MyMedR

CYP3A5 genetic variants and their associations with carbamazepine and valproic acid response in Malaysian epileptic patients

Miyata-Nozaka Y, Tan HJ, Wong SW, Raymond AA, Omar H, Zain SM

Int J Clin Pharmacol Ther, 2021 Jan;59(1):8-16.

PMID: 33026315 DOI: 10.5414/CP203761

OBJECTIVE: Epilepsy is a common chronic neurological condition characterized by recurrent seizures. Approximately 30 - 40% of epileptic patients do not respond to antiepileptic drugs. Previous studies suggest that CYP3A5 polymorphisms affect carbamazepine metabolism.

MATERIALS AND METHODS: To examine this hypothesis, in the present study, the associations between CYP3A5 variants (rs776746 and rs1419745) and response to carbamazepine and valproic acid monotherapy in Malaysian epileptic patients were evaluated.

RESULTS: A total of 288 Malaysian epileptic patients were recruited and further reviewed, of whom 63 patients were on carbamazepine monotherapy, and 85 patients were on valproic acid monotherapy. There was no patient with drug hypersensitivity syndrome within the population. Subjects were genotyped by using Sequenom MassARRAY platform. This study found a significant association of CYP3A5 rs776746 with the carbamazepine treatment response in total patients (p = 0.026) and Malay ethnic subgroup (p = 0.006). In addition, a marginal significant association of CYP3A5 rs1419745 with carbamazepine treatment response was reported in the Malays. Similarly, CYP3A5 rs776746 was associated with valproic acid response in total patients (p = 0.037) and Malays (marginal p = 0.05).

CONCLUSION: Our findings suggest that CYP3A5 polymorphisms affect carbamazepine and valproic acid response in Malaysian epileptic patients.

A case series of super-refractory status epilepticus successfully treated with electroconvulsive therapy

Tan HJ, Tee TY, Husin M, Khoo CS, Woon LS

Epileptic Disord, 2020 Dec 01;22(6):828-833.

PMID: 33337333 DOI: 10.1684/epd.2020.1233

Super-refractory status epilepticus (SRSE) is a neurocritical emergency, associated with significant morbidity and mortality. The precise pathophysiology is still not completely understood. The likelihood of spontaneous seizure termination reduces with time, and it is of paramount importance to abort status in order to prevent permanent long-term neurological sequelae and death. A few neuroprotective strategies, such as general anaesthesia, steroids, ketogenic diet and hypothermia, have been used to treat SRSE, however, the clinical outcome remains inconclusive. We herein present two cases of SRSE, which were successfully treated with electroconvulsive therapy (ECT) after failing all pharmacological measures.

Validity and reliability of the Malay-language translation of the Rome III Diagnostic Questionnaire for irritable bowel syndrome

Lee YY, Waid A, Tan HJ, Chua SB, Whitehead WE

J Gastroenterol Hepatol, 2012 Apr;27(4):746-50.

PMID: 22004172 DOI: 10.1111/j.1440-1746.2011.06943.x

The Malay language is widely used within the "Malay Archipelago" particularly in Malaysia, Indonesia, Philippines, Singapore and Brunei with a combined population of 300 million. There are no reliable data on the epidemiology of irritable bowel syndrome (IBS) in the Malay speaking population because the Rome Diagnostic Questionnaire has not been translated and validated for the Malay language. The current study aimed to translate and validate the Rome III IBS Diagnostic Questionnaire, Red Flag and Psychosocial Alarm questionnaires into the Malay language.

Fulltext Rome III survey of irritable bowel syndrome among ethnic Malays

Lee YY, Waid A, Tan HJ, Chua AS, Whitehead WE

World J Gastroenterol, 2012 Nov 28;18(44):6475-80; discussion p. 6479.

PMID: 23197894 DOI: 10.3748/wjg.v18.i44.6475

To survey irritable bowel syndrome (IBS) using Rome III criteria among Malays from the north-eastern region of Peninsular Malaysia.

Fulltext Belly dancer syndrome induced by salbutamol

Wong CK, Ng CF, Tan HJ, Wan Yahya WNN

BMJ Case Rep, 2021 Feb 26;14(2).

PMID: 33637510 DOI: 10.1136/bcr-2020-241244

Controversy of proton pump inhibitor and clopidogrel interaction: a review

Tan HJ

J Dig Dis, 2010 Dec;11(6):334-42.

PMID: 21091895 DOI: 10.1111/j.1751-2980.2010.00466.x

A proton pump inhibitor (PPI) is often co-prescribed with clopidogrel to reduce the gastrointestinal risk of bleeding ulcers in patients following acute coronary syndrome or a stent implant. However, the safety issue of such practice has been scrutinized after some studies reporting an increased incidence of cardiovascular events and mortality, although there have also been contrary research reports. This has lead to a warning statement from the US Food and Drug Administration cautioning the concomitant use of PPI and clopidogrel. This review examines the evidence of PPI as gastroprotective agent, histamine H(2) antagonists as an alternative therapy, the influence of PPI on the antiplatelet effect of clopidogrel, and the controversies of various studies.

Fulltext First Reported Case of Neuroleptospirosis Complicated With Anton's Syndrome

Saeed N, Khoo CS, Remli R, Law ZK, Periyasamy P, Osman SS, et al.

Front Neurol, 2018;9:966.

PMID: 30564184 DOI: 10.3389/fneur.2018.00966

Leptospirosis is a spirochetal zoonotic disease with a wide clinical spectrum, often underdiagnosed especially when presented as an acute neurological manifestation. We report a case of a 24-year-old man with serologically positive leptospirosis, who presented with altered sensorium, seizures and subsequently developed cortical blindness. His brain MRI revealed bilateral occipital and later parietal lobe cerebritis.

An unusual neurological complication from a garden-variety organism: post-melioidosis parkinsonism

Ng CS, Azmin S, Law ZK, Sahathevan R, Wan Yahya WN, Remli R, et al.

Med J Aust, 2015 Apr 06;202(6):333-4.

PMID: 25832163

Knowledge of Acute Stroke Management Among Healthcare Professionals: Development and Validation of Acute Stroke Management Questionnaire (ASMaQ)

Sim CY, Wan Zaidi WA, Shah SA, Wan Yahya WNN, Tan HJ

J Stroke Cerebrovasc Dis, 2021 Jan;30(1):105421.

PMID: 33160125 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105421

BACKGROUND: Around 15.0% of all strokes occurred in hospitalised patients and studies showed significant delay in the stroke recognition and lack of awareness on thrombolytic therapy for acute ischaemic stroke (AIS) which lead to higher mortality for in-hospital stroke. We aimed to develop and validate a new instrument known as acute stroke management questionnaire (ASMaQ) to evaluate the awareness of healthcare professionals in managing acute ischaemic stroke cases.

METHODS: This study consisted of 3 steps; the formulation of ASMaQ draft, content validation and construct validity. A total of 110 questions were drafted with 5-point Likert scale answers. From the list, 31 were selected and subsequently tested on 158 participants. The results were analysed and validated using exploratory factor analysis on SPSS. Components were extracted and questions with low factor loading were removed. The internal consistency was then measured with Cronbach's alpha.

RESULTS: Following analysis, 3 components were extracted and named as general stroke knowledge, hyperacute stroke care and advanced stroke management. Two items were deleted leaving 29 out of 31 questions for the final validated ASMaQ. Internal consistency showed high reliability with Cronbach's alpha of 0.82. Our respondents scored a total cumulative mean of 113.62 marks or 66.6%. A sub analysis by occupation showed that medical assistants scored the lowest in the group with a score of 57% whilst specialists including neurologists scored the highest at 79.4%.

CONCLUSION: The ASMaQ is a newly developed and validated questionnaire consisting of 29 questions testing the respondents' acute stroke management knowledge.

Fulltext Myasthenia gravis and premature ovarian failure - a causal link

Mohamed Arifin N, Khoo CS, Leong D, Tee TY, Tan HJ

Neurol Neurochir Pol, 2021;55(2):233-235.

PMID: 33555605 DOI: 10.5603/PJNNS.a2021.0015

Fulltext Preeruptive Unilateral Cerebellar Ataxia in an Immunocompetent Adult: A Rare Case of Varicella

Ng CF, Ong BH, Tan HJ

J Neurosci Rural Pract, 2018 5 5;9(2):281-283.

PMID: 29725187 DOI: 10.4103/jnrp.jnrp_461_17

Fulltext Use of complementary and alternative medicine and adherence to antiepileptic drug therapy among epilepsy patients: a systematic review

Farrukh MJ, Makmor-Bakry M, Hatah E, Tan HJ

Patient Prefer Adherence, 2018;12:2111-2121.

PMID: 30349205 DOI: 10.2147/PPA.S179031

Purpose: To identify the use pattern of complementary and alternative medicine (CAM) and its impact on antiepileptic drug (AED) adherence among patients with epilepsy.

Method: Potential studies were identified through a systematic search of Scopus, Science Direct, Google Scholar, and PubMed. The keywords used to identify relevant articles were "adherence," "AED," "epilepsy," "non-adherence," and "complementary and alternative medicine." An article was included in the review if the study met the following criteria: 1) conducted in epilepsy patients, 2) conducted in patients aged 18 years and above, 3) conducted in patients prescribed AEDs, and 4) patients' adherence to AEDs.

Results: A total of 3,330 studies were identified and 30 were included in the final analysis. The review found that the AED non-adherence rate reported in the studies was between 25% and 66%. The percentage of CAM use was found to be between 7.5% and 73.3%. The most common reason for inadequate AED therapy and higher dependence on CAM was the patients' belief that epilepsy had a spiritual or psychological cause, rather than primarily being a disease of the brain. Other factors for AED non-adherence were forgetfulness, specific beliefs about medications, depression, uncontrolled recent seizures, and frequent medication dosage.

Conclusion: The review found a high prevalence of CAM use and non-adherence to AEDs among epilepsy patients. However, a limited number of studies have investigated the association between CAM usage and AED adherence. Future studies may wish to explore the influence of CAM use on AED medication adherence.

Fulltext A case of Guillain-Barré syndrome (GBS) presenting with acute urinary retention and T6 sensory level

Khoo CS, Ali AH, Remli R, Tan HJ

Clin Med (Lond), 2018 08;18(4):308-310.

PMID: 30072555 DOI: 10.7861/clinmedicine.18-4-308

Guillain-Barré syndrome (GBS) is an acute immune-mediated demyelinating disease. Early recognition of this disease is crucial as it can progress to life-threatening conditions such as respiratory failure or autonomic dysfunction. Typical clinical manifestations of GBS include progressive weakness of the limbs, bulbar, facial muscles and ophthalmoplegia. Sensory level and bladder dysfunction are more suggestive of acute myelopathy. We report a case of GBS presenting with acute urinary retention and T6 sensory level, which was successfully treated with plasma exchange.

Prevalence and factors of verbal learning and memory dysfunction in patients with epilepsy - A single centre study

Subramaniam SR, Khoo CS, Raymond AA, Che Din N, Syed Zakaria SZ, Tan HJ

J Clin Neurosci, 2020 Mar;73:31-36.

PMID: 32094071 DOI: 10.1016/j.jocn.2020.02.003

The objective of this study is to determine prevalence and factors leading to verbal learning and memory dysfunction among patients with epilepsy. A total of 211 subjects were recruited. Their verbal memory was assessed by Rey's Auditory Verbal Learning Test (RAVLT). This test was further subdivided into four major spheres for analysis, namely the verbal learning, interference list, immediate memory and delayed memory. All data collected were analyzed using Statistical Package for Social Sciences. Among the 211 patients, 55% (n = 116) had focal seizures and the remaining 45% (n = 95) had generalized seizures. Prevalence of verbal learning and memory impairment was high at 39.97% overall, and found most commonly in patients with focal impaired awareness seizures. Verbal learning and immediate memory dysfunction were significantly lower in focal impaired awareness group compared to others. Age more than 50 years, exposure to three or more antiepileptic drugs and use of carbamazepine more than 1000 mg a day were the predictors in poor verbal memory outcome. No statistical difference was observed in the mean RAVLT scores among the gender and hand dominance groups. Between patients with and without electroencephalogram changes as well as brain magnetic resonance imaging changes, the mean RAVLT scores showed no statistically significant difference. Verbal learning and memory impairment is prevalent among the epilepsy patients. The consequences of the memory impairment can be as debilitating as the seizure control. RAVLT is a reliable and practical test in the clinical setting.

Fulltext Cerebral Lupus and Cryptococcal Meningitis in a Pregnant Woman

Khoo CS, Marzukie MM, Yap SS, Wan Yahya WNN, Tan HJ

J Neurosci Rural Pract, 2020 Jan;11(1):183-186.

PMID: 32140026 DOI: 10.1055/s-0039-3402895

Systemic lupus erythematosus (SLE) is a chronic autoimmune and multisystem disorder, which frequently affects young women. During pregnancy, SLE flares could occur up to 65%, with renal and hematological manifestations being the most common. However, reports on neuropsychiatric lupus in pregnant women are scarce. We herein report a 26-year-old lupus pregnant woman, who had cerebral lupus with concurrent cryptococcal meningitis. This case highlights the complexity in diagnosing and managing our patient to achieve the best outcome for both the mother and infant.

Internal carotid artery injury during endonasal sinus surgery: our experience and review of the literature

Lum SG, Gendeh BS, Husain S, Gendeh HS, Ismail MR, Toh CJ, et al.

Acta Otorhinolaryngol Ital, 2019 Apr;39(2):130-136.

PMID: 30745587 DOI: 10.14639/0392-100X-1312

Fulltext Longitudinally Extensive Transverse Myelitis in Highly Active Relapsing-remitting Multiple Sclerosis

Ng CF, Remli R, Tan HJ

Neurol India, 2021 11 9;69(5):1412-1413.

PMID: 34747827 DOI: 10.4103/0028-3886.329533

Transverse myelitis in multiple sclerosis is typically a short cord lesion with patchy distribution. Rarely, longitudinally extensive transverse myelitis can be seen in those with highly active disease or frequent relapses. The recognition of this uncommon phenotype in multiple sclerosis is important as the treatment is largely different from other demyelinating diseases. We describe a patient with highly active relapsing-remitting multiple sclerosis on interferon beta-1a who developed LETM after multiple relapses.

Tuberculous meningitis mimicking Creutzfeldt-Jakob disease

Khoo CS, Krishnan L, Ng CF, Teh PC, Norlinah MI, Tan HJ

Rev Neurol (Paris), 2021 03;177(3):319-321.

PMID: 32747046 DOI: 10.1016/j.neurol.2020.05.013

Reply letter to "Are the self-administered questionnaires appropriate to uncover undiagnosed depression among people with epilepsy?"

Tan JK, Khoo CS, Baharudin A, Tan HJ

Epilepsy Res, 2022 Feb 15;181:106889.

PMID: 35182826 DOI: 10.1016/j.eplepsyres.2022.106889

Prevalence and associated risk factors of undiagnosed depression among people with epilepsy in a multiethnic society

Tan JK, Khoo CS, Beh HC, Hod R, Baharudin A, Yahya WNNW, et al.

Epilepsy Res, 2021 Dec;178:106772.

PMID: 34763265 DOI: 10.1016/j.eplepsyres.2021.106772

BACKGROUND: Depression is the most frequent psychiatric comorbidity of epilepsy. However, clinicians often neglect to screen for depressive symptoms among patients with epilepsy and, therefore, fail to detect depression. Many studies have described the risks associated with depression in patients with epilepsy, but few studies have elaborated whether these risks are similar in those with undiagnosed depression, especially in a multiethnic community.

METHODS: In the present cross-sectional study conducted at a tertiary teaching hospital, we aimed to investigate the prevalence and associated risk factors of undiagnosed depression in patients with epilepsy. We recruited patients with epilepsy aged 18-65 years after excluding those with background illnesses that may have contributed to the depressive symptoms. In total, 129 participants were recruited. We collected their demographic and clinical details before interviewing them using two questionnaires-the Neurological Disorders Depression Inventory for Epilepsy and Beck's Depression Inventory-II. Subsequently, if a participant screened positive for depression, the diagnosis was confirmed using the Diagnostic and Statistical Manual of Mental Disorders questionnaire, and a psychiatric clinic referral was offered.

RESULTS: Among the 129 participants, 9.3 % had undiagnosed major depressive disorder, and there was a female preponderance (66.7 %). The risk factors for undiagnosed depression among patients with epilepsy included low socioeconomic background (p = 0.026), generalized epilepsy (p = 0.036), and temporal lobe epilepsy (p = 0.010). Other variables such as being underweight and unmarried were more common among patients diagnosed with depression than without but no statistically significant relationship was found.

CONCLUSION: The prevalence of undiagnosed depression among patients with epilepsy was higher than that in population-based studies conducted in Western countries. Although questionnaires to screen for depression are widely available, some clinicians rarely use them and, therefore, fail to identify patients who may benefit from psychosocial support and treatment that would improve their disease outcomes and quality of life. The present study indicated that clinicians should use screening questionnaires to identify undiagnosed depression in people with epilepsy.

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