Abdul Hanif Khan Yusof Khan

Inner speech recognition using electroencephalogram (EEG) signals shows strong potential for developing assistive communication technologies. Existing methods often process spatial and temporal features separately, lack interpretability, and are usually tested on a single dataset, limiting their generalization. This study proposes a dual-branch deep learning framework that combines spatial features extracted through common spatial patterns (CSPs) with spectral-temporal features derived from multitaper spectrograms, using convolutional and long short-term memory networks. The model was evaluated on two public datasets, achieving classification accuracies of 89.99% and 92.47% in subject-dependent experiments. Subject-independent evaluation using leave-one-subject-out cross-validation yielded reduced accuracies of 26.20% and 20.47%, reflecting intersubject variability. Interpretability analyses using saliency maps, gradient-weighted class activation mapping, and feature contribution ratios highlighted physiologically meaningful patterns related to model decisions. The proposed method demonstrates strong performance and interpretability for subject-dependent inner speech recognition; while future work will focus on increasing data diversity and improving subject-independent generalization. This study contributes to the development of reliable and explainable EEG-based inner speech decoding for communication applications.

Intracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke, yet geometric stenosis alone may not fully reflect the functional hemodynamic burden of a lesion. This study used computational fluid dynamics (CFD) with a shear-thinning non-Newtonian Carreau viscosity model to quantify the combined effects of stenosis severity and blood viscosity on intracranial hemodynamics. A middle cerebral artery (MCA) stenosis model with an original ~70% narrowing was reconstructed from computed tomography angiography, and additional idealized stenosis variants (30%, 50%, and 90%) were generated on the same anatomical background to enable controlled comparisons. Three viscosity states (below-normal, normal, and high) were simulated under transient, incompressible, laminar flow with rigid walls and identical boundary conditions. Velocity, pressure, and wall shear stress (WSS), oscillatory shear index (OSI) and time-averaged wall shear stress (TAWSS) were evaluated. The results show that flow behavior is governed by the combined influence of geometry and rheology, rather than by stenosis severity alone. Severe stenosis produced a dual pathological shear environment, characterized by elevated WSS within the stenotic region and disturbed low-shear flow downstream. In addition, TAWSS showed a non-monotonic response, increasing up to 70% stenosis and then decreasing at 90% stenosis. OSI also showed viscosity-dependent elevation under severe stenosis, with values ranging from approximately 0.38 to 0.48, indicating enhanced oscillatory and disturbed flow.These findings support integrating non-Newtonian hemorheology and hemodynamic metrics with geometric assessment to improve ICAS risk stratification and inform hemodynamics-guided intervention timing.

Holmes tremor (HT) is a rare occurrence due to insults located at the midbrain. We are reporting a case of HT, which occurred in a retroviral disease patient who presented with a 1-week history of fever associated with third and fourth cranial nerve palsy. Magnetic resonance imaging of the brain revealed a midbrain lesion favoring abscess with blood investigations revealed positive serology for toxoplasmosis. The patient was started on toxoplasmosis treatment coupled with a six-week course of antibiotics. Following one-month post-treatment, the patient complained of a tremor that characteristics of HT with repeated computed tomography brain revealed resolving brain abscess. This case highlights an important reminder of potential neurological sequelae due to midbrain abscess and the importance of recognition of HT. The management of HT is challenging, involving the initial use of dopaminergic agonists with a potential role of deep brain stimulation in refractory cases.

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.

In this chapter, we outline the trends in incidence, prevalence, and the burden of stroke in developing countries (lower- and middle-income countries—LMICs) over recent decades. We highlight the changes in risk factors and types of stroke (ischemic vs. hemorrhagic) in LMICs, comparing them to high-income countries (HIC). We will also use statistics from specific countries as case examples. The lack of resources and its impact on stroke management will be discussed. The authors include stroke physicians who are part of the World Stroke Organization Future Leaders Program and have carried out quality improvement projects in Sub-Saharan Africa, among other initiatives.

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.

Background: Despite the proven efficacy of telestroke in improving clinical outcomes by providing access to specialized expertise and allowing rapid expert hyperacute stroke management and decision-making, detailed operational evidence is scarce, especially for less developed or lower income regions. Aim: We aimed to map the global telestroke landscape and characterize existing networks. Methods: We employed a four-tiered approach to comprehensively identify telestroke networks, primarily involving engagement with national stroke experts, stroke societies, and international stroke authorities. A carefully designed questionnaire was then distributed to the leaders of all identified networks to assess these networks’ structures, processes, and outcomes. Results: We identified 254 telestroke networks distributed across 67 countries. High-income countries (HICs) concentrated 175 (69%) of the networks. No evidence of telestroke services was found in 58 (30%) countries. From the identified networks, 88 (34%) completed the survey, being 61 (71%) located in HICs. Network setup was highly heterogeneous, ranging from 17 (22%) networks with more than 20 affiliated hospitals, providing thousands of annual consultations using purpose-built highly specialized technology, to 11 (13%) networks with fewer than 120 consultations annually using generic videoconferencing equipment. Real-time video and image transfer was employed in 64 (75%) networks, while 62 (74%) conducting quality monitoring. Most networks established in the past 3 years were located in low- and middle-income countries (LMICs). Conclusion: This comprehensive global survey of telestroke networks found significant variation in network coverage, setup, and technology use. Most services are in HICs, and a few services are in LMICs, although an emerging trend of new networks in these regions marks a pivotal moment in global telestroke care. The wide variation in quality monitoring practices across networks, with many failing to report key performance metrics, underscores the urgent need for standardized, resource-appropriate, quality assurance measures that can be adapted to diverse settings.

Peripheral neuropathy is a common cause for neurological consultation, especially among those with diabetes mellitus. However, research on peripheral neuropathy among the general population is lacking in Malaysia. This study aimed to determine the prevalence and factors associated with peripheral neuropathy in a setting of retail pharmacies. This cross-sectional study of 1283 participants was conducted at retail pharmacies in Selangor. Peripheral neuropathy was defined as the final score in the mild to severe category in the severity rating scale using a biothesiometer. SPSS version 26 was used to perform the analysis. Multiple logistic regressions were used to determine the factors associated with peripheral neuropathy. The prevalence of peripheral neuropathy based on the biothesiometer was 26.5%. According to multiple logistic regression, the predictors of peripheral neuropathy were those who have diabetes (AOR = 3.901), aged more than 50 years (AOR = 3.376), have secondary education or below (AOR = 2.330), are male (AOR = 1.816), and have underlying hypertension (AOR = 1.662). Peripheral neuropathy is a reasonably prevalent condition, affecting a quarter of the general population, and often goes undiagnosed. It is crucial for healthcare providers to proactively screen for peripheral neuropathy, particularly in high-risk populations, to prevent potential complications.

Background: The Stroke e-Learning Module (SEM) is a nationwide initiative to improve stroke care in Malaysia. This study aimed to assess the module’s effectiveness in improving knowledge on acute ischaemic stroke (AIS) management among Malaysian doctors. Methods: This was a pre-post study design. Medical officers, specialists and general practitioners from various disciplines who work in healthcare facilities in Malaysia were recruited virtually from those who registered for the SEM on the Docquity platform between 1 February 2021 and 31 January 2022. The Acute Stroke Management Questionnaire (ASMaQ), an existing validated questionnaire, was used to measure the doctors’ knowledge of AIS management before and after the SEM. The ASMaQ had three domains: i) general stroke knowledge (GSK), ii) hyperacute stroke management (HSM) and iii) advanced stroke management (ASM). The paired t- and the McNemartests were used to evaluate the effectiveness of the module. Results: One hundred and seventy-one participants voluntarily responded to the pre- and post-module questionnaires. The paired t-test revealed statistically significant improvement for the ASM knowledge scores (mean difference = 2.5; 95% CI: 1.8, 3.2; P < 0.001). The baseline proportion of participants with good knowledge of GSK, HSM and ASM were 92.4%, 64.9%, and 76%, respectively. The McNemar test showed that approximately 14% of the participants had significant improvement in ASM knowledge (P < 0.001). However, no significant changes were noted for GSK (–0.6%) and HSM (4.1%). Conclusion: The SEM has been shown to increase Malaysian doctors’ knowledge on ASM. However, greater effort should be made to improve GSK and HSM knowledge, particularly in areas related to stroke thrombolysis.