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Malang Neurology Journal
Published by Universitas Brawijaya
Malang Neurology Journal (MNJ) is a continuously published twice a year scientific journal which is using review by peer group system. MNJ accepts original research article, review, case report, and readers’ letters related to neurology.
Articles
66
Articles
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EXTRACRANIAL METASTASIS OF GLIOBLASTOMA: A RARE CASE

Rahmawati, Dessika, Marhaendraputro, Eko Arisetijono, Kurniawan, Shahdevi Nandar, Wirathmawati, Andina

Malang Neurology Journal Vol 5, No 1 (2019): January
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Abstract

Glioblastoma is the most common primary malignant tumor in the neural tissue and a highly aggressive primary tumor in human. It involves glial cells in 52% of functional brain tissue cases and 20% of all intracranial tumors. Extra cranial metastasis of Glioblastoma is very rare. Metastasis outside CNS was uncommon in GBM but it could occur with frequency 0.2% and can spread in head and neck sites. The mechanism of this spread is not understood yet. The extracranial spread routes were speculated on the direct lymphatic connections, the venous system and the adjacent structure like dura and bone. We present a case of female patient with a known glioblastoma who had an extracranial metastasis on her left neck with complete Radiotherapy n Chemotherapy and survive more than 2 years.

AROMATASE AND NEUROREGENERATION

Ulhaq, Zulvikar Syambani

Malang Neurology Journal Vol 5, No 1 (2019): January
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Abstract

Aromatase (cyp19a1) is a converting enzyme for estrogen biosynthesis. A single gene of cyp19a1 identified in mammals and specific promoter differentially regulates E2 produce in the brain.Interestingly, teleost fish having two isoforms of cyp19a1, cyp19a1a and cy19a1b, encoding ovarian and brain aromatase, respectively. In addition, teleost fish are characterized by having highly aromatase activity and neuroregenerative response. In contrast with fish, neuroregeneration process is limited in mammals. Therefore, understanding molecular mechanism of estradiol signaling in neural injury in fish may give a new insight for the development of novel treatment in mammals, particularly in neurodegenerative diseases. Here, the author briefly reviews and discusses the potential role of neural estrogen for regeneration process.

KEARNS-SAYRE SYNDROME MIGHT BE MIXED UP WITH CPEO PLUS

Finsterer, Josef, Mahjoub, Sinda Zarrouk-

Malang Neurology Journal Vol 5, No 1 (2019): January
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Abstract

In a recent article, Al Ghamdi presented a 40yo parturient with Kearns-Sayre syndrome (KSS) who had received an implantable cardioverter defibrillator (ICD) because of an AVblock II (Mobitz 2 (2:1)) 11y earlier and underwent caesarean delivery for preeclampsia in local anesthesia with bupivacaine and fentanyl.(1) We have the following comments and concerns.

A REVIEW OF BURDEN OF CAREGIVERS OF PATIENTS WITH ALZHEIMER'S DISEASE

Ridzuan, Sayyidah Aqilah, Darussalam, Siti Eliza, Hisham, Nur Hazrina Mohamed, Namasivayam, Prashaantini, Nichole, Yam Min Yi, Zaid, Danial Syafiq Shahrir, Nor, Nurul Huda Mohd, Mohamed, Mohd Hazmi, Mooi, Ching Siew, Devaraj, Navin Kumar, Ismail, Iskasymar Bin Itam, Hashim, Hasnur Zaman, Mat, Liyana Najwa Inche, Kee, Hoo Fan, Basri, Hamidon, Sulaiman, Wan Aliaa Wan

Malang Neurology Journal Vol 5, No 1 (2019): January
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Abstract

Many are still unaware of the fact that Alzheimer’s disease (AD) also affects the caregivers quite significantly. Caregivers refer to people who are accountable of taking care of AD patients which provide helps with his or her daily living activities and may become a full-time commitment for the caregiver. This gives rise to a concept called caregiver burden. As these caregivers spend most of their time taking care of AD patients, most of them suffer psychologically as well as physically.Unfortunately, the risk of mental and physical impairment among the caregivers of Alzheimer’s patient may cause poor quality of life to both the patients and their caregivers. In addition, due to their role and responsibilities as a caretaker, they often do not have the opportunity to seek help and advices. This review article was conducted by sieving through numerous literature and studies regarding the challenges and how to help the burden of the caregivers of Alzheimer’s patients . This paper aims to give and overview, suggestions as well as to increase the awareness of the caregiver’s burden.

EFFECT ANTHOCYANIN OF PURPLE POTATO GUNUNG KAWI ON MDA LEVELS, EXPRESSION OF CASPASE-3, AND SPATIAL MEMORY FUNCTION ON DIABETIC WISTAR RATS

Prabawati, Risma Karlina, Ratnawati, Retty, Rahayu, Masruroh, Prakosa, Ardani Galih

Malang Neurology Journal Vol 5, No 1 (2019): January
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Abstract

Background: Hyperglycemia condition will decline cognitive function. No basic therapy has been 2 found for this. Purple potato anthocyanins are useful as anti-inflammatory, antioxidant, neuroprotectant, and antidiabetic.Objective: Evaluate effect of purple potato’s anthocyanins on MDA levels, brain’s caspase-3 expressiom, and spatial memory function in diabetic model of Wistar rats.Methods: This is an experimental study using diabetic model rats. The sample was divided into negative and positive control, anthocyanin dose of 10 mg/kg, 20 mg/kg, and 80 mg/kg groups. MDA levels were measured using spectrophotometer, caspase-3 expression with immunohistochemistry, and spatial memory function using Morris water maze test.Results: Tukey test showed that anthocyanin 10, 20, and 80 mg/kg lowering MDA levels, caspase-3 expression, and Morris water maze’s travel time compared to control positive (p = 0.000). But anthocyanin 80 mg/kg make a significant increase on these three variabels compared to 10 and 20mg/kg groups (p = 0.010). Pearson test showed that there no correlation between anthocyanin’s dose, MDA levels, caspase-3 expression, and Morris water maze test.Conclusion: Anthocyanin doses 10 and 20 mg/kg lowering MDA levels and caspase-3 expression, also improves spatial memory function on diabetic model of Wistar rats.

THE INFLUENCE OF SAMPLING TIME TO SERUM GLIAL FIBRILLARY ACIDIC PROTEIN (GFAP) LEVELS IN ACUTE STROKE

Raisa, Neila, Sujuti, Hidayat, Rahayu, Masruroh, Dalhar, Mochamad

Malang Neurology Journal Vol 5, No 1 (2019): January
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Abstract

Background: Serum Glial Fibrillary Acidic Protein (GFAP) is a great potential for biomarker that is widely studied as a diagnostic biomarker of acute stroke. Sampling within 6 hours after onset is the best time window, but in Indonesia, stroke patients often arrive late more than 6 hours.Objective: To identify the difference in time of blood sampling with serum GFAP levels within 24 hours onset of ischemic stroke (IS) patients and intracerebral hemorrhage (ICH) strokes.Methods: Cross-sectional analysis with purposive sampling, sampling in IS and ICH strokes that arrive at the ER within 24-hour on-site. The serum GFAP examination was performed with ELISA.Results: In this study, 41 acute stroke patients with 24-hour onset of each stroke were grouped into group 1 (<6 hours), group 2 (6-12 hours) and group 3 (12-24 hours). One Way ANOVA and Tukey's analysis showed no significant difference in GFAP levels among the three groups in both IS and ICH. Conclusion: There was no significant difference in GFAP levels in samples <6 hours, 6-12 hours, and 12-24 hours in ischemic strokes and ICH strokes.

DIAGNOSTIC TEST OF POLYNEUROPATHY SCORE, 10-G SEMMES WENSTEIN MONOFILAMENT (SWM) AND VIBRATION PERCEPTION TRESHOLD (VPT)-QUANTITATIVE SENSORY TESTING (QST) IN DISTAL SENSORY POLYNEUROPATHY (DSP)-HUMAN IMMUNODEFICIENCY VIRUS (HIV)

Purbasari, Bethasiwi, Kurniawan, Shahdevi Nandar, Husna, Machlusil, Candradikusuma, Didi, Al-Rasyid, Harun

Malang Neurology Journal Vol 5, No 1 (2019): January
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Abstract

Background: HIV/AIDS is a worldwide pandemic. Peripheral neuropathy is the most common neurologic complication with distal sensory polyneuropathy (HIV-DSP) as the most frequent form of manifestation. HIV-DSP is one of the major causes of global pain morbidity and often undiagnosed earlier, resulting in treatment given when HIV-DSP grade is already severe. Early detection is imperative to prevent the progression of HIV-DSP and improve patient’s quality of life. Polyneuropathy score, 10-g Semmes-Weinstein Monofilament (SWM) and vibration perception threshold (VPT)-quantitative sensory testing (QST) are considered to be potential candidates for HIVDSP screening tool.Objective: To measure the reability of Polyneuropathy Score, SWM and VPT- QST in diagnosing HIV-DSP.Methods: This research is a descriptive study with cross-sectional design. Research was conducted on 77 patients of HIV/AIDS outpatient clinic in RS Saiful Anwar (RSSA) during November 2016 - April 2017 (n = 77). Patients were screened for HIV-DSP by using polyneuropathy score, such as: Michigan Neuropathy Screening Instrument (MNSI), Toronto Clinical Scoring Sysytem (TCSS), Brief Peripheral Neuropathy Score (BPNS), SWM, and VPT-QST. Sensitivity, specificity, positive predictive value and negative predictive value of BPNS, TCSS, MNSI, SWM and VPT-QST are analyzed using cross tabulation. Area under receiver operating characteristic (ROC) curve analysis was used to measure diagnostic accuracy of each tools. SPSS 19.0 was used for statistical analysis.Results: TCSS had a sensitivity, specificity, positive predictive value, negative predictive value positive likelihood ratio, negative likelihood ratio, and accuracy as much as: 70%, 97%, 97%, 74%, 23,33, 0,28 and 83%. The result of TCSS analysis using ROC showed that TCSS had excellent diagnostic value with AUC (Area Under Curve) of 0.89 (95%CI 82%-96,5%). The AUC of BPNS score, monofilamen and VPT-QST respectively: 0,469, 0,194, and 0,189.Conclusion: The result of the HIV-DSP diagnostic test using TCSS score has the best value compared to other tools.

COMPARISON OF CARPASTRETCH® WITH SPLINT IN NON-SURGICAL TREATMENT OF CARPAL TUNNEL SYNDROME: A RANDOMIZED OPEN LABEL STUDY

Malshikare, Vijay, Desai, Sanjay Mukund, Arekar, Anil Shridhar, Bhosale, Neelambari Abhay, Bonde, Shital Ravindra, Awdhani, Mansi Abhishek

Malang Neurology Journal Vol 5, No 1 (2019): January
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Abstract

Background: The present study was conducted with an aim to compare the efficacy and safety of CarpaStretch® relative to wrist splinting in patients with CTS.Objective: To examine the effect of using CarpaStretch®, a novel dynamic splint for the treatment of Carpal Tunnel Syndrome.Methods: The efficacy and safety of CarpaStretch® was compared with conventional splints in a prospective 6-month trial with a follow-up at 12 months. 30 subjects with confirmed Carpal Tunnel Syndrome were enrolled in each group. Nerve conduction tests, wrist MRI, provocation tests and patient satisfaction questionnaires were assessed in the study.Results: At the end of 6 months, there were significant increases in sensory nerve conduction velocity in both intervention and control groups, and the difference between groups were not significant. A higher proportion of subjects using CarpaStretch® showed improvement in severity grade relative to control at 6 months. Small but clinically meaningful increases were seen in carpal tunnel dimensions in the CarpaStretch® group. There was a greater reduction in the incidence of paraesthesia and increase in the time of paraesthesia in the CarpaStretch® group. No adverse effects were reported in either group, but 4 subjects in the control group opted for surgery.Conclusion: CarpaStretch® can be used for effective non-surgical management of Carpal Tunnel Syndrome.

COMPARISON EFFECT BETWEEN PEGAGAN (Centella asiatica) EXTRACT AND PRAMIPEXOLE TOWARD LOCOMOTOR ACTIVITIES, ? - SYNUCLEIN, AND NRF2 EXPRESSION IN ZEBRAFISH PARKINSON MODEL

Trisnawati, Ayu, Anasrulloh, Anasrulloh, Rianawati, Sri Budhi, Khotimah, Husnul, Ali, Mulyohadi, Susetya, Budi

Malang Neurology Journal Vol 5, No 1 (2019): January
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Abstract

Background: Parkinson disease is characterized with deposition of Lewy Bodies containing ?–synuclein happened due to the effect of chronic neuroinflammation that causes the death of dopaminergic neurons through oxidative stress processes, so it involves the response of Nuclear factor erythroid 2-like 2 (Nrf2). Centella asiatica  (C.asiatica) contains antioxidant effect, inhibits the aggregation of ?–synuclein and improves the locomotor on Parkinson-model animals so it needs to compare to the standard medication.Objective: To compare the C. asiatica extract and Pramipexole to the zebrafish Parkinson model by determining the locomotor activity, ?–synuclein expression, and Nrf2.Methods: This study used six groups of zebrafish: negative control, rotenone rotenone [5 ?g/L], pramipexole1, 2, 3 (rotenone + pramipexole [3,5] ng/mL, [7] ng/mL, [14] ng/mL), and C. asiatica(rotenone + C. asiatica [10] ?g/mL). The observations of locomotor activity of day 0, 14, and 28 were continued to the ?–synuclein immunohistochemical examination, and Nrf2 on the midbrain area.Results: There are significant differences in locomotor activity on day 28 among the C. asiatica group with rotenone (p<0,05), while there are no significant differences among the C. asiatica group with pramipexole [7] ng/mL and [14] ng/mL (p>0,05). ?–synuclein expression of the C. asiatica group is the lowest and significantly different from all groups (p<0,05), while Nr2 had no significant differences (p>0,05).Conclusion: C. asiatica extract [10] ?g/mL is equal to pramipexole [7] ng/mL and [14] ng/mL in improving locomotor activity, but C. asiatica extract holds excellence as it decreases ?–synuclein expression better than pramipexole, while Nrf2 expression shows no differences.

ELECTRONEUROMYOGRAPHY EXAMINATION OF DIABETIC POLYNEUROPATHY PATIENTS

Nurlaela, Siti, Kurniawan, Shahdevi Nandar, Husna, Machlusil

Malang Neurology Journal Vol 5, No 1 (2019): January
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Abstract

Background: Diabetic polyneuropathy (DPN) is one of the chronic complications that occur in approximately 80% of diabetes mellitus (DM) patients. This condition is a results of metabolic, vascular, and immunological disorders.Objective: To determine the profile of electroneuromyography (ENMG) examination of DPN patients at neurology clinic of Saiful Anwar General Hospital.Methods: This cross-sectional observational descriptive study was carried out at Saiful Anwar General Hospital Malang from June 1, 2015 to December 31, 2015, with purposive sampling method. A total of 43 DM patients with symptoms of polyneuropathy fulfilling inclusion criteria and no exclusion criteria were examined for ENMG. ENMG examirnation were including distal latency, amplitude and nerve conduction velocity of 4 motoric nerves (median, ulnar, tibial, peroneal) & 3 sensory nerves (median, ulnar, sural), and F waves of ulnar, median and peroneal nerves of the left and right extremities.Results: Of the 43 patients evaluated in this study, the mean sensory sural nerve conduction velocity was 13.01 m/s. The majority type of nerve damage in diabetic polyneuropathy patients in this studywere mixed type (52.33% in the median nerve, 60.47% in the ulnar nerve, 72.10% in the tibial nerve, and 54.65% in the peroneal nerve in motor nerve studies and 80.23% in the median nerve and 88.37% in the peroneal nerve in the sensory nerve studies).Conclusion: The nerve damage that occurs in DPN patients at Saiful Anwar general Hospital is severe, with the majority being the axonal demyelinating type, especially in the sensory nerve fibers in the inferior extremities.