01 5th Parkinson’s Disease & Movement Disorders Symposium 03 Community Care Partners Programme Integrated Community Care Programme04 Parkinson’s Disease Public Forum Living with Parkinson’s Disease05 Young Onset Cognitive Impairment Programme 06 Making It Better and Age-friendly for Our Patients

08 My Fellowship in Sonography of the Peripheral Nervous System09 Accolades10 Joint Study Discovers Role of New Tumour Suppressor 11 Mark Your Calendar12 Calendar of Events Support Groups

Contents

Centre for the Care of the Brain, Spine, Nerve and Muscle

Continued to page 2

5th Parkinson’s Disease anD MoveMent DisorDers syMPosiuM

January - June 2012 volume 14, no:1

MICA (P) 077/06/2012

The National Neuroscience Institute (NNI) organised its 5th Singapore International Parkinson’s Disease and Movement Disorders Symposium (PDMDS) from 23 – 24 March 2012 at the Concorde Hotel.

The symposium provided an opportunity for participants to update themselves on various disorders, and work together to find better ways to diagnose, evaluate, manage and care for the patients. It attracted over 400 participants, from international and local comprising physicians, scientists, allied heath professionals, nurses and community care partners.

This biennial symposium started in 2002 and has garnered a successful participant support over the years. The two-day event provided a relevant opportunity to review significant advances in the fields of genetics, pathogenesis, diagnosis and management of Parkinson’s Disease (PD) and movement disorders.

This year’s symposium was especially enriching, led by many renowned international and local experts in the field of PD and movement disorders. The faculty delivered lectures and conducted parallel sessions covering all major aspects from rehabilitation,

cognitive dysfunction, surgery, spasticity, neuropsychiatric complications to genetic disorders.

The specially invited international faculty included Prof Bastiaan Bloem from Radboud University Nijmegen Medical Center, Netherlands; Prof Marek Drozdzik from Pomeranian Medical University, Poland; Prof Beom S Jeon from Seoul National University Hospital, South Korea; Prof Peter Silburn from University of Queensland, Australia; Prof Eduardo Tolosa from Hospital Clinic Universitari, Spain; Prof Pei Zhong from

02

Guest-of-Honour, Prof Ivy Ng,Group Chief Executive Officer, SingHealth Services addressing the audience at the Opening Ceremony.

Participants at the “Use of Botulinum Toxin Injections in Movement Disorders” workshop.

The international faculty and NNI organisers with the video presenters.Front row (left – right): Prof Pei Zhong, Prof Mitsutoshi Yamamoto, Prof Beom S Jeon, Dr Prakash Kumar, NNI, Prof Bastiaan Bloem and Prof Peter Silburn. Back row: (3rd and 4th from left) Prof Tan Eng King, Vice Organising Chairman, and Dr Au Wing Lok, NNI and (1st from right) A/Prof Louis Tan, Organising Chairman with the video presenters.

The First Affiliated Hospital, China and Prof Mitsutoshi Yamamoto from Kawaga Prefectural Central Hospital, Japan.

The workshops focused on specific areas of non-motor aspects of PD, use of botulinum toxin injections, rehabilitation and surgery for PD, genetic movement disorders and community care. The plenary sessions covered a broad range of issues relevant to PD and other movement disorders. The symposium came to a fitting close with a series of video presentations by both foreign and local delegates. The international faculty shared their expertise as panel judges, as cases with interesting diagnostic problems were discussed.

Continued from page 1

Prof Pei Zhong, Prof Mitsutoshi Yamamoto and Prof Beom S Jeon conducting the Genetic Movement Disorders workshop.

Prof Marek Drozdzik speaking on “Pharmacogenetic Considerations in PD”.

03

CCPPPartners Renew Partnership

NNI Brings Parkinson’s Care into the Community

The partners of the NNI-Community Care Progamme for Parkinson’s disease renewed their support and participation on 24 March 2012. The Certification Ceremony was held on the second day of the 5th Singapore International Parkinson’s Disease and Movement Disorders Symposium.

The Community Care Partners Programme (CCPP) for Parkinson’s disease is an initiative by the Parkinson’s Disease and Movement Disorders Centre of the National Neuroscience Institute (NNI), toprovide specialist training for healthcare workers in the community who are managing patients with Parkinson’s disease. This programme enables NNI to partner with community healthcare providers and voluntary welfare organisations by offering them training and resources to better manage patients with Parkinson’s disease. It is a partnership programme with community care facilities that has a core team of healthcare professionals who have completed training workshops organised by NNI.

The National Neuroscience Institute (NNI) has introduced the Integrated Community Care Programme to help provide care for Parkinson’s disease patients at the community level.

The NNI-Integrated Community Care Programme is aimed at giving the best care possible to people with Parkinson’s disease by bridging the gap in patient management in the community

By providing care within the community, the programme aims to reduce unnecessary hospital admissions or unscheduled clinic visits to healthcare providers. This will improve the quality of life and care for advanced patients and their families as patients may be cared for in the community rather than being placed in nursing homes or other long term care facilities.

The CCPP works towards improving the delivery of care and support to the Parkinson community. By providing training, education and resources, the NNI has built partnerships with community healthcare providers so that the Parkinson community will continue to receive the best possible care at all levels of healthcare service. Our Community Care Partners help provide the crucial link between NNI and the dependent Parkinson’s disease patients in the community.

the inclusion criteria are:

1. ‘At-risk’ patients defined as “patients in Hoehn and Yahr stage 3 and above” with poor

social support (either staying alone, staying with elderly spouse or maid only, or left

alone at home for a significant portion of the day).

2. Home-bound and bed-bound patients who have difficulty coming for specialist

outpatient clinics or therapy services regularly.

our CCPP Partners1. Ang Mo Kio-Thye Hua Kwan Hospital 2. AWWA Elderly Services3. Econ Healthcare Group4. Handicaps Welfare Association5. Henderson Senior Citizens’ Home6. Home Nursing Foundation7. Ling Kwang Home for Senior Citizens8. Metta Day Rehabilitation Centre For

The Elderly9. Moral Therapy Hub 10. PAP Community Foundation – Tampines

East (3-in-1 Family Centre – Aged Care)11. Ren Ci Hospital 12. Society For The Physically Disabled 13. St. Andrew’s Community Hospital14. St Luke’s Hospital15. Sunshine Welfare Action Mission 16. TOUCH Home Care17. TSAO Foundation 18. TP Healthcare Ltd 19. United Medicare Centre

04

UNDERSTANDING PARKINSON’S FOR BETTER OUTCOMES

Living with Parkinson’s Disease

On Saturday, 14 April 2012, over 300 participants turned up for the public forum “understanding Parkinson’s For Better outcomes” conducted concurrently in English and Mandarin at Singapore General Hospital. The expert panel from the National Neuroscience Institute (NNI) and Singapore General Hospital (SGH) comprised neurologists, neurosurgeon, therapist, and dietitian who spoke about the disease and how to better control the symptoms of Parkinson’s Disease. Topics such as how to improve your speech, how to eat safely, and care for your mind, were also discussed at the forum.

The public forum was organised by NNI and SGH in collaboration with the Parkinson’s Disease Society of Singapore (PDSS), in conjunction with World Parkinson’s Day, which falls on 11 Aprileach year.

There is no question that a diagnosis of Parkinson’s disease represents a serious life change, and it is only natural to worry about the future. There will probably be ‘good’ and ‘bad’ days, and feelings of sadness, discouragement, irritability and frustration which are all understandable. It will help to share any anxieties with your family and friends, gain good professional advice, and take advantage of local support networks.

If you start to experience more serious feelings of sadness or withdrawal, you may be suffering from depression. Signs of depression may include sleep disturbances, problems with concentration, weight loss or gain, anxiety or irritability and panic

attacks. If you or your family think that you are suffering from depression, do not be afraid to ask for help or advice.

Counselling can help. A Counsellor can provide individual or family counselling about how to adjust to the changes Parkinson’s disease is making to your life. Depression can often improve without treatment once anti-parkinsonian drugs begin to take effect. Simple measures such as adjusting the medication may help.

Source: http://www.parkinsonsingapore.com/

The panel of speakers led by (right) Mr Christopher Gabriel, Principal Neuropsychologist, SGH.

Dr Prakash Kumar, Consultant, Department of Neurology, NNI talking about Understanding Parkinson’s disease.

Ms Julie Lau, President of PDSS welcoming the audience.

05

NNI Programme for Young Patients with Cognitive ImpairmentRecognising the different challenges faced by younger patients with cognitive impairment, the National Neuroscience Institute (NNI) has set up the Young Onset Cognitive Impairment (YOCI) Programme foryounger patients (under 65) affected by Alzheimers and dementia related conditions.

The NNI YOCI Programme provides a structured and holistic framework that aims to improve the quality of life of such patients. The programme includes an initial assessment, diagnostic review

What Is YOCI?YOCI includes mild cognitive impairment and dementia occurring in patients under the age of 65 years.

Signs and Symptoms• Shows behavioural and mood

changes• Difficulty in abstract thinking and

reasoning• Disorientation to time and place• Forgetfulness that affects day to day

function• Forgets recently given instruction• Misplaces personal items• Neglects personal hygiene• Problems with language

• Repeats questions• Unable to perform familiar tasks

Causes of YOCIMild cognitive impairment (MCI) is an important cause of YOCI. MCI refers to individuals with mild cognitive impairment, who have difficulty in memory and other cognitive abilities but have normal daily functions. Causes of dementia in the young include:

• Alzheimer’s Disease• Vascular Dementia• Frontotemporal Dementia• Autoimmune Dementia• Normal Pressure Hydrocephalus

Challenges faced by:Patient• Lack of knowledge about the disease• Lack of support system• Unaware of the various support

facilities

Caregiver• Lack of understanding about the

disease• Caregiver stress in looking after

person with dementia• Lack of knowledge about existing

resource and ways to access the support system

YOCI Service at NNIYOCI patients and their families face different problems and needs compared to other dementias. Many encounter difficulty in gaining access and support to locally available services as most existing services are tailored for the elderly or disabled.

Objectives of NNI YOCI Programme:• To improve quality of life of

patients with YOCI.• To provide counselling to

caregivers of patients with YOCI.• To equip caregivers with skills to

manage the behavioural changes of patients with YOCI.

• To provide a support system for patients with YOCI and their families.

Where to seek help?• National Neuroscience Institute

at TTSH campus Alzheimer’s disease and Dementia Clinic

• National Neuroscience Institute at SGH campus Neurodegenerative Disease Clinic

• Alzheimer’s Disease Association (Singapore) Tel : 6377 0700

visits and a support group of monthly meetings to address specific concerns related to YOCI. Caregivers will also receive counselling and be equipped with the skills to manage the behavioural changes of patients with YOCI.

GPs can refer patients by calling for an appointment for consultation at our nni specialist outpatient Clinic (nsoC), at 6357 7095.

06

Making It Better and Age-Friendly For Our Patients What’s Improved?

Better wayfinding at NNI – Clinic locations on lifts. Re-designed reception, registration and billing counters.

Larger consultation room number signs.

Waiting chairs with armrest for better support.

Internal directional signs in bigger font.

Rounded handrail.

Wider walkway at Neurodiagnostic Laboratory.

Separate waiting areas for inpatients and outpatients for improved privacy at Neuroradiology.

Handrails on both sides of corridors.

07

What’s New?

Wheelchairs at NNI entrance

Wellness TVs

12-month NNI calendar at clinic registration counters.

Self registration kioks

Electronic Queue Board System

Have some fun while you wait “Brain Teasers”.

Queue Board next to each consultation room.

NNI Feedback Form Now In Multi-Language As part of our effort to standardise the forms across all SingHealth institutions, NNI has updated the Feedback form. It is now available in English, Mandarin, Malay and Tamil.

08

I found myself most fortunate to have received the Healthcare Manpower Development Programme

(HMDP) award and spent six weeks in the Department of Neurology, St. Radboud University Medical Centre (UMC), Nijmegen, Netherlands under the guidance of Dr Nens van Alfen, Chief of Clinical Neurophysiology.

In 2010, the output of UMC’s Neurology Department has included over 200 publications, of which more than 10 percent in journals with the highest impact factor. This has made the Department of Neurology the quantitatively and qualitatively best performing department in terms of research within the Radboud University Nijmegen Medical Centre.

Dr Nens has been working closely with her colleague, Dr Sigrid Pillen refining the technique of muscle ultrasound and in the process have written books and articles about the use of ultrasound in neuromuscular disease. Dr Nens is also extensively involved in research collaborations with her peers in Europe and USA.

For about at least 4-5 years, they had been courageously fighting to promote this innovative art while faced with the initial hardship and criticisms. As the techniques matured and gained support through emerging scientific papers, the institute becomes active in the teaching of such related technique by conducting workshops and courses especially for other medical professionals within the country.

For my training, I was well received by a group of very enthusiastic and friendly colleagues, and embarked on a

journey which would soon change my perception of too many things I have previously experienced with diagnostic work.

During the training, I found myself experiencing and learning new techniques for the dynamic imaging for the various nerves of interest by applying the various ultrasound techniques, probes selection, settings adjustment and through anatomical understandings. I had also chanced upon the picking up of other techniques, and methodologies to localize and quantify quality, and thickness for muscle of interest using echo-intensity, and the appropriate software; the recognition and identification of fasciculation and fibrillation activities within the muscle; and needle guidance all through the application of modern sonography.

I was also glad to have my supervisor, Dr Kamal Verma, Senior Consultant, Department of Neurology, National Neuroscience Institute (NNI) to be present with me for two weeks of my attachment time. With him around, we were able to work out more closely on the practicality issues, possible limitation(s) or hindrance(s) for implementation of each technique; the diagnostic value of each technique in terms of clinical relevance and cost issues.

In future, we would introduce some of the ultrasonographic techniques relevant to our patients in phased manner to increase the diagnostic yield.

My Fellowship in Sonography of the Peripheral Nervous Systemby: Mr Johnny EngNeurodiagnostic Laboratory, NNI

Back Row (Left - Right): Wilma Raijmann, Jose Bor, Henny Janssen from UMC with Johnny. Front Row (Left - Right): Dr Nens van Alfen and Dr Kamal Verma, NNI

09

Accolades

National Day Awards 2011 – Long Service Medal

NNI Neurologist in“Top 150 Cited Parkinson’sDiseaseInvestigators”

National Neuroscience Institute (NNI) nurses, Patient Service Assistants, and administrative staff were among the 2,694 healthcare professionals from 17 organisations recognised at the 2nd Singapore Health Quality Service Award held on 13 January 2012. Winners from public healthcare institutions, community hospital, and private healthcare were presented with Silver, Gold and Star awards. NNI was awarded with a Gold award and nine Silver awards.

Initiated by SingHealth in 2011, it is Singapore’s first dedicated platform to honour healthcare professionals who have demonstrated commitment in delivering quality care and service excellence.

Our Service Superstars! Singapore Health Quality Service Award

From left – right : Tan Teck Kim, Eunice Thng , Farah Julieanna Bte Md Saleh, Mahalakshmi Sangaran, Steven Sobak, Prof Tan Ser Kiat, Ng Ham Moi, Amy Chew, Tay Lian Bee, Pica Emmanuel, Roslina Binte Rahim, Neumala Devi and Ng Hwee Lan

Professor tan eng king Senior Consultant, Department of Neurology (NNI-SGH Campus) and Director of Research, was ranked 124th in the “Top 150 Most Cited Investigators” in Parkinson’s Disease in a decade from 2001 to 2010.* Prof Tan, together with Professors Yoshikuni Mizuno and Nobutaka Hattori from Tokyo are among the few Asians in this top list.

* Source: Journal of Parkinson’s Disease (JPD)

a/Prof helen tjiaSenior ConsultantDepartment of Neurology (NNI-TTSH Campus)

Dr Chumpon Chantharakulpongsa Senior Consultant, Department of Neurosurgery (NNI-SGH Campus)

Tan Chew Seah

Professor Tan with the NNI PD team colleagues, A/Prof Louis Tan (right) and Dr Au Wing Lok (left).

10

Joint study by NNI, NUS and SICS discover role of new tumour suppresor A multi-institutional collaborative work by researchers from National Neuroscience Institute (NNI), National University of Singapore (NUS), and Singapore Institute for Clinical Sciences (SICS), A*STAR, has uncovered the role of a new tumour suppressor known as Parkin in brain cancer that promises to shed insights into why certain brain tumours are more aggressive than others.

The discovery is the collaborative work led by Associate Professor Lim Kah Leong at the NUS Yong Loo Lin School of Medicine’s Department of Physiology, and Dr Carol Tang, Research Scientist at NNI together with Associate Professor Ang Beng Ti, Consultant from the Department of Neurosurgery at NNI and Senior Principal Investigator at SICS. The study, which began in 2009, was published in the 15 May 2012 issue of Cancer Research, a leading international cancer journal.

Forming the majority of adult malignant brain tumours, gliomas affect a significant number of individuals globally, including here in Singapore. The NNI sees about 50 new cases of malignant glioma each year and continues to manage its existing glioma caseload by means of a multi-disciplinary neuro-oncology clinic. The prognosis for the majority of these tumours remains grim, particularly for patients with glioblastoma multiforme (GBM), the most aggressive form of brain tumour. For reasons yet unclear, others readily succumbed to the disease within a much shorter time. The study showed that the level of parkin expression in glioma cells can determine the survival outcome and disease progression of patients, i.e. those who have high parkin expression in their cancer cells tend to survive longer with lower tumour grades than their parkin-deficient counterparts.

“With this understanding, instead of generalising malignant brain cancer patients, we can now differentiate their tumours based on their molecular characteristics” said A/Prof Lim and Dr Tang. Agreeing, A/Prof Ang added, “This is significant as the stratification would allow us to formulate the most appropriate treatment for each patient.”

The investigators also found that the restoration of parkin expression in parkin-deficient cells can slow down their proliferation rate and decrease their tumour size significantly. They are currently testing drugs that can mimic Parkin’s protective function to combat brain tumours.

The Straits Times, 8 June 2012

LianHe ZaoBao, 7 June 2012

TODAY, 7 June 2012

11

MARKYOUR CALENDAR

12

CaLenDar oF events(July-December 2012)

suPPort GrouPs

enquiries and registration Tel: (65) 6357 7152 / 6357 7163 Fax: (65) 6256 4755Email: nni_secretariat@nni.com.sgWebsite: http://www.nni.com.sg

advisorsProfessor Lee Wei LingDr Francis HuiMr Steven Sobak

editorChristina Wee

editorial Committee

the articles published in neus-link are meant for information and should not be used as substitute for medical diagnosis or treatment. Please seek your doctor’s advice before starting any treatment or if you have any questions related to your health or medical condition. Contents in neus-link are not to be quoted or reproduced without the permission from the Corporate Communications Department of national neuroscience institute (nni).

Members, editorial BoardDr Lishya Liauw Dr Kamal VermaDr Ernest Wang

addressNeus-link c/o Corporate Communications National Neuroscience Institute 11 Jalan Tan Tock SengSingapore 308433Tel : (65) 6357 7153 Fax : (65) 6256 4755

emailnni_enquiry@nni.com.sg

Websitehttp://www.nni.com.sg

epilepsy support Groupc/o Singapore Epilepsy Foundation149 Rochor Road, #04-07 Fu Lu Shou ComplexSingapore 188425Tel: 6479 8611 Website: http://www.epilepsy.com.sg

Multiple sclerosis support Group c/o MS Care Tel : 6835 9916 Email : info@chcsa.org.sg

Muscular Dystrophy support Group c/o Muscular Dystrophy Association (Singapore)9 Bishan Place #06-01, Junction 8Singapore 579837Tel: 6259 6933 Website: http://www.mdas.org.sg

neurovascular Befriender servicesc/o National Neuroscience InstituteDepartment of Neurosurgery Tel : 6357 7545

Parkinson’s Disease support Groupnni at tan tock seng hospital c/o National Neuroscience InstituteNeuroscience Specialists Outpatient Clinics (Level 1)Tel: 6357 7605

nni at singapore General hospitalc/o National Neuroscience Institute (SGH Campus) Rehabilitation Centre (Education Resource Room, Block 1, Level 1) Tel : 8125 3543

stroke support Group c/o Singapore National Stroke Association26 Dunearn Road, Singapore 309423Tel: 6358 4138 Website: http://www.snsa.org.sg

For more information on support Groups, visit our website at www.nni.com.sg

• Neuroscience Seminars for Family Physicians 2013* - stroke (25 august) - epilepsy and sleep Disorders (29 september)

• NNI Dementia Awareness Day (Memory assessment and Public Forum) (6 october)

• 12th Advanced Neuroradiology Course (18-19 october)

• Community Care Partners Workshop (3 november)

• 14th Singapore Stroke Conference (9-10 november)

* Dates subject to change.