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Profile of neurological practice in Myanmar.

Neurology Asia.2007;12(1):53-55.

Neurological services in Myanmar began in 1969 in the Yangon General Hospital. Presently the country has 10 neurologists and 13 neurosurgeons serving the 54 million populations in 4 neurological centers. The ratio of population per neurologist is 5.4 million. All of the centers have CT scan, 2 have MRI and EEG, and one has electromyography. The pattern of neurological diseases is largely similar to elsewhere, with stroke, epilepsy and headache as the main illnesses treated. There is a training program for neurologists in the Yangon General Hospital. The Myanmar Neurology Society was founded in 2000. It is affiliated to World Federation of Neurology and ASEAN Neurological Association.
Myanmar ; seconds ; Neurologic ; Neurology ; Hospitals, General

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Changes in neuromedin S and its receptor after traumatic brain injury in cycling rats

Mohammad Khaksari ; Fatemeh Maghool ; Gholamreza Asadikaram ; Vida Naderi

Neurology Asia.2015;20(3):375-384.

Animal studies indicate that gonadal steroids have prominent neuroprotective effects in several models of experimental traumatic brain injury (TBI). Neuromedin U (NMU) and neuromedin S (NMS) are regulatory peptides involved in inflammatory and stress responses, and modulation of the gonadotropic axis. Since steroid hormone levels change during the estrous cycle, we sought to determine whether variations in ovarian hormones would affect blood-brain barrier (BBB) permeability and brain levels of NMS, NMU, and neuromedin S receptor 2 in experimental TBI. Two groups (proestrus and nonproestrus) of female rats underwent diffuse TBI. At 24 hrs after TBI, results showed a significantly decrease in BBB permeability in traumatic-proestrus animals (TBI-P) in comparison to traumatic nonproestrus (TBI-NP) rats. Western blot analyzes demonstrated an enhanced expression of prepro-NMS in TBI-P compared with that in the TBI-NP group. Likewise, TBI-P rats exhibited significantly higher NMUR2 gene expression compared with those of TBI-NP, whereas no significant difference in brain NMU content was seen between sham and traumatic animals. Our findings indicate that diffuse TBI induces an increase in prepro-NMS and neuromedin S receptor 2 expression in traumatic-proestrus rats which may mediate the anti-edematous effects of gonadal hormones in proestrus rats following trauma.

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Methods and clinical applications of targeted temperature management

Sombat Muengtaweepongsa

Neurology Asia.2015;20(4):325-333.

Hypoxic/ischemic brain damage is well-known catastrophic injury. The specific treatment, socalled neuroprotective therapy, aims to prevent or diminish this havoc damage. However, approved neuroprotective therapy in clinical practice is limited. Targeted temperature management (TTM) shows the most promising neuroprotective therapy. Moreover, TTM is also useful for intracranial pressure (ICP) control. Many methods of TTM have been reported. TTM can apply to several clinical conditions associated with hypoxic/ischemic brain injury or elevated intracranial pressure.
Hypoxia-Ischemia, Brain ; Hypoxia, Brain

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Pathological findings in a mouse model of Japanese encephalitis infected via the footpad

Tzeh Long Fu ; Kien Chai Ong ; Kum Thong Wong

Neurology Asia.2015;20(3):349-354.

We have developed and characterised a mouse model of Japanese encephalitis virus (JEV) infection via footpad inoculation in order to better mimic viral transmission by mosquito bites. Two-week-old and 5-week-old mice consistently developed signs of infection such as ruffled fur, weight loss, hunchback posture, tremors, mask-like facies and occasionally, hindlimb paralysis at 4 days post infection (dpi) and 11-13 dpi, respectively. Most of the animals died within 24 to 48 hours following the onset of signs of infection, with mortalities of 100% and 33.3% in 2-week-old and 5-week-old mice, respectively. Mild meningitis and variable parenchymal inflammation with formation of microglial nodules, focal necrosis and neuronophagia, and perivascular cuffing by inflammatory cells were observed in the caudate nucleus, putamen, thalamus, cerebral cortex, brainstem, and spinal cord. Viral antigens/RNA were demonstrated by immunohistochemisty and in situ hybridization, respectively, in most of these areas as well as in the hippocampus and cerebellum, albeit more focally. The pathological findings in this mouse model were generally similar to human Japanese encephalitis (JE) and other established JE models but perhaps, compared to other JEV mouse models, it demonstrates lethal encephalitic infection more consistently. We believe that our mouse model should be useful to study the pathogenesis of JE, and for testing anti-viral drugs and vaccines

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Prevalence of pain and depression and their coexistence in patients with early stage of Parkinson’s disease

Shinji Ohara ; Ryoichi Hayashi ; Katsuhiko Kayanuma ; Harumi Kuwabara ; Kotaro Aizawa ; Hiroshi Koshihara ; Kenya Oguchi ; Yo-ichi Takei ; Naoko Tachibana

Neurology Asia.2015;20(3):355-361.

Depression and pain are common and often early non-motor symptoms of Parkinson disease (PD). The relationship between pain and depression in PD has been unsettled, with conflicting findings. The PD patients followed up at the general neurology outpatient clinics were requested to complete Beck Depression Inventory (BDI) and McGill pain questionnaire. The patients were categorized in three groups according to the Hoehn-Yahr (H-Y) stage of PD; mild (stage I&II), moderate (stage III) and advanced stage (stage IV&V), and group comparisons were performed in each group between those with and without pain. A total of 186 patients completed the questionnaires. Their mean age was 74±9.3 years, and the mean H-Y stage was 2.8±0.8.Sixty-nine percent of the patients reported pain symptoms of various natures. The BDI scores were significantly higher in the pain group (P< 0.0001) despite the absence of statistically significant differences in the mean age, H-Y stage, and duration of illness. Only PD patients of mild stage revealed significant difference of BDI scores between those with pain and without pain (P <0.001). Our results showed that pain is a common symptom in patients with PD and suggest that it may be related to depression in the early stage of the disease.

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Retinal nerve fiber layer thickness in patients with essential tremor

Yakup Turkel ; Nurgul Ornek ; Ersel Dag ; Kemal Ornek ; Murat Alpua ; Tevfik Ogurel ; Yasar Olmez

Neurology Asia.2015;20(3):363-366.

Objective: To investigate the retinal nerve fiber layer (RNFL) thickness in essential tremor (ET). Methods: Twenty-seven eyes of 27 patients with essential tremor were included in this study. Twentyseven eyes of 27 healthy volunteers served as controls. All eyes were examined with spectral domain optical coherence tomography (OCT) (Retinascan Advanced RS-3000; NIDEK, Gamagori, Japan) using image filling software program (NAVIS-EX, NIDEK, Tokyo, Japan). Results: No statistically significant difference was detected between ET patients and control group for overall (RNFL) and foveal retinal thickness parameters. [RNFL thickness (Average thickness p=0.86, superior average p=0.22, inferior average p=0.24, nasal average p=0.06, temporal average p=0.88), foveal retinal thickness p=0.63] There was no relationship between OCT parameters and age, gender and duration of ET (all p>0.05). Conclusion: We did not find altered RNFL and foveal thickness values in patients with ET compared to controls. Retinal thickness changes do not seem to be a potentially useful biomarker in ET patients.

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Lao Association for Patient with Epilepsy: Report of activity 2011-2014

Phetvongsinh CHIVORAKOUN ; Vimalay SOUVONG ; Somchit VORACHIT ; Vatthanaphone LATTHAPHASAVANG ; Ketmany PHETSIRISENG ; Philaysak NAPHAYVONG

Neurology Asia.2015;20(3):385-387.

In Lao PDR, the care of patients with epilepsy faces many challenges. There are around 50,000 people living with epilepsy (PWE) but only 10% have access to antiepileptic medication. The mortality is high among untreated PWE. Misconception about the disease and stigma are common in the general population. The availability of antiepileptic medication is poor. Knowledge on epilepsy among health personnel is poor. Improvement in the management of epilepsy in Lao PDR requires training of health workers on epilepsy, a system to provide antiepileptic drugs and improvement of knowledge on the causes and effective treatment of epilepsy among PWE and the public. The Lao Association for Patients with Epilepsy (APE) was established in 2011 with four main activities: organizing scientific conferences on epilepsy in Laos; providing three days training on epilepsy to health personal at both provincial and district levels; supporting the provision of antiepileptic drugs through a revolving drug fund at provincial and district hospitals; and promoting the dissemination of information on epilepsy to the public. Up to now, 31 health professionals among 52 who were trained on epilepsy provide consultations at both provincial and the district levels. A total of 129,200 tablets of a first line antiepileptic drug (phenobarbital) have been provided to provincial and district hospitals. An estimated 1,112 PWE are currently under treatment. There is a daily information campaign through the media; pamphlets and posters are disseminated at epilepsy clinics. A Lao medical network has been established that will improve access to treatment by PWE.

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Characteristics of neuropathic pain in Indonesia: A hospital based national clinical survey

Thomas Eko Purwata ; Henny A Sadeli ; Yudiyanta ; Yuneldi Anwar ; Darwin Amir ; Chris Asnawi ; Suroto ; Dani Rahmawati ; Leksmono Partoatmodjo ; Susi Aulina ; Putu Eka Widyadarma ; Moch Dalhar ; Endang Mutiawati ; Theresia Runtuwene ; Lucas Meliala ; Andradi Suryamihardja ; Agus Permadi ; Fredy Sitorus ; Untung Gunarto ; Yusak Mangara Tua Siahaan ; Edison Marpaung ; Yulius Mandua

Neurology Asia.2015;20(3):389-394.

We conducted a hospital based study to collect data on the clinical characteristics of neuropathic pain (NP) patients in neurology outpatients in 13 big cities in Indonesia. We aimed to identify the clinical characteristics of NP among patients with the symptoms of pain. A simple questionnaire was conducted to explore the clinical symptoms and signs. Participants who reported of NP symptom was 1,779 (21.8%) among 8,160 patients. The higher prevalence of NP was reported in 41-60 years old (n= 1,030; 57.9%). It was more prevalent in male (n=1,104; 62.1%). The group of patients with low educational level has higher prevalence of pain with NP (n=1,177; 66.1%). There are five main clinical symptoms of NP patients, pinprick sensation (n=589; 33.1%), electric shock like sensation (n=542, 30.5%), burning (n=407, 22.9%), paresthesia (n=401; 22.5%) and hyperalgesia (n=351, 19.7%). In this study, NP was mostly associated with low back pain (n=509, 28,6%), carpal tunnel syndrome (n=343; 19.3%), frozen shoulder syndrome (n=191, 10.7%), diabetic neuropathy (n=170, 9.6%) and brachialgia (n=108, 6.1%). The most frequent modality to treat NP symptoms were adjuvant analgesics, antidepressants or anticonvulsants (n=1,199; 67.4%), non-steroidal anti-inflammatory drugs (n=1,177, 66.2%), non-opioids analgesics (n=606; 34.1%), non-pharmacological treatment (n=366; 20.6%) and opioid treatments (n=100, 5.6%).

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Kinetic and kinematic gait analysis in a spastic hemiplegic patient after selective tibial neurotomy: a case report

Ippei Kitade ; Hidetaka Arishima ; Ken-ichiro Kikuta

Neurology Asia.2015;20(3):395-399.

Kinematics-based studies before and after selective tibial neurotomy (STN) gait have not been performed. It is very important for spastic patients before and after STN to evaluate quality of gait motion. We examined the quantitative changes in kinetic and kinematic parameters in the gait of a hemiplegic patient after STN. A patient with stroke-related hemiplegia who did not require aids to walk underwent a three-dimensional gait analysis (3DGA) before and after STN. 3DGA system was used to obtain spatiotemporal, kinetic and kinematic parameters of the lower extremities. Postoperative increases in walking speed and the single leg support ratio were detected in the paralyzed limb. Kinetic and kinematic analyses of the stance phase performed after STN detected dorsiflexion in the ankle, the appearance of generation power during plantar flexion, an extension of the range of hip movement during the gait cycle, and the disappearance of genu recurvatum. The acquisition of a normalized ankle joint gait pattern after STN might result in coordinated improvements in the kinetic and kinematic parameters of other joints. The measurement of spatiotemporal, kinetic, and kinematic gait parameters using 3DGA systems might aid decisions regarding the optimal post-STN rehabilitation strategies for spastic patients who hope to improve their gaits.

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An infant with cerebellar tumor presenting with torticollis as the only initial symptom

Hye Young Choi ; Seungnam Son ; Hong Sik Jo ; Min-Kyun Oh

Neurology Asia.2015;20(3):401-403.

Torticollis is an usual symptom that can be the result of various disorders, such as sternocleidomastoid muscle pathology, bony abnormalities of the cervical spine, disorders of the central or peripheral nervous system, various ocular diseases, and brain tumors, especially in children. A 12-month-old male visited our hospital because of torticollis. He was normal on systemic examination, with no neurological abnormality, and his cervical spine CT was also normal. About 4 weeks later, he revisited the emergency department due to vomiting with altered mental status, and was diagnosed with a cerebellar tumor with hemorrhage. Although torticollis is known to be an important sign of a posterior fossa tumor, associated neurological or ocular symptoms are usually present. We report here a patient with posterior fossa tumor where torticollis was the only initial presenting symptom.

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