MyMedR

Fulltext Phenothiazine deposits in corneo and lens

Choong YY, Lim KS

Med J Malaysia, 2001 Mar;56(1):92-4.

Phenothiazines have been associated with various ocular adverse effects, in particular cataract and corneal deposits. Several effects are vision threatening. Awareness of these effects, in particular by Psychiatrists and Ophthalmologist, is essential for prompt diagnosis and appropriate treatment. We report two patients presented to us with corneal deposits and lenticular opacities following long term use of Phenothiazines.

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.

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.

Combined large radial retinotomy and circumferential retinectomy in the management of advanced proliferative vitreoretinopathy

Lim AK, Alexander SM, Lim KS

Retina, 2009 Jan;29(1):112-6.

PMID: 18784619 DOI: 10.1097/IAE.0b013e318187f14a

Fulltext Assessment of Reinforced Concrete Surface Breaking Crack Using Rayleigh Wave Measurement

Lee FW, Chai HK, Lim KS

Sensors (Basel), 2016;16(3).

PMID: 26959028 DOI: 10.3390/s16030337

An improved single sided Rayleigh wave (R-wave) measurement was suggested to characterize surface breaking crack in steel reinforced concrete structures. Numerical simulations were performed to clarify the behavior of R-waves interacting with surface breaking crack with different depths and degrees of inclinations. Through analysis of simulation results, correlations between R-wave parameters of interest and crack characteristics (depth and degree of inclination) were obtained, which were then validated by experimental measurement of concrete specimens instigated with vertical and inclined artificial cracks of different depths. Wave parameters including velocity and amplitude attenuation for each case were studied. The correlations allowed us to estimate the depth and inclination of cracks measured experimentally with acceptable discrepancies, particularly for cracks which are relatively shallow and when the crack depth is smaller than the wavelength.

Fulltext Anti N-Methyl-D-Aspartate receptor encephalitis: An under-recognised cause of encephalitis

Rajahram GS, Nadarajah R, Lim KS, Menon J

Med J Malaysia, 2015 Dec;70(6):363-4.

PMID: 26988212 MyJurnal

Anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis is an immune mediated condition with characteristic clinical presentation. We report the first case from Borneo, Sabah and the use of electroconvulsive therapy (ECT) in treating recalcitrant psychiatrist symptoms associated with this condition.

Neuroimaging in refractory epilepsy. Current practice and evolving trends

Ramli N, Rahmat K, Lim KS, Tan CT

Eur J Radiol, 2015 Sep;84(9):1791-800.

PMID: 26187861 DOI: 10.1016/j.ejrad.2015.03.024

Identification of the epileptogenic zone is of paramount importance in refractory epilepsy as the success of surgical treatment depends on complete resection of the epileptogenic zone. Imaging plays an important role in the locating and defining anatomic epileptogenic abnormalities in patients with medically refractory epilepsy. The aim of this article is to present an overview of the current MRI sequences used in epilepsy imaging with special emphasis of lesion seen in our practices. Optimisation of epilepsy imaging protocols are addressed and current trends in functional MRI sequences including MR spectroscopy, diffusion tensor imaging and fusion MR with PET and SPECT are discussed.

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.

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.

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.

Fulltext Methylene blue related sterile endophthalmitis

Lim AK, Ulagantheran V V, Siow YC, Lim KS

Med J Malaysia, 2008 Aug;63(3):249-50.

PMID: 19248701 MyJurnal

To report a case of methylene blue related endophthalmitis. Observational case report. Review of clinical record, photographs. A 60 year old man developed endophthalmitis after methylene blue was accidentally used to stain the anterior capsule during phacoemulsification of cataract. His left visual acuity deteriorated from 6/12 to 6/36 two weeks after the operation. Despite intensive treatment with topical and intravitreal antibiotics, his condition deteriorated. A vitrectomy and silicone oil injection eventually managed to control the progression of the disease and salvage the eye. However the visual outcome remained poor due to corneal decompensation and retinal ischemia. Both vitreous tap and vitreous biopsy were negative for any organism. Methylene blue is extremely toxic to ocular structures and should not be used intraocularly.

Hypotensive anesthesia in the management of a posterior suprachoroidal foreign body

Hashim H, Lim KS, Choong YY, Nor NM

Retina, 2005 Jan;25(1):87-9.

PMID: 15655449

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.

Periodic lateralized epileptiform discharges (PLEDs) in cerebral lupus correlated with white-matter lesions in brain MRI and reduced cerebral blood flow in SPECT

Aye SM, Lim KS, Ramli NM, Tan CT

Lupus, 2013 Apr;22(5):510-4.

PMID: 23358870 DOI: 10.1177/0961203312474705

This is a case report on an uncommon correlation between periodic lateralized epileptiform discharges (PLEDs) and white-matter lesions in cerebral lupus, and with a reduced cerebral blood flow (CBF) in single-photon emission computed tomography (SPECT). A 47-year-old woman with a long-term history of systemic lupus erythematosus (SLE) presented with a seizure followed by frontal lobe dysfunction clinically. An electroencephalogram (EEG) showed bilateral independent PLEDs in the frontal region. A magnetic resonance image of the brain showed white-matter changes in the frontal periventricular region. Cerebral angiogram did not reveal any evidence of vasculitis. A cerebral SPECT with tracer injected during the EEG showing PLEDs showed a reduction in CBF in the frontal regions. Clinical recovery was observed with intravenous immunoglobulin. This case shows that PLEDs can be seen with white-matter changes in SLE.

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.

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.

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)

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.

Mindfulness-based intervention to promote psychological wellbeing in people with epilepsy: A randomized controlled trial

Lai ST, Lim KS, Tang V, Low WY

Epilepsy Behav, 2021 05;118:107916.

PMID: 33743343 DOI: 10.1016/j.yebeh.2021.107916

BACKGROUND: We investigated the efficacy of mindfulness-based intervention (MBI) in promoting psychological wellbeing in people with epilepsy (PWE) using an assessor-blinded randomized controlled design.

METHODS: A total of 28 PWE were randomly assigned to either intervention (n = 14 cases) or control group (n = 14 controls). The intervention group received a six 2.5-hour weekly MBI, while the control group did not receive any intervention. They were assessed at three timepoints (T0: before intervention, T1: immediately after intervention, and T2: 6 weeks after intervention). Repeated measures of analyses of variance (RM-ANOVAs) were used for inter-group comparisons to determine intervention effect from baseline -to T1 and -to T2 for all outcome measures. The individual changes were calculated using the reliable change index (RCI). Key outcomes included depression (BDI-II), anxiety (BAI), epilepsy-related quality of life (QOLIE-31), satisfaction with life (SWLS), and level of mindfulness (MAAS).

RESULTS: Participants who participated in the MBI showed significant reduction in BDI-II (p = 0.001), significant increases in MAAS (p = 0.027) and QOLIE-31 (p = 0.001) at T1 when compared with the control group. However, BAI and SWLS were not significant. The trend was similar at 6-week follow-up, all outcome measures of MBI remained significant (p 

Fulltext Efficacy and safety of retigabine/ezogabine as adjunctive therapy in adult Asian patients with drug-resistant partial-onset seizures: A randomized, placebo-controlled Phase III study

Lim KS, Lotay N, White R, Kwan P

Epilepsy Behav, 2016 Jul 1;61:224-230.

PMID: 27376872 DOI: 10.1016/j.yebeh.2016.05.018

The purpose of this study was to evaluate the efficacy and safety of adjunctive retigabine/ezogabine (RTG/EZG) therapy in Asian adults with partial-onset seizures.

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