Lai Choo Ong

Early post-traumatic seizures in children: Clinical and radiological aspects of injury

Objective: To determine the type and outcome of early post‐traumatic seizures in children and the factors associated with it.

Sleep habits and disturbances in Malaysian children with epilepsy

Aims:  To compare sleep habits and disturbances between Malaysian children with epilepsy and their siblings (age range 4–18 years) and to determine the factors associated with greater sleep disturbance.

Predictors of neurodevelopmental outcome of Malaysian very low birthweight children at 4 years of age

Objective: To determine neonatal, early developmental and social risk factors that predict the neurocognitive and behavioural outcome of very low birthweight (VLBW) preschool children at four years of age.

Sleep disturbances in Malaysian children with cerebral palsy.

The aim of the study was to compare the frequency and type of sleep disturbances in a group of Malaysian children aged 4 to 18 years with cerebral palsy (CP) with their nearest‐age, able‐bodied siblings and to identify factors associated with sleep disturbances.

Massively Parallel Sequencing of Patients with Intellectual Disability, Congenital Anomalies and/or Autism Spectrum Disorders with a Targeted Gene Panel

Developmental delay and/or intellectual disability (DD/ID) affects 1–3% of all children. At least half of these are thought to have a genetic etiology. Recent studies have shown that massively parallel sequencing (MPS) using a targeted gene panel is particularly suited for diagnostic testing for genetically heterogeneous conditions. We report on our experiences with using massively parallel sequencing of a targeted gene panel of 355 genes for investigating the genetic etiology of eight patients with a wide range of phenotypes including DD/ID, congenital anomalies and/or autism spectrum disorder. Targeted sequence enrichment was performed using the Agilent SureSelect Target Enrichment Kit and sequenced on the Illumina HiSeq2000 using paired-end reads. For all eight patients, 81–84% of the targeted regions achieved read depths of at least 20×, with average read depths overlapping targets ranging from 322× to 798×. Causative variants were successfully identified in two of the eight patients: a nonsense mutation in the ATRX gene and a canonical splice site mutation in the L1CAM gene. In a third patient, a canonical splice site variant in the USP9X gene could likely explain all or some of her clinical phenotypes. These results confirm the value of targeted MPS for investigating DD/ID in children for diagnostic purposes. However, targeted gene MPS was less likely to provide a genetic diagnosis for children whose phenotype includes autism.

Vincristine-induced peripheral neuropathy in survivors of childhood acute lymphoblastic leukaemia

Vincristine, an essential component of childhood acute lymphoblastic leukaemia (ALL) therapeutic protocols, is associated with dose‐dependent neurotoxicity, but its long‐term morbidity in treated children has not been clearly elucidated. The aim of this study is to determine the prevalence of vincristine‐induced peripheral neuropathy (VIPN) among Malaysian childhood ALL survivors and its impact on motor function and quality of life.

Treatment of drooling in children with cerebral palsy using ultrasound guided intraglandular injections of botulinum toxin A

The aim of this study was to determine whether botulinum toxin A (BTX-A), injected into both parotid and sub- mandibular salivary glands of children with cerebral palsy and sialorrhea, could decrease their drooling and improve their quality of life. Twenty-one children aged 4 to 12 years (mean age 8.4 years) received 60-80 units BTX-A (mean dose 3.6 U/kg) under sedation using ultrasound guidance. Response was assessed by several methods (drool frequency and severity score, drool quo- tient, number of bib changes per day and a visual analogue score) at baseline, 2, 8 and 16 weeks post-injection. A questionnaire related to quality of life and caregiver satisfaction was administered at baseline and week 8. Adverse events were recorded at each visit. Drool frequency and severity scores were significantly reduced at weeks 2, 8 and 16 compared to baseline ( P< 0.001). Significant reductions were also seen for the visual analogue scale, number of bibs changed daily and drool quotient ( P< 0.001). Mean quality of life scores dropped from 35 ± 4.8 at baseline to 29 ± 5.2) at week 8 ( P< 0.001). Caregiver satisfaction was high at weeks 2, 8 and 16. Pain or swelling (19%), excessively thick saliva (9.5%), fever (9.5%) and chewing difficulties (4.8%) were transient and subsided within 2 weeks of the injection. Eighteen (87.5%) caregivers indicated they wanted repeat injections in the future. In conclusion, percutaneous intraglandular injection of BTX-A was safe and had a sustained effect for up to 16 weeks, with a concomitant improvement in their quality of life and caregiver satisfaction.

Vitamin D deficiency and its risk factors in Malaysian children with epilepsy

Long‐term use of antiepileptic drugs (AEDs) is a significant risk factor for vitamin D deficiency in children with epilepsy. The aims of our study were to evaluate the prevalence and risk factors for vitamin D deficiency among Malaysian children with epilepsy.

Predictors of parenting stress in mothers of children with spina bifida

Study design:Prospective cross-sectional multidimensional study using clinical assessment and standard measures.Objectives:To determine the medical and social factors associated with parenting stress among mothers of children with spina bifida.Setting:Spina bifida clinics of two tertiary hospitals in urban Kuala Lumpur, Malaysia.Methods:A total of 81 mothers of children aged 1–18 years completed the Parenting Stress Index-Short Form (PSI/SF). Each childs adaptive skills were assessed using the Vineland Adaptive Behaviour Scales (VABS), Interview Edition. Medical and social data were obtained from direct interviews and case note reviews. Hierarchical multiple regression analysis was used to investigate factors that were determinants for high scores in the parental distress (PD), difficult child (DC) and parent–child dysfunctional interaction (P-CDI) subdomains of the PSI/SF. Results were expressed as beta coefficient (β) and 95% confidence intervals (95% CIs).Results:Single-parent families (β 8.6, 95% CI 3.4–13.9) and the need for clean intermittent catheterization of bladder (β 3.5, 95% CI 0.7–6.2) were associated with high PD scores. Clean intermittent catheterization (β 3.0, 95% CI 0.5–5.5) was associated with higher DC scores. Lower composite VABS scores (β −0.08, 95% CI −0.02 to −0.15) and mother as the sole caregiver (β 2.6, 95% CI 0.15–4.96) was associated with higher P-CDI scores.Conclusion:The need for clean intermittent catheterization was the only medical factor associated with parenting stress in mothers of children with spina bifida. This was mediated by single parenthood, caregiver status and the childs adaptive skills.

Determinants of linear growth in Malaysian children with cerebral palsy

Objective: To compare the linear growth and nutritional parameters of a group of Malaysian children with cerebral palsy (CP) against a group of controls, and to determine the nutritional, medical and sociodemographic factors associated with poor growth in children with CP.