A 9-year review of dystonia from a movement disorders clinic in Singapore.

The clinical features of dystonia have not been evaluated in Southeast Asia. We therefore investigated the clinical spectrum and characteristics of dystonia in Singapore, a multi-ethnic Southeast Asian country comprising 77% Chinese, 14% Malays, and 8% Indians. We identified all dystonia patients from the Movement Disorders database and Botulinum Toxin clinic between 1995 and November 2004. Their medical records were reviewed to verify the diagnosis of dystonia and obtain demographic and clinical data using a standardized data collection form. A total of 119 (73%) patients had primary dystonia whilst 45 (27%) had secondary dystonia. There were 77% Chinese, 9% Malays, and 8% Indians. The most common focal dystonia were cervical dystonia (47%), writer's cramp (32%), and blepharospasm (11%). There was no significant difference in the distribution of dystonia between the different races. Males were noted to have earlier onset of dystonia overall. There was a significant male predominance in primary dystonia overall (M:F 1.6:1, P=0.008) and in the subgroup of focal dystonia (M:F 1.6:1, P=0.037). This contrasts with previous studies that found a female predominance. The role of genetic, hormonal, and environmental factors and their interactions need to be investigated to better understand the gender differences in the occurrence of dystonia.

Clinical characteristics of patients with multiple system atrophy in Singapore.

INTRODUCTION: Our study aimed to describe the clinical features of multiple system atrophy (MSA) in Singapore and verify its diagnosis using the consensus statement in the diagnosis of MSA. MATERIALS AND METHODS: All patients suspected to have MSA between 1995 and March 2005 were identified from the Movement Disorders database and the autonomic function testing results. The medical records were reviewed using a standardised data collection form. The diagnosis of MSA was verified using the consensus statement. Disease progression was evaluated using 2 pre-determined events: aid-requiring walking and wheelchair use. RESULTS: Seventy-two per cent (33/46) fulfilled the consensus statement. There were 85% Chinese, 9% Malays, and 6% Indians. The mean age at onset of the disease was 60 +/- 10 years. We found a predominance of males (M:F = 1.5:1) as well as MSA-C cases (67%). The most common initial presenting features were parkinsonism and cerebellar signs (27% each). Abnormal neuroimaging was seen in 29 patients (91%). Autonomic function testing was abnormal in 58% (7/12). The risk for aid-requiring walking and wheelchair use at 3 years from onset of the disease was 31% and 17%, respectively. By 5 years, this had increased to 45% and 30%, respectively. There was no difference in the events rate between MSA subtypes. CONCLUSIONS: The clinical characteristics of MSA in Singapore are presented. Our study revealed a predominance of MSA-C patients as well as a later age at onset of disease and longer median time to aid-requiring walking and wheelchair use compared to Japanese patients.

Hemifacial spasm in Singapore: clinical characteristics and patients ' perceptions.

INTRODUCTION: The aim of this study was to determine the clinical characteristics and patients ' perception of hemifacial spasm (HFS) in Singapore. MATERIALS AND METHODS: A clinical survey of 137 consecutive patients with HFS seen in our Botulinum Toxin Clinic over a 15-month period was undertaken. RESULTS: Forty-six men and 91 women were interviewed. Their mean age at onset of HFS was 48 years. The median disease duration was 60 months (range, 2 to 360 months). Left-sided spasm was common in 51.8 % of patients, and the orbicularis oculi was the first muscle to be affected in 86.1 % of them. The majority (65 %) had the spasm aggravated by stress and anxiety. In fact, 32 patients perceived stress and anxiety as a possible aetiology of HFS. Stroke was a main concern in 17 patients and 7 patients thought the spasm was a sign of demonic possession or a bad omen. The spasm embarrassed 75.2 % of the patients, rendered 65 % of them depressed, affected the vision in 60.6 % of them and compromised their work performance in 35.8 %. Overall, treatment was delayed by a median interval of 6 months from onset of symptoms (range, 0 to 132). More than half (53.3 %) tried traditional therapies (acupuncture or herbal medicine), while only 48.2 % had botulinum toxin as the initial treatment. All patients eventually received botulinum toxin injections and more than 90 % showed improvement at 1 month posttreatment. CONCLUSIONS: The clinical characteristics and patients ' perception of HFS in Singapore were presented. HFS affects patients both psychosocially and functionally. Effective treatment with botulinum toxin exists and should be provided early to the patients.

Prevalence of Parkinson disease in Singapore: Chinese vs Malays vs Indians.

OBJECTIVE: To investigate the prevalence of Parkinson disease (PD) in Singapore and compare the rates between Singaporean Chinese, Malays, and Indians. METHODS: A three-phase community-based survey among a disproportionate random sample of 15,000 individuals (9,000 Chinese, 3,000 Malays, 3,000 Indians) aged 50 years and above who live in central Singapore was conducted. In phase 1, trained interviewers conducted a door-to-door survey using a validated 10-question questionnaire. In phase 2, medical specialists examined participants who screened positive to any of the questions. Participants suspected to have PD had their diagnosis confirmed in phase 3 by a movement disorders specialist. RESULTS: The participation rate was 67% among 22,279 eligible individuals. Forty-six participants with PD were identified of which 16 were newly diagnosed cases. The prevalence rate of PD for those aged 50 and above in Singapore was 0.30% (95% CI: 0.22 to 0.41), age-adjusted to US 1970 census. The prevalence rates increased significantly with age. The age-adjusted prevalence rates among Chinese (0.33%, 95% CI: 0.22 to 0.48), Malays (0.29%, 95% CI: 0.13 to 0.67), and Indians (0.28%, 95% CI: 0.12 to 0.67) were the same (p = 1.0). CONCLUSIONS: The prevalence of PD in Singapore was comparable to that of Western countries. Race-specific rates were also similar to previously reported rates and similar among the three races. Environmental factors may be more important than racially determined genetic factors in the development of PD.