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Background: The COVID-19 pandemic has resulted in long-term consequences for a subset of affected individuals, known as long COVID syndrome. The neurological and psychiatric effects of this condition remain incompletely understood. This study aims to evaluate heightened common mental disorders in long COVID through assessing psychiatric, cognitive, neurophysiological aspects, and emphasizing lasting mental health impacts. Methods: This cross-sectional study compared patients with long COVID to those who had recovered from COVID-19 without residual symptoms using quantitative electroencephalogram (qEEG) analysis. We conducted qEEG analyses, and Montreal Cognitive Assessment (MoCA) and Self-Rating Questionnaire (SRQ) tests on participants. Analyses included brain spectrum examination, hemispheric asymmetry, and inter-electrode connectivity. Results: Analyses revealed lower MoCA scores in the memory domain were lower in the long COVID group (Mann Whitney Utest), indicating that individuals with long COVID experience more substantial cognitive deficits. There is no statistical difference for spectrum examination and hemispheric asymmetry observed in the qEEG data between the COVID and long COVID groups. Connectivity analysis showed statistically significant higher connectivity in temporal-occipital (T6-O2) in long COVID groups (Mann Whitney Utest). Conclusion: Our findings underscore the persistent neuropsychiatric impact of COVID-19, particularly in long COVID patients. Notably, working memory deficits in MoCA scores were identified as one of the most frequent neuropsychological symptoms in these individuals. Decreased brain connectivity indicates cognitive-sensorimotor decline and is confirmed by the frequent brain fog symptoms in long COVID.

Introduction. Due to their immunocompromised state from immunosuppressive therapy and respiratory efficiency, patients with Myasthenia Gravis (MG) are more likely to get infected with COVID-19. Currently, reports on MG patients exposed with COVID-19 in Indonesia are still limited. Therefore, this study was conducted to determine the clinical characteristics and outcomes of MG patients infected with COVID-19, especially in Jakarta, Indonesia. Methods. It is a retrospective study of MG patients in a National Referral Hospital in Indonesia from September 2021 to December 2022. The data obtained includes demographics, medical history, clinical characteristics, and severity of MG assessed by MG composite scale (MGCS), Myasthenia Gravis Foundation of America (MGFA) classification, symptoms, and therapy. Results. Of the 8 patients, 7 patients were female. The range of age at COVID-19 onset was 28-62 years old. On admission to the hospital, 2 patients were mild MG, 2 patients were moderate MG, 3 patients with severe MG, and one patient could not be identified because the patient came in an unconscious state. Five patients were classified as moderate COVID-19, two patients had severe COVID-19, and one patient was classified as critical COVID-19. Most patients experience MG exacerbation or require oxygen support during hospitalization. Only one patient deceased while receiving treatment at the emergency room, while the rest improved and were discharged home. Conclusion. MG patients exposed with COVID-19 tend to experience moderate, severe, and critical COVID-19 symptoms. However, with proper management of the infection and other comorbidities, MG patients with COVID-19 may achieve favorable outcome.

Introduction: Since the COVID-19 pandemic, there has been increasing use ofchat-based telemedicine, including for patients with neuropathy complaints. It is imperative to learn how to effectively use telemedicine. This study describes the characteristics of patients with neuropathy complaints in chat-based telemedicine services in Indonesia and their influence on treatment decisions and referrals. Methods: This is a retrospective cross-sectional study during the COVID-19 pandemic era (March 2020 to December 2021) using anonymous secondary data from patient chat databases on Indonesian application-based telemedicine services (Halodoc, Alodokter, Good Doctor, and Milvik). We applied bivariate and multivariate analysis. Results: We obtained 1051 patients with suspected peripheral nerve complaints (4 per 10,000) from a total of 2,199,527 user consultations, with the majority being 40–64 years old females and diabetes mellitus was the leading comorbid (90.7%). Most patients received treatment (90.7%) and only 11.4% patients were referred. Multivariate analysis showed that treatment was more likely to be given by a neurologist (p

Abstract—Phenytoin is an antiepileptic drug (AED) metabolized by cytochrome P450 enzymes, especially by CYP2C9 (90%) and CYP2C19 (10%), where both enzymes are polymorphic so that they can undergo polymorphism and it can change the metabolic rate of the drug. Phenytoin is one of the drugs whose risk of side effects may increase due to its narrow therapeutic window of 10-20 µg/mL if the metabolism is slow. The main literature was taken from publications through the library databases in 2017 – 2021. Studies and reviews describing the metabolism, CYP2C9 and CYP2C19 polymorphisms, and neurotoxicity of phenytoin were included, and unrelated research were excluded. There were 18 of 853 articles describing CYP2C9 and CYP2C19 polymorphisms, metabolism, and neurotoxicity events associated with phenytoin used. The authors conclude that based on the results from various literature, there is an association between CYP2C9 and CYP2C19 polymorphism, metabolism, and neurotoxicity after Phenytoin administration with CYP2C9*2 and CYP2C9*3 types of polymorphisms for CYP2C9 and CYP2C19*2 and CYP2C19*3 types for CYP2C19*3 enzymes which can slow down the phenytoin metabolism and increase its concentration in serum so that the risk of causing neurotoxicity. Keywords: CYP2C9, CYP2C19,metabolism, neurotoxicity, phenytoin Abstrak—Fenitoin merupakan obat antibangkitan yang dimetabolisme oleh enzim sitokrom P450 terutama oleh CYP2C9 (90%) dan CYP2C19 (10%), dimana kedua enzim tersebut bersifat polimorfik sehingga dapat mengalami polimorfisme dan dapat mempengaruhi laju metabolisme obat. fenitoin merupakan salah satu obat yang risiko efek sampingnya dapat meningkat jika metabolismenya lambat karena jendela terapeutiknya yang sempit, yaitu 10-20 µg/mL. Literatur utama diambil dari publikasi melalui database perpustakaan tahun 2017 – 2021. Penelitian dan ulasan yang menggambarkan metabolisme, polimorfisme CYP2C9 dan CYP2C19, dan neurotoksisitas fenitoin, dan penelitian yang tidak terkait dikeluarkan. Terdapat 18 dari 853 artikel yang menjelaskan polimorfisme CYP2C9 dan CYP2C19, metabolisme, dan kejadian neurotoksisitas terkait dengan fenitoin yang digunakan. Peneliti menyimpulkan bahwa berdasarkan hasil dari berbagai literatur, terdapat hubungan antara polimorfisme, metabolisme, dan neurotoksisitas CYP2C9 dan CYP2C19 setelah pemberian fenitin dengan jenis polimorfisme CYP2C9*2 dan CYP2C9*3 untuk CYP2C9 dan CYP2C19*2 dan CYP2C19*3 jenis enzim CYP2C19*3 yang dapat memperlambat metabolisme fenitoin dan meningkatkan konsentrasinya dalam serum sehingga berisiko menyebabkan neurotoksisitas. Kata kunci: CYP2C9, CYP2C19, fenitoin, metabolisme, neurotoksisitas

ObjectiveMenstrual disorders are more common in women with epilepsy than in those without epilepsy. This study aimed to examine the characteristics of reproductive function in women with epilepsy at an Indonesian national referral hospital.MethodsA case-control study was conducted from March 2020 to March 2021. Women with and without epilepsy aged ≥18 years were enrolled. All women were premenopausal before epilepsy diagnosis. Data on demographic characteristics, menstrual profiles, epileptic syndrome, seizure type, seizure frequency, etiology, localization, and anticonvulsant medication were collected. Hormone levels (follicle stimulating hormone, luteinizing hormone, prolactin, and estradiol) were measured.ResultsA total of 72 women with and 50 without epilepsy (controls) were included. Dysmenorrhea was more common in women with epilepsy than in those without (59.7 vs. 20%, p < 0.001; odds ratio: 5.931 [95% confidence interval: 2.566–13.709]). Marriage rates were higher in women without epilepsy (82 vs. 45.8%, p < 0.001). No difference was found in hormone levels between the groups. The frequency of seizures was associated with prolactin and estradiol levels (p < 0.001). Polytherapy with clobazam was associated with menstrual cycle regularity. In women with epilepsy with menstrual disorders, valproic acid was associated with higher estradiol levels (p = 0.001) and lamotrigine with lower follicle stimulating hormone levels (p = 0.008).SignificanceWomen with epilepsy experienced more dysmenorrhea. A higher frequency of seizures associated with lower prolactin and estradiol levels. Polytherapy with clobazam was associated with irregular menstrual cycles, while valproic acid and lamotrigine was associated with estradiol and follicle stimulating hormone levels.

Background: Theta burst stimulation (TBS) and quadripulse stimulation (QPS) are known to induce synaptic plasticity in humans. There have been no head-to-head comparisons of the efficacy and variability between TBS and QPS. Objective: To compare the efficacy and interindividual variability between the original TBS and QPS protocols. We hypothesized that QPS would be more effective and less variable than TBS. Methods: Forty-six healthy subjects participated in this study. Thirty subjects participated in the main comparison experiment, and the other sixteen subjects participated in the experiment to obtain natural variation in motor-evoked potentials. The facilitatory effects were compared between intermittent TBS (iTBS) and QPS5, and the inhibitory effects were compared between continuous TBS (cTBS) and QPS50. The motor-evoked potential amplitudes elicited by transcranial magnetic stimulation over the primary motor cortex were measured before the intervention and every 5 min after the intervention for 1 h. To investigate the interindividual variability, the responder/nonresponder/opposite-responder rates were also analyzed. Results: The facilitatory effects of QPS5 were greater than those of iTBS, and the inhibitory effects of QPS50 were much stronger than those of cTBS. The responder rate of QPS was significantly higher than that of TBS. QPS had a smaller number of opposite responders than TBS. Conclusion: QPS is more effective and stable for synaptic plasticity induction than TBS.

Introduction: Moderate-to-severe traumatic brain injury (msTBI) can cause non-convulsive status epilepticus (NCSE). Electroencephalography (EEG) is employed as a diagnostic tool due to the non-specificity of clinical symptoms. This study aimed to identify clinical and EEG features related to NCSE in patients with msTBI. Methods: This was a cross-sectional study. Suspected NCSE in msTBI was examined using EEG data collected in consecutive patients from January 2017 to December 2019 at Dr. Cipto Mangunkusumo Hospital, Jakarta. Diagnoses of NCSE were made based on clinical manifestations and EEG features using the modified Salzburg Consensus Criteria for NCSE (mSCNC). Results: Of the 39 msTBI patients, 19 were diagnosed with NCSE; only two fulfilled the definitive criteria, and the remaining were possible NCSE. Delirium and perceptual impairment were only found in NCSE, while psychomotor agitation was higher (12.8% vs. 5.1% in NCSE vs. non-NCSE). The most common EEG feature was rhythmic activity (>0.5 Hz) without fluctuation, which improved with anti-epileptic drug administration. The Glasgow Coma Scale (GCS) score at onset and at hospitalisation discharge was significantly lower in patients with NCSE. The lesions in NCSE mostly originated from the temporal lobe. Injury to the temporal lobe had a significant relationship with NCSE occurrence (p = 0.036, odds ratio 11.45 [95% confidence interval 1.17–111.6]). Discussion: Post-traumatic NCSE can manifest as an alteration in mental status that could lead to missed diagnosis. In this study, delirium, perceptual impairment, and psychomotor agitation were confirmed as NCSE using EEG. The most common discharge originated from the injured temporal lobe, and this site was a significant factor associated with NCSE in patients with msTBI. Conclusion: NCSE can be found in msTBI cases with clinical manifestations of altered mental status, psychomotor agitation, and hallucination. An injured temporal lobe was a susceptible site for the development of NCSE.

Background: During the COVID-19 pandemic, patients with myasthenia gravis (MG) are most likely to be affected by this situation. Corticosteroids and immunosuppressant agents increase the risk of severe infection. Furthermore, viral infection and some medications in COVID-19 may exacerbate MG symptoms. Case description: We presented three patients with MG who contracted COVID-19. All of the patients had a favourable outcome. Only one patient who was not treated with corticosteroids or immunosuppressant therapy experienced deterioration of MG symptoms, while the other patients who received immunosuppressant therapy did not develop MG exacerbation. Surprisingly, azithromycin did not provoke myasthenic crisis (MC) in patients with normal MGFA classification. Conclusion: Using immunosuppressant agents may not lead to MG deterioration and may not be related to unfavourable outcomes.

The decisions we make are sometimes influenced by interactions with other agents. Previous studies have suggested that the prefrontal cortex plays an important role in decision-making and that the dopamine system underlies processes of motivation, motor preparation, and reinforcement learning. However, the physiological mechanisms underlying how the prefrontal cortex and the dopaminergic system are involved in decision-making remain largely unclear. The present study aimed to determine how decision strategies influence event-related potentials (ERPs). We also tested the effect of levodopa, a dopamine precursor, on decision-making and ERPs in a randomized double-blind placebo-controlled investigation. The subjects performed a matching-pennies task against an opposing virtual computer player by choosing between right and left targets while their ERPs were recorded. According to the rules of the matching-pennies task, the subject won the trial when they chose the same side as the opponent, and lost otherwise. We set three different task rules: (1) with the alternation (ALT) rule, the computer opponent made alternating choices of right and left in sequential trials; (2) with the random (RAND) rule, the opponent randomly chose between right and left; and (3) with the GAME rule, the opponent analyzed the subject’s past choices to predict the subject’s next choice, and then chose the opposite side. A sustained medial ERP became more negative toward the time of the subject’s target choice. A biphasic potential appeared when the opponent’s choice was revealed after the subject’s response. The ERPs around the subject’s choice were greater in RAND and GAME than in ALT, and the negative peak was enhanced by levodopa. In addition to these medial ERPs, we observed lateral frontal ERPs tuned to the choice direction. The signals emerged around the choice period selectively in RAND and GAME when levodopa was administered. These results suggest that decision processes are modulated by the dopamine system when a complex and strategic decision is required, which may reflect decision updating with dopaminergic prediction error signals.

Parkinson's disease (PD) patients experience various symptoms including extrapyramidal motor disturbances and cognitive impairments, which cause difficulties in daily life. However, PD patients have rarely been studied under realistic task situations that require high-level interaction of cognitive and motor skills. The aim of this study was to investigate the contribution of cognitive and motor factors to the performance of PD patients under high cognitive and kinematic loads. Twenty-six PD patients and 14 control subjects participated in the study. The PD patients performed a task involving hitting targets and avoiding distractors in levodopa On and Off states. A robotic manipulandum device recorded the numbers of target and distractor hits and hand kinematics, including movement area and speed. Performance on standard cognitive batteries and the Movement Disorder Society – Unified Parkinson's Disease Rating Scale motor scores were examined. The results indicated that the PD patients hit significantly fewer targets and more distractors than did the controls (p < 0.05). In PD patients, the average hand speed was slower and the area of hand movement was smaller than those of the control subjects (p < 0.001). Levodopa significantly increased the average hand speed and movement area (p < 0.01), but levodopa had an insignificant effect on the number of correct targets hit and erroneous distractor hits. The scores of cognitive batteries predicted the performance with regard to both targets hit and distractor avoidance. Our results were indicative of a dynamic interaction between cognitive and kinematic skills while the PD patients performed a virtual reality game. Single-dose levodopa enhanced kinematic capacity, and the global intelligence level predicted game performance.

Observing mouth movements has strikingly effects on the perception of speech. Any mismatch between sound and mouth movements will result in listeners perceiving illusory consonants (McGurk effect), whereas matching mouth movements assist with the correct recognition of speech sounds. Recent neuroimaging studies have yielded evidence that the motor areas are involved in speech processing, yet their contributions to multisensory illusion remain unclear. Using functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) in an event-related design, we aimed to identify the functional roles of the motor network in the occurrence of multisensory illusion in female and male brains. fMRI showed bilateral activation of the inferior frontal gyrus (IFG) in audiovisually incongruent trials. Activity in the left IFG was negatively correlated with occurrence of the McGurk effect. The effective connectivity between the left IFG and the bilateral precentral gyri was stronger in incongruent than in congruent trials. The McGurk effect was reduced in incongruent trials by applying single-pulse TMS to motor cortex (Ml) lip areas, indicating that TMS facilitates the left IFG-precentral motor network to reduce the McGurk effect. TMS of the Ml lip areas was effective in reducing the McGurk effect within the specific temporal range from 100 ms before to 200 ms after the auditory onset, and TMS of the Ml foot area did not influence the McGurk effect, suggesting topographical specificity. These results provide direct evidence that the motor network makes specific temporal and topographical contributions to the processing of multisensory integration of speech to avoid illusion. [ABSTRACT FROM AUTHOR]