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  1. Fulltext Epilepsy stigma in Asia: the meaning and impact of stigma
    Lim, Kheng-Seang, Tan, Chong-Tin
    Neurology Asia, 2014;19(1):1-10.
    MyJurnal
    Stigma is conceptually broad and culturally variable. Understanding stigma from the conceptual theories, culturally application based on the word stigma in other languages, the definition of stigma and its synonyms, as well as the medical implications in other stigmatized disease such as AIDS, will help us to understand the complexity of stigma in epilepsy. This review investigated the meaning and types of stigma from different perspectives, leading to staging stigma into 5 levels, i.e. social identity, stereotype, prejudice, discrimination and social disability. In addition to the conventional categorization of stigma into social, felt, self-perceived or internalized stigma, new categories of stigma i.e. personal and general attitudes towards epilepsy based on a newly developed Public Attitudes Toward Epilepsy (PATE) scale was introduced. Courtesy stigma was further elaborated in related to Asian culture. Based on well-established and recently developed theories, the causation and impact of epilepsy stigma was discussed in an Asian context, especially from the aspects of language and society values which are culturally specific. Integrating these theories of causation, illness and stereotype perceptions were proposed to be the mediating mechanism of stigma, which led to the development of a practical and multi-dimensional stigmatization model, aiming to guide, widen and deepen the scope of future stigma research in epilepsy. Using the established model, together with review of related studies, research priorities in epilepsy stigma research especially in Asia focusing on five aspects, i.e. expanding population studies especially on significant others, understanding stigma from personal attitude perspective, investigating the cultural and social causation of stigma, and the impacts of stigma on patients as well as the family members, were proposed.
  2. Fulltext Epilepsy and comorbidities: towards unravelling the common underlying mechanisms
    Paudel, Yam Nath, Lisgaras, Christos Panagiotis, Lim, Kheng Seang, Shaikh, Mohd. Farooq
    Neuroscience Research Notes, 2018;1(3):1-4.
    MyJurnal
    Epilepsy is a chronic neurological disorder characterized by the rapid occurrence of epileptic seizures affecting approximately 70 million people worldwide[1,2]. The quality of life of people with epilepsy (PWE) is challenged by a series of comorbidities that might include neurologic and neuropsychiatric disorders (cognitive decline, depression, anxiety, schizophrenia, and autism) as well as metabolic, cardiovascular and respiratory diseases[3]. Neurobehavioral and other comorbidities might share a reciprocal and complex relationship with epileptogenesis and ictogenesis thus biomarkers of the former might be useful for the prediction of the latter and vice versa[4].
  3. Fulltext Malaysian society of neurosciences (MSN) –Asian and Oceanian myology centre (AOMC) annual scientific meeting 2018
    Lim, Kheng-Seang, Goh, Khean-Jin, Tan, Ai-Huey, Low, Soon-Chai, Mustapha Muzaimi
    Neuroscience Research Notes, 2018;1(2):6-11.
    MyJurnal
    The conjoint 17thAsian and Oceanian Myology Centre (AOMC) and 28thMalaysian Society of Neurosciences (MSN) Annual Scientific Meeting, held in Hotel Istana, Kuala Lumpur, Malaysia from 27 to 29 July 2018, was a great success to gather all neurosciences professionals locally and in the Asian-Oceanian region to share the latest updates in Neurology and specifically Myology. This congress attracted 516 local participants and 167 international delegates from 14 countries
  4. Fulltext Spontaneous remission without progression to limbic encephalitis in a patient with LGi1 seropositive faciobrachial dystonic seizure
    Sherrini Bazir Ahmad, Suhailah Abdullah, Chong, Tin Tan, Lim, Kheng Seang, Goh, Khean Jin
    Neurology Asia, 2016;21(2):191-193.
    MyJurnal
    Faciobrachial dystonic seizures are pathognomonic of leucine-rich glioma inactivated-1 (LGi1) antibody, non-paraneoplastic limbic encephalitis. Faciobrachial dystonic seizures usually precede limbic encephalitis by about a month. It is unknown whether, if untreated, faciobrachial dystonic seizures inevitably progress to limbic encephalitis. We present an LGi1 seropositive patient with a year’s history of faciobrachial dystonic seizures, who achieved remission spontaneously without immunotherapy or antiepileptic drug treatment, and did not develop evidence of limbic encephalitis over a three-year follow-up.
  5. Fulltext Efficacy of repetitive transcranial magnetic stimulation on refractory epilepsy in Malaysia
    Sherrini Bazir Ahmad, Lim, Kheng Seang, Goh, Hui Ting, Wo, Chen Mun, Low, Siew Yong, Tan, Chong Tin
    Neurology Asia, 2016;21(3):225-233.
    MyJurnal
    Background & Objective: Modulation of cortical excitability by low frequency repetitive transcranial
    magnetic stimulation (rTMS) has demonstrated therapeutic use in epilepsy. This study aimed to evaluate
    the efficacy of low-frequency rTMS on refractory epilepsy in a group of Malaysian subjects. Methods:
    Nine patients with refractory epilepsy completed the study. All patients received 10 sessions of 1Hz
    rTMS (1000 pulses per session) at 90% of resting motor threshold. Outcome measures included seizure
    frequency, Symptom Checklist-90 (SCL-90), Beck Depression Inventory II (BDI II) and Quality of
    Life in Epilepsy-31 (QOLIE-31). Responders were defined as having ≥ 50% seizure reduction. Results:
    The mean age was 33.8 years (SD 11.7), with 4 male. Three patients had mesial temporal sclerosis
    (MTS); 4 with focal cortical dysplasia (FCD) and two lesion-negative. Three patients achieved >50%
    seizure reduction at 8 weeks post-treatment, with 2 of them had improvement in the number of IED.
    All of the responders had FCD. The responders were younger (mean 24.7 vs. 38.3 years old), had
    shorter duration of illness (mean 15.7 vs. 30.5 years) and had less frequent seizure frequency prior to
    treatment (mean 5.5 vs. 10.8 attacks per week), as compared to the non-responders. Six patients had
    improvement in BDI-II scores, two in QOLIE-31 and four in SCL-90 post treatment, irrespective of
    seizure control. The mean scores in BDI-II improved significantly with treatment (p
  6. Focal epilepsy recruiting a generalised network of juvenile myoclonic epilepsy: a case report
    Khaing M, Lim KS, Tan CT
    Epileptic Disord, 2014 Sep;16(3):370-4.
    PMID: 25166001 DOI: 10.1684/epd.2014.0672
    We report a patient with juvenile myoclonic epilepsy who subsequently developed temporal lobe epilepsy, which gradually became clinically dominant. Video telemetry revealed both myoclonic seizures and temporal lobe seizures. The temporal lobe seizures were accompanied by a focal recruiting rhythm with rapid generalisation on EEG, in which the ictal EEG pattern during the secondary generalised phase was morphologically similar to the ictal pattern during myoclonic seizures. The secondary generalised seizures of the focal epilepsy responded to sodium valproate, similar to the myoclonic epilepsy. In this rare case of coexistent Juvenile Myoclonic Epilepsy and Temporal lobe epilepsy, the possibility of focal epilepsy recruiting a generalised epileptic network was proposed and discussed.
  7. Periodic lateralized epileptiform discharges in neuropsychiatric lupus: association with cerebritis in magnetic resonance imaging and resolution after intravenous immunoglobulin
    Lim KS, Cheong KL, Tan CT
    Lupus, 2010 May;19(6):748-52.
    PMID: 20133346 DOI: 10.1177/0961203309351539
    A 13-year-old girl with a known diagnosis of systemic lupus erythematosus presented with seizures and psychosis. An electroencephalogram (EEG) revealed continuous, non-evolving periodic lateralized epileptiform discharges (PLEDs) in the left temporal region, which did not resolve with benzodiazepine. A magnetic resonance imaging (MRI) brain scan demonstrated a focal hyperintensity in the left medial temporal and left occipital lobes, left thalamus and bilateral cerebellar white matter, with evidence of vasculitis in the magnetic resonance angiography. Intravenous immunoglobulin was given because of failed steroid therapy, which resulted in a full resolution of clinical, EEG and MRI abnormalities. Lupus cerebritis should be considered as a possible aetiology in PLEDs, and immunoglobulin can be effective in neuropsychiatric lupus.
  8. Fulltext Bilateral thalamic internal medullary lamina involvement in a case of dengue encephalitis
    Sherrini Bazir Ahmad, Chin, Sum Cheong, Lim, Shen-Yang, Kartini Rahmat, FaizatulIzza Rozalli, Sekaran, Shamala Devi, et al.
    Neurology Asia, 2016;21(4):374-379.
    MyJurnal
    There are 50-100 million dengue infections each year, but dengue encephalitis is relatively
    uncommon. The aetiology of neuronal injury is proposed to be due to direct viral neurotropism or
    host immune response-mediated inflammation causing neuronal damage. We report a case of severe
    dengue encephalitis, presenting during the acute viraemic phase of the disease. This was associated
    with inflammation and haemorrhage of the internal medullary lamina of both thalami which, to our
    knowledge, has not yet been reported in other infections of the central nervous system.
  9. Fulltext Validity and reliability of the Chinese parent proxy and child self-report health related quality of life measure for children with epilepsy (CHEQOL-25) in Malaysia
    Wo, Su Woan, Lai, Pauline Siew Mei, Ong, Lai Choo, Low, Wah Yun, Lim, Kheng Seang, Tay, Chee Geap, et al.
    Neurology Asia, 2016;21(3):235-245.
    MyJurnal
    Objective: To determine the validity and reliability of the Chinese parent proxy and child self-report
    health related quality of life measure for children with epilepsy (CHEQOL-25) in Malaysia. Methods:
    Face and content validity of the Chinese parent proxy and child self-report CHEQOL-25 was verified
    by an expert panel, and piloted in five children with epilepsy (CWE). The Chinese CHEQOL-25 was
    then administered to 40 parent proxies and their CWE (aged 8-18 years), from two tertiary hospitals,
    at baseline and 2 weeks later. Results: Forty parents and their CWE were recruited. Cronbach’s alpha
    for each subscale ranged from 0.56-0.83. At test-retest, the interclass correlation for all items ranged
    from 0.68-0.97. Items 8 and 25 were removed as their corrected item-total correlation values were
  10. Fulltext Association between HLA-B* 15:02 and carbamazepine induced severe cutaneous adverse drug reactions in Myanmar
    Amy Hui-Ping Khor, Lim, Kheng-Seang, Tan, Chong-Tin, Seinn Mya Mya Aye, Yan Lynn Aung, Yin Minn Aye, et al.
    Neurology Asia, 2017;22(3):283-285.
    MyJurnal
    Genetic predisposition to carbamazepine (CBZ)-induced Stevens-Johnson syndrome (SJS) and toxic
    epidermal necrolysis (TEN) had been reported in several Southeast Asian populations, but not in
    Myanmar. Previous studies had so far reported more than 70% of CBZ-induced SJS/TEN cases
    positive for HLA-B*15:02 allele.1-4 Myanmar, as the second largest country in Southeast Asia with a
    population of 54.5 million, has high HLA-B*15:02 carrier frequency in its general population (27.3-
    49.1%).5,6 We investigated the association of HLA-B alleles and CBZ-induced SJS/TEN in Myanmar
    population. HLA-B*15:02 was detected in 3/3 (100%) of cases and 6/53 (11.3%) of tolerant controls,
    and HLA-B*15:02 is significantly associated with CBZ-SJS/TEN in Myanmar population (OR 51.2,
    95% CI 2.36-1106.95, p=0.003). (Copied from article)
  11. Fulltext Level 4 comprehensive epilepsy program in Malaysia, a resource-limited country
    Lim, Kheng-Seang, Sherrini Ahmad Bazir Ahmad, Vairavan Narayanan, Kartini Rahmat, Norlisah Mohd Ramli, Mun, Kein-Seong, et al.
    Neurology Asia, 2017;22(4):299-305.
    MyJurnal
    Background and Objective: There is a great challenge to establish a level 4 epilepsy care offering
    complete evaluation for epilepsy surgery including invasive monitoring in a resource-limited country.
    This study aimed to report the setup of a level 4 comprehensive epilepsy program in Malaysia and the
    outcome of epilepsy surgery over the past 4 years.

    Methods: This is a retrospective study analyzing
    cases with intractable epilepsy in a comprehensive epilepsy program in University Malaya Medical
    Center (UMMC), Kuala Lumpur, from January 2012 to August 2016.

    Results: A total of 92 cases
    had comprehensive epilepsy evaluation from January 2012 till August 2016. The mean age was 35.57
    years old (range 15-59) and 54 (58.7%) were male. There were 17 cases having epilepsy surgery
    after stage-1 evaluation. Eleven cases had mesial temporal sclerosis and 81% achieved Engel class
    I surgical outcome. Six cases had lesionectomy and 60% had Engel class I outcome. A total of 16
    surgeries were performed after stage-2 evaluation, including invasive EEG monitoring in 9 cases.
    Among those with surgery performed more than 12 months from the time of data collection, 5/10
    (50%) achieved Engel I outcome, whereas 2 (20%) had worthwhile improvement (Engel class III)
    with 75% and 90% seizure reduction.

    Conclusion: Level 4 epilepsy care has an important role and is possible with joint multidisciplinary
    effort in a middle-income country like Malaysia despite resource limitation.
  12. Fulltext HLA-B*1502 and carbamazepine induced Stevens-Johnson syndrome/toxic epidermal necrolysis in Indonesia
    Herlyani Khosama, Astri Budikayanti, Amy Hui Ping Khor, Lim, Kheng Seang, Ng, Ching-Ching, Indra G. Mansyur, et al.
    Neurology Asia, 2017;22(2):113-116.
    MyJurnal
    Background & Objective: Association between HLA-B*1502 and carbamazepine-induced StevenJohnson
    syndrome/toxic epidermal necrolysis (CBZ-SJS/TEN) was reported in many Southeast Asian
    populations but not in Indonesian. The purpose of this study was to evaluate the association between
    HLA-B*1502 andCBZ-SJS/TEN in an Indonesian population.

    Methods: Patients with history of
    CBZ-SJS/TEN are recruited as cases and those who tolerated CBZ as controls. HLA-B typing was
    performed.

    Results: We recruited 14 cases with CBZ-SJS/TEN and 53 controls. Positive HLA-B*1502
    was found in 8 (57.1%) cases and 14 (26.4%) controls (OR 3.7, 95% CI 1.09-12.61, p=0.035).

    Conclusion: HLA-B*1502 is associated with CBZ-SJS/TEN patients in Indonesian.
  13. Malay public attitudes toward epilepsy (PATE) scale: translation and psychometric evaluation
    Lim KS, Choo WY, Wu C, Tan CT
    Epilepsy Behav, 2013 Nov;29(2):395-9.
    PMID: 24090773 DOI: 10.1016/j.yebeh.2013.08.027
    INTRODUCTION: None of the quantitative scales for public attitudes toward epilepsy had been translated to Malay language. This study aimed to translate and test the validity and reliability of a Malay version of the Public Attitudes Toward Epilepsy (PATE) scale.
    METHOD: The translation was performed according to standard principles and tested in 140 Malay-speaking adults aged more than 18 years for psychometric validation.
    RESULTS: The items in each domain had similar standard deviations (equal item variance), ranging from 0.90 to 1.00 in the personal domain and from 0.87 to 1.23 in the general domain. The correlation between an item and its domain was 0.4 and above for all items and was higher than the correlation with the other domain. Multitrait analysis showed that the Malay PATE had a similar variance, floor and ceiling effects, and relative relationship between the domains as the original PATE. The Malay PATE scale showed a similar correlation with almost all demographic variables except age. Item means were generally clustered in the factor analysis as the hypothesized domains, except those for items 1 and 2. The Cronbach's α values were within acceptable range (0.757 and 0.716 for the general and personal domains, respectively).
    CONCLUSION: The Malay PATE scale is a validated and reliable translated version for measuring public attitudes toward epilepsy.
  14. Development and validation of a public attitudes toward epilepsy (PATE) scale
    Lim KS, Wu C, Choo WY, Tan CT
    Epilepsy Behav, 2012 Jun;24(2):207-12.
    PMID: 22564888 DOI: 10.1016/j.yebeh.2012.03.038
    A quantitative scale of public attitudes toward epilepsy is essential to determine the magnitude of social stigma against epilepsy. This study aims to develop and validate a cross-culturally applicable scale of public attitudes toward epilepsy.
  15. EEG spectral analysis on Muslim prayers
    Doufesh H, Faisal T, Lim KS, Ibrahim F
    Appl Psychophysiol Biofeedback, 2012 Mar;37(1):11-8.
    PMID: 21965118 DOI: 10.1007/s10484-011-9170-1
    This study investigated the proposition of relaxation offered by performing the Muslim prayers by measuring the alpha brain activity in the frontal (F3-F4), central (C3-C4), parietal (P3-P4), and occipital (O1-O2) electrode placements using the International 10-20 System. Nine Muslim subjects were asked to perform the four required cycles of movements of Dhuha prayer, and the EEG were subsequently recorded with open eyes under three conditions, namely, resting, performing four cycles of prayer while reciting the specific verses and supplications, and performing four cycles of acted salat condition (prayer movements without any recitations). Analysis of variance (ANOVA) tests revealed that there were no significant difference in the mean alpha relative power (RP(α)) between the alpha amplitude in the Dhuha prayer and the acted conditions in all eight electrode positions. However, the mean RP(α) showed higher alpha amplitude during the prostration position of the Dhuha prayer and acted condition at the parietal and occipital regions in comparison to the resting condition. Findings were similar to other studies documenting increased alpha amplitude in parietal and occipital regions during meditation and mental concentration. The incidence of increased alpha amplitude suggested parasympathetic activation, thus indicating a state of relaxation. Subsequent studies are needed to delineate the role of mental concentration, and eye focus, on alpha wave amplitude while performing worshipping acts.
  16. Impact of epilepsy on employment in Malaysia
    Lim KS, Wo SW, Wong MH, Tan CT
    Epilepsy Behav, 2013 Apr;27(1):130-4.
    PMID: 23416283 DOI: 10.1016/j.yebeh.2012.12.034
    Studies on the impact of epilepsy on employment have been extensively performed in European and some Asian countries but not in Southeast Asia such as Malaysia, a country with a robust economy, low unemployment rate, and minimal social security benefits for the unemployed. This study aims to determine the impact of epilepsy on employment in Malaysia.
  17. Employability among people with uncontrolled seizures: An interpretative phenomenological approach
    Wo MC, Lim KS, Choo WY, Tan CT
    Epilepsy Behav, 2015 Apr;45:21-30.
    PMID: 25794681 DOI: 10.1016/j.yebeh.2015.02.016
    This study aimed to explore positive and negative factors affecting the employability in patients with uncontrolled seizures.
  18. Employability in people with epilepsy: A systematic review
    Wo MC, Lim KS, Choo WY, Tan CT
    Epilepsy Res, 2015 Oct;116:67-78.
    PMID: 26354169 DOI: 10.1016/j.eplepsyres.2015.06.016
    People with epilepsy were (PWE) reported to have poorer employment rate. However, the methodologies used differ greatly from one study to another, making global comparison difficult. We aimed to determine the employment rate of PWE globally using a unified definition of employment rate and to summarize the reported positive and negative factors affecting employability in PWE, using a systematic review.
  19. Factors affecting the employability in people with epilepsy
    Wo MC, Lim KS, Choo WY, Tan CT
    Epilepsy Res, 2016 Dec;128:6-11.
    PMID: 27792885 DOI: 10.1016/j.eplepsyres.2016.10.003
    PURPOSE: People with epilepsy (PWE) are negatively prejudiced in their ability to work. This study aimed to examine demographic, clinical and psychological factors associated with employability in PWE.

    METHODS: This study recruited epilepsy patients from a neurology clinic in Malaysia. Employability was measured using employment ratio, with a ratio ≥90% (ER90) classified as high employability. Basic demographic data such as age, gender, marital status, religion, education level and household income was collected. Clinical measures consisted of age of seizure onset, seizure frequency, type of epilepsy, aura, polytherapy, nocturnal seizures and seizure control. Psychological measures included Work Self-Determination Index (WSDI), Rosenberg Self-Esteem Scale (SES), and Multidimensional Scale of Perceived Social Support (MSPSS).

    RESULTS: Of 146 PWE, 64.4% had high employability. The participants were predominantly female (52%), Chinese (50.7%), single (50%), having tertiary education (55.5%) and focal epilepsy (72.6%). Clinically, only type of epilepsy was significantly correlated to employability of PWE. Employability of PWE was associated with ability to work (indicated by education level, work performance affected by seizures, ability to travel independently and ability to cope with stress at work) and family overprotection. The high employability group was found to have lower self-perceived stigma (ESS), higher self-determined motivation (WSDI), self-esteem (SES) and perceived social support (MSPSS), than the low employability group. Logistic regression analysis showed that tertiary education level (AOR 3.42, CI: 1.46-8.00), higher self-determination (WSDI, AOR 1.09, CI: 1.012-1.17), lower family overprotection (AOR 0.76, CI: 0.61-0.95), and generalised epilepsy (AOR 4.17, CI: 1.37-12.70) were significant predictors for higher employability in PWE.

    CONCLUSION: Ability to work (education level), clinical factor (type of epilepsy) and psychological factor (self-determined motivation and family overprotection) were important factors affecting employability in PWE.

    Study site: neurology clinic Universiti Malaya Medical Centre (UMMC)
  20. Validity and reliability of the Turkish version of Public Attitudes Toward Epilepsy scale
    Aktürk T, Tanık N, Saçmacı H, Chia ZJ, Lim KS
    Epilepsy Behav, 2020 10;111:107245.
    PMID: 32693372 DOI: 10.1016/j.yebeh.2020.107245
    OBJECTIVE: This study was conducted to test the validity and reliability of the Turkish version of the Public Attitudes Toward Epilepsy (PATE) scale, which aims to understand public perceptions of seizures and epilepsy.

    METHODS: The scale was translated following the standard procedures. For psychometric validation, the Turkish version of the PATE scale was administered to 201 native Turkish speakers above the age of 18 who had no history of seizures or epilepsy. It was found that the respondents were able to fill out the scale quickly and without difficulty in understanding the translated items on the scale.

    RESULTS: Cronbach's alpha coefficient was found to be 0.843 for the overall scale and above 0.7 for each individual item. Cronbach's alpha was 0.78 for the general domain and 0.792 for the personal domain. Exploratory and confirmatory factor analyses were carried out and showed that the scale had a structure similar to that of the original scale, with the 14 items grouped under two dimensions, similar to the original scale.

    CONCLUSION: The Turkish version of the PATE scale was a valid and reliable tool to measure the attitudes toward epilepsy in Turkish society.

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