exudates and Epilepsy

There remains a lack of information and understanding of the prevalence and incidence of Alzheimer's disease and related dementia in Indigenous populations. Little evidence available suggests that Indigenous peoples may have disproportionately high rates of Alzheimer's disease and related dementia (ADRD).. Given this information, this study systematically explores what risk factors may be associated with ADRD in Indigenous populations.. A search of all published literature was conducted in October 2016, March 2018, and July 2019 using Medline, Embase, and PsychINFO. Subject headings explored were inclusive of all terms related to Indigenous persons, dementia, and risk. All relevant words, phrases, and combinations were used. To be included in this systematic review, articles had to display an association of a risk factor and ADRD. Only studies that reported a quantifiable measure of risk, involved human subjects, and were published in English were included.. Of 237 articles originally identified through database searches, 45 were duplicates and 179 did not meet a priori inclusion criteria, resulting in 13 studies eligible for inclusion in this systematic review.. The large number of potentially modifiable risk factors reported relative to non-modifiable risk factors illustrates the importance of socioeconomic context in the pathogenesis of ADRD in Indigenous populations. The tendency to prioritize genetic over social explanations when encountering disproportionately high disease rates in Indigenous populations can distract from modifiable proximal, intermediate, and distal determinants of health.

Topics: Adverse Childhood Experiences; Age Factors; Alzheimer Disease; Australia; Canada; Cardiovascular Diseases; Cognitive Dysfunction; Craniocerebral Trauma; Dementia; Diabetes Mellitus; Educational Status; Epilepsy; Guam; Humans; Hypertension; Incidence; Indigenous Canadians; Indigenous Peoples; Inuit; Malaysia; Native Hawaiian or Other Pacific Islander; Obesity; Risk Factors; Sedentary Behavior; Sex Factors; Smoking; Social Class

Approximately a third of newly diagnosed epilepsy patients do not respond to antiepileptic drugs (AEDs). Evidence suggests that low penetrance variants in the genes of drug targets such as voltage-gated sodium channels may be involved in drug responsiveness. To examine this hypothesis, we compared data from two epilepsy cohorts from Malaysia and Hong Kong, as well as a meta-analysis from published data.. Genotype analysis of 39 polymorphisms located in the SCN1A, SCN2A and SCN3A genes was performed on 1504 epilepsy patients from Malaysia and Hong Kong who were receiving AEDs. Meta-analysis was performed for pooled data of SCN1A rs3812718 and rs2298771, and SCN2A rs17183814 polymorphisms.. Our data from the Hong Kong and Malaysia cohorts showed no significant allele, genotype and haplotype association of polymorphisms in the SCN1A, SCN2A, and SCN3A genes with drug responsiveness in epilepsy. This finding was supported by a meta-analysis for SCN1A rs3812718 and rs2298771, and for SCN2A rs17183814 polymorphisms.. Our comprehensive study suggests that common polymorphisms in SCN1A, SCN2A and SCN3A do not play major roles in influencing response to AEDs. Original submitted 11 March 2013; Revision submitted 31 May 2013.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alleles; Anticonvulsants; Child; Child, Preschool; Cohort Studies; Epilepsy; Female; Genetic Predisposition to Disease; Genotype; Hong Kong; Humans; Infant; Malaysia; Male; Middle Aged; NAV1.1 Voltage-Gated Sodium Channel; NAV1.2 Voltage-Gated Sodium Channel; NAV1.3 Voltage-Gated Sodium Channel; Polymorphism, Genetic; Sodium Channels; Young Adult

Approximately 30% of epilepsy patients do not response to antiepileptic drugs (AEDs). The functional SCN1A IVS5N+5 polymorphism may play a role in response to some AEDs. The purpose of this study was to examine this hypothesis in a cohort study of Malaysian and Hong Kong Chinese epilepsy patients on sodium valproate (VPA) monotherapy and in a meta-analysis.. The SCN1A IVS5N+5 polymorphism was genotyped in 583 Malaysian (84%) and Hong Kong Chinese (16%) epilepsy patients receiving VPA monotherapy. The related association studies, including the current study, were meta-analyzed by using fixed- and random-effects models under various genetic models.. A total of 277 (47.5%) and 306 (52.5%) patients were VPA nonresponsive and responsive, respectively. Unlike Chinese and Indian patients, Malay nonresponsive patients with idiopathic generalized epilepsy showed significant association, probably caused by the small sample size.. The cohort study and meta-analysis did not demonstrate an association between AED responsiveness and this polymorphism. Future studies with a larger sample size of Malays with idiopathic generalized epilepsy are suggested.

Topics: Adolescent; Adult; Alternative Splicing; Anticonvulsants; Asian People; Child; Cohort Studies; Epilepsy; Epilepsy, Generalized; Female; Gene Frequency; Genetic Association Studies; Hong Kong; Humans; Malaysia; Male; Middle Aged; Models, Genetic; NAV1.1 Voltage-Gated Sodium Channel; Polymorphism, Genetic; Valproic Acid; Young Adult

The SYN2 rs3773364 A>G polymorphism has been proposed to be involved in susceptibility to epilepsy, but research results have been inconclusive. The aim of this study was to investigate the association between the SYN2 rs3773364 A>G polymorphism and susceptibility against epilepsy in a case-control study and a meta-analysis.. The SYN2 rs3773364 A>G polymorphism was successfully genotyped in 1182 samples (618 epilepsy patients) of Chinese, Indian, and Malay ethnicities. Meta-analysis of the related studies, including this case-control study, was performed under alternative genetic models.. Data from the case-control study indicated no allelic and genotypic association of this locus with susceptibility to epilepsy in the tri-ethnic Malaysian population. Similar finding was obtained by stratified analysis by epilepsy syndrome for idiopathic epilepsy. These results were verified by meta-analysis of the related pooled data.. Our study indicated that SYN2 rs3773364 A>G polymorphism is not a risk factor for susceptibility to epilepsy.

Topics: Asian People; Case-Control Studies; Epilepsy; Female; Genetic Predisposition to Disease; Genotype; Humans; Malaysia; Male; Polymorphism, Genetic; Risk Factors; Synapsins; White People

Improving health-related quality of life (HRQoL) among people with epilepsy (PWE) has become the focus of various treatment programmes and behavioural interventions which continue to be challenging to both patients and healthcare professionals.. To investigate the impact of SMS-based epilepsy education programme on PWE's HRQoL status and to determine the predictors for good HRQoL.. Eligible epilepsy out-patients from three public hospitals in East Coast Peninsular Malaysia were randomized into two groups: intervention (IG) and control (CG). Patients in the CG were supplied with only printed epilepsy educational module, while those in the IG additionally received short message service (SMS) from the Mobile Epilepsy Educational System (MEES). The Malay Quality of Life in Epilepsy Inventory-30 (MQOLIE-30) was utilized for HRQoL assessment. Descriptive statistics, paired t test, analysis of covariance and multiple logistic regression were employed for data analyses (SPSS 16).. One hundred and forty-four PWE were recruited for the study (age = 30.5 ± 11.8; unmarried = 60.4 %; education level ≤ SPM/Cambridge O' level = 76.4 %; illness duration > 5 years = 51.1 %). After controlling for possible confounders, IG exhibited positive changes in HRQoL profile compared to CG particularly in Seizure Worry, Overall Quality of Life, Emotional Well-Being, Social Functioning and Overall Score (p < 0.05). After adjusting for covariates, being employed and receiving additional SMS-based epilepsy education programme emerged as the significant predictors of good HRQoL among PWE.. Receiving continuous SMS-based epilepsy information from the MEES seemed to generate positive impacts on PWE's overall HRQoL. This study has provided a basis for future innovations to inspire efforts in ensuring the welfare and HRQoL of PWE and their families.

Topics: Adult; Cell Phone; Epilepsy; Female; Health Knowledge, Attitudes, Practice; Health Status; Humans; Malaysia; Male; Middle Aged; Outcome Assessment, Health Care; Outpatients; Pamphlets; Patient Education as Topic; Quality of Life; Socioeconomic Factors; Surveys and Questionnaires; Telemedicine; Text Messaging; Young Adult

We evaluated an epilepsy education programme based on text messaging (SMS). Epilepsy outpatients from three hospitals in Malaysia were randomised into two groups: intervention and control. Patients in the control group were supplied with printed epilepsy educational material while those in the intervention group also received text messages from the Mobile Epilepsy Educational System (MEES). A total of 136 patients completed the study (mean age 31 years; 91% Malay; 51% with an illness duration of more than 5 years). A between-group analysis showed that the awareness, knowledge and attitudes (AKA) about epilepsy did not significantly differ between the groups at baseline (P > 0.05). The intervention patients reported better AKA levels during follow-up compared to the control patients (P < 0.05). A within-group analysis showed that in intervention patients, there were significant improvements in all AKA domains with larger effect sizes (P < 0.01) while control patients also exhibited significant improvement in most domains except for Awareness but with smaller effect sizes. After controlling for possible confounding variables (age, gender, educational qualification, monthly income and baseline mean for each domain), the intervention group still reported significantly higher AKA than the control group particularly in Awareness (P < 0.001) and Total AKA (P = 0.003). There was also significantly better medication adherence and clinic attendance in the intervention group (P < 0.05). The results suggest that the addition of the MEES to conventional epilepsy education is effective in improving AKA.

Topics: Adult; Analysis of Variance; Awareness; Epilepsy; Female; Health Behavior; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Medication Adherence; Patient Education as Topic; Program Evaluation; Telemedicine; Text Messaging

Approximately 30% of epilepsy patients do not response to antiepileptic drugs (AEDs). The functional SCN1A IVS5N+5 polymorphism may play a role in response to some AEDs. The purpose of this study was to examine this hypothesis in a cohort study of Malaysian and Hong Kong Chinese epilepsy patients on sodium valproate (VPA) monotherapy and in a meta-analysis.. The SCN1A IVS5N+5 polymorphism was genotyped in 583 Malaysian (84%) and Hong Kong Chinese (16%) epilepsy patients receiving VPA monotherapy. The related association studies, including the current study, were meta-analyzed by using fixed- and random-effects models under various genetic models.. A total of 277 (47.5%) and 306 (52.5%) patients were VPA nonresponsive and responsive, respectively. Unlike Chinese and Indian patients, Malay nonresponsive patients with idiopathic generalized epilepsy showed significant association, probably caused by the small sample size.. The cohort study and meta-analysis did not demonstrate an association between AED responsiveness and this polymorphism. Future studies with a larger sample size of Malays with idiopathic generalized epilepsy are suggested.

Topics: Adolescent; Adult; Alternative Splicing; Anticonvulsants; Asian People; Child; Cohort Studies; Epilepsy; Epilepsy, Generalized; Female; Gene Frequency; Genetic Association Studies; Hong Kong; Humans; Malaysia; Male; Middle Aged; Models, Genetic; NAV1.1 Voltage-Gated Sodium Channel; Polymorphism, Genetic; Valproic Acid; Young Adult

Telemedicine innovations, including short message service (SMS), have been used to address a range of health concerns in a variety of settings. Practical, safe, and cost-effective, this simple tool can also potentially improve patients' understanding toward their own diseases via knowledge enhancement. This study was designed to develop and assess the feasibility and acceptability of an SMS-based epilepsy educational program for epilepsy patients.. This was a prospective randomized interventional study. Epilepsy outpatients from three general hospitals in East Coast Peninsular Malaysia received the SMS-based mobile epilepsy educational system (MEES) for a 3-month period.. In total, 51 patients completed the study (median age, 25.0 years; 51.0% female; 92.2% Malay; 56.9% single; education level, 70.6% ≤SPM/Cambridge O-level equivalent; 25.5% supportive workers; monthly income, 58.8% ≤MYR 500.0/USD 158.5). Approximately 86.0% of the patients owned at least a mobile phone. The total cost of SMS delivery was economically affordable (MYR 3.08/USD 0.98 per patient). Overall, 74.0% agreed that MEES was either very or quite useful. It is encouraging that the majority of patients have offered positive comments and favorable opinions specifically toward epilepsy education (94.0%), drug-taking reminder (90.0%), and clinic appointment reminder (88.0%). It was also reported that 88.2% of the participants would recommend MEES to other people with epilepsy.. The current study adds to the growing evidence suggesting that a greater investment in telemedicine programs involving SMS would be both feasible and well received by patients and could be a potentially valuable approach to increase access and effectiveness of epilepsy care.

Topics: Adolescent; Adult; Aged; Ambulatory Care; Cell Phone; Epilepsy; Feasibility Studies; Female; Humans; Malaysia; Male; Middle Aged; Patient Education as Topic; Patient Satisfaction; Surveys and Questionnaires; Text Messaging; Young Adult

We estimated individual and population Michaelis-Menten pharmacokinetic parameters for phenytoin (DPH) in epileptic patients attending our neurology clinic using the computer programme. OPT. Our results agreed well with literature values but were lower than those we obtained earlier in a smaller number of patients. The Km was independent of age, weight and sex but there was a weak, correlation between Vm and body weight. We conclude that the use of population Vm and Km in normograms could lead to errors in DPH dose estimations as they correlated very poorly with patient characteristics. OPT was easy to use and sufficiently accurate for deriving dose estimates in routine patients. Its use would enable practitioners to generate their patients' own parameters for use in individual dosage adjustments. The estimates can subsequently be updated as more data become available.

Topics: Adolescent; Adult; Asian People; Body Weight; Child; Epilepsy; Female; Humans; Linear Models; Malaysia; Male; Middle Aged; Phenytoin; Software; White People

People with epilepsy frequently encounter sleep disruptions that can stem from a variety of complex factors. Epilepsy-related sleep disturbance can lead to reduced quality of life and excessive daytime hypersomnolence. Identification of sleep disturbances may help in the overall management of epilepsy patients. This study was conducted to determine the prevalence and predictors of poor sleep quality and daytime sleepiness in epilepsy.. A cross-sectional study on 284 epilepsy patients was performed in a local tertiary centre. The demographic and clinical epilepsy data were collected. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) questionnaires were utilised to determine the quality of life and daytime hypersomnolence of epilepsy patients, respectively.. Poor sleep quality was reported in 78 (27.5%) patients while daytime hypersomnolence was present in 17 (6%) patients. The predictors of poor sleep quality include structural causes (OR = 2.749; 95% CI: 1.436, 5.264, p = 0.002), generalised seizures (OR = 1.959, 95% CI: 1.04, 3.689, p = 0.037), and antiseizure medications such as Carbamazepine (OR = 2.34; 95% CI: 1.095, 5.001, p = 0.028) and Topiramate (OR 2.487; 95% CI: 1.028, 6.014, p = 0.043). Females are 3.797 times more likely score higher in ESS assessment (OR 3.797; 95% CI: 1.064, 13.555 p = 0.04).. Sleep disturbances frequently coexist with epilepsy. Patients should be actively evaluated using the PSQI and ESS questionnaires. It is imperative to identify the key factors that lead to reduced sleep quality and heightened daytime sleepiness in patients with epilepsy, as this is essential to properly manage their condition.

Topics: Cross-Sectional Studies; Disorders of Excessive Somnolence; Epilepsy; Female; Humans; Malaysia; Narcolepsy; Prevalence; Quality of Life; Sleep; Sleep Initiation and Maintenance Disorders; Sleep Quality; Sleep Wake Disorders; Surveys and Questionnaires

This is a follow-up study on mortality in adult patients in Malaysia. This study aimed to determine the cause of death and the factors associated with epilepsy-related death in PWE in Malaysia.. 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.. 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).. 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.

Topics: Adult; Death, Sudden; Epilepsy; Follow-Up Studies; Hospitals; Humans; Malaysia; Male; Risk Factors

Antiseizure medication can potentially cause severe cutaneous adverse reactions, and certain antiseizure medication-induced severe cutaneous adverse reactions are associated with specific human leukocyte antigen alleles. This caused a change in antiseizure medication prescribing patterns, which may influence the incidence of antiseizure medication-induced severe cutaneous adverse reactions. Thus, we aimed to determine the incidence of antiseizure medication-induced severe cutaneous adverse reactions and its change over 15 years (2006-2019) in Malaysia. This retrospective analysis combined antiseizure medication-induced SCAR cases from the national adverse drug reaction database in the National Pharmaceutical Regulatory Agency, antiseizure medication usage data from the Malaysian Statistics of Medicine, and prescribing data from University Malaya Medical Centre, a national-level tertiary hospital to calculate antiseizure medication-induced SCAR incidence in Malaysia. We observed an upward trend in reported antiseizure medication-induced SCAR cases from 28 cases in 2006 to 92 in 2016. The incidence of carbamazepine (CBZ)-induced severe cutaneous adverse reactions increased from 7.5 per 1000 person-years (2006) to 17.8 per 1000 person-years (2016) but dropped to 7.2 per 1000 person-years subsequently (2019). Concurrently, there was an increase in the incidence of severe cutaneous adverse reactions secondary to phenytoin and lamotrigine. The prevalent users of CBZ had reduced from 22.8% (2006) to 14.1% (2016), whereas the levetiracetam and sodium valproate users increased by 5.5% and 4.8%, respectively. The incidence of CBZ-induced severe cutaneous adverse reactions had reduced since 2016, probably related to the implementation of human leukocyte antigen-B*1502 screening in Malaysia or substitution of CBZ with other antiseizure medications. However, this was accompanied by an increase in SCAR incidence related to phenytoin and lamotrigine.

Topics: Anticonvulsants; Drug Eruptions; Epilepsy; HLA Antigens; Humans; Incidence; Lamotrigine; Malaysia; Phenytoin; Retrospective Studies

Seizure remission rates of 60% with antiseizure medications were reported in developed countries, but might be lower in resource-limited countries. The challenges in epilepsy care in resource-limited regions were highlighted 10 years ago, and still remain an ongoing issue. This study aimed to determine the seizure freedom rates in level-2 epilepsy care centres (centres with general neurologists) compared to level-3/4 centres (centres with epileptologists providing epilepsy surgery evaluation) in Malaysia. This is a retrospective study of 1,347 adult epilepsy patients from two level-2 (n = 290) and two level-3/4 epilepsy care centres (n = 1,057). The seizure remission rates were significantly lower in level-2 centres (42.5%) compared to the level 3/4 centres (61.9%, p < 0.05). Level-2 centres had significantly more patients with undetermined seizure types compared to level-3/4 centres (6.6% vs 3.1%, p < 0.05). Level-3/4 centres had significantly more patients with epilepsy of structural and genetic origins, whereas more patients in level-2 centres had unknown aetiology (46.2% vs. 34.0% in level-3/4, p < 0.05). Level-2 centres had a lower neurologist-to-patient ratio (1:97 vs. 1:50 in level-3/4 centres, p < 0.05). Level-2 centres also had fewer patients, who underwent investigations such as EEG (74.1% vs. 89.6%) and brain MRI (54.1% vs. 72.4%, p < 0.05) in comparison with level-3/4 centres. Our study emphasized the existing challenges in epilepsy care in a resource-limited country to achieve the ideal 60% seizure remission rate.

Topics: Adult; Anticonvulsants; Epilepsy; Humans; Longitudinal Studies; Malaysia; Retrospective Studies; Seizures

Epilepsy is a common chronic neurological condition characterized by recurrent seizures. Approximately 30 - 40% of epileptic patients do not respond to antiepileptic drugs. Previous studies suggest that. To examine this hypothesis, in the present study, the associations between. Our findings suggest that

Topics: Anticonvulsants; Carbamazepine; Cytochrome P-450 CYP3A; Epilepsy; Humans; Malaysia; Valproic Acid

The lifetime prevalence of epilepsy varies greatly from 1.5-14.0 per 1000 persons among the Asian countries. We aim to study the prevalence of epilepsy in Malaysia to have a better insight into the burden of disease in the country.. A population-based door-to-door survey was carried out throughout the country, using questionnaire for brief screening in ascertainment of epilepsy, using a questionnaire and its validated multilingual versions. Respondents who were screened positive underwent second-stage diagnostic phone interview by neurologists/ research assistants.. A total 16, 686 respondents participated in the survey and 646 (3.8 %) respondents were screened positive during the first stage interview. A total of 185 consented for second stage diagnostic interview and 118 (63.8 %) respondents were contacted successfully for the second stage diagnostic phone interview, of which 17 (14.4 %) respondents were diagnosed to have epilepsy. An additional 68 (57.6 %) respondents had febrile seizures only. After applying a weighting factor to each respondent to adjust for non-response and for the varying probabilities of selection, the adjusted lifetime epilepsy prevalence was 7.8 in 1000 population, and the adjusted prevalence for active epilepsy was 4.2 in 1000 population in Malaysia.. The prevalence of lifetime epilepsy in Malaysia is 7.8 per 1000 persons.

Topics: Cross-Sectional Studies; Epilepsy; Humans; Malaysia; Prevalence; Surveys and Questionnaires

The standardized mortality ratio (SMR) of epilepsy in Asia ranges from 2.5 to 5.1. However, there are no such published data in Malaysia to date. Understanding the mortality rate and related factors will allow us to better assess and monitor the health status of PWE, thereby, preventing premature deaths among PWE. Hence, this study aimed to determine the mortality rate of adults with epilepsy (PWE) at the University Malaya Medical Centre (UMMC), a tertiary hospital in Malaysia.. 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.. 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).. 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.

Topics: Adolescent; Adult; Asia; Epilepsy; Female; Humans; Malaysia; Male; Retrospective Studies; Tertiary Care Centers; Young Adult

The objective of this study is to determine prevalence and factors leading to verbal learning and memory dysfunction among patients with epilepsy. A total of 211 subjects were recruited. Their verbal memory was assessed by Rey's Auditory Verbal Learning Test (RAVLT). This test was further subdivided into four major spheres for analysis, namely the verbal learning, interference list, immediate memory and delayed memory. All data collected were analyzed using Statistical Package for Social Sciences. Among the 211 patients, 55% (n = 116) had focal seizures and the remaining 45% (n = 95) had generalized seizures. Prevalence of verbal learning and memory impairment was high at 39.97% overall, and found most commonly in patients with focal impaired awareness seizures. Verbal learning and immediate memory dysfunction were significantly lower in focal impaired awareness group compared to others. Age more than 50 years, exposure to three or more antiepileptic drugs and use of carbamazepine more than 1000 mg a day were the predictors in poor verbal memory outcome. No statistical difference was observed in the mean RAVLT scores among the gender and hand dominance groups. Between patients with and without electroencephalogram changes as well as brain magnetic resonance imaging changes, the mean RAVLT scores showed no statistically significant difference. Verbal learning and memory impairment is prevalent among the epilepsy patients. The consequences of the memory impairment can be as debilitating as the seizure control. RAVLT is a reliable and practical test in the clinical setting.

Topics: Adolescent; Adult; Aged; Anticonvulsants; Epilepsy; Female; Humans; Malaysia; Male; Memory and Learning Tests; Memory Disorders; Memory, Short-Term; Middle Aged; Neuropsychological Tests; Prevalence; Verbal Learning; Young Adult

Children with epilepsy (CWE) are at risk of vitamin D deficiency. Single nucleotide polymorphisms (SNPs) affecting the vitamin D pathway are potentially important risk factors for serum 25-hydroxyvitamin D [25(OH)D] concentration. The aims of our study were to evaluate the association of vitamin d-related SNPs to serum 25(OH)D concentrations in Malaysian CWE.. Cross-sectional study of Malaysian ambulant CWE on antiseizure medication for >1 year. Sixteen SNPs in 8 genes (GC, VDR, CYP2R1, CYP24A1, CYP27B1, CYP27A1, CYP3A4, NADSYN1/DHCR7) were genotyped. Linear and logistic regression models and co-variates adjusted analyses were used. SNPs with significant associations were further analysed in a group of ethnically-matched healthy Malaysian children.. 239 CWE were recruited (52.7% Malay, 24.3% Chinese and 23.0% Indian) with mean serum 25(OH)D of 58.8 nmol/L (SD 25.7). Prevalence of vitamin D deficiency (≤37.5 nmol/L) was 23.0%. Minor allele of GC-rs4588-A was associated with lower serum 25(OH)D in the meta-analysis of both CWE (β -8.11, P = 0.002) and Malaysian healthy children (β -5.08, P < 0.001), while VDR-rs7975232-A was significantly associated with reduced odds of vitamin D deficiency in Malay subgroup of CWE (OR: 0.16; 95% CI: 0.06-0.49; P = 0.001) and this association was not found in the healthy children group.. Our results suggest that GC-rs4588 is associated with lower serum 25(OH)D concentration in both Malaysian CWE and healthy children, while VDR-rs7975232A is associated with lower risk of vitamin D deficiency in Malaysian CWE of Malay ethnicity. Our findings may assist in the genetic risk stratification of low vitamin D status among CWE.

Topics: Child; Comorbidity; Cross-Sectional Studies; Epilepsy; Female; Genetic Association Studies; Humans; Malaysia; Male; Polymorphism, Single Nucleotide; Receptors, Calcitriol; Vitamin D; Vitamin D Deficiency; Vitamin D-Binding Protein

Epilepsy stigma is an important issue affecting people with epilepsy (PWE) in various social aspects of life. Most studies on stigma were among the metropolitan population but rarely on indigenous people. Hence, this study aimed to understand the attitudes toward epilepsy of the East Malaysians, comparing with the West Malaysians previously reported.. This study was performed among the indigenous people in Kuching and Sibu (Sarawak) and Kota Kinabalu (Sabah) using the Public Attitudes Toward Epilepsy (PATE) scale. A higher score indicates poorer attitude.. A total of 360 respondents (41.7% Kadazan-Dusun, 30.6% Bidayuh, and 24.7% Iban) aged 34.6 ± 12.6 years completed the questionnaire. They were predominantly females and had lower education level and income compared with the West Malaysians. The Sabah population had significantly lower mean scores (better attitudes) than those in Sarawak, in both personal and general domains (p < .001). As compared with West Malaysia, the mean score in the personal domain was significantly lower in Sabah, while Sarawak had significantly higher scores in general domain (p < .001). Subanalysis showed that the Sabah population had better attitudes toward marriage and employment in PWE than the West Malaysians, whereas Sarawak had poorer attitudes toward education and social contact in PWE.. The attitudes toward epilepsy were different among the indigenous populations in Sabah and Sarawak, and from the West Malaysians, which could be attributable to their sociocultural differences.

Topics: Adolescent; Adult; Epilepsy; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Population Groups; Public Opinion; Social Stigma; Surveys and Questionnaires; Young Adult

Non-adherence to anti-seizure medication (ASM) therapy is an important contributing factor to the higher mortality rate and treatment failure of epilepsy. This study aimed to determine the rate and factors associated with non-adherence to ASM therapy through the WHO five dimensions of medication adherence framework.. We conducted a cross-sectional study at an outpatient Neurology Clinic of a tertiary government hospital in Malaysia. Between March and July 2019, we identified 217 patients with a confirmed diagnosis of epilepsy, receiving oral ASM therapy and able to administer their medications. We performed a semi-structured interview to gather information on sociodemographic background, clinical and medication history, and perceptions on healthcare services. Adherence to ASM therapy was evaluated using the Medication Compliance Questionnaire (MCQ). Patient's illness perception was assessed by the Brief Illness Perception Questionnaire (B-IPQ).. 208 patients participated in this study. The median age of the study participants was 35 years (IQR 26-44). 58.2% were females and majority, 55.8%, were from the Malay ethnic group. Based on the MCQ scoring, 89 patients (42.8%) were non-adherent. Multiple logistic regression demonstrated that being employed or students (adjusted odds ratio [aOR] 2.26, 95%CI: 1.19-4.29 p = 0.012) and having an average or below average perceived access to pharmacy services (aOR 2.94, 95%CI: 1.38-6.24, p = 0.005) were significant contributors to non-adherence.. Being employed or students and having an average or below average perceived access to pharmacy services were associated with ASM non-adherence Efforts to improve ASM adherence should adopt a comprehensive approach considering the success of adherence is contingent on the interrelationship of multiple dimensions.

Topics: Adult; Anticonvulsants; Area Under Curve; Cross-Sectional Studies; Epilepsy; Female; Humans; Logistic Models; Malaysia; Male; Medication Adherence; ROC Curve; Surveys and Questionnaires; Tertiary Care Centers

Self-management is crucial in the management of chronic diseases. However, information is limited on medication self-management among parents of children with epilepsy. This study aimed to assess medication self-management among parents of children with epilepsy and its association with sociodemographic data, clinical characteristics, antiepileptic drug (AED) regimen complexity, and parent self-reported AED adherence.. A cross-sectional survey was conducted at a tertiary care center in Malaysia from February 2019 to June 2019. Parents of children with epilepsy who were on AED for at least 3 months and aged ≤18 years old were recruited. Medication self-management was assessed using a validated Pediatric Epilepsy Medication Self-Management Questionnaire (PEMSQ). A higher total score reflects better medication self-management.. The overall medication self-management was satisfactory. Barriers to treatment should be addressed to empower parents to achieve better medication self-management. Furthermore, medication self-management should be reinforced among Malaysian Chinese patients and children with comorbidities.

Topics: Adolescent; Adult; Anticonvulsants; Child; Child, Preschool; Cross-Sectional Studies; Epilepsy; Female; Humans; Malaysia; Male; Medication Adherence; Middle Aged; Parents; Self Report; Self-Management; Tertiary Care Centers

Prevalence studies of epilepsy in Asia revealed a prevalence ranging from 1.5 to 14.0 per 1000 among Asian populations. However, the prevalence of epilepsy in Malaysia is not available for comparison with other countries. This study aimed to translate and validate a Malay brief screening instruments for ascertainment of epilepsy.. We translated into Malay a brief screening instrument for ascertainment of epilepsy designed and validated by Ottman et al., using the three-stage cross-cultural adaptation process developed by the International Quality of Life Assessment (IQOLA) project. We then administered the translated questionnaire via online survey to 162 cases (patients with epilepsy under follow-up care at the neurology clinic in University of Malaya Medical Centre, Kuala Lumpur) and 146 controls with no known history of epilepsy for validation.. Applying the most liberal definition for a positive screen, we obtained a sensitivity of 96.3% (95% confidence interval [CI]: 91.8-98.5%), with a specificity of 66.4% (95% CI: 58.1-73.0%) and positive predictive value (PPV) of 2.0%. The most stringent definition for a positive screen (only epilepsy) resulted in a sensitivity of 97.4% (95% CI: 62.0-72.6%), specificity of 98.6% (95% CI: 94.6-99.7%), and PPV of 26.6%. Narrowing the definition of a positive screen decreased sensitivity but improved PPVs. When compared to the original English questionnaire, the sensitivities were similar for all four definitions of a positive screen.. This is the first validated epilepsy screening questionnaire in the Malay language and represents a useful tool for the ascertainment of epilepsy in population-based studies.

Topics: Asian People; Cross-Cultural Comparison; Epilepsy; Humans; Malaysia; Mass Screening; Predictive Value of Tests; Quality of Life; Reproducibility of Results; Sensitivity and Specificity; Surveys and Questionnaires; Translations

The literature on caregiver burden tends to focus on children and teenagers with epilepsy and less on adults. As caregiving is a dynamic, complex process across the trajectories, this study aims to examine the factors associated with caregiving burden in those caring for adults with epilepsy.. This is a cross-sectional, survey-based study in which participants responded to questionnairesregarding perceived burden (ZBI), quality of life (IEQoL), psychological distress (DASS-21), family functioning (FAD) and perceived social support (MSPSS). Additional measures include socio-demographics and clinical characteristics of the care-recipient.. A total of 111 caregivers participated, of whom 72.1% were females, 55% parents, 59.5% Chinese, 51.4% unemployed and 46.0% with tertiary education.Approximately half (42.3%) reported mild-to-moderate levels of burden (mean ZBI score 29.93, SD 16.09).Furthermore, multiple regression analysisidentified10 predictors of caregiver burden, namely family functioning, weekly caregiving hours, number of caregivers per family, attitude towards epilepsy, family support, caregivers' gender, personal income and as well as care-recipients' age of onset, seizure frequency and ADL dependency (F(10, 85) = 11.37, p < 0.001). Stepwise regression highlighted family functioning as the main predictor (β = 0.299, p < 0.001). The total ZBI score was positively correlated with caregivers' reported levels of depression (r = 0.549, p < 0.001), anxiety (r = 0.599, p < 0.001) and stress (r = 0.576, p < 0.001) subscales in DASS-21, and negatively correlated with IEQoL (r=-0.637, p < 0.001).. This study shows that caregivers' burden is highly associated with the family system (family functioning, support and number of caregivers), besides demographics, psychosocial and clinical characteristics. Future research is required to learn how to support this sub-group of caregivers within the family system.

Topics: Adult; Aged; Aged, 80 and over; Anxiety; Caregivers; Cost of Illness; Cross-Sectional Studies; Depression; Epilepsy; Family; Female; Humans; Malaysia; Male; Middle Aged; Quality of Life; Stress, Psychological; Young Adult

Children with epilepsy on long-term antiepileptic drugs (AEDs) are at risk of low bone mineral density (BMD). The aims of our study were to evaluate the prevalence and determinants of low BMD among Malaysian children with epilepsy.. Cross-sectional study of ambulant children with epilepsy on long-term AEDs for >1 year seen in a tertiary hospital in Malaysia from 2014 to 2015. Detailed assessment of anthropometric measurements; environmental lifestyle risk factors; serum vitamin D, calcium and parathyroid hormone levels; genotyping of single nucleotide polymorphisms of genes in vitamin D and calcium metabolism; and lumbar spine BMD were obtained. Low BMD was defined as BMD Z-score ≤ -2.0 SD.. Eighty-seven children with mean age of 11.9 years (56 males) participated in the study. The prevalence of low lumbar BMD was 21.8% (19 patients). Multivariate logistic regression analysis identified polytherapy >2 AEDs (OR: 7.86; 95% CI 1.03-59.96), small frame size with wrist breadth of <15th centile (OR 14.73; 95% CI 2.21-98.40), and body mass index Z-score < -2.0 (OR 8.73, 95% CI 1.17-65.19) as significant risk factors for low BMD.. One-fifth of Malaysian children with epilepsy on long-term AEDs had low BMD. Targeted BMD should be performed for those who are on >2 AEDs, underweight or with small frame size as they are at higher risk of having low BMD.

Topics: Adolescent; Anticonvulsants; Bone Density; Bone Diseases; Calcium; Child; Child, Preschool; Cross-Sectional Studies; Epilepsy; Female; Genotype; Humans; Lumbar Vertebrae; Malaysia; Male; Parathyroid Hormone; Polymorphism, Single Nucleotide; Prevalence; Risk Factors; Vitamin D

Children with epilepsy (CWE) are at risk of impaired quality of life (QOL), and achieving a good QOL is an important treatment goal among CWE. To date, there are no published multiethnic QOL studies in Asia. Our study aimed to: i) investigate the QOL of multiethnic CWE in Malaysia as reported by both the child and parent; ii) determine the level of agreement between child-self report and parent-proxy report QOL; and iii) explore potential correlates of sociodemographic, epilepsy characteristics, and family functioning with QOL in CWE.. Cross-sectional study of all CWE aged 8-18years old with at least 6months' duration of epilepsy, minimum reading level of primary school education Year 1, and attending mainstream education. Quality of life was measured using the parent-proxy and child self-report of Quality of Life Measurement for Children with Epilepsy (CHEQOL-25) questionnaire. Total and subscale CHEQOL-25 scores were obtained. The levels of parent-child agreement were determined using intraclass correlation coefficients (ICC). Family functioning was assessed using the General functioning subscale (GF-12).. A total of 115 CWE and their parents participated in the study. In general, Malaysian parents rated children's total CHEQOL-25 scores poorer than the children themselves [mean total parent score: 68.56 (SD: 10.86); mean total child score: 71.82 (SD: 9.55)]. Agreement between child and parent on the CHEQOL-25 was poor to moderate (ICC ranged from 0.31-0.54), with greatest discordance in the epilepsy secrecy domain (ICC=0.31, p=0.026). Parent and child were more likely to agree on more external domains: intrapersonal/social (ICC=0.54, p<0.001) and interpersonal/emotional (ICC=0.50, p<0.001). Malay ethnicity, focal seizure and high seizure frequency (≥1 seizure per month) were associated with lower CHEQOL-25 scores. There was a significant but weak correlation between GF-12 and parent-proxy CHEQOL-25 Total Scores (r=-0.186, p=0.046).. Our results emphasize the importance to have the child's perspective of their QOL as the level of agreement between the parent and child reported scores were poor to moderate. Malaysian CWE of Malay ethnicity, those with focal seizures or high seizure frequency are at risk of poorer QOL.

Topics: Adolescent; Child; Cross-Sectional Studies; Epilepsy; Female; Humans; Malaysia; Male; Parents; Patient Reported Outcome Measures; Proxy; Quality of Life; Seizures; Surveys and Questionnaires

Because of the nature of epilepsy, and the unpredictability of seizure recurrence, epilepsy requires long-term treatment with medications. As a consequence, epilepsy has a negative pervasive impact in children with epilepsy (CWE), and their parents. Hence, our aim was to explore the needs and challenges of parents and their CWE. In-depth interviews (IDIs) were conducted with 15 families (12 mothers and 3 fathers) and 15 CWE (aged 8-18 years). Data were transcribed verbatim and thematically analyzed using the descriptive phenomenology approach. The experiences of parents and their CWE could be divided into two time frames: "experiences during a child's first seizure" and "experiences whilst growing up with epilepsy". Parents' main concerns and worries were regarding their child's physical health, psychological and emotional wellbeing, academic achievement, and future. The children's main concerns were restrictions imposed, their interpersonal relationship with peers, and being independent in the future. Parents reported that they needed epilepsy-related information, continuity of care, and a parental support group, while CWE reported that their main needs were independence and autonomy. The views of parents and their child with epilepsy were similar in physical functioning and academic achievement. However, parents and children had different views on how epilepsy impacted on the child emotionally, as well as behavioral and interpersonal relationship with peers.

Topics: Adolescent; Adult; Child; Emotions; Epilepsy; Female; Health Services Needs and Demand; Humans; Malaysia; Male; Parent-Child Relations; Parents; Qualitative Research

A strong association has been documented between HLA-B*15:02 and carbamazepine-induced severe cutaneous adverse reactions (SCARs) in Asians. Human leucocyte antigen testing is potentially valuable in many countries to facilitate early recognition of patient susceptibility to SCARs.. To determine the cost-effectiveness of universal HLA-B*15:02 screening in preventing carbamazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis in an ethnically diverse Malaysian population.. A hybrid model of a decision tree and Markov model was developed to evaluate three strategies for treating newly diagnosed epilepsy among adults: (i) carbamazepine initiation without HLA-B*15:02 screening (current practice); (ii) universal HLA-B*15:02 screening prior to carbamazepine initiation; and (iii) alternative treatment [sodium valproate (VPA)] prescribing without HLA-B*15:02 screening. Base-case analysis and sensitivity analyses were performed over a lifetime time horizon. Incremental cost-effectiveness ratios were calculated.. Both universal HLA-B*15:02 screening and VPA prescribing were dominated by current practice. Compared with current practice, universal HLA-B*15:02 screening resulted in a loss of 0·0255 quality-adjusted life years (QALYs) at an additional cost of 707 U.S. dollars (USD); VPA prescribing resulted in a loss of 0·2622 QALYs at an additional cost of USD 4127, owing to estimated differences in antiepileptic treatment efficacy.. Universal HLA-B*15:02 screening is unlikely to be a cost-effective intervention in Malaysia. However, with the emergence of an ethnically diverse population in many other countries, this may render HLA-B*15:02 screening a viable intervention when an increasing proportion of the population is at risk and an equally effective yet safer antiepileptic drug is available.

Topics: Adolescent; Adult; Anticonvulsants; Asian People; Carbamazepine; Cost-Benefit Analysis; Efficiency; Epilepsy; HLA-B15 Antigen; Humans; Malaysia; Markov Chains; Mass Screening; Middle Aged; Quality-Adjusted Life Years; Stevens-Johnson Syndrome; Young Adult

Sudden unexpected death in epilepsy (SUDEP) is an important cause of mortality in epilepsy. To date, there is only one published UK study evaluating information provision of SUDEP among parents of children with epilepsy (CWE), and there are no studies published from Asia. Although SUDEP information provision is recommended among parents of CWE, it is uncertain if these recommendations are applicable to Asian countries due to the different cultural attitude towards epilepsy. Our prospective cohort study consisted of multiethnic parents of children with epilepsy (CWE) seen in a tertiary hospital in Malaysia. Information on SUDEP was delivered to parents using an epilepsy educational software program. Participants completed a set of standardized questionnaire and Depression Anxiety Stress Scales-Short Form (DASS-21) immediately after and retested 3-6months after the SUDEP information provision. A total of 127 parents (84 mothers) participated in the study. The CWE consisted of 3 ethnic groups (38% Malay, 30% Chinese, 32% Indian) with a mean age of 9.6years. Majority (70.9%) felt positive after SUDEP information provision, 90.6% wanted SUDEP discussion for themselves with 70.1% wanted SUDEP discussion with their child, and a lower proportion (58.3%) would discuss SUDEP with their child. None of the participants reported increased symptoms of depression, stress or anxiety attributed to SUDEP information provision. Most parents took steps to reduce SUDEP risk, and most parents did not report an impact on their own functioning. However, there was an increase in parental report over time of impact on their child's functioning following SUDEP information (P<0.05). In conclusion, most Malaysian parents of CWE wanted SUDEP information. Following SUDEP information disclosure, majority did not report negative emotions; however, an increase in parents over time reported an impact on their child. Our findings reiterate that provision of SUDEP information should form part of care of CWE and parents should receive ongoing support as they undergo a period of parenting adjustment when dealing with the information provided.

Topics: Adult; Child; Death, Sudden; Disclosure; Epilepsy; Female; Health Knowledge, Attitudes, Practice; Humans; Information Seeking Behavior; Malaysia; Male; Parents; Prospective Studies; Risk Factors

Epilepsy is a common neurological disease characterized by recurrent unprovoked seizures. Evidence suggested that abnormal activity of brain-derived neurotrophic factor (BDNF) contributes to the pathogenesis of epilepsy. Some previous studies identified association between genetic variants of BDNF and risk of epilepsy. In this study, this association has been examined in the Hong Kong and Malaysian epilepsy cohorts. Genomic DNA of 6047 subjects (1640 patients with epilepsy and 4407 healthy individuals) was genotyped for rs6265, rs11030104, rs7103411, and rs7127507 polymorphisms by using Sequenom MassArray and Illumina HumanHap 610-Quad or 550-Duo BeadChip arrays techniques. Results showed significant association between rs6265 T, rs7103411 C, and rs7127507 T and cryptgenic epilepsy risk (p = 0.00003, p = 0.0002, and p = 0.002, respectively) or between rs6265 and rs7103411 and symptomatic epilepsy risk in Malaysian Indians (TT vs. CC, p = 0.004 and T vs. C, p = 0.0002, respectively) as well as between rs6265 T and risk of cryptogenic epilepsy in Malaysian Chinese (p = 0.005). The Trs6265-Crs7103411-Trs7127507 was significantly associated with cryptogenic epilepsy in Malaysian Indians (p = 0.00005). In conclusion, our results suggest that BDNF polymorphisms might contribute to the risk of epilepsy in Malaysian Indians and Chinese.

Topics: Adult; Brain-Derived Neurotrophic Factor; Case-Control Studies; Demography; Epilepsy; Female; Genetic Association Studies; Genetic Predisposition to Disease; Hong Kong; Humans; Malaysia; Male; Polymorphism, Single Nucleotide; Risk Factors

Long-term use of antiepileptic drugs (AEDs) is a significant risk factor for vitamin D deficiency in children with epilepsy. The aims of our study were to evaluate the prevalence and risk factors for vitamin D deficiency among Malaysian children with epilepsy.. Cross-sectional study of ambulant children with epilepsy on long-term AEDs for >1 year seen in three tertiary hospitals in Malaysia from April 2014 to April 2015. Detailed assessment of pubertal status, skin pigmentation, sunshine exposure behavior, physical activity, dietary vitamin D and calcium intake, anthropometric measurements and bone health blood tests (vitamin D, alkaline phosphatase, calcium, phosphate, and parathyroid hormone levels) were obtained on all patients. Vitamin D deficiency was defined as 25-hydroxy vitamin D [25(OH)D] levels ≤35 nmol/L and insufficiency as 25(OH)D levels of 36-50 nmol/L.. A total of 244 children (146 male) participated in the study. Ages ranged between 3.7 and 18.8 years (mean 12.3 years). 25(OH)D levels ranged between 7.5 and 140.9 nmol/L (mean 53.9 nmol/L). Vitamin D deficiency was identified in 55 patients (22.5%), and a further 48 (19.7%) had vitamin D insufficiency. Multivariate logistic regression analysis identified polytherapy >1 AED (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.07-4.36), age >12 years (OR 4.16, 95% CI 1.13-15.30), Indian ethnicity (OR 6.97, 95% CI 2.48-19.55), sun exposure time 30-60 min/day (OR 2.44, 95% CI 1.05-5.67), sun exposure time <30 min/day (OR 3.83, 95% CI 1.61-9.09), and female (OR 2.61, 95% CI 1.31-5.20) as statistically significant (p < 0.05) risk factors for vitamin D deficiency.. Despite living in the tropics, a high proportion of Malaysian children with epilepsy are at risk of vitamin D deficiency. Targeted strategies including vitamin D supplementation and lifestyle advice of healthy sunlight exposure behavior should be implemented among children with epilepsy, particularly for those at high risk of having vitamin D deficiency.

Topics: Adolescent; Age Factors; Anthropometry; Anticonvulsants; Child; Child, Preschool; Cross-Sectional Studies; Epilepsy; Female; Humans; Malaysia; Male; Prevalence; Risk Factors; Sunlight; Vitamin D; Vitamin D Deficiency; Young Adult

Children with epilepsy need targeted strategies to ensure they get sufficient vitamin D, say researchers in Malaysia.

Topics: Adolescent; Anticonvulsants; Child; Child, Preschool; Epilepsy; Humans; Malaysia; Vitamin D; Vitamin D Deficiency

RAR-related orphan receptors A (RORA) and B (RORB) and voltage-gated sodium channel type 1 (SCN1A) genes play critical roles in the regulation of the circadian clock. Evidence has shown an association of RORA and RORB polymorphisms with susceptibility to autism and depression. Hence, we tested the association of RORA rs12912233, rs16943429, rs880626, rs2290430, and rs12900948; RORB rs1157358, rs7022435, rs3750420, and rs3903529; and SCN1A rs3812718 with epilepsy risk in the Malaysians. DNA was genotyped in 1789 subjects (39% epilepsy patients) by using MassARRAY (Sequenom). Significant association was obtained for rs12912233 in Malaysian Chinese (p=0.003). Interaction between rs12912233-rs880626 and rs3812718 was associated with the epilepsy risk in the subjects overall (p=0.001). Results show that RORA rs12912233 alone might be a possible risk variant for epilepsy in Malaysian Chinese, but that, together with RORA rs880626 and SCN1A rs3812718, this polymorphism may have a synergistic effect in the epilepsy risk in Malaysians.

Topics: Adolescent; Adult; Case-Control Studies; Epilepsy; Epistasis, Genetic; Female; Genetic Predisposition to Disease; Humans; Malaysia; Male; Middle Aged; NAV1.1 Voltage-Gated Sodium Channel; Nuclear Receptor Subfamily 1, Group F, Member 1; Nuclear Receptor Subfamily 1, Group F, Member 2; Polymorphism, Single Nucleotide; Risk; Young Adult

We aimed to cross-culturally adapt the parent-proxy Health-Related Quality of Life Measure for Children with Epilepsy (CHEQOL-25) into Malay and to determine its validity and reliability among parents of children with epilepsy in Malaysia.. The English version of the parent-proxy CHEQOL-25 was translated according to international guidelines to Malay. Content validity was verified by an expert panel and piloted in five parents of children with epilepsy (CWE). The Malay parent-proxy CHEQOL-25 was then administered to 40 parents of CWE, aged 8-18years from two tertiary hospitals, at baseline and 2weeks later. Parents were also required to complete the Malay PedsQL™ 4.0 so that convergent validity could be assessed. Hypothesis testing was assessed by correlating the individual subscales in the parent-proxy CHEQOL-25 with epilepsy severity, the number of anticonvulsants, and the number of close friends.. Participants from the pilot study did not encounter any problems in answering the final translated Malay parent-proxy CHEQOL-25. Hence, no further modifications were made. Cronbach's α for each subscale of the Malay parent-proxy CHEQOL-25 ranged from 0.67 to 0.83. The intraclass correlation coefficient for all items at test-retest ranged from 0.70 to 0.94. Both the CHEQOL-25 and the PedsQL™ 4.0 showed good correlation in the social and emotional subscales (r=0.598, p=0.002 and r=0.342, p=0.031, respectively). The severity of epilepsy, higher number of antiepileptic drug(s), poorer cognitive ability of the child, lower number of close friends, and lesser amount of time spent with friends were significantly associated with poorer health-related quality of life.. The Malay parent-proxy CHEQOL-25 was found to be a valid and reliable instrument to assess parents' perceived HRQOL of their CWE in Malaysia.

Topics: Adolescent; Child; Cross-Cultural Comparison; Epilepsy; Female; Humans; Malaysia; Male; Parents; Pilot Projects; Proxy; Psychometrics; Quality of Life; Reproducibility of Results; Translations

To determine the quality of life of patients with epilepsy and its relationship with depression, and the clinical and sociodemographic variables.. This was a cross-sectional study in which a total of 120 epilepsy patients were recruited from a neurology outpatient clinic. Sociodemographic and clinical variables were recorded. Hospital Anxiety and Depression Scale (HADS) and Mini International Neuropsychiatric Interview (M.I.N.I.) were used to screen and diagnose for depression, respectively. Quality of Life Inventory of Epilepsy (QOLIE-31) was used to assess quality of life.. Patients with epilepsy with major depression had poorer quality life (36.4 ± 1.8) compared to those without depression (41.7 ± 3.8, P < 0.001). Depression, having one seizure or more per month and having seizures within one month of interview were correlated with poorer quality of life, P < 0.001. Multivariate linear regression analyses showed that depression and recent seizures predicted having poorer quality of life in patients with epilepsy.. Depression and poor seizure control were predictors for poor quality of life in patients with epilepsy. Therefore, epilepsy patients should be regularly screened for depression and treatment for epilepsy must be optimized to minimize the negative impact of having epilepsy for these patients.

Topics: Adolescent; Adult; Aged; Anxiety Disorders; Cross-Sectional Studies; Depressive Disorder; Epilepsy; Female; Humans; Malaysia; Male; Middle Aged; Psychiatric Status Rating Scales; Quality of Life; Young Adult

The authors describe a case of a 37-year-old Malay lady with an unusually slow carbamazepine clearance, which may be related to genetic polymorphisms of drug metabolizing enzymes and transporters. When given a small daily dose of 200 mg immediate-release carbamazepine, this patient experienced drowsiness. Subsequently, she reduced her carbamazepine dose to 200 mg twice a week (on Mondays and Fridays), resulting in poor seizure control. At the same time, the patient was diagnosed with hyperthyroidism and was given carbimazole and propranolol. Hyperthyroidism and the concurrent use of these antihyperthyroid agents may have further slowed down the metabolism of carbamazepine. Therapeutic drug monitoring of carbamazepine was carried out, and a slow carbamazepine clearance of 1.45 L·h⁻¹ per 70 kg was observed. Genotyping of selected genetic variants in CYP3A4, CYP3A5, EPHX1, ABCB1, and ABCC2 revealed that she has CYP3A5*3/*3 and ABCB1 3435-CC genotypes. Both genotypes have been shown to be associated with higher adjusted mean serum carbamazepine concentration in Chinese and Korean patients with epilepsy. Physicians should be vigilant about the risk of adverse effects among patients with a slow carbamazepine clearance, especially in Malays. Simulations of carbamazepine dosing regimen based on the pharmacokinetic parameters of this patient were performed to allow individualization of drug therapy.

Topics: Adult; Anticonvulsants; Antithyroid Agents; Carbamazepine; Carbimazole; Dose-Response Relationship, Drug; Drug Monitoring; Epilepsy; Female; Genetic Variation; Genotype; Humans; Hyperthyroidism; Malaysia; Medication Adherence; Multidrug Resistance-Associated Protein 2; Polymorphism, Genetic; Propranolol; Thyrotoxicosis

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.. Two hundred fifty subjects (52.4% male) with a mean age of 35.2 years were recruited from a tertiary neurology clinic in Malaysia.. Of the 250 subjects, 69.6% were employed full-time, 10.4% employed part-time, and 20.0% unemployed. Furthermore, 42.8% had a monthly income below poverty line, i.e., RM1000 (USD 320). Unemployment was associated with female gender, lower education level, younger age of seizure onset, less responsiveness to first antiepileptic drug (AED), higher seizure frequency and less seizure freedom, and higher total score in seizure severity scale. The age of onset (p=0.017), total score in the seizure severity scale (p=0.018), and the responsiveness to first AED (p=0.045) were the significant predictors of unemployment. Patients with part-time employment had similar education level with those who were unemployed, but they are more likely to be male and married, with intermediate age of seizure onset and seizure severity but with higher seizure frequency. As compared to their age-matched siblings, the patients were more likely to be unemployed (OR 13.1), to be single, and to have lower education level and lower monthly income.. Patients with epilepsy have high unemployment rate in Malaysia despite a robust economy and minimal social security. Besides those who were unemployed, many were in part-time or low-income employment.

Topics: Adolescent; Adult; Aged; Anticonvulsants; Dental Alloys; Employment; Epilepsy; Female; Humans; Malaysia; Male; Middle Aged; Siblings; Social Security; Statistics, Nonparametric; Young Adult

There is a lack of study comparing the attitudes toward epilepsy between the teachers and general population, teachers and students, using a similar quantitative scale.. This study was performed in one primary and one secondary school in Kuala Lumpur, Malaysia, using the Public Attitudes Toward Epilepsy (PATE) scale.. A total of 186 teachers aged 39.6±10.4 years completed the questionnaire. The mean scores in both personal and general domains of PATE scale were significantly better in the teachers, comparing to the scores in the secondary and college students reported in previous study (Lim et al., 2013; p<0.001 and <0.05, respectively). The mean scores in personal domain was significantly better in the teachers, comparing to the general population reported by Lim et al. (2012; p<0.001). This hold true when comparing teachers with general population with tertiary education, suggesting that the better attitude is specific to the job, rather than tertiary education generally. Subanalysis showed that the attitudes of teachers were significantly better than the general population and the students related to employment and social life, but were equally negative on issues directly related to education, such as placing children with epilepsy in regular classes.. Teachers had more positive attitudes toward epilepsy as compared with the general population with tertiary education. Attitude to epilepsy may differ specific to types of work.

Topics: Adult; Attitude; Data Interpretation, Statistical; Epilepsy; Female; Humans; Malaysia; Male; Middle Aged; Psychometrics; Schools; Socioeconomic Factors; Students; Surveys and Questionnaires; Young Adult

Epilepsy, a chronic disorder of brain characterised by a predisposition to generate epileptic seizures, has an effect on the psychosocial well-being of sufferers. Measuring the quality of life (QOL) of people with epilepsy (PWE) is increasingly recognized as an important component of clinical management. QOL measures differ between countries and there is limited information regarding PWE in Malaysia. The aim of this study was to determine the health related QOL and its relationship with the presence of seizures in PWE at a Malaysian tertiary referral center.. A total of 106 adults with epilepsy attending the weekly neurology clinic of Universiti Sains Malaysia Hospital were interviewed in this cross-sectional study. The QOL was measured using a validated Malay translated version of the Quality of Life in Epilepsy Scale-31 (QOLIE-31). Analysis of covariance was used for data analysis.. The mean age was 31.8 years old (standard deviation (SD) 11.0) and 56.6% were females. The mean total score of QOLIE-31was 68.9 (SD 15.9). The highest subscale score was the medication effects with a mean of 79.4 (SD 28.5) and the lowest was seizure worry with 47.5 (SD 25.0). Respondents who had one or more seizures in the past four weeks had significantly lower mean score of QOL [63.4, 95% CI: 59.2, 67.5] than those who had no seizure [mean score 73.5, 95% CI: 69.3, 77.9] after adjusting for age, sex, treatment, duration and age at onset of epilepsy [F test =11.215, p = 0.001, R2 = 0.159]. All the sub-scales of QOL showed significant moderate correlation with the frequency of seizures except for cognitive functioning.. Worrying about seizure had the major contribution on QOL, while medication effect had the least. This study confirms the importance of seizure control for a better QOL in Malaysian patients with epilepsy.

Topics: Adolescent; Adult; Age of Onset; Anxiety; Cross-Sectional Studies; Epilepsy; Female; Hospitals, Teaching; Humans; Linear Models; Malaysia; Male; Middle Aged; Quality of Life; Referral and Consultation; Seizures; Social Class; Surveys and Questionnaires; Tertiary Care Centers; Young Adult

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.. The translation was performed according to standard principles and tested in 140 Malay-speaking adults aged more than 18 years for psychometric validation.. 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).. The Malay PATE scale is a validated and reliable translated version for measuring public attitudes toward epilepsy.

Topics: Adult; Cognition Disorders; Epilepsy; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Psychometrics; Public Opinion; Reproducibility of Results; Translating

Being well-informed and knowledgeable about their illnesses would be a great advantage to children with epilepsy (CWE). Subsequently, an effective education programme which could secure interest and simultaneously improve their awareness, knowledge and attitudes (AKA) is essential in enhancing well-being and health outcomes.. To describe the development of a new interactive animated epilepsy education programme (IAEEP) for children and to assess its feasibility, acceptability and practicality.. The IAEEP was developed by an interdisciplinary group of neurologist, paediatrician, pharmacist, biomedical scientist and educators which was based on two established epilepsy education programmes: the educational programme for patients with epilepsy and their relatives (MOSES) and the modular educational program for children with epilepsy and their parents (FAMOSES). CWE from paediatric department of three general hospitals in Terengganu were initially introduced to the IAEEP and were requested to complete an evaluation form assessing its feasibility, acceptability and practicality. Descriptive statistics were employed for data analyses (SPSS 20.0).. Sixteen CWE (median age=13.0; male=56.2%; Malay=81.2%; secondary school=56.2%) and their corresponding parents were recruited. Each CWE owned at least a computer/notebook/tablet (100%). The cost of distribution of IAEEP (in compact disc form) among CWE was estimated at about MYR 17.99/USD 5.90 per CWE. The average time required to interact with the programme was 22.8 minutes (SD=3.3, range 18-28 minutes). The programme was 100% acceptable and received full support from both CWE and their parents (100%).. The favourable findings from this study add to the growing evidence suggesting that investment in interactive and animated education programme would be both feasible, well-received by patients and could be a potentially valuable approach to increase access and effectiveness of epilepsy care especially among CWE.

Topics: Adolescent; Child; Epilepsy; Feasibility Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Microcomputers; Patient Education as Topic; Program Evaluation; Software

To assess the practices associated with the application of therapeutic drug monitoring (TDM) for antiepileptic drugs (AEDs) in the management of children with structural-metabolic epilepsy.. It was a retrospective chart review and included children aged ≥2 years old with structural-metabolic epilepsy, treated with AEDs, and received TDM. The data were extracted from the medical records.. Thirty-two patients were identified with 50 TDM assays. In two thirds of the assays, "check level" and "recheck level" were the reasons behind the requesting of serum level monitoring of AEDs. Knowledge of serum AED levels led to alterations in the management in 60% of the assays. Thirty-two (76%) pediatrician's actions were consistent with the recommendation of TDM pharmacist. Forty-nine (98%) levels were appropriately indicated. In relation to the appropriateness of sampling time, 9 (18%) levels were not assessed due to missing data. Twenty-seven (54%) levels were appropriately sampled.. More studies should be designed to improve the component of the current TDM request form, especially in the reason section. By the same token, the number of pointless assays and the costs to the health care system can be reduced both by enhancing and improving the educational standards of the requesting neurologists.

Topics: Adolescent; Anticonvulsants; Child; Child, Preschool; Drug Monitoring; Epilepsy; Female; Humans; Malaysia; Male; Pharmaceutical Services; Pharmacists; Practice Patterns, Physicians'; Retrospective Studies; Time Factors

Students' attitudes toward epilepsy have been studied in several countries, but none of the studies used a quantitative scale. We aimed to determine the validity and reliability of the Public Attitudes Toward Epilepsy (PATE) scale in a homogenous population consisting of secondary and tertiary students in Malaysia and to quantify their attitudes toward epilepsy, using a web-based survey.. A total of 227 respondents with a mean age of 19.6±2.07 years, predominantly Chinese (85%), female (62%), and in a pre-university education level (71%) completed the web-based survey. Psychometric testing showed that the PATE is a valid and reliable scale to be applied in a homogenous population. The mean score in the personal domain was significantly higher than that in the general domain (2.73±0.61 vs. 2.12±0.60, respectively, p<0.001). Compared with a study previously performed on a general population (Lim et al., 2012 [10]), the mean score in the general domain was significantly lower (p<0.01), whereas there was no significant difference between the mean scores in the personal domain. The mean scores in the general domain were significantly lower for those with tertiary education (p<0.001) but did not correlate with gender and ethnicity.. The attitudes of secondary and tertiary students are more positive than those of the general population in the general domain but not in the personal domain.

Topics: Adolescent; Attitude; Epilepsy; Female; Health Knowledge, Attitudes, Practice; Humans; Internet; Malaysia; Male; Psychometrics; Reproducibility of Results; Students; Surveys and Questionnaires; Young Adult

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.. A set of questions was selected from questionnaires identified from a literature review, following which a panel review determined the final version, consisting of 18 items. A 1-5 Likert scale was used for scoring. Additional questions, related to perception of the productivity of people with epilepsy and of a modified epilepsy stigma scale, were added as part of construct validation. One hundred and thirty heterogeneous respondents were collected, consisting of various age groups, ethnicity and occupation status levels.. After item and factor analyses, the final version consisted of 14 items. Psychometric properties of the scale were first determined using factor analysis, which revealed a general and a personal domain, with good internal consistency (Cronbach's coefficient 0.868 and 0.633, respectively). Construct validation was demonstrated. The mean score for the personal domain was higher than that for the general domain (2.72±0.56 and 2.09±0.59, respectively). The mean scores of those with tertiary education were significantly lower for the general domain, but not for the personal domain. Age was positively correlated with the mean scores in the personal domain, but not in the general domain.. This scale is a reliable and valid scale to assess public attitudes toward epilepsy, in both the general and personal domains.

Topics: Adult; Aged; Asian People; Attitude; Cross-Cultural Comparison; Efficiency; Employment; Epilepsy; Ethnicity; Factor Analysis, Statistical; Female; Humans; Malaysia; Male; Middle Aged; Psychometrics; Public Opinion; Reproducibility of Results; Social Stigma; Socioeconomic Factors; Surveys and Questionnaires; Young Adult

Aims of this study were to estimate the first-year medical care costs of newly diagnosed children with structural-metabolic epilepsy and to determine the cost-driving factors in the selected population.. This was a prevalence-based retrospective chart review that included patients who attended a pediatric neurology clinic in a tertiary referral center in Malaysia. The total first-year medical care costs were estimated from the provider (i.e., hospital) perspective, using a bottom-up, microcosting analysis. Medical chart/billing data (i.e., case reports) obtained from the hospital (i.e., provider) were collected to determine the resources used. Prices or cost data were standardized for the year 2010 (One Malaysian Ringgit MYR is equivalent to 0.26 Euro or 0.32 USD).. The most expensive item in the costs list was antiepileptic drugs, whereas ultrasound examination represented the cheapest item. Hospitalization and the use of non-antiepileptic drugs were the second and third most costly items, respectively. The cost of therapeutic drug monitoring comprised only a small proportion of the total annual expenditure. None of the demographic variables (i.e., gender, race, and age) significantly impacted the first-year medical care costs. Similarly, child development, seizure type, therapy type (i.e., polytherapy versus monotherapy), and therapeutic drug monitoring utilization were also not associated with the cost of management. The first-year medical care costs positively correlated with seizure frequency (r(s)=0.294, p=0.001). However, the only variable that significantly predict the first-year medical care costs was the type of antiepileptic drugs (R(2)=0.292, F=7.772, p<0.001).. This investigation was the first cost analysis study of epilepsy in Malaysia. The total first-year medical care costs for 120 patients with structural-metabolic epilepsy were MYR 202,816 (i.e., MYR 1690.13 per patient per year). The study findings highlight the importance of optimizing seizure control in reducing the cost of management.

Topics: Child; Epilepsy; Female; Health Care Costs; Humans; Malaysia; Male; Prevalence; Retrospective Studies

Over-expression of P-glycoprotein, encoded by the ABCB1 gene, is proposed to be involved in resistance to antiepileptic drugs in about 30% of patients with epilepsy. Here, we investigated the possible association between ABCB1 polymorphisms and sodium valproate (VPA) treatment in Malaysian epilepsy patients. Genotypes were assessed in 249 drug-resistant and 256 drug-responsive Malaysian patients for C1236T, G2677T/A, and C 5T polymorphisms in the ABCB1 gene. No genotypes, alleles, or haplotypes were associated with the response to VPA in either the overall group or Chinese, Indian, and Malay subgroups. Our data suggest that C1236T, G2677T/A, and C3435T polymorphisms in the ABCB1 gene do not contribute to the response to VPA in patients with epilepsy.

Topics: Adult; Alleles; Anticonvulsants; ATP Binding Cassette Transporter, Subfamily B; ATP Binding Cassette Transporter, Subfamily B, Member 1; Epilepsy; Gene Frequency; Genotype; Haplotypes; Humans; Malaysia; Pharmacogenetics; Polymorphism, Genetic; Retrospective Studies; Valproic Acid

The influence of awareness, knowledge, and attitudes (AKA) on the health-related quality of life (HRQoL) of patients with epilepsy has not been widely established. The aims of this preliminary study were to (1) assess general AKA and HRQoL levels, (2) correlate AKA and HRQoL levels, and (3) compare the HRQoL of patients with epilepsy with different AKA levels. A cross-sectional sample of outpatients with epilepsy were recruited from the Neurology Clinic, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia. Data analysis was carried out using the Statistical Package for Social Sciences Version 15 employing descriptive and nonparametric statistics. On written consent, included patients completed the Malay AKA Epilepsy and the Malay Quality of Life in Epilepsy-30 (MQOLIE-30) instruments. Across all patients, both AKA levels (median: 80.0, range: 0-170) and overall HRQoL (median 51.5; range 15-97) were moderate. Awareness was significantly correlated only with Seizure Worry (r(s)=+0.29, p<0.05), whereas Knowledge was not significantly linked to any domain. However, Attitudes was significantly correlated with all domains (r(s)=+0.35 to +0.47, p<0.01) except Medication Effects and Seizure Worry. Patients with good AKA levels (Total Score ≥ median) experienced significantly better Overall Quality of Life and Cognitive Functioning (p<0.05). Findings showed that AKA may play an important role in influencing patients' HRQoL, suggesting that epilepsy treatment efforts should also focus on enhancing AKA through epilepsy awareness to improve health outcomes.

Topics: Adolescent; Adult; Aged; Awareness; Chi-Square Distribution; Cross-Sectional Studies; Epilepsy; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Pilot Projects; Prospective Studies; Quality of Life; Statistics, Nonparametric; Surveys and Questionnaires; Young Adult

To compare sleep habits and disturbances between Malaysian children with epilepsy and their siblings (age range 4-18 years) and to determine the factors associated with greater sleep disturbance.. The Sleep Disturbance Scale for Children (SDSC) questionnaire was completed by the primary caregiver for 92 epileptic children (mean age 11.1 years, 50 male, 42 females) and their healthy siblings (mean age 11.1 years, 47 males, 45 females). Details of sleep arrangements and illness severity were obtained. Multiple regression analysis was used to determine factors associated with high Total SDSC scores in epileptic patients.. Compared with their siblings, epileptic children had significantly higher total SDSC score (difference between means 8.7, 95% confidence interval (CI) 6.4-11.1) and subscale scores in disorders of initiating and maintaining sleep (3.9, 95% CI 2.8-5.2), sleep-wake transition disorders (2.1, 95% CI 1.3-2.9), sleep-disordered breathing (0.7, 95% CI 0.3-1.1) and disorders of excessive sleepiness (1.5, 95% CI 0.6-2.4). Epileptic children had a higher prevalence of co-sleeping (73.7% vs 31.5%) and on more nights per week (difference between means 3, 95% CI 2.0-3.9) than their siblings. Higher Epilepsy Illness Severity scores were associated with higher total SDSC scores (P= 0.02).. Co-sleeping was highly prevalent in children with epilepsy, who also had more sleep disturbances (especially problems with initiating and maintaining sleep and sleep-wake transition disorders) than their siblings. Epilepsy severity contributed to the sleep disturbances. Evaluation of sleep problems should form part of the comprehensive care of children with severe epilepsy.

Topics: Adolescent; Case-Control Studies; Child; Child, Preschool; Epilepsy; Female; Humans; Malaysia; Male; Multivariate Analysis; Prevalence; Regression Analysis; Sleep Wake Disorders

Mowat-Wilson syndrome (MWS) is a recently delineated mental retardation; a multiple congenital anomaly syndrome characterised by a typical facial gestalt, Hirschsprung disease or severe constipation, genitourinary anomaly, congenital heart defects, agenesis of corpus callosum and eye defects. Some cases also present with epilepsy, growth retardation with microcephaly and speech impairment. MWS was first described in 1998 by Mowat et al, and approximately 180 cases have been reported as of August 2008. The syndrome occurs as a result of heterozygous mutations or deletions in the zinc finger E-box-binding homeobox 2 gene, ZEB2, previously called ZFHX1B (SIP1). Most cases reported so far were sporadic occurrences; however, rare cases of sibling recurrence have been cited. The facial phenotype is particularly important for the initial clinical diagnosis and provides the hallmark, warranting ZEB2 mutational analysis even in the absence of Hirschsprung disease. We present the first two molecularly confirmed Malaysian MWS patients, one of whom has a novel mutation.

Topics: Abnormalities, Multiple; Child; Child, Preschool; Constipation; Epilepsy; Female; Gene Deletion; Hirschsprung Disease; Homeodomain Proteins; Humans; Malaysia; Repressor Proteins; Zinc Finger E-box Binding Homeobox 2

This study was carried out to gauge the preliminary insight regarding epilepsy among the rural society. The purposes of this study were: (1) to determine general level of awareness, knowledge and attitudes (AKA) towards epilepsy among rural communities, (2) to compare the AKA level based on socio-demographic characteristics and (3) to investigate rural cohort's perception of the best epilepsy treatment, preference for epilepsy information delivery and preference for mode of transportation to seek medical treatment. This prospective, cross sectional study included a sample of 615 rural residents enrolled via cluster sampling in East Coast region of Peninsular Malaysia (mean age=41.6+/-18.02, female=56.6%, married=65.5%, Malay=94.0%, monthly income < or = RM 500=56.9%). The Total AKA level was generally low (2.66+/-0.7). Gender-wise no significant difference was shown regarding AKA level (p>0.05). However, respondents with higher education significantly possessed better attitudes and higher Total AKA level compared to those with lower education level (p<0.001). Employed respondents reported significantly more favourable attitudes than unemployed respondents (p=0.011). Additionally, higher income rural cohorts possessed both significantly better attitudes and better AKA. These rural communities perceived modern medicine as the best epilepsy treatment (56.60%), preferred to obtain direct epilepsy-related information from health personnel (60.4%) and chose to use their own car to seek medical treatment in hospital (76.30%). The outcomes of this preliminary study signified the need to devise a dedicated epilepsy education program for implementation among rural residents. Increased AKA level in the society could enhance the people's acceptance, reduce stigmatisation and improve health-related quality of life (HRQoL) for epilepsy patients and their family.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Data Collection; Education; Employment; Epilepsy; Family; Female; Health Knowledge, Attitudes, Practice; Humans; Income; Malaysia; Male; Middle Aged; Prejudice; Prospective Studies; Quality of Life; Reproducibility of Results; Rural Population; Socioeconomic Factors; Surveys and Questionnaires; Transportation; Young Adult

People with epilepsy are socially discriminated against on the grounds of widespread negative public attitudes, misunderstandings and defensive behaviour. The primary purpose of this study was to evaluate the public understanding of and attitudes toward epilepsy among the Chinese population in Malaysia.. A validated, self-administered questionnaire comprising 23 questions was utilised to evaluate the understanding of and attitudes toward epilepsy among randomly approached respondents from the Chinese population living in the urban areas of Penang, Klang Valley, Kuala Lumpur and Sibu in Malaysia.. Out of 1,000 people approached, 697 (69.7 percent) respondents agreed to participate in the study. When asked whether people with epilepsy are slow learners and have intellectual functioning below normal, 448 (64.3 percent) respondents answered 'no'. This positive answer was mainly provided by female (35.6 percent) as compared to male (28.6 percent) respondents. Moreover, more than half responded positively to the following statements: people with epilepsy should not be isolated from the normal population; epileptics can perform daily activities; epileptics can receive academic education; and epileptics can become useful members of society. In addition, significant associations were discovered between the education level of the respondents and several statements, including whether epileptics are as intelligent as everyone else (p-value is 0.009), whether epilepsy can be treated with drugs (p-value is 0.037) and whether epileptics can be as successful as other people in their chosen career (p-value is 0.009). Positive responses were mainly acquired from those with secondary education and above. A large number of the respondents felt that people with epilepsy should not be employed as lorry drivers, firefighters, doctors and army personnel.. The general Chinese population in the urban areas of Malaysia had, at the time of the investigation, a relatively high level of understanding and positive attitudes toward certain aspects of epilepsy, although a minority of the study population demonstrated prejudice and discriminatory behaviours toward people with epilepsy.

Topics: Adolescent; Adult; Aged; Attitude to Health; China; Educational Status; Epilepsy; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Surveys and Questionnaires; Urban Population

The objective of this study was to describe and compare the pathways followed by Malay patients with psychoses (schizophrenia and schizophreniform disorder) and Malay patients with epilepsy to a tertiary health center in the northeastern area of peninsular Malaysia. There were 60 patients in each group. The most popular pathway for both groups was first contact with traditional or alternative healers. Consultation with Malay traditional healers (bomohs) and/or homeopathic practitioners (44.2%) was significantly higher for psychotic patients (61.7%) than for patients with epilepsy (26.7%) (chi(2)(2)=15.609, P<0.001). Direct access (24.2%) was the second most popular pathway and almost equally followed by both groups of patients. The third and last pathway was initial contact with private general practitioners and government doctors, respectively. Patients with epilepsy dominated the last two pathways. The treatment delay (TD) was significantly longer in epileptic than psychotic patients regardless of their visit to a bomoh and/or homeopathic practitioner (P<0001) or not (p<0.01). The socioeconomic status of psychotic patients also was significantly better than people with epilepsy (chi(2)=9.957, chi(2)(4), p=0.041).

Topics: Adolescent; Adult; Complementary Therapies; Cross-Sectional Studies; Developing Countries; Epilepsy; Family Practice; Female; Health Services Accessibility; Health Services, Indigenous; Homeopathy; Humans; Malaysia; Male; Middle Aged; Patient Acceptance of Health Care; Primary Health Care; Psychotic Disorders; Referral and Consultation; Schizophrenia; Socioeconomic Factors

The objective of this article is to describe and compare the use of traditional/complementary medicine (T/CM) among psychotic (schizophrenia and schizophreniform disorder) and epileptic Malay patients in peninsular Malaysia. There were 60 patients in each group. T/CM consultation was uniformly spread across all levels of education and social status. We could not find a single over-riding factor that influenced the decision to seek T/CM treatment because the decision to seek such treatment was complex and the majority of decisions were made by others. Fifty-three patients (44.2%), consisting of 37 (61.7%) psychotic and 16 (26.7%) epileptic patients had consulted Malay traditional healers (bomoh) and/or homeopathic practitioners in addition to modern treatment; of these, only three had consulted bomoh and homeopathic practitioners at the same time. The use of T/CM was significantly higher in psychotic than in epileptic Malay patients.

Topics: Adolescent; Adult; Complementary Therapies; Culture; Epilepsy; Female; Homeopathy; Humans; Magic; Malaysia; Male; Medicine, East Asian Traditional; Mental Healing; Patient Acceptance of Health Care; Psychotic Disorders; Schizophrenia; Young Adult

To study the prevalence of dementia in Singapore among Chinese, Malays, and Indians.. A two-phase, cross-sectional study of randomly selected population from central Singapore with disproportionate race stratification.. Community-based study. Subjects screened to have cognitive impairment at phase 1 in their homes were evaluated clinically for dementia at phase 2 in nearby community centers.. Fourteen thousand eight hundred seventeen subjects aged 50 and older (67% participation rate).. The locally validated Abbreviated Mental Test was used to screen for cognitive impairment at phase 1. Dementia was diagnosed at phase 2 as per Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Possible Alzheimer's disease (AD) and possible vascular dementia (VD) were diagnosed along the National Institute of Neurological and Communicative Disorders-Alzheimer's Disease and Related Disorders Association and National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neuroscienes criteria, respectively.. The overall age- and race-standardized dementia prevalence was 1.26% (95% confidence interval (CI)=1.10-1.45). Prevalence (in 5-year age bands) was 0.08% (50-54), 0.08% (55-59), 0.44% (60-64), 1.16% (65-69), 1.84% (70-74), 3.26% (75-79), 8.35% (80-84), and 16.42% (>/=85). From age 50 to 69, 65% of dementia cases were VD; at older ages, 60% were AD. Logistic regression (adjusted for age, sex, education) showed that Malays had twice the risk for AD as Chinese, and Indians had more than twice the risk for AD and VD than Chinese.. Singapore's dementia prevalence, primarily influenced by its Chinese majority, is lower than seen in the West. The striking interethnic differences suggest a need for a dementia incidence study and further investigation of underlying genetic and cultural differences between the three ethnic groups in relation to dementia risk.

Topics: Aged; Aged, 80 and over; Asian People; China; Cross-Sectional Studies; Dementia; Epilepsy; Female; Humans; India; Malaysia; Male; Middle Aged; Parkinson Disease; Prevalence; Risk Factors; Singapore; Stroke

Advances in neuroimaging techniques, particularly Magnetic Resonance Imaging (MRI), have proved invaluable in detecting structural brain lesions in patients with epilepsy in developed countries. In Malaysia, a few electroencephalography facilities available in rural district hospitals run by trained physician assistants have Internet connections to a government neurological center in Kuala Lumpur. These facilities are more commonly available than MRI machines, which require radiological expertise and helium replacement, which may problematic in Southeast Asian countries where radiologists are found in mainly big cities or towns. We conducted a cross-sectional study over a two year period begining January 2001 on rural patients, correlating EEG reports and MRI images with a clinical diagnosis of epilepsy to set guidelines for which rural patients need to be referred to a hospital with MRI facilities. The patients referred by different hospitals without neurological services were classified as having generalized, partial or unclassified seizures based on the International Classification of Epileptic Seizures proposed by the International League Against Epilepsy (ILAE). The clinical parameters studied were seizure type, seizure frequency, status epilepticus and duration of seizure. EEG reports were reviewed for localized and generalized abnormalities and epileptiform changes. Statistical analysis was performed using logistic regression and area under the curve. The association between clinical and radiological abnormalities was evaluated for sensitivity and specificity. Twenty-six males and 18 females were evaluated. The mean age was 20.7 +/- 13.3 years. Nineteen (43.2%) had generalized seizures, 22 (50.0%) had partial seizures and 3 (6.8%) presented with unclassified seizures. The EEG was abnormal in 30 patients (20 with generalized abnormalities and 10 localized abnormalities). The MRI was abnormal in 17 patients (38.6%); the abnormalities observed were cerebral atrophy (5), hippocampal sclerosis (4), infarct/gliosis (3), cortical dysgenesis (2) and tumors (2). One patient had an arachnoid cyst in the right occipital region. Of the 17 patients with an abnormal MRI, 14 had an abnormal EEG, this difference was not statistically significant. There was no significant associaton between epileptographic changes and MRI findings (p = 0.078). EEG findings were associated with MRI findings (p = 0.004). The association between an abnormal EEG and an abnormal MRI had

Topics: Adolescent; Adult; Child; Cross-Sectional Studies; Epilepsy; Female; Health Services Accessibility; Hospitals, Rural; Hospitals, Urban; Humans; Magnetic Resonance Imaging; Malaysia; Male; Middle Aged; Referral and Consultation; Sensitivity and Specificity

University students represent a better-educated group of society and it is important that they possess the correct knowledge and attitude towards healthcare issues. The aim of this study was to determine the current level of awareness and knowledge of epilepsy among students at a public university in Malaysia.. A survey was conducted within the main campus of the Universiti Sains Malaysia (USM), Penang, Malaysia. Students were required to answer a series of questions on awareness and knowledge of epilepsy. The questionnaire was written in the Malay language.. Over a one-week period, 289 students completed the self-administered questionnaire. It was found that 86.5% of students had heard or read about epilepsy, while 55.6% had observed an epileptic seizure. Only 30.7% said that they knew the cause of epilepsy and 5.3% thought epilepsy was caused by evil spirits. Epilepsy was considered hereditary by 66.9% of respondents, while 4.9% thought it was contagious. Furthermore, 60% of students did not think that epilepsy was a shameful illness.. The findings indicate a generally favorable level of awareness and knowledge of epilepsy among students at the university. Nevertheless, there is still a need to improve certain aspects of knowledge and understanding of epilepsy among university students.

Topics: Adult; Awareness; Demography; Epilepsy; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Students; Surveys and Questionnaires; Universities

(1) To determine the effect of lamotrigine add-on therapy on the seizure frequency and cost in paediatric patients. (2) To determine the prescribing pattern of other antiepileptic drugs (AEDs).. A retrospective study of medical records was carried out from October 2000 to June 2001 at the paediatric clinic, Hospital Pulau Pinang.. Seizure frequency, cost of drug and types of AED prescribed.. A total of 209 medical records were retrieved during the study period. Lamotrigine (LTG) was prescribed in 29 patients as add-on therapy. In 18 patients, there was a significant reduction in seizure frequency after the addition of LTG. Approximately 70% experienced a reduction in seizure frequency of more than 50%. Side effects of LTG were considered mild and manageable. However, drug cost after the addition of LTG increased by 103%. In the remaining 180 patients, the most common AED prescribed was sodium valproate (VPA). Only 15% of the patients received combination therapy. Mean monthly cost of monotherapy was found to be RM 24.4 while monthly cost of combination therapy was RM 45.4 (1 Euro-RM 5.00).. The majority of paediatric patients in the study are on AED monotherapy and only a small percentage was prescribed lamotrigine. The use of lamotrigine is associated with better seizure control but with an increase in drug cost.

Topics: Adolescent; Adult; Anticonvulsants; Carbamazepine; Child; Child, Preschool; Cost-Benefit Analysis; Drug Therapy, Combination; Drug Utilization; Epilepsy; Female; Humans; Lamotrigine; Malaysia; Male; Medical Records; Practice Patterns, Physicians'; Retrospective Studies; Seizures; Triazines; Valproic Acid

An observational study of all children with intractable epilepsy at the Paediatric Institute prescribed Lamotrigine as an add-on therapy between January 1994 and November 1998 was conducted. A total of 30 children were recruited. Three had adverse effects to the drug and it was withdrawn. Of the remaining 27, there were 20 boys and 7 girls, ranging from 2 to 17 years. Fifteen children had generalised epilepsy, 6 had partial epilepsy, 2 had West syndrome and 4 had Lennox Gastaut syndrome. Six children (20%) became seizure free, and 14 (54%) had a greater than 50% reduction in seizure frequency. However 7 children (23%) did not respond and 3 experienced a deterioration in seizure severity. Nine children were noted to have an improvement in alertness and behaviour. Our small series suggests that Lamotrigine is useful as add-on therapy in childhood intractable epilepsy.

Topics: Adolescent; Anticonvulsants; Child; Child, Preschool; Drug Therapy, Combination; Epilepsy; Female; Hospitals; Humans; Lamotrigine; Malaysia; Male; Triazines

To determine the characteristics of newly diagnosed epilepsy in the multiracial population of Malaysia.. This is a prospective study of 165 consecutive newly diagnosed cases of epilepsy presenting to the neurology laboratory of the University Hospital, Kuala Lumpur. The inclusion criteria were: two or more seizures with interval of > 24 hours, age > 1 month, residents of Klang Valley. All the patients underwent an awake and sleep EEG.. One hundred and sixty-five cases were collected over 1992-1994. Their ethnic origin was: Chinese (36%), Indian (35%), Malay (29%). The mean age of onset of epilepsy was 18.7 years. Localisation related epilepsies accounted for 57.6% of cases while the remaining 42.4% were generalised epilepsies. Of the generalised epilepsies, subclassification was as follows: idiopathic generalised epilepsy 28.5%, juvenile myoclonic epilepsy 5.5%, childhood absence epilepsy 3.6%, West syndrome 3%, Lennox Gastaut syndrome 1.2% and photosensitive epilepsy 0.6%. Twenty-two percent of the cases were symptomatic and 78% were cryptogenic/idiopathic. The patients had a mean of 3.9 other siblings. Only 0.76% of the close relatives (parents and siblings) had a history of epilepsy.. The characteristics of epilepsy in Malaysia is largely similar to those reported elsewhere. Genetic factors may be playing a relatively minor role in causing epilepsy in this community.

Topics: Adolescent; Adult; Age of Onset; Aged; Child; Child, Preschool; Epilepsy; Ethnicity; Female; Humans; Infant; Malaysia; Male; Middle Aged; Prospective Studies

In a study with 113 Asian children in which phenobarbitone was used as the sole antiepileptic drug in 75 children, including Chinese, Malays, and Indians, the mean phenobarbitone dosage required to produce a plasma level of 15 micrograms/ml was 5.2 mg/kg/day. While the mean plasma level/dose ratio varied, the differences between the three ethnic groups were not statistically significant. Also of little difference were the ratios between the male and female groups. For those patients with poor seizure control, however, the mean plasma level/dose ratio was significantly lower than in those whose seizures were controlled. Using additional anticonvulsant drugs concurrently with phenobarbitone in 40 children raised the mean plasma level/dose ratios significantly in each ethnic group. Further, the greater age level in those given additional antiepileptic drugs might have contributed slightly to a higher mean plasma level/dose ratio.

Topics: Adolescent; Child; Child, Preschool; China; Dose-Response Relationship, Drug; Drug Therapy, Combination; Epilepsy; Humans; India; Infant; Malaysia; Phenobarbital; Singapore

The causal explanation given by a 24-year-old Malay woman from a low socioeconomic class for her epilepsy is described. This case illustrates how cultural explanations can protect an individual from the stigma of illness. The Malay concept of the supernatural and the causation of illness is discussed.

Topics: Adult; Epilepsy; Ethnicity; Female; Humans; Malaysia; Medicine, Traditional; Singapore; Spiritualism