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The Epworth Sleepiness Scale (ESS), Sleep Apnea Scale of Sleep Disorders Questionnaire (SA-SDQ), and Pittsburgh Sleep Quality Index (PSQI) are widely used in English speaking countries for sleep problem screening. However, there is no officially validated Thai-version of sleep questionnaires available.To provide standard Thai version of three sleep questionnaires and find cut-off level to screening sleep problems in Thai population.We used Mapi Research Institute Methods for translation from original language to Thai questionnaire. Then, test-retest reliability analysis was performed. Finally, we collected data from patients who underwent polysomnography in Phramongkutklao Sleep Lab Centre between June and August 2011. Cut-off value to screen population at risk for sleep-related disorder was researched.The questionnaires were translated with very good inter-rater agreement. Cut-off of ESS, SA-SDQ, and PSQI suggested sleep disorders would be 9, 27, and 6.5 respectively.Sleep disorder questionnaires including ESS, SA-SDQ, and PSQI were translated into Thai with high validity, reliability, and accuracy.

Epilepsy surgery has been established for treatment of drug-resistant focal epilepsy. We aimed to determine long-term outcomes of epileptic surgery in various aspects including seizure outcome, quality of life, and psychosocial consequences after surgery.A single center, cross-sectional study was conducted. The patients with drug-resistant focal epilepsy who underwent epileptic surgery for at least one year were recruited.Thirty-seven adult drug-resistant epilepsy patients after epileptic surgery were enrolled with an average follow-up period of 5.8 years. Twenty-three (62.2%) had temporal lobe epilepsy (TLE) and 14 (37.8%) had neocortical epilepsy. Four were (10.8%) compatible with lesional negative refractory epilepsy. Hippocampal sclerosis was the most common etiology (45.9%), followed by focal cortical dysplasia/gliosis (21.6%) and brain tumor (21.6%). The three commonest postoperative complications were any medical illnesses (18.9%), memory impairment (18.9%), and visual filed defect (13.5%). Twenty patients (54.1%) had no complications. Seizure outcomes, employment status, quality of life, depression, frank psychosis, and number of antiepileptic drug (AED) between pre- and post-surgical period (interviewing time) were compared. Engel Class I (seizure freedom) was persistently achieved in 19 (51.4%) patients. There were nine (24.3%) patients in Engel Class II, eight (21.6%) in Engel Class III, and one (2.7%) in Engel Class IV. Seizure outcome, quality of life, and self-assessment were improved after epileptic surgery at any age groups, duration of epilepsy, epileptogenic zone, and side of operation. In some subgroups, it was found that income was increased and number of AED was reduced. However, depression and frank psychosis did not change the outcome. On self-assessment, global impression of change in memory showed 27% improvement and 32.4% no change. For language and communication skills, 29.7% was improved but 21.6% was worsened.In this longitudinal study, epilepsy surgery showed improvement in seizure control, quality of life, and some neuropsychological aspects.

To measure the changes of mean platelet volume (MPV) after using four antiplatelet drugs in acute non-cardioembolic ischemic stroke patients and assess the association of antiplatelets and MPV and stroke outcome.Ischemic stroke survivors with National Institute of Health Stroke Scale (NIHSS) 8 were randomly allocated intofour groups, receiving aspirin, clopidogrel, combined aspirin and dipyridamole, and cilostazol. The change of MPV NIHSS, and modified Rankin Scale (mRS) were recorded at baseline and week 4 in all studied groups. MPV was measured using the standard automated blood test for complete blood count.Twenty-one subjects were included in this study. They comprised of five cases in each antiplatelet group, except for aspirin, which had six subjects. Male was 57%, and hypertension was the most common risk factor (61.9%). Most of participants (76%) had small vessel disease. At 4-week, MPVwas reduced and NIHSS, mRS were improved in every studied group. Clopidogrel sign ficantly reduced NIHSS score (p = 0.003), and it produced the greatest reduction in MPV compared to others.Every type of antiplatelets included in this study reduced MPV NIHSS, and mRS in acute non-cardioembolic stroke patients. Clopidogrel improved NIHSS the most.

Non-motor symptoms (NMS) ofParkinson's disease (PD) have been recently recognized to be as disabling as motor symptoms in PD. However these symptoms are still under recognized causing delay in treatment and inadequate management. This study aimed to identify NMS in Thai PD patients using the NMS screening questionnaire (NMSQuest).Patients with idiopathic Parkinson's disease visiting the neurology clinic in 2008 were enrolled. NMSQuest-Thai version (NMSQ-T) was applied to patients to identify NMS.Collected data from questionnaires completed by 165 probable idiopathic PD was analyzed. The demographic profiles showed mean age of 68.6 years with mean disease duration 5.4 years, and male 56.4%. Patients had HoehnYahrstaging, stage-2: 43%, stage-3: 24.8%, stage-I: 24.2% and stage-4: 7.9%. The average dosage oflevodopa was 456.4 mg/d. Mean total NMSQ-T score was 9.5. Most prevalent of non-motor symptom was nocturia (64.2%). The domains which gained most positive answers were urinary domain (54.55%). Inter-domain correlations were significantly found in all, except the sexual domain. Multivariate analysis revealed the duration ofPD and stages were significantly correlated with the total score ofNMS. Only three percent denied having any non-motor symptoms.Almost all Thai PD had NMS. Urinary domain is the most prevalent in our series. Screening using NMSQ-Tto recognize NMS would be a helpful tool to improve the quality of life in Thai Parkinson 's disease.

Sleepiness is a common complaint in epilepsy. Also obstructive sleep apnea (OSA) is increasingly detected and would affect the epilepsy prognosis. We aimed to determine the frequency and predictors of sleepiness and OSA in epileptic patients.This was a cross-sectional descriptive study using Epworth Sleepiness Scale questionnaire (ESS) and Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ) to identify excessive daytime sleepiness and OSA in our consecutive epileptic patients in Neurology out-patient clinic.Overall 113 patients (male 55%) answered a personal survey and completed ESS and SA-SDQ. Mean age was 47 years (range 15-93). Average body mass index (BMI) was 24. Excessive daytime sleepiness (ESS 10) was demonstrated in 37%, and the prevalence of OSA diagnosed by using SA-SDQ was 20% (male 18%, female 22%). OSA were identified 68% among individuals whose BMI of more than 25, which was significant higherfi-equency than in the nomnnal BMI group (32%). The predictors of having OSA were older age and higher BMI. Epworth Sleepiness Scale score was also higher in the OSA group than in non-OSA group.Excessive daytime sleepiness was identified around one third ofour epileptic individutals. Twenty percent had met the questionnaire criteria of having OSA. Overweight was the most important and modifiable risk factor ofOSA.

To identify the frequency of behavioral and psychological symptoms of dementia (BPSD) and to explore the different characteristics between subgroup and severity of dementia.Sixty-seven patients with Alzheimer's disease, vascular dementia, and mixed dementia were recruited to our cross-sectional study. Neuropsychiatric batteries including the Mini Mental Status Examination-Thai 2002, Thai Geriatric Depression Scale, 23 items from Alzheimer's Disease co-operative Study activities of daily living inventory, Behavioralpathology in Alzheimer's disease rating scale, and Pittsburg Sleep Quality Index were tested.The most common behavioral and psychological symptoms of dementia (BPSD) were sleep problems (100%), paranoid/delusion (59.7%), diurnal disturbance (49.2%) and aggressiveness (46.3%). Hallucination and affective problems were more severe in AD than in VaD/mixed dementia. Sleep problems were identified more severe in mild dementia than moderate-to-severe dementia. With longer duration of having dementia, exceptfor affective problem, there was no diffemence in behavioral and psychological symptoms observed compared to the shorter dementia group.Behavioral and psychological symptoms were very common in Alzheimer disease, vascular dementia, and mixed dementia. Since these symptoms cause cognitive and functional decline, institutionalization, caregiver distress and increase direct costs ofcare, the problem must be identified and addressed.

Kleine-Levin syndrome (KLS) is a rare disorder characterized by periodic hypersomnia, cognitive and behavioral disturbances. Other unique symptoms in KLS are megaphagia, hypersexuality and some psychiatric disturbances such as compulsion and depression. Definite diagnosis requires the elimination of other potential etiologies. We reported a typical case of KLS in a young Thai man who suffered from seven episodes of periodic hypersomnia within 1.5 years and eventually he was diagnosed with Kleine-Levin syndrome after excluding known possible neurological conditions and sleep disorders.

Parkinson's disease (PD) is one of the neurogenic etiologies of orthostatic hypotension, a non-motor symptoms complex, that tends to be under-recognized and under-treated leading to a major cause of disability for PD patients. This complication is associated with one or recurrent falls causing mortality and morbidity. To the authors' knowledge, there is no study about this condition in Thai PD population. The authors therefore aimed to determine the frequency, clinical and risk factors of orthostatic hypotension in PD patients treated in Phramongkutklao Hospital.The authors enrolled consecutive patients with idiopathic PD over a 10-month period. Supine and standing blood pressure (BP) were measured sequentially as the standard techniques. Orthostatic hypotension (OH) was diagnosed if there was a reduction in systolic or diastolic BP of at least 20 or 10 mmHg respectively within 3 minutes after standing. The authors analyzed for the frequency of this condition as well as determined the risk factors between the OH and non-OH groups.The number of patients enrolled was 82 with the mean age of 69 years. The median duration of PD was 4 years. Eighty-five percent were in HoehnYahr stage 1-3. Thirty-three patients (40.2%) had orthostatic hypotension and 70% of them were asymptomatic. By univariate and multivariate analysis, the risk factors for this condition were the longer duration of PD diagnosis, the more advanced staging and the use of selegiline.The frequency of orthostatic hypotension among the present PD was 40.2%. The longer duration of disease, the more advanced stage of Parkinson's disease and selegiline usage were the factors associated with this non-motor condition.

To study prevalence of depression in poststroke survivors in Phramongkutklao Hospital and factors associated with depression.From 150 stroke survivors, therefor 101 patients who met inclusion criteria. These subjects were screened with Thai Geriatric Depressive Scale (TGDS) and interviewed. Demographic data that would effect depression were evaluated.During 9 months of studying period, 101 of 150 patients diagnosed with poststroke survivors were eligible. The prevalence of depression was 46.53%. Severity of depression were mild depression 20.79%, moderate 18.81% and severe depression 6.93%. There were no statistically significant among sex, diabetes mellitus, hypertension, smoking, hyperlipidemia, and site of stroke between depression and non-depression groups. Risk factors for severe poststroke depression were younger age, duration within one year after stroke onset and history of coronary artery disease.The prevalence of poststroke depression was 46.53%. Risk factors of severe depression were younger age, duration within one year of stroke onset and history of coronary artery disease.

To determine the prevalence of depression among epileptic patients in Phramongkutklao Hospital and to find the factors associated with depression.One hundred and ten epileptic patients were enrolled and 60 patients met the inclusion criteria. These subjects were screened with Thai Geriatric Depressive Scale (TGDS) and were interviewed. Demographic data that effect depression were evaluated.During the 1-year study period, 60 of 110 patients diagnosed epilepsy were eligible. Prevalence of depression was 38.3%, which is similar to previous studies. Mild depression was found in 65.2% and moderate 34.8%, without severe depression. Comparing between male and female, there was no statistical significant difference (p = 0.75). The age group that compared between age equal or less than 25 years and more than 25 years had no statistical significant difference (p = 0.77). Other variables were not found to be significant risk factors of depression among epileptic patients including duration of seizures [equal or less than 5 and more than 5 per year (p = 0.43)], type of seizures [generalized tonic-clonic seizures and partial seizures (p = 0.69)], and number of antiepileptic drugs [monotherapy and polytherapy (p = 0.44)].Prevalence of depression among epileptic patients was 38.3%, divided between mild (65.2%) and moderate (34.8%). There were no significant risk factors correlated with depression. Epileptic patients should be made aware of this and seek prompt treatment for depression.

To determine the prevalence, risk factors of dementia and depression in end stage renal disease (ESRD) who were treated with hemodialysis (HD) compared with those who had continuous ambulatory peritoneal dialysis (CAPD).A cross-sectional study was conducted on 90 ESRD patients (60 HD and 30 CAPD groups). The authors reviewed the demographic data, investigation results. Thai Mental State Examination, DSM IV criteria and Thai Depression Inventory were interviewed to determine dementia and depression respectively.Both prevalence of dementia and depression in ESRD on continuous dialysis were 6.7%. In the HD group had 8.3% prevalence of dementia and 6.7% of depression, whereas there was 3.3% of dementia and 6.7% of depression in the CAPD group. The severity of depression in the present study was mild to moderate (6.7%) and no major depression was seen. The significant risk factors for dementia were ageor = 60 years (p=0.003), Education10 years (p=0.037) and female sex (p=0.036). The significant risk factor for depression was female sex (p=0.036). There was no significance different on prevalence of dementia and depression comparison between the HD and CAPD group.Prevalence of dementia and depression in the overall dialysis in ESRD was 6.7% (with 8.3%, 6.7% among the HD group and 3.3%, 6.7% among CAPD group). There was no significant difference on prevalence of dementia and depression comparison between the HD and CAPD group.

To determine efficacy and tolerability of aspirin plus dipyridamole (combination) versus aspirin alone in acute intervention treatment after acute ischemic stoke among Thai patients.This pilot study enrolled ischemic stroke patients within 48 hours and randomized to aspirin 300 mg/d or combination (aspirin 300 mg/d+ standard release dipyridamole 75 mg thrice a day) and followed up for 6 months. Endpoints were recurrent ischemic stroke, transient ischemic attack and vascular death. Side effects were recorded. National Institutes of Health Stroke Scale was assessed at entry and at 6 months period for determining neurological functions.Of 38 patients, mean age was 64.3 years. Male and female were 52.6% and 47.4% respectively. There were 18 patients in the aspirin group and 20 patients in the combination group. No patient developed end point events or no significant adverse event in both groups. The combination group showed more improvement in neurological function than the aspirin group (p-value 0.009).This pilot study showed equal efficacy and tolerability of the combination group and aspirin alone in acute intervention treatment for prevention of recurrent stroke or vascular death within 6 months.

To explore association of variables influencing MMSE-Thai version (MMSE-T) score among Thai subjects.365 general non dementia Thai subjects of age 45-87 years were randomly recruited in Bangkok. All subjects were screened with MMSE-T and interviewed. Demographic factors that might affect the score of MMSE-T were collected. Relationship between demographic variables and MMSE-T score were evaluated.Of 365 subjects, mean MMSE-T score was 27.2 and ranged 17-30. There were 27 cases (7.44%) with MMSE-T scoreor = 23. Subjects who had a scoreor = 23, were 18 cases (27.69%) and 9 cases (3.01%) in education level less than bachelor degree and at least bachelor degree respectively (p value0.001). By linear regression analysis, the factors significantly affected the lower score were age higher than 60 years (p=0.017) and education below bachelor degree (p0.001).Factors including elderly and low education were negatively influenced on MMSE-T performance among Thai subjects.

To compare the prevalence of Post Dural Puncture Headache (PDPH) between 6 hour- supine recumbence and early ambulation in Thai patients.The present study was a prospective controlled study and enrolled the patients who underwent Lumbar Puncture (LP) from Phramongkutklao Hospital, Thailand. The background characteristics were recorded Standard LP method was done. The patients were randomized to 6 hour-supine recumbence andor = 1 hour- (early ambulation) groups. Prevalence and characteristics of PDPH were compared.Of 65 patients, there were 33 patients (50.8%) in the 6 hour-recumbent group and 32 patients (49.2%) in the early ambulation group. The background characteristics and CerebroSpinal Fluid (CSF) findings were not different between the groups. Prevalence of PDPH was 16.9% (overall), 18.2% (6 hours) and 15.6% (early ambulation). There was no statistically significant difference in prevalence, pattern and severity of PDPH between the groups.The prevalence and characteristics of PDPH were not different between the 6 hour- recumbence and early ambulation groups.

Melioidosis which is infection with Burkholderia pseudomallei, is an important cause of sepsis in India, southeast Asia and northern Australia. Mortality is high and treatment is problematic. Neurological melioidosis is unusual but meningoencephalitis, encephalomyelitis and brain microabscess can occur Dural sinus thrombosis is not an uncommon cerebrovascular disorder with various etiologies. Hypercoagulable state, pregnancy, dehydration, certain blood dyscrasia and contraceptive pills are common causes however meningitis and local headneck infections may lead to this condition. Dural sinus thrombosis complicating septicemic melioidosis has never been reported. The authors report a 42-year-old Thai man suffering from septicemic melioidosis with dural sinus thrombosis. He had high fever, headache, left hemiparesis, focal seizure and increased intracranial pressure. Diabetes and mild alcoholic cirrhosis were diagnosed in this admission. CT scan, MRI brain and MRV revealed superior saggital sinus thrombosis with complicating venous infarction over right posterior parietal lobe. Hemoculture demonstrated Burkholderia pseudomallei and CSF was acellular Investigations for causes of dural sinus thrombosis were all negative. This patient gradually improved after treatment with ceftazidime, antiepileptic drug and heparin without clinical recurrence. Neuromelioidosis is a rare syndrome that may present as brain abscess, encephalitis or meningoencephalitis. The authors report dural sinus thrombosis associated with septicemic melioidosis. The authors' hypothesis of venous thrombosis in the presented case is sepsis induced hypercoagulable state. Physicians should be aware of cerebral venous thrombosis in case of suspicious melioidosis with neurological involvement. Prompt treatment with intravenous heparin and antibiotic is potentially effective.

Tuberculosis (TB) is a common infectious disease worldwide. It can affect many organs, the most common is lungs infection. Upper respiratory tract involvement is uncommon and the least common regional involvement is nasopharyngeal region. The authors report a case of nasopharyngeal tuberculosis who came with diplopia which is a very rare presentation. Nasopharyngeal tuberculosis is a rare condition that is found in only reported cases in the literature. In Thailand, the present case is the second case of this condition with diplopia. Nasopharyngeal examination reveal mass or ulceration. The diagnostic tool is lesional biopsy. Histology is necessary to diagnose tuberculosis and to exclude other conditions especially nasopharyngeal cancer Nasopharyngeal tuberculosis has a good prognosis after treatment.

Streptococcal group A infection is reported as a medical problem in several parts of the world. The most serious complication of this infection is streptococcal toxic shock syndrome (STSS) which is associated with a very high mortality rate. The present study aimed to determine the clinical manifestations, including underlying conditions, mortality and prognostic factors, of invasive streptococcal group A infection and STSS from southern Thailand (Songklanagarind Hospital).The medical records of infected patients from January 1, 1995 to June 30, 1999 were reviewed retrospectively. Criteria for diagnosis of STSS were as follows (JAMA 1993). Prognostic factors were analyzed by logistic regression model.176 cases of STSS and streptococcal group A infection, 89.9 per cent were community acquired infections. About 70 per cent of the infected patients had previous underlying conditions, the most common was cancer. The commonest site of infection was the skin and soft tissue (80.1%). The total mortality rate from streptococcal group A infection was 9.1 per cent. STSS was identified in 12 patients (6.8%), with a 50 per cent mortality rate. Prognostic factors for mortality in this infection were diabetic mellitus (odds ratio 9.67, p0.025), history of steroid use (odds ratio 11.17, p0.017), STSS (odds ratio 22.16, p0.005) and received cancer chemotherapy (odds ratio 115.19, p0.003). Predictive factors for STSS couldn't be identified, while age65 years and steroid use were suggested protective factors for this condition [odds ratio 0.02, p0.0001 and odd ratio 0.07, p0.027 respectively].