Characteristics of Patients With Trigeminal Neuralgia Referred to the Indonesian National Brain Center Neurosurgery Clinic

Trigeminal neuralgia (TN) is a debilitating neuropathic pain involving the fifth cranial nerve. There has been no study investigating the clinical and socioeconomical characteristics of patients with TN in Indonesia. A total of 100 patients were included in this study. Symptoms indicating a later stage of the illness, namely, involvement of all the trigeminal nerve branches, numbness, and concomitant persistent pain, were the common presentations found in our cohort. Only one TN diagnosis was made by a general practitioner (GP). None were immediately referred to a neurosurgeon following their diagnosis. Access to our clinic took as long as 4.7 ± 5.1 years (mean ± SD) from the onset. Older age was a significant predictor of an increased likelihood of not knowing their illness upon the referral (21.9%, p = 0.008). Upon their first presentation, 25.5% of patients had experienced drug-related side effects due to prolonged medication. Only 50% of patients were compensated by the universal health coverage (UHC) system. Seven patients spent ≥ 50 million rupiahs and eight patients had already lost their jobs. In conclusion, early contact with a neurosurgeon contributes to better management of TN, both for the patients and healthcare system in Indonesia. A refined understanding of TN nature is still needed in this country.

Spatial Cognition in Teleost Fish: Strategies and Mechanisms

Teleost fish have been traditionally considered primitive vertebrates compared to mammals and birds in regard to brain complexity and behavioral functions. However, an increasing amount of evidence suggests that teleosts show advanced cognitive capabilities including spatial navigation skills that parallel those of land vertebrates. Teleost fish rely on a multiplicity of sensory cues and can use a variety of spatial strategies for navigation, ranging from relatively simple body-centered orientation responses to allocentric or “external world-centered” navigation, likely based on map-like relational memory representations of the environment. These distinct spatial strategies are based on separate brain mechanisms. For example, a crucial brain center for egocentric orientation in teleost fish is the optic tectum, which can be considered an essential hub in a wider brain network responsible for the generation of egocentrically referenced actions in space. In contrast, other brain centers, such as the dorsolateral telencephalic pallium of teleost fish, considered homologue to the hippocampal pallium of land vertebrates, seem to be crucial for allocentric navigation based on map-like spatial memory. Such hypothetical relational memory representations endow fish’s spatial behavior with considerable navigational flexibility, allowing them, for example, to perform shortcuts and detours.

Neuropeptide Y and Metabolism Syndrome: An Update on Perspectives of Clinical Therapeutic Intervention Strategies

Through the past decade of research, the pathogenic mechanisms underlying metabolic syndrome have been suggested to involve not only the peripheral tissues, but also central metabolic regulation imbalances. The hypothalamus, and the arcuate nucleus in particular, is the control center for metabolic homeostasis and energy balance. Neuropeptide Y neurons are particularly abundantly expressed in the arcuate of the hypothalamus, where the blood-brain barrier is weak, such as to critically integrate peripheral metabolic signals with the brain center. Herein, focusing on metabolic syndrome, this manuscript aims to provide an overview of the regulatory effects of Neuropeptide Y on metabolic syndrome and discuss clinical intervention strategy perspectives for neurometabolic disease.

Abstract 17030: Stress-Related Neurobiological Activity Contributes to the Link Between Cardiovascular Polygenic Risk Score and Myocardial Infarction

Introduction: A polygenic risk score for coronary artery disease (PRS CAD ) integrates information from many sites of DNA variation into a single metric of inherited susceptibility. Heightened metabolic activity of the amygdala (AmygA), a stress-associated brain center, associates with increases in leukopoietic activity, atherosclerosis and CVD risk. We hypothesized that genes included in the PRS CAD link to MI in part by encoding for heightened stress-associated neurobiological activity. Accordingly, we tested whether CVPRS associates with heightened AmygA as a contributing factor linking high CVPRS and CVD events. Methods: Individuals (N=16821, median age (IQR): 63 (52, 74) years, 46% male) were identified from the Partners Biobank where genome-wide PRS CAD and principle components of ancestry (PCI) were calculated. Using validated 18 FDG-PET/CT imaging methods, AmygA was measured in individuals with prior clinical imaging (N=854). MI incidence was derived using International Classification of Diseases (ICD) diagnoses. Traditional CVD risk factors and psychiatric history were obtained using ICD codes and questionnaires and were used for covariable adjustments. Linear and logistic regression were employed. Results: A total of 2046 (12.1%) participants experienced an MI. PRS CAD associated with increased AmygA after adjusting for age and sex (β [95% confidence interval (CI)]: 0.099 [0.015, 0.183], p=0.021) as well as increased MI incidence (odds ratio (OR) [95% CI]: 1.208 [1.120, 1.302], p<0.001) ( Table 1, Figure 1 ). Concurrently, AmygA associated with increased MI incidence in adjusted analyses (OR [95% CI]: 1.451 [1.061, 1.983], p=0.003). Conclusion: High PRS CAD associates with higher AmygA and AmygA in-turn associates with MI. These findings suggest increased stress-related neurobiological activity may contribute to the link between PRS CAD and MI.

Evaluation of Drug-Related Problems in Ischemic Stroke Patients Undergoing Inpatients at the National Brain Center Hospital (RSPON) in 2018

Stroke is a cerebrovascular disease that is increasingly found. Stroke carries a high risk of death. Victims can reverse vision and /or talk, paralysis, and confusion.1 In Indonesia, around 550,000 new stroke patients every year. This figure is considered to be very high and ranks third as the cause of death in Indonesia, after cardiovascular and cancer.2 Many factors can cause stroke, diabetes, hypertension, and high cholesterol levels, so treatment is needed for more complicated drug therapy to deal with stroke and its associated diseases.3 The more complex the drug, the more challenging the doctor to receive the right drug therapy. Therefore, in clinical practice, various drug-related problems can increase.4,5 Therefore, identifying DRP is an important priority for health professionals to improve health-related quality of life in stroke patients.6,7 OBJECTIVE—Evaluating drug-related problems in ischemic stroke patients undergoing hospitalization at the National Brain Center Hospital (PON) in 2018 METHOD—Non-experimental research with quantitative descriptive analysis using medical records of inpatient ischemic stroke patients. RESULTS AND CONCLUSIONS—174 male ischemic stroke patients (69.32%); 77 female patients (30.68%); The age of most ischemic stroke patients was in the range of 50 -59 years 85 patients (33.86%); and the least was at the age of <40 years; 7 people (2.79%); Most types of JKN insurance financing were used by 220 people (87.64%) at least 1 patient was guaranteed by the company (0.40%); The longest stay in the hospital was 60 days for a maximum of 1 person (0.40%) and the shortest was 3-10 days for 225 people (89.64%); The most prescribed number of drug items was 70-80 items per person (0,40%) and the least was 5 to 10 drug items received by 60 patients (23,90%); Most comorbidities were hypertension + dyslipidemia 83 patients (33.03%) and the least was hypertension 5 people (1.98%); The most prescribed group of drugs was 468 prescribing (13.81%) drugs which affecting the blood clotting process, and the least prescription antibiotic medications was 122 times (3.63%); Medication errors, were the most given drugs, with a very large dose of 13 times (43.33%) and the least wrong drug; wrong dose; wrong dosage form; and the wrong frequency for each was 1 case (3.3%); Drug interactions which had the most moderate criteria were 1313 cases.