METHOD: A total of 2218 PWE were recruited retrospectively into this study. Deceased cases from 2009-2018 were identified from the National Registry Department of Malaysia. Age-, gender-, and ethnic-specific SMR were calculated.
RESULT: There was a total of 163 deaths, of which 111 (68.1%) were male. The overall case-fatality rate (CFR) was 7.3%. Male PWE had higher CFR (9.2%) compared to females (5.1%, p<0.001). The annual death rate of PWE was 867 per 100, 000 persons. The overall all-cause SMR was 1.6 (CI 95% 1.3-1.8). The SMR for younger age groups (15-19 and 20-29 years) were higher (5.4-5.5) compared to other age groups (0.4-2.5). Overall SMR for male PWE (1.8, 95% CI 1.5-2.1) was higher than females (1.2, 95% CI 0.9-1.6). However, the SMR for female PWE in the younger age groups (15-19, 20-29 and 30-39 years) was higher. SMR among the Indian PWE was the highest (1.6, 95% CI 1.2-2.0) compared to the Chinese (1.5, 95% CI 1.2-1.9) and the Malays (1.4, 95% 1.0-1.9). The CFR was higher in those with focal epilepsy (8.5% vs. 2.5-3.7% in genetic and other generalized epilepsies, p=0.003), epilepsy with structural cause (9.5% vs. 5.9% in others, p=0.005) and uncontrolled seizures (7.9% vs. 5.2% in seizure-free group, p<0.001).
CONCLUSION: The mortality rate of PWE in Malaysia is higher than that of the general population but lower compared to other Asian countries. Specifically, the rates are higher in the younger age group, male gender, and Indian ethnicity. Those with focal epilepsy, structural causes and uncontrolled seizures have higher mortality rates.
METHOD: Deceased PWE from 2005 to 2020 were identified from the National Registry Department of Malaysia. The details of the cause of death and predictors for epilepsy-related deaths was ascertained from medical records and phone interviews.
RESULT: There were a total of 227 deaths, 144 (63.4%) were male, two (0.9%) underwent autopsy and 46.3% passed away in the community. The majority of deaths (55.5%) were due to causes unrelated to epilepsy. Forty-five (19.8%) death were related to epilepsy, of which, 22 (9.7%) were due to death directly related to epilepsy including probable SUDEP (5.3%) and status epilepticus (4.4%). The cause of death was unknown in 56 (24.7%) cases. Binary logistic regression analysis identified 3 predictors for epilepsy-related deaths, i.e., structural causes (OR 3.09, 95% CI 1.100-8.691, p = 0.032), younger age of death (OR 2.35, 95% CI 1.039-5.333, p = 0.040) and history of brain surgery (OR 8.09, 95% CI 2.014-32.510, p = 0.003). Twelve (5.3%) had probable SUDEP. The incidence rate of probable SUDEP was 0.42 per 1000 person-years. The majority of them had intellectual disability (9/12), generalized tonic-clonic seizures (9/12), and 2 or more ASMs (9/12).
CONCLUSION: Epilepsy-related deaths accounted for 20% of the deaths in PWE, associated with structural cause, younger age of death, and previous brain surgery. Probable SUDEP is not uncommon in Malaysia and could be under-diagnosed.
OBJECTIVES: This qualitative study aimed to explore the lived experience of caregivers of AWE in Malaysian families and understand their caregiving challenges. Individual semi-structured interviews were held with 12 primary caregivers of AWE. Interpretative Phenomenological Approach (IPA) was used. The interview transcripts were analyzed using NVivo12 software.
RESULTS: Primary caregivers of AWE were parents or siblings, with ages ranging from 56 to 80 years old and years of caregiving from 24 to 40 years. Most AWE (58%) were intellectually disabled and fully dependent on ADL needs. Two categories of themes emerged, including four themes on caregiver burden, i.e., physical, emotional, and social burdens, and challenges in future planning of care, and two themes on coping strategies (problem- or emotional-focused). In future planning of care, most caregivers especially parents carried a burden of responsibility and were reluctant to depend on others or institutional services.
CONCLUSION: The caregiving burden among caregivers for adult AWE was not confined to current burdens only but also challenges in future planning. A better understanding of the caregiving burden for AWE and coping strategies is needed to provide tailored psychoeducation or psychosocial intervention to support this population.
METHODOLOGY/PRINCIPAL FINDINGS: This study was conducted using the motion analysis technique with the reflex responses measured in terms of knee angles. Forty healthy subjects were selected and categorized into three different age groups. Patellar reflexes were elicited from both the left and right patellar tendons of each subject at three different tapping angles and using the Jendrassik maneuver. The findings suggested that age has a significant effect on the magnitude of the reflex response. An angle of 45° may be the ideal tapping angle at which the reflex can be elicited to detect age-related differences in reflex response. The reflex responses were also not influenced by gender and were observed to be fairly symmetrical.
CONCLUSIONS/SIGNIFICANCE: Neurologically normal individuals will experience an age-dependent decline in patellar reflex response.
METHODS: Both ictal and interictal ESI were performed by the use of patient-specific realistic forward models and 3 different linear distributed inverse models. Lateralization as well as concordance between ESI-estimated focuses and single-photon emission computed tomography (SPECT) focuses were assessed.
RESULTS: All the ESI focuses (both ictal and interictal) were found lateralized to the same hemisphere as ictal SPECT focuses. Lateralization results also were in agreement with the lesion sides as visualized on magnetic resonance imaging. Ictal ESI results, obtained from the best-performing inverse model, were fully concordant with the same cortical lobe as SPECT focuses, whereas the corresponding concordance rate is 87.50% in case of interictal ESI.
CONCLUSIONS: Our findings show that ictal ESI gives fully lateralized and highly concordant results with ictal SPECT and may provide a cost-effective substitute for ictal SPECT.
METHODS: We used the Public Attitudes Toward Epilepsy (PATE) scale, including its Japanese version (PATE-J), to survey 113 Japanese and 130 Malaysian participants. Demographic data and PATE scores were compared using t-tests and χ² tests. Covariance analysis (ANCOVA) was conducted to adjust for potential confounding factors such as age and education level.
RESULTS: No significant differences were found in PATE total scores (P = 0.484), general domain (P = 0.101), or personal domain (P = 0.217) between Japan and Malaysia. However, after adjusting for age and education using ANCOVA, education significantly influenced the general domain (F = 4.512, P = 0.012) and total scores (F = 3.302, P = 0.038), while country (F = 7.191, P = 0.008) and age (F = 6.633, P = 0.011) were significant for the personal domain. Malaysian participants were significantly younger (P
METHODS: This retrospective observational study included all VEM cases performed in the University Malaya Medical Centre, Kuala Lumpur, Malaysia from 1st January 2011 to 30th April 2024, with SPECT as part of the pre-surgical evaluation.
RESULTS: A total of 189 cases were included. The mean age was 33.3 years old (range 9-68), and 105 (55.6 %) were male. The mean baseline seizure frequency before VEM was 21.8 per month. The mean number of seizures recorded during a 48-hour VEM was 10.9. A total of 44 (23.3 %) patients had ictal SPECT with a single SPECT session. Ictal SPECT was significantly associated with a higher number of seizures during 48-hour VEM (31.5 ± 58.7 vs 4.4 ± 6.3, p
METHODS: Previous studies relevant to this topic were identified from 7 databases. Searches were performed in PubMed, CINAHL, Web of Science (WOS), Scopus, Psychology and Behavioral Science Collection (PBSC), Embase, PsychINFO from 1 Jan 1980 to 31 December 2023. The findings were reported according to caregiver burden, caregiver needs, and coping strategies.
RESULTS: 22 studies were included in this review, including 14 quantitative and 8 qualitative studies. Six types of burdens were identified: psychological, physical, medical, economic, social, and family. The predominantly reported burden was the psychological burden in developed and developing countries. However, caregivers in developing countries reported additional physical, social, and economic burdens due to cultural and socioeconomic factors. Furthermore, inaccessible and unaffordable health care with a lack of medical knowledge exacerbated the challenges. Stigma and misconceptions led to more psychological distress and social restriction. There is a need for psychological, social, and family support as well as medical information to promote self-efficacy among caregivers. Most caregivers develop their own coping strategies for dealing with caregiving stress.
CONCLUSION: The caregiving burden for AWE is an understudied area that needs to be addressed by healthcare professionals. The caregivers are experiencing unaddressed psychological and other types of burdens, together with a lack of appropriate interventions and healthcare information.