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. 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. Using immunosuppressant agents may not lead to MG deterioration and may not be related to unfavourable outcomes.

This study aims to describe the variations in neurology training pathways in all Association of Southeast Asian Nations (ASEAN) countries. A cross-sectional survey using questionnaires was conducted among the representatives of ASEAN countries from October 2023 to March 2024. Neurology training programs are available in 9 of the 11 ASEAN countries except Timor Leste and Cambodia. Despite the growing number of neurologists, with a doubling of the neurologist-to-patient ratio in most countries in the past 2 decades, the neurologist density per 100,000 population remained low. Thailand, Singapore, and Brunei Darussalam have more than 1 neurologist per 100,000 population compared with 2007 when only Singapore and Brunei Darussalam had more than this ratio. In Cambodia, Lao People's Democratic Republic (PDR), Myanmar, and Timur Leste, although the number of neurologists has increased substantially, the ratio of neurologists remains low, with less than 1 in a million population in Myanmar, 1:625,000 population in Lao PDR, 1:526,000 population in Cambodia, and 1:430,000 in Timur Leste. The total duration of training from undergraduate to certified neurologist varies greatly because of compulsory internal medicine (IM) training and postinternship services. To enroll in neurology training, candidates in 4 countries (Brunei, Singapore, Malaysia, and Myanmar) must have completed IM as a prerequisite. Candidates from Thailand and Indonesia must fulfill their 2-year compulsory government or general practice service requirement before they are eligible for neurology training. After fulfilling the eligibility criteria to enter neurology training, the overall training duration ranges from 3 to 13 years. Malaysia and Myanmar are countries where candidates spend more than 10 years becoming certified neurologists. The number of neurologists and the neurologist-to-patient ratio have improved since 2007 in ASEAN countries. Diverse neurology curricula and the variable duration to complete neurology training and subspecialty practice are the main challenges in improving neurology training in ASEAN countries.

Objective: Menstrual 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.Methods: A 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.Results: A 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).Significance: Women 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.

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. 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). 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]). 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. 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.

Purpose: Myasthenia gravis (MG) can cause respiratory muscle weakness and the need of ventilator support. Spirometry as the gold standard for pulmonary function examination has limited availability, especially in our hospital which is only available in outpatient clinic during work hours (not in emergency room or patient room). Furthermore, all primary healthcare in Indonesia do not have spirometry equipment, thus other alternatives are required. This study aimed to analyze the relationship between a single breath counting test (SBCT), peak flow meter (PFM), and spirometry to assess pulmonary function in MG patients in a national referral hospital in Indonesia. Patients and Methods: A single-center, cross-sectional study was conducted and SBCT, PFM, and spirometry examination were performed in MG patients and healthy controls. Results: Seventy patients, aged 47.7 ± 13.4 years old, participated in this study. SBCT, forced vital capacity first second (FVC1), and forced expiratory volume first second (FEV1) value between MG patients and healthy controls showed a significant difference, in which healthy controls have higher SBCT, FVC1, and FEV1 values (p = 0.000, p = 0.000 and p = 0.001 respectively). There was a significant difference between PFM with SBCT and FVC1 value in MG patients. Strong correlation was found between SBCT and FVC1 in MG patients. Conclusion: MG patients had worse pulmonary function compared to healthy controls. SBCT and PFM examination have a significant correlation with FVC1 in MG patients. Therefore, SBCT and PFM can be used as a bedside tool to detect respiratory impairment in MG patients.

Background: Adherence to epilepsy treatment varies greatly and is often compromised by adverse drug reactions. Spontaneous reporting of these reactions has improved pharmacovigilance in many countries. Knowledge, attitudes, and behavior are also key factors influencing treatment adherence. This study aimed to investigate the types of adverse drug reactions in epilepsy, as well as the knowledge, attitudes, and behavior of patients, and how these factors relate to medication adherence. Methods: This cross-sectional study assessed adverse drug reactions using the Indonesian version of the Liverpool Adverse Event Profile and medication adherence with the Morisky Adherence Questionnaire. Knowledge, attitude and behavior were measured using a self-reported Indonesian knowledge-attitude-behavior questionnaire. Data were collected at two periods of time (2019 and 2022), in which the first period measured adherence, and adverse drug reactions, while the second period measured adherence, and adverse drug reactions, alongside knowledge, attitude, and behavior. Data were gathered from epilepsy patients at the neurology outpatient clinic at Cipto Mangunkusumo National Referral Hospital, and analyzed using Chi-square, likelihood ratio, independent t -test, or Mann–Whitney U Tests, followed by multivariate logistic regression. Results: Adherence rates in both periods exceeded 50% (50.88% vs. 55.70%). Adverse drug reactions were reported by 78.07% of subjects, and were significantly associated with non-adherence ( P = 0.007). The mean knowledge score was 15.41 ± 3.83, and lower knowledge scores were linked to higher odds of non-adherence. Although not statistically significant ( P = 0.077), higher knowledge scores showed a trend toward more frequent reporting of adverse drug reactions. Female subjects had higher odds of adherence compared to males ( P = 0.013). Conclusions: Our findings suggest that adverse drug reaction reporting, along with patient knowledge, attitudes, and behavior, are important factors associated with medication adherence. Targeted interventions by healthcare providers to support these areas may help improve adherence in people with epilepsy.