Hamidon Basri

Neurological and cardiovascular disorders frequently coexist, yet targeted dual-system interventions remain underinvestigated. Transcranial magnetic stimulation (TMS), including intermittent and continuous theta-burst stimulation (iTBS/cTBS), non-invasively modulates primary motor cortex (M1) excitability. Concurrently, ketone monoesters (KME) show neuroprotective potential and alter cardiovascular hemodynamics. In a randomized, double-blind, placebo-controlled crossover study, 44 healthy young adults were stratified to receive iTBS or cTBS (n = 22/group). Participants completed two sessions separated by 1 week, consuming either a KME or placebo beverage, followed by TBS 1-hour post-ingestion. Motor evoked potentials (MEPs) from the right first dorsal interosseous muscle were tracked for 30 minutes post-stimulation. Blood pressure was measured every 3-5 minutes, heart rate was monitored continuously, and venous blood was sampled for glucose, beta-hydroxybutyrate (BHB), pro-BDNF, mature BDNF (mBDNF), and the BDNF rs6265 polymorphism. We found that KME significantly elevated blood BHB and heart rate while decreasing blood glucose and diastolic blood pressure. KME did not alter resting motor threshold, baseline MEP amplitude, or MEP latency. Factorial analysis showed no significant modification of post-TBS MEP time courses by KME. In exploratory within-condition analyses, placebo-cTBS induced significant late increases in MEP amplitude, whereas KME-cTBS showed a blunted post-stimulation response. Serum mBDNF and pro-BDNF concentrations remained unchanged. In conclusion, combining KME and TBS is feasible, well-tolerated, and may exert concurrent neurological and cardiovascular effects. This work opens the door to a novel metabolic-neuromodulatory avenue that merits confirmation in larger cohorts and establishment of clinical relevance in patients with comorbid neurological and cardiovascular disorders.

Background: Carpal Tunnel Syndrome (CTS) is the most common type of nerve entrapment and can cause significant disability by impairing hand functionality. This study aims to evaluate the efficacy and tolerability of an oral combination of alpha-lipoic acid (ALA) and vitamin B complex in alleviating CTS symptoms and improving the quality of life in patients with mild to moderate CTS. Method: A total of 70 patients with mild to moderate CTS were enrolled in this study at Hospital Sultan Abdul Aziz Shah, Selangor, Malaysia. Using a double-blind Randomized Controlled Trial (RCT) design, participants were randomly assigned to either the treatment group ( n = 37) or the placebo group ( n = 33). The treatment group received two tablets once daily containing alpha-lipoic acid (300 mg), methylcobalamin (500 mcg), vitamin B1 (39 mg), and vitamin B6 (8 mg) i.e. Bionerv while placebo group received combination of maltodextrin, microcrystalline cellulose, tricalcium phosphate, silicon gioxide, magnesium stearate; two tablets once daily for 6 months. Patients were evaluated across three visits: baseline (Visit 1), 3 months (Visit 2), and 6 months (Visit 3). During each visit, patients were evaluated using three assessments. The three assessments included three standardized questionnaires: SF-36, VAS, and BCTQ, Nerve Conduction Study (NCS) and Patient-Reported Questionnaire to monitor any side effects. Results: A significant improvement in VAS scores was observed in the treatment group, indicating better pain control. However, no statistically significant differences were found between the treatment and placebo groups in other outcome measures, including SF-36, BCTQ, and NCS parameters. While improvements in SF-36 and BCTQ scores were noted in the treatment group, these changes did not reach statistical significance and should be interpreted as a positive trend rather than definitive evidence of efficacy. The combination of alpha-lipoic acid and vitamin B complex was well tolerated, with most participants reporting minimal and self-limiting adverse effects. The most common side effects were mild gastrointestinal symptoms, such as abdominal discomfort and diarrhea, which resolved upon discontinuation of drugs. Conclusion: The oral combination of alpha-lipoic acid and vitamin B complex (Bionerv) demonstrated potential pain relief benefits in patients with mild to moderate CTS and was found to be well tolerated. Future studies with larger sample sizes are recommended to strengthen the findings and provide more comprehensive insights.

Collaboration among health and non-health professionals is growing exponentially as we approach the personalized medicine era, where the intervention plan is tailored according to the patient’s needs. This collaboration aims to develop highly efficient, patient-centered, holistic approaches, rather than singular interventions. Interdisciplinary rehabilitation is a rising theme to coordinate the efforts of various professionals, with the ultimate goal of increasing rehabilitants’ satisfaction and improving their overall quality of life. A typical rehabilitation team may comprise a rehabilitation physician, rehabilitation nurse, occupational therapist, physiotherapist, speech and language therapist, clinical psychologist, social worker, prosthetist, orthotist, rehabilitation engineer, and dietician. The need for inclusion of additional professions in the rehabilitation team is dynamic and varies depending on the population and health condition. Recently, various countries have begun incorporating interdisciplinary rehabilitation models into their healthcare frameworks. For example, the U.S. Veterans Affairs Polytrauma Rehabilitation Centers have set a precedent for integrating interdisciplinary approaches into neurological rehabilitation, while European nations such as Germany and Sweden have successfully implemented stroke and pain rehabilitation programs. Although interdisciplinary rehabilitation has demonstrated effectiveness in improving patient outcomes, further research is required to explore its long-term benefits, cost-effectiveness, and adaptability in resource-limited settings. In this mini-review, we summarize the current evidence on employing interdisciplinary rehabilitation in patients with neurological disorders and highlight the implications for future research and clinical practice.

A growing number of research has suggested that bilingualism could be related to enhanced cognitive control functions (Bellegarda & Macizo, 2021), because of frequent interference suppression of the first language when a bilingual speaker chooses to speak in the second language and vice versa. Nevertheless, the relationship was not shown in some studies, which raises various questions regarding previous findings. Hence, more studies are done to explore other facets of bilingual speaker’s experience that could modulate the cognitive control functions. Accordingly, the bilingualism threshold is examined to investigate the bilingual benefits. It is suggested that bilingual benefits are not just about knowing two languages, but more so into the usage of the languages possessed. Hence, some studies claimed that balanced language dominance would have better cognitive control capacity. This is a result of the continuous practice of suppressing one language over the targeted language. Therefore, there is a need to look at how language dominance could be related to cognitive control capacity as language dominance may impact the frequency of switching as well as activation of the two languages. This study reports the findings of the relationship between cognitive control capacity and language dominance of Malay bilinguals. The participants of this study were 69 balanced bilinguals and 74 Malay-dominant bilinguals. The Bilingual Language Profile was adopted to measure the language dominance of the participants of this study. Cognitive control capacity of the participants was measured with the Stroop Task. Through a Pearson-correlation analysis, it was found that there is a significant relationship between language dominance and cognitive control capacity. Thus, the findings of this research as in line with previous literatures where language dominance of a bilingual is related to enhanced cognitive control functions.

Cerebral neuroinflammation has emerged as a significant pathway contributing to the progression of Alzheimer's disease (AD) pathology. Research implicates the NOD-like receptor family, pyrin domain containing 3 (NLRP3) inflammasome complex, initiating caspase 1-mediated maturation of interleukin-1 β (IL-1β) and interleukin-18 (IL-18). This study investigates whether chronic cerebral hypoperfusion (CCH), induced via permanent bilateral occlusion of the common carotid arteries (PBOCCA), leads to cognitive dysfunction and NLRP3 inflammasome activation. Twenty male Sprague Dawley (SD) rats underwent PBOCCA to induce CCH. Two weeks post-surgery, locomotor and Morris water maze (MWM) tests were conducted to examine motor functions, spatial learning, and memory, respectively. The gene expression levels of cathepsin B, NLRP3, an apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), and caspase-1 were analysed using real-time PCR, while the expression levels of the inflammatory cytokines were estimated using the ELISA method. Structural damage to the hippocampus was assessed using hematoxylin and eosin (HE) staining. Escape latencies and time spent in specific quadrants in PBOCCA significantly increased compared to sham-operated animals. There was no notable difference in locomotor activity between the PBOCCA and sham-operated groups. The number of pyknotic neurons with cytoplasmic shrinkage increased in the hippocampus. Gene expression of cathepsin B, NLRP3, ASC, and caspase-1 was upregulated in the PBOCCA group. The expression levels of IL-1β, IL-18, interleukin-6 (IL-6), and amyloid-β 1-42 (Aβ 1-42) were elevated in the PBOCCA group relative to sham. The findings confirm NLRP3 inflammasome induction, cognitive dysfunction, and inflammatory cytokines associated with AD and cerebral ischemia. The PBOCCA model provides a valuable tool for studying neurodegenerative including AD.

Transcranial magnetic stimulation (TMS) has emerged as a novel technique to stimulate the human brain through the scalp. Over the years, identifying the optimal brain region and stimulation parameters has been a subject of debate in the literature on therapeutic uses of repetitive TMS (rTMS). Nevertheless, the primary motor cortex (M1) has been a conventional target for rTMS to treat motor symptoms, such as hemiplegia and spasticity, as it controls the voluntary movement of the body. However, with an expanding knowledge base of the M1 cortical and subcortical connections, M1-rTMS has shown a therapeutic efficacy that goes beyond the conventional motor rehabilitation to involve pain, headache, fatigue, dysphagia, speech and voice impairments, sleep disorders, cognitive dysfunction, disorders of consciousness, anxiety, depression, and bladder dysfunction. In this review, we summarize the latest evidence on using M1-rTMS to treat non-motor symptoms of diverse etiologies and discuss the potential mechanistic rationale behind the management of each of these symptoms.