MyMedR

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

Fulltext Neurological melioidosis in East Malaysia: case series and review of the literature

Tan, Ai Huey, Low, Soon Chai, Tan, Chong Tin, Fong, Si Lei, Wong, Jin Shyan

Neurology Asia, 2017;22(1):25-32.

MyJurnal

Melioidosis is an infectious disease caused by an aerobic, non-spore forming gram negative bacillus,
Burkholderia pseudomallei. It is known to be of high incidence in parts of rural South East Asia,
and in Northern Australia. Pneumonia is the commonest manifestation. We report here three cases of
neurological melioidosis from the registry of 169 cases of melioidosis in Bintulu Hospital, Sarawak,
East Malaysia, with a review of neurological melioidosis in the literature. The annual incidence of
melioidosis is estimated to be 8 per 100,000 populations in the Bintulu district. Neurological melioidosis
accounts for 1.8% of our melioidosis cases. A review of 76 cases of neurological melioidosis reported
in the literature inclusive of our 3 cases shows that localized brain or spinal inflammation or abscess
is the most common manifestation occurring in 80% of patients. Close to half (53%) have intra axial
abscess (brain or spinal cord), a quarter (27%) have extra axial lesions only (epidural or subdural
collection, osteomyelitis or scalp abscess), and another quarter (27%) have both intra and extra axial
lesions. Thus, B. pseudomallei appears to be unique among the bacterial central nervous system
infection to be able to affect the brain and its contiguous tissues, crossing the tissue plane particularly
resulting in osteomyelitis, scalp abscess and vice versa. Two thirds of the neurologicalmelioidosis
patients have only neurological disease with no evidence of disease elsewhere.

Historical perspective: The pros and cons of conventional outcome measures in Parkinson's disease

Lim SY, Tan AH

Parkinsonism Relat Disord, 2018 Jan;46 Suppl 1:S47-S52.

PMID: 28793970 DOI: 10.1016/j.parkreldis.2017.07.029

BACKGROUND: Conventional outcome measures (COMs) in Parkinson's disease (PD) refer to rating scales, questionnaires, patient diaries and clinically-based tests that do not require specialized equipment.

METHODS: It is timely at this juncture - as clinicians and researchers begin to grapple with the "invasion" of digital technologies - to review the strengths and weaknesses of these outcome measures.

RESULTS: This paper discusses advances (including an enhanced understanding of PD itself, and the development of clinimetrics as a field) that have led to improvements in the COMs used in PD; their strengths and limitations; and factors to consider when selecting and using a measuring instrument.

CONCLUSIONS: It is envisaged that in the future, a combination of COMs and technology-based objective measures will be utilized, with different methods having their own strengths and weaknesses. Judgement is required on the part of the clinician and researcher in terms of which instrument(s) are appropriate to use, depending on the particular clinical or research setting or question.

Movement Disorder Rounds: Learning through observation, building on collective experiences

Tan AH, Gatto EM

Parkinsonism Relat Disord, 2023 Apr 05.

PMID: 37045676 DOI: 10.1016/j.parkreldis.2023.105396

Osmotic Demyelination Syndrome With Evolving Movement Disorders

Tan AH, Lim SY, Ng RX

JAMA Neurol, 2018 07 01;75(7):888-889.

PMID: 29799978 DOI: 10.1001/jamaneurol.2018.0983

Teaching Video NeuroImages: Purposeless groaning in progressive supranuclear palsy

Low SC, Tan AH, Lim SY

Neurology, 2017 01 03;88(1):e9.

PMID: 28025406 DOI: 10.1212/WNL.0000000000003465

Fulltext Improvement of "Bouncy Gait" in Lance-Adams Syndrome with Perampanel

Lim SY, Jasti DB, Tan AH

Cureus, 2020 Jan 25;12(1):e6773.

PMID: 32117660 DOI: 10.7759/cureus.6773

Lance-Adams syndrome (LAS) is chronic post-hypoxic myoclonus that is often associated with sudden lapses in muscle tone (negative myoclonus) in the legs, causing a disabling "bouncy gait." Given its relative rarity, there are no controlled treatment studies of LAS. The majority of cases require polypharmacy management, with an incomplete response. "Bouncy gait," in particular, is notoriously medication-refractory. Here, we report a patient with long-standing LAS who improved markedly when low-dose perampanel was added to his existing treatment regime consisting of clonazepam, levetiracetam, sodium valproate, and acetazolamide.

Levodopa and Parkinson Disease-Myths Revisited

Lim SY, Poewe W, Tan AH

JAMA Neurol, 2017 10 01;74(10):1270.

PMID: 28973082 DOI: 10.1001/jamaneurol.2017.2560

Deep brain stimulation in Dopa-Responsive Parkinsonism - Look out for red flags: Expert commentary

Lim SY, Tan AH, Tay YW

Parkinsonism Relat Disord, 2023 Jan 10.

PMID: 36641339 DOI: 10.1016/j.parkreldis.2022.105276

Brief Clinical Rating Scales Should Not Be Overlooked

Lim SY, Lim KB, Hor JW, Tan AH

Mov Disord, 2020 10;35(10):1884-1885.

PMID: 33068479 DOI: 10.1002/mds.28274

Fulltext Genotypic and phenotypic variation of CADASIL among Chinese, Indians and Rungus in Malaysia

Toh, Tsun-Haw, Lim, Kheng-Seang, Ng, Ching-Ching, Imran Idris, Sherrini Bazir Ahmad, Lim, Thien-Thien, et al.

Neuroscience Research Notes, 2019;2(3):1-11.

MyJurnal

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary disease of small cerebral arteries. This case series aims to describe the mutations in NOTCH3and their phenotypes in Malaysia. We includedpatients who were genetically confirmed to have CADASIL, diagnosed at the University of Malaya Medical Centre, Malaysia. Family members who fulfilled clinical or imaging criteria, and patients from two previous published Malaysian families were also included. Six families (eleven cases) were included in this series. Genetic testing revealed NOTCH3 mutations in c.328C>T (p.Arg110Cys, R110C), c.553T>G (p.Cys185Gly, C185G), c.1630C>T (p.Arg544Cys, R544C) and c.160C>T (p.Arg54Cys, R54C). Two out of four Chinese families had R544C mutation in exon 11, with a later age of onset, absence of migraine and lack of anterior temporal pole involvement on MRI. One family with mixed Indian and Chinese ancestry had a mutation in exon 3 with R110C and another Indian family exon 4 with C185G mutation. This case series highlights the genotypic and phenotypic variability of CADASIL in a multi-ethniccountry. The finding of p.Arg544Cys mutation among the older Chinese families, similar to those reported in Jeju Island and Taiwan, suggest the need to screen the older Chinese stroke patients with typical MRI changes.

Fulltext Purposeless Groaning in Parkinson's Disease

Lim SY, Tan AH, Lim JL, Ahmad-Annuar A

J Mov Disord, 2018 May;11(2):87-88.

PMID: 29860787 DOI: 10.14802/jmd.18004

Purposeless groaning has been reported in advanced progressive supranuclear palsy. We present a case of purposeless groaning occurring as a primary complaint in a patient with advanced Parkinson's disease. Purposeless groaning is thought to be a manifestation of disinhibition and perseveration due to frontal-subcortical dysfunction. Proper recognition of this phenomenon will help clinicians to avoid unnecessary investigations and treatment (e.g., prescription of opioid medications).

Methylmalonic Aciduria: A Treatable Disorder of Which Adult Neurologists Need to Be Aware

Tan AH, Mah JSY, Thong MK, Lim SY

Mov Disord Clin Pract, 2015 09 16;3(1):104-105.

PMID: 30713905 DOI: 10.1002/mdc3.12237

Fulltext Probiotics for Parkinson's disease: Current evidence and future directions

Tan AH, Hor JW, Chong CW, Lim SY

JGH Open, 2021 Apr;5(4):414-419.

PMID: 33860090 DOI: 10.1002/jgh3.12450

The gut-brain axis is a hot topic in Parkinson's disease (PD). It has been postulated that gut pathogens and dysbiosis can contribute to peripheral inflammatory states or trigger downstream metabolic effects that exacerbate the neurodegenerative process in PD. Several preclinical and clinical studies have demonstrated disrupted intestinal permeability, intestinal inflammation, altered gut microbiome, and reduced fecal short-chain fatty acids in PD. In this regard, microbial-directed therapies such as probiotics are emerging as potential therapeutic options. Probiotic supplementation is postulated to confer a variety of health benefits due to the diverse functions of these live microorganisms, including inhibition of pathogen colonization, modulation/"normalization" of the microbiome and/or its function, immunomodulatory effects (e.g. reducing inflammation), and improved host epithelial barrier function. Interestingly, several PD animal model studies have demonstrated the potential neuroprotective effects of probiotics in reducing dopaminergic neuronal degeneration. Notably, two randomized placebo-controlled trials have provided class I evidence for probiotics as a treatment for constipation in PD. However, the effects of probiotics on other PD aspects, such as motor disability and cognitive function, and its long-term efficacy (including effects on PD drug absorption in the gut) have not been investigated adequately. Further targeted animal and human studies are also warranted to understand the mechanisms of actions of probiotics in PD and to tailor probiotic therapy based on individual host profiles to improve patient outcomes in this disabling disorder.

Advice to People with Parkinson's in My Clinic: Probiotics and Prebiotics

Hor JW, Toh TS, Lim SY, Tan AH

J Parkinsons Dis, 2024 Aug 23.

PMID: 39213091 DOI: 10.3233/JPD-240172

There is increasing evidence that microbial-based therapies can be useful in people with Parkinson's disease (PD). In this viewpoint, we provide a state-of-the-art review of the clinical and pre-clinical evidence for probiotics and prebiotics in PD. Currently, short-term clinical studies, including double-blind placebo-controlled randomized clinical trials, have demonstrated safety, and efficacy primarily in improving constipation-related symptoms. Pre-clinical studies consistently reported improvements in a range of biological markers and outcomes, including evidence for attenuation of gut dysfunction and neuroprotection. Bacteria from the genus Lactobacillus and Bifidobacterium have been the most frequently studied both in clinical and pre-clinical probiotics studies, while research into prebiotics is still limited and primarily involved resistant starch and fructooligosaccharides. We provide practical suggestions for clinicians on how to advise patients in the clinic regarding these popular treatments, and important caveats to be aware of. Finally, areas for further advancements are highlighted. It is envisaged that in the future, microbial-based therapies may benefit from personalization based on an enhanced understanding of a whole range of host factors and host-microbiome interactions.

Opsoclonus-myoclonus-ataxia syndrome associated with dengue virus infection

Tan AH, Linn K, Sam IC, Tan CT, Lim SY

Parkinsonism Relat Disord, 2015 Feb;21(2):160-1.

PMID: 25443556 DOI: 10.1016/j.parkreldis.2014.11.009

Fulltext Hyperglycemia-Associated Hemichorea-Hemiballismus with Predominant Ipsilateral Putaminal Abnormality on Neuroimaging

Fong SL, Tan AH, Lau KF, Ramli N, Lim SY

J Mov Disord, 2019 Sep;12(3):187-189.

PMID: 31390855 DOI: 10.14802/jmd.19014

Parkinson's disease and the gastrointestinal microbiome

Lubomski M, Tan AH, Lim SY, Holmes AJ, Davis RL, Sue CM

J Neurol, 2020 Sep;267(9):2507-2523.

PMID: 31041582 DOI: 10.1007/s00415-019-09320-1

Recently, there has been a surge in awareness of the gastrointestinal microbiome (GM) and its role in health and disease. Of particular note is an association between the GM and Parkinson's disease (PD) and the realisation that the GM can act via a complex bidirectional communication between the gut and the brain. Compelling evidence suggests that a shift in GM composition may play an important role in the pathogenesis of PD by facilitating the characteristic ascending neurodegenerative spread of α-synuclein aggregates from the enteric nervous system to the brain. Here, we review evidence linking GM changes with PD, highlighting mechanisms supportive of pathological α-synuclein spread and intestinal inflammation in PD. We summarise existing patterns and correlations seen in clinical studies of the GM in PD, together with the impacts of non-motor symptoms, medications, lifestyle, diet and ageing on the GM. Roles of GM modulating therapies including probiotics and faecal microbiota transplantation are discussed. Encouragingly, alterations in the GM have repeatedly been observed in PD, supporting a biological link and highlighting it as a potential therapeutic target.

Fulltext Rare homozygous PRKN exon 8 and 9 deletion in Malay familial early-onset Parkinson's disease

Tay YW, Lim JL, Tan AH, Annuar AA, Lim SY

Ann Acad Med Singap, 2021 04;50(4):353-355.

PMID: 33990826 DOI: 10.47102/annals-acadmedsg.2020508

Relapsing encephalopathy with dancing eyes and jerky limbs

Mohd Fauzi NA, Abdullah S, Tan AH, Mohd Ramli N, Tan CY, Lim SY

Parkinsonism Relat Disord, 2020 06;75:110-113.

PMID: 30846242 DOI: 10.1016/j.parkreldis.2019.02.025

We report a case of relapsing-remitting opsoclonus-myoclonus-ataxia syndrome (OMAS) in a patient with Hashimoto's encephalopathy, diagnosed after comprehensive evaluation. OMAS as a manifestation of Hashimoto's encephalopathy has been reported once previously. It is hoped that recognition of this entity and early initiation of immunotherapy will improve clinical outcomes for patients.

Displaying publications 1 - 20 of 77 in total