores in both the personal domain and general domains in the PATE scale
(p<0.05). Only 8 out of 34 items in EKQ were associated significantly with the mean scores in the
personal domain, and 4 other items were with the general domain of the PATE scale.
Conclusion: This study showed that although the overall knowledge in epilepsy is significantly associated
with better attitudes toward epilepsy, only certain aspects of knowledge in the scale contributed to
this association.
3.Spontaneous remission without progression to limbic encephalitis in a patient with LGi1 seropositive faciobrachial dystonic seizure
Sherrini Bazir Ahmad ; Suhailah Abdullah ; Chong Tin Tan ; Kheng Seang Lim ; Khean Jin Goh
Neurology Asia 2016;21(2):191-193
Faciobrachial dystonic seizures are pathognomonic of leucine-rich glioma inactivated-1 (LGi1)
antibody, non-paraneoplastic limbic encephalitis. Faciobrachial dystonic seizures usually precede
limbic encephalitis by about a month. It is unknown whether, if untreated, faciobrachial dystonic
seizures inevitably progress to limbic encephalitis. We present an LGi1 seropositive patient with
a year’s history of faciobrachial dystonic seizures, who achieved remission spontaneously without
immunotherapy or antiepileptic drug treatment, and did not develop evidence of limbic encephalitis
over a three-year follow-up.
Limbic Encephalitis
4.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
5.Bilateral thalamic internal medullary lamina involvement in a case of dengue encephalitis
Sherrini Bazir Ahmad ; Chin Sum Cheong ; Shen-Yang Lim ; Kartini Rahmat ; Faizatul Izza Rozalli ; Shamala Devi Sekaran ; Helmi Sulaiman, Sasheela Ponnampalavanar ; Kheng Seang Lim ; Chong Tin Tan
Neurology Asia 2016;21(4):375-379
There are 50-100 million dengue infections each year, but dengue encephalitis is relatively
uncommon. The aetiology of neuronal injury is proposed to be due to direct viral neurotropism or
host immune response-mediated inflammation causing neuronal damage. We report a case of severe
dengue encephalitis, presenting during the acute viraemic phase of the disease. This was associated
with inflammation and haemorrhage of the internal medullary lamina of both thalami which, to our
knowledge, has not yet been reported in other infections of the central nervous system.
Dengue
6.Level 4 comprehensive epilepsy program in Malaysia, a resource-limited country
Kheng-Seang LIM ; Sherrini Ahmad Bazir Ahmad ; Vairavan NARAYANAN ; Kartini RAHMAT ; Norlisah Mohd RAMLI ; Kein-Seong MUN ; Kum-Thong WONG ; Noraini ISMAIL ; Shweh-Fern LOO ; Chong-Tin TAN
Neurology Asia 2017;22(4):299-305
Background and Objective: There is a great challenge to establish a level 4 epilepsy care offeringcomplete evaluation for epilepsy surgery including invasive monitoring in a resource-limited country.This study aimed to report the setup of a level 4 comprehensive epilepsy program in Malaysia and theoutcome of epilepsy surgery over the past 4 years. Methods: This is a retrospective study analyzingcases with intractable epilepsy in a comprehensive epilepsy program in University Malaya MedicalCenter (UMMC), Kuala Lumpur, from January 2012 to August 2016. Results: A total of 92 caseshad comprehensive epilepsy evaluation from January 2012 till August 2016. The mean age was 35.57years old (range 15-59) and 54 (58.7%) were male. There were 17 cases having epilepsy surgeryafter stage-1 evaluation. Eleven cases had mesial temporal sclerosis and 81% achieved Engel classI surgical outcome. Six cases had lesionectomy and 60% had Engel class I outcome. A total of 16surgeries were performed after stage-2 evaluation, including invasive EEG monitoring in 9 cases.Among those with surgery performed more than 12 months from the time of data collection, 5/10(50%) achieved Engel I outcome, whereas 2 (20%) had worthwhile improvement (Engel class III)with 75% and 90% seizure reduction.Conclusion: Level 4 epilepsy care has an important role and is possible with joint multidisciplinaryeffort in a middle-income country like Malaysia despite resource limitation.
7.How many more seizure remission can we achieve with epilepsy surgeries in a general epilepsy population?
Si-Lei Fong ; Kheng-Seang Lim ; Khine Yee Mon ; Sherrini Ahmad Bazir ; ChongTin Tan
Neurology Asia 2020;25(4):467-472
Background & Objective: We knew that 63.6% of the epilepsy population can be seizure free with
the use of anti-epileptic drugs (AED), but are unsure how many more with epilepsy surgeries. We
aimed to determine the additional remission rate achieved with epilepsy surgeries in addition to AED.
Methods: We analysed the seizure outcome among epilepsy patients seen retrospectively over oneyear period in University Malaya Medical Centre, Malaysia, which provides all levels (level 1-4) of
epilepsy cares, in response to anti-epileptic drug (AED) and epilepsy surgeries. The seizure outcome
was categorised into remission and drug-resistant, according to ILAE definition of drug resistance.
Results: There were 909 patients seen during the study period, majority with focal epilepsy (63.3%),
and Chinese (37.4%). Of those, 409 (45.0%) were in seizure remission, 238 (26.2%) had drug-resistant epilepsy and 262 (28.8%) uncertain. Only the remission and drug-resistant groups (N=647) were included in subsequent analysis. The mean age of onset in drug-resistant group was 14.8±12.3 years old, which was significantly younger than the remission group (20.8±16.8, p<0.05). There were 40 (54.8%) patients who underwent resective epilepsy surgeries (10 were lesion-negative cases). The
seizure freedom rate with epilepsy surgery was 60.0% (n=24). Overall, a total of 59.5% of patients
were in seizure remission with AED, with an additional 3.7% with epilepsy surgery.
Conclusion: There were 3.7% of epilepsy patients achieved seizure remission with epilepsy surgeries
in a general epilepsy cohort in addition to AEDs.