Revisiting the public awareness, attitudes, and understanding towards epilepsy among Singapore residents.

A survey to assess the familiarity, attitudes, and knowledge about epilepsy was done using a questionnaire identical to the one used in 1999. Two hundred forty-six people participated in our survey in 2017 as compared with 214 in the 1999 survey. In terms of familiarity about epilepsy, 76% had heard or read about epilepsy, 55.7% had witnessed a seizure, and 35.8% knew someone with epilepsy (85%, 56%, and 36% respectively in 1999). Forty point five percent were not familiar with or did not know what to do if they witnessed a seizure (44% in 1999); 25.6% would put something in the mouth of a person having a seizure (32% in 1999). In terms of attitudes towards epilepsy, 14.6% would object to their children associating with one with epilepsy while 19.9% would object to their children marrying a person with epilepsy (13% and 36% respectively in 1999). Only 43.1% would employ a person with epilepsy while 68.3% would employ if seizures do not interfere with the job (42 and 66% respectively in 1999). In terms of knowledge of seizures and epilepsy, 66.3% associated epileptic attack with convulsion (68% in 1999). Only 37.5% were aware of nonconvulsive forms of epilepsy (25% in 1999). Twenty-six point eight percent did not know what treatment to recommend to relatives/friends with epilepsy while 60.6% recommend western medicine (22% and 60% respectively in 1999). CONCLUSION: The awareness, attitudes, and understanding towards epilepsy does not seem to show any significant difference when compared with that in 1999. Reluctance to marry and employ a person with epilepsy persists. The awareness about first aid of a patient having a seizure, attitudes towards marrying a person with epilepsy, and the understanding of cause of epilepsy have shown some positive changes over 17 years.

Low conversion rate of ocular to generalized myasthenia gravis in Singapore.

INTRODUCTION: Ocular myasthenia gravis (OMG) is a common condition of the neuromuscular junction that may convert to generalized myasthenia gravis (GMG). Our aim in this study was to determine the conversion rate and predictive factors for generalization in OMG, in an Asian population. METHODS: The investigation consisted of a retrospective study of OMG patients with a minimum 2 years of follow-up. RESULTS: Among 191 patients with OMG, 155 had the minimum 2-year follow-up. The conversion rate at median follow-up (40.8 months) was 10.6% (95% confidence interval 7.9%-13.3%), and at the 2-year follow-up it was 7.7% (95% confidence interval 5.6%-9.8%). At baseline, the predictive factors for generalization were positive acetylcholine receptor antibodies (hazard ratio 3.71, P = 0.024), positive repetitive nerve stimulation (RNS) studies (hazard ratio 4.42, P = 0.003), and presence of radiologically presumed or pathologically confirmed thymoma (hazard ratio 3.10, P = 0.013). DISCUSSION: The conversion rate of OMG to GMG in Asian patients is low, as predicted by presence of acetylcholine receptor antibodies, presence of thymoma, and positive RNS studies. Muscle Nerve 57: 756-760, 2018.

Predictive Value of Electrophysiology for Presence of Thymic Pathology in Myasthenia Gravis.

OBJECTIVE: Single fibre electromyography (SFEMG) and repetitive nerve stimulation (RNS) are routinely performed investigations in evaluation of patients with myasthenia gravis (MG). Significant number of MG patients have a thymic pathology. We aimed to explore the relationship between the SFEMG and RNS findings with the presence of thymic pathology. METHODS: We studied 159 consecutive patients with MG over a 10 year period. The SFEMG parameters - mean jitter (MJ) and percentage of abnormal fibres (POAF) and the RNS result were correlated with the thymic findings. RESULTS: As compared to patients with normal thymus (MJ:58.3 µsec; POAF:63.5%), patients with thymic pathology had a significantly higher MJ (80.9 µsec; p < 0.0005) and POAF (83.5%; p < 0.0005). MG patients with thymic hyperplasia had the highest MJ (87.6 µsec) and POAF (84.4%) followed by patients with thymoma (MJ:78.6 µsec; POAF:83.2%). The MJ and POAF did not correlate with the stage of thymoma. Mean jitter values above 34.9 µsec and POAF above 31% had 100% sensitivity for the presence of thymic pathology. A positive RNS increased the risk of thymic pathology (OR = 3.9, CI = 1.8-8.5) and thymoma. (OR = 3.5; CI = 1.5-8.1). CONCLUSION: Electrophysiology could be valuable complimentary tool to identify MG patients at high risk for thymic pathology. However, it does not aid us to identify the exact thymic pathology and does not correlate with the stage of thymoma. All OMG patients with higher MJ and PAOF values should also be screened for thymoma. The results reinforce the immunological role of thymic pathology in neuromuscular transmission interference.

Methotrexate induced leucoencephalopathy: A stroke mimic.

With increasing usage of thrombolysis in the treatment of acute ischemic strokes within 4.5- hour window, it is becoming more important to recognize stroke mimics. Though the incidence of stroke mimics being thrombolysed is less than 3%, it is essential to diagnose them so as to avoid wrong thrombolytic treatment which carries potential complications of bleeding. We describe the case of a 17 year old girl with acute lymphoblastic leukemia, who developed stroke like episodes on two consecutive challenges with a chemotherapeutic regime which included intravenous and intrathecal methotrexate. She had MRI changes consistent with acute ischemic stroke on both occasions. Her deficits recovered completely and spontaneously, as did the MRI changes. She did not have any further episodes when methotrexate was excluded from the chemotherapeutic regime.