MATERIALS AND METHODS: Eight hundred and twenty-eight subjects (404 PD patients, and 424 age and gender-matched control subjects without neurological disorders) were recruited. Genotyping was done by Taqman® allelic discrimination assay on an Applied Biosystems 7500 Fast Real-Time PCR machine.
RESULTS: The heterozygous A419V genotype was found in only 1 patient with PD, compared to 3 in the control group (0.4% vs 1.3%), giving an odds ratio of 0.35 (95% confidence interval (CI), 0.01 to 3.79; P = 0.624).
CONCLUSION: A419V is not an important LRRK2 risk variant in our Asian cohort of patients with PD. Our data are further supported by a literature review which showed that 4 out of 6 published studies reported a negative association of this variant in PD.
METHODS: A cross-sectional survey using questionnaires was conducted among the representatives of ASEAN countries from October 2023 to March 2024.
RESULTS: Neurology training programs are available in 9 of the 11 ASEAN countries except Timor Leste and Cambodia. Despite the growing number of neurologists, with a doubling of the neurologist-to-patient ratio in most countries in the past 2 decades, the neurologist density per 100,000 population remained low. Thailand, Singapore, and Brunei Darussalam have more than 1 neurologist per 100,000 population compared with 2007 when only Singapore and Brunei Darussalam had more than this ratio. In Cambodia, Lao People's Democratic Republic (PDR), Myanmar, and Timur Leste, although the number of neurologists has increased substantially, the ratio of neurologists remains low, with less than 1 in a million population in Myanmar, 1:625,000 population in Lao PDR, 1:526,000 population in Cambodia, and 1:430,000 in Timur Leste. The total duration of training from undergraduate to certified neurologist varies greatly because of compulsory internal medicine (IM) training and postinternship services. To enroll in neurology training, candidates in 4 countries (Brunei, Singapore, Malaysia, and Myanmar) must have completed IM as a prerequisite. Candidates from Thailand and Indonesia must fulfill their 2-year compulsory government or general practice service requirement before they are eligible for neurology training. After fulfilling the eligibility criteria to enter neurology training, the overall training duration ranges from 3 to 13 years. Malaysia and Myanmar are countries where candidates spend more than 10 years becoming certified neurologists.
DISCUSSION: The number of neurologists and the neurologist-to-patient ratio have improved since 2007 in ASEAN countries. Diverse neurology curricula and the variable duration to complete neurology training and subspecialty practice are the main challenges in improving neurology training in ASEAN countries.