ASEAN Neurological Association
Journal ASNA

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Autosomal dominant spinocerebellar ataxias: An Asian perspective

Eng King TAN MRCP FAMS (Neurology)
Full article available
Department of Neurology, Singapore General Hospital
Autosomal dominant cerebellar ataxias, frequently referred to as spinocerebellar ataxias (SCAs) have been under intense scientific research limelight since expansions of coded CAG trinucleotide repeats were demonstrated to cause several dominantly inherited SCAs. The number of new SCA loci has expanded dramatically in recent years. At least ten genes have been identified for SCAs 1, 2, 3, 6, 7, 8, 10, 12, 17, dentatorubral-pallidoluysian atrophy (DRPLA), and six loci responsible for SCAs 4, 5, 11,13, 14, &16 have been mapped. Genetic testing is essential for diagnosis due to the overlapping and varied phenotypic features of the different SCAs. While there is no effective treatment available, genetic counseling is important for addressing the many ethical, social, legal, and psychological issues facing SCA patients. Researchers have recently provided valuable information on the pathogenesis of the disease and hopefully a cure can be available in the near future.
Neurol J Southeast Asia 2002; 7:1-8

Factors associated with post-stroke depression, a Malaysian study

Mihajlo T GLAMCEVSKI II G.Dip.PSY, G.Dip.Appl.Sc (Counselling), *Lynne C. MCARTHUR PhD, Heng Thay CHONG MRCP, Chong Tin TAN FRCP MD
Full article available
Department of Medicine, University of Malaya, *Centre for Industrial and Applicable Mathematics, University of South Australia
The study aims to examine specific factors associated with depression in a stroke population of the University Malaya Medical Centre. The sample group consisted of 80 patients who suffered a stroke 3-6 months prior to the study. Interviews were conducted based on a 26-item questionnaire. Zung Self-Rating Scale, modified Barthel and Social Resources Scale were used to assess depression, activity of daily living and social support, respectively. Diagnosis of major depressive episode was confirmed by a psychiatrist, based on DSM-IV criteria. The mean age of the patient was 58.6 (SD 12.5) years. Sixty-six percent of the patients were depressed, and a level of moderate to severe depression was present in 15% of the patients. In this paper, it is demonstrated that the occurrence of depression was significantly correlated with advancing age, Malays and Chinese in contrast to the Indians ethnic population, non-continuance of pre-stroke lifestyles, and poor performance in the activities of daily living rating.
Neurol J Southeast Asia 2002; 7:9-12

Nipah Encephalitis: A report of 18 patients from Kuala Lumpur Hospital

Bee-Fung SIM, Md Rani JUSOH, Choong-Chor CHANG, Raihanah KHALID
Full article available
Department of Neurology, Kuala Lumpur Hospital, Malaysia.
Nipah virus, a previously unknown paramyxovirus, was identified as the cause of the encephalitis outbreak among pig-farmers in Malaysia. We describe the clinical features and results of investigation in 18 patients seen in the Kuala Lumpur Hospital. Twelve patients were Malaysians and 6 patients were foreign workers. The majority were young adult males who have direct body contact with pigs. Incubation period ranged from 2 days to one month. Prodromal symptoms were nonspecific, followed by drowsiness and confusion after a few days. Most common neurological signs were coma, hyporeflexia or areflexia, segmental myoclonus, gaze palsy and limb weakness. Notable laboratory findings include thrombocytopaenia and abnormal cerebrospinal fluid analysis. Of the 18 patients, 17 required ventilation of whom 11 died (61%). Another patient died of respiratory infection 4 months after discharge. Of the survivors, only one patient recovered with no neurological deficits.

Conclusions: Infection with Nipah virus causes fulminant encephalitis with high mortality and morbidity.
Neurol J Southeast Asia 2002; 7:13-18

A community based inter-cultural study on precipitating factors of headache

Chun-Wearn KOH, Li-Ping TAN, Chong-Tin TAN
Full article available
Department of Medicine, University of Malaya
Background and Objectives: In the medical literature, there are considerable differences in the precipitating causes of headache from different cultures and geographical areas. This study aims to confirm this difference by studying two different cultures and geographical locations. Methods: A cross sectional study on headache sufferers from Kuala Lumpur, Malaysia and in Melbourne, Australia using similar inclusion criteria and a standard questionnaire. Patients with more than 6 headaches in the last year were included in the study. Results: 400 subjects were studied, 200 in each geographical area. The Male: Female ratio, severity of headache, type of pain and associated features were similar in both groups of subjects. There were significant differences in many triggering factors of headache in both groups. They were: heat, 63% in Malaysian subjects versus 24% in Australian subjects (p<0.001); exposure to sun, 49% in Malaysian subjects versus 24% in Australian subjects (p<0.001); change of weather, 23% in Malaysian subjects versus 13% in Australian subjects (p=0.01), and glare, 14% versus in Malaysian subjects versus 24% in Australian subjects (p=0.01). As for food, fried food (p<0.001), mutton (p<0.001), "heaty" food (p=0.002) were significant precipitating factors among Malaysian subjects as compared to the Australian subjects. There were also significantly more Malaysian subjects who resorted to drinking lots of water and taking "cooling" food as remedies for headache. This was consistent with the common cultural belief among Malaysians that "heatiness" causes headache.

Conclusion: This community based inter-cultural study confirms that significant differences exist in the triggering factors and remedies among Malaysian and Australian headache sufferers. These differences may be partly due to the different cultural beliefs.
Neurol J Southeast Asia 2002; 7:19-24

Safety, tolerability, and efficacy of gabapentin in neuropathic pain: Results of a post-marketing surveillance study in 1214 Filipino patients

Ester S BITANGA MD, *Alejandro C BAROQUE MD, **Alberto S SANTOS-OCAMPO MD, **Almar Y GUEVARRA RN, **Margaret B QUERIJERO MD, ***Carlos L CHUA MD
Full article available
Philippine Neurological Association, *Santo Tomas University Hospital, **Medical Affairs Division, Pfizer Philippine, ***University of Philippine-Philippine General Hospital
A post-marketing surveillance study of gabapentin usage in Filipino patients with neuropathic pain was conducted. Safety, tolerability and analgesic efficacy were assessed after a minimum of two weeks of gabapentin treatment, with starting and final doses determined by the prescribing physician. Of the 1,214 patients who entered the study, 95.7% completed the minimum two weeks duration of therapy. The mean age was 54 years, and the most common neuropathic pain diagnoses were painful diabetic neuropathy (30.4%), nonspecific neuropathies (20.2%), trigeminal neuralgia (12.8%), central pain after stroke (8.8%), and post-herpetic neuralgia (8.4%). Ninety-two percent of patients were maintained within a dose range of 300mg/day to 1200mg/day. The incidence of adverse events was 6%, and consisted mostly of somnolence and dizziness, with 76% of patients reporting "very good" to "excellent" tolerability. There were 34 documented dropouts (2.9%), of which only seven (0.6%) were thought to be related to an adverse event from gabapentin. Visual analog scale pain scores declined significantly from a mean of 67.8 + 20 mm at baseline, to 16.1 + 15mm after treatment (p<0.05). In conclusion, gabapentin at 300mg/d to 1200mg/d is well tolerated and efficacious among Filipino patients with various neuropathic pain syndromes.
Neurol J Southeast Asia 2002; 7:25-34

Severe spinal cord involvement is a universal feature of Asians with multiple sclerosis: A joint Asian study

Heng Thay CHONG, Patrick CK LI, Benjamin ONG, Kwang Ho LEE, Ching Piao TSAI, Bhim S SINGHAL, Naraporn PRAYOORWIWAT, Chong Tin TAN
Full article available
University of Malaya, Queen Elizabeth Hospital, Hong Kong, National University of Singapore, Samsong Medical Center, Seoul, Korea, Veterans General Hospital, Taipei, Taiwan, Siriraj Hospital, Bangkok, Thailand; all members of Multiple Sclerosis in Asia Pacific Study Group
This is a joint clinical study of multiple sclerosis involving 7 regions in Asia. The inclusion criteria were patients who fulfilled the Poser's criteria for clinically definite or laboratory-supported definite multiple sclerosis. A total of 263 patients from Hong Kong, Malaysia, Singapore, Korea, Taiwan, India and Thailand were studied. The mean age of onset was 31 years, and the mean duration of illness was 9.3 years. The clinical course was relapsing remitting in 79% of the patients. The mean relapse rate was 0.86 attacks per annum. Forty percent of the patient had optic-spinal recurrent and 60% had Western forms of multiple sclerosis. The study confirmed features peculiar to the Asian multiple sclerosis noted previously. There was a high female to male ratio of 3.8:1. The female preponderance was more marked among the Chinese, Malays and Thai patients. For the patients from Malaysia and Singapore whose population consisted of Chinese and Malays at a ratio of 1:1.4, there was preponderance among Chinese as compared to Malays with a ratio of 8.6:1. The patients with optic-spinal recurrent and Western forms of multiple sclerosis in this study shared many similarities, including high female to male ratio, mean age of onset, and rate of relapse. When compared to the Western series, both groups of patients had high frequency of acute transverse myelitis, paroxysmal tonic spasm, long segment of spinal cord lesion in MRI, and low rate of positive cerebrospinal fluid oligoclonal band. Severe involvement of spinal cord is thus a universal feature of Asians with multiple sclerosis, seen in both optic-spinal recurrent and Western form of multiple sclerosis.
Neurol J Southeast Asia 2002; 7:35-40

Primary angiitis of the central nervous system associated with testicular tumor, a case report

Full article available
Department of Neurology & *Pathology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
A 32 year old man developed a 1-year history of episodic transient right sided neurological deficits, with bilateral predominantly white matter confluent lesions seen on MRI brain. Histological examination of the biopsy after an episode of intracerebral bleeding revealed features of granulomatous angiitis. There was no evidence of arteritis elsewhere in the body, nor a known secondary cause of vasculitis. During follow-up whilst on treatment, he developed a generalized lymphadenopathy. Systemic search for a primary malignancy revealed a burnt-out testicular cancer with extragonadal metastasis. The occurrence of primary angiitis of the nervous system with testicular cancer as paraneoplastic phenomenon has not been previously reported.
Neurol J Southeast Asia 2002; 7:41-45