About Dr. Lee Moon Keen
July 22, 2010 439 Comments
MBBS (Malaya), Dip Clinical Neurology (London), FRCP (Edinburgh), Fellow, Academy of Medicine, Malaysia
Consultant Neurologist and Movement Disorders Specialist
Dedicated and highly accomplished Consultant Neurologist with a distinguished career spanning three decades. Fellowship of the Royal College of Physicians of Edinburgh, extensive experience in Parkinson’s Disease and Movement Disorders, and a track record of pioneering medical advancement in Deep Brain Stimulation surgery for Parkinson’s Disease. Known for contributions to Neurology Clinical Practice Guidelines and as an expert witness in medicolegal cases.
Dr Lee Moon Keen is a Consultant Neurologist who was trained at the University of Malaya and later at the Institute of Neurology, University of London, through the Chevening Scholarship of the British High Commission. She lectured at the University of Malaya until 1994, after which she commenced private practice.
Dr Lee’s main interest is in Movement Disorders, including Parkinson’s disease. She is Director of the Sunmed Functional Surgery Team which performed the first Parkinson’s Surgery for Deep Brain Stimulation (DBS) in Malaysia in February 2003 at Sunway Medical Centre.
Dr Lee is a Founder Member of the Malaysian Society of Neurosciences and has served as Vice-President. She is adviser to the Movement Disorders Council of which she was a founding member.
As a Fellow of the Academy of Medicine of Malaysia, Dr Lee was a member of the Neurology Credentialling Committee for the National Specialist Register. She has served on the Subcommittee for Strategic Planning as well as various expert committees for drafting Clinical Practice Guidelines on Parkinson’s Disease, Stroke and Brain Death Certification. For the Malaysian Medical Council, she worked with the guideline on Good Medical Practice. Dr Lee served on the expert panel of the “Asian Parkinson Disease Network Meeting” in Tokyo in May 2015.
Dr Lee has published research in Movement Disorders, Deep Brain Stimulation, Stroke and Muscular Dystrophy. She is an occasional reviewer for articles on Neuromodulation.
About mkleeneuro
M K Lee Neuro Clinic 
Good morning Dr Lee. I’ve been experiencing pressure like migraines particularly behind and around my left eye, which radiates to around my left cheek and sometimes the back of the ear and back of my left side of my head. Some puffiness/swelling is also noticeable just below my left eye. I’m also experiencing some imbalance, not severe but unsteadiness especially when walking around or sitting down to have a meal. Appreciate if you could advice accordingly. This has been happening for about a month. Tq.
Dee
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Dear Dee
Your symptoms may well be due to migraine. However, you need a clinical examination by your family doctor to check for other causes of puffiness below the eye and unsteadiness on walking. For example, viral infection and sinus infection come to mind. Once the cause is established, the appropriate medications will provide relief. Best wishes for you recovery.
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Hi and good morning
May i know availability of edaravone?
My friend been diagnosed with ALS/MND which the neurologist there(Middle East) suggest this medications
It is greatly appreciated if I can help enquire about medication to lessen his burden
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Dear Najwa,
Thank you for your enquiry. For information, we do not have supply of edaravone.
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Dear Dr.Lee,
May I know whether the procedure for treating Tourette syndrome and Tics (pioneered by 2 dental surgeons in USA)using a special
” dental mouthpiece ” is available in yr medical centre?( I am aware of DBS in sunway medical centre).
Thk you in advance and hope to get yr feedback .
Rgds,
Cheah
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Dear Cheah, Thank you for your enquiry. We don’t offer any dental procedure/prosthetic for Tourette Syndrome. Best wishes.
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Dear Dr. Lee,
I hope this comment finds you well.
I have a family history of Machado-Joseph disease on my fathers side. I am currently in my 20s and feel like I am showing signs of the disease (unsteady walking gait, difficulty writing, constantly fatigues even when I am not doing anything, slight dysdiadochokinesia). I understand that the only way to diagnose is through genetic testing however, there are many drawbacks to this (future employability, insurance etc.)
I would really appreciate your advise on the matter of genetic testing.
Many thanks.
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Hello,
I am experiencing migraines or headaches usually on the left side of my head. It occurs at random at least once a week, regardless of whether I am stressed or relaxed.
I do not have any visual disturbances and recent visits to the ophthalmologist have deemed my eyes healthy.
Can you advise on the matter?
Thank you.
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Dear Jason
Assuming your diagnosis of migraine is accurate, the management consists of identifying and avoiding trigger factors, failing which migraine prophylaxis with medications is considered.
Trigger factors are multiple and varied, hence some detective work may be needed to identify them. Here is a useful link https://www.migrainetrust.org/about-migraine/trigger-factors/common-triggers/
Best wishes.
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Dear Dr Lee, may I know if neurologist like yourself is the doctor to see for trapped nerve condition? Many thanks.
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Hi Doctor. Hope you and your family are healthy. I am suffering from syringomyelia since a year ago. I had done 2 MRI since last one year. After a year having syringomyelia, my legs feel not strong enough since early of this year. Now every night I can’t sleep comfortably because my right hand feel so painful. Sometimes my right hand feel like burning. I have met my doctor last week and he suggest to make 1 more MRI soonest. He said that if the MRI result getting worsen, I should consider to go for an operation.
I need your advice on this type of sickness. Is it risky to do the operation? I am wondering in Malaysia which doctor from Neurologist is good and which doctor or hospital have the experience in handling this kind of operation with success story since I read in many article that this type of sickness are somewhat rare. Do you have any recommendation?
Besides, may I know is it exercise can help in reducing the hand pain or it might cause the condition getting worse? What type of exercise is recommended? Is there any other way can help in reduce the symptoms? Thank you a lot for your kind attention.
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Dear Khairul
Thank you for your enquiry. In general, syringomyelia is treated by surgery if it is already causing neurological malfunction. This procedure is done by neurosurgeons. Your doctor would be in the best position to advise on the appropriate surgeon and medical centre nearest to you. Risks of surgery are related to the type of procedures needed in your case, and the experience and skill of the individual surgeon. Exercise plays a role in the recovery process after surgery. It is not likely to be of much benefit until the condition has been treated adequately.
Best wishes.
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Hello – We feel that my brother’s son have eye ticking… He is constantly squeezing his eyes… It gets extreme when he watch TV or concentrate on anything… Also if he see any light he does it often…
Can you please help me with any possible remedies.
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Dear Raj
Young children may go through a phase of semi-voluntary movements of the body, especially the head and neck. You are advised to consult the child’s paediatrician for an assessment. A doctor who is familiar with the child would be in a position to advise whether this is a benign habit spasm or more serious tic disorder. A period of observation is usually advised, to avoid undue alarm over a serious disorder.
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Hi Doctor,
Having a chronic headache since 2014. Tried many remedies but no cure. Please advise.
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Dear Nahla
Chronic headache may be due to a variety of causes.
These include migraine, tension headache, cluster headache, and cervicogenic headache, among others.
Do consult your family doctor for a precise diagnosis so that you can be prescribed the appropriate treatment.
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Dear Doctor,
Happy Chinese New Year.
My mom has issue with her left thigh, where part of it with numbness, originally was a size of palm, but now had growth bigger. This had happen for years and the area grows slowly.
My question is, is this under treatment or exminate by neurologist? And do u need a doctor refer to make appointment with you?
Thanks in advance.
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Dear M Pang
The symptom you describe is nonspecific. In general, an examination by the Family Doctor is the first step, to determine if specialist referral is needed. Do consult your GP for the initial assessment.
Best wishes.
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Hi Dr. Lee,
My boy turn to 8 this coming Jan 10. We discovered that he had tic symptom since he was 6. For first symptom was he unconsciously both eyes rolling but under monitor by us (my husband and I) for keep asking him to stop doing it then it gone after few months during his age of 6. But his condition getting worse after he entered primary 1.
Beginning of last year first quarter, he start eyes itching and keep use his hand to rub especially during evening, so we thought that he is allergic so, we kept calm his itchiness with put on warm towel till he fell sleep. We can feel my son has anxiety to his school life as his form teacher is old school teaching type with canning method but we felt that my son should able to overcome it after a while. However, his condition getting worse where we found out that his face always oily and food stain. We did blame him and discipline him for his hygiene and must always clean his mouth after food. My son is a good boy and he did what we told but his face still look dirty most of time. Then I tried talking to him when we are in peace environment as I would like to understand what caused him love to do that. My son told me that “Mum, I can’t control my hand for touching my right and left cheek.” He asked me that why i have this kind of bad habit? I couldn’t able to answer him and start then I put more attention and observe his reaction time to time without let him know. My son is right that he can’t control and keep touching his cheek not only eating however playing time, reading time and watching cartoon time.
After his 2nd school test, he wasn’t get his exam result as good as 1st test. Then his school teacher canned him for 18 times and start scolding him with picking a tiny errors in his school works. Teachers kept complaining his concentration is getting poor and he likes to talk in class, so they canned him to discipline him. Teachers believed that he can perform excellent in his school test and they put trust in their believed. So, teachers even had few parent counselling session with both my husband and I for keep asking us to put more attention and push my son to be more hardworking at home. We already told teachers that we are happy with his school performance as even his school result not as good as 1st test but he still remain 3rd place in his class rank. We understand the school syllabus is getting difficult and my son mother tongue is English since born. So, we never expect he can score in Chinese primary school system.
I found out that my son condition getting worse after mid-term exam where he also has other strange actions where he also quite often turn his face to left then upward even he is watching cartoon at couch. When he hold Ipad to watch cartoon show, his hand will keep pull in the Ipad screen like gamer playing game on Ipad. Initially I thought he was playing game and keep scolding him that he played too much game until he has the bad habit for pull in the Ipad. I felt very sorry to my son because he cried and told me that he can’t control to all the strange actions. He wants me to help remind him for not doing them because he felt ugly for all these weird reactions. I have discussed with my husband that may be our son too stress for his primary school life, so we give him some room when back home. We did it and we can see that my son show more smiles and relax. However, it didn’t help much for all his bad habits. But he start vocal out some strange voice like “er…er…er”, then sometime he will raise his voice in different tone when speak halfway and he uncontrollable repeat what we said for last few words… I asked him what happened to him and he told me that he didn’t know and unconsciously did it. He start stop speak English and turn to Mandarin which is strange because he loves English so much. I also asked him when we are in better peace condition, what make him like Mandarin and it really surprise me with his response “Mum, I still love English but I have no choice because I couldn’t speak and pronounce well anymore…I feel breathless to complete pronoun an English word and will have voice tone problem when I want to complete a sentence. Mandarin sentence and word shorter, so I can avoid to show my voice tone problem from you, daddy, grandma, grandpa, teachers and friends.” To be honest, as a mother me is super sad when I heard this response from my son.
I start browsed medical knowledge web and found out my son bad habits may caused by tic or Tourette Syndrome. This is my own suspect based on his symptom. To be honest, my husband and I also couldn’t face the fact of tic that it may cause due to gene inherit in some medical study pointed out. So, I start monitoring his condition till last month then both of us decided to bring my son to visit his usual Pediatrician specialist since born as my son begged me that he wants to visit Dr. Dan (his pediatrician) as he is nervous that he couldn’t control all the bad habits and he doesn’t want his friend treat him as “alien”. Dr. Dan diagnosed that he is cheerful boy but he has anxiety in school life and caused him has tic, so he referred my son to Psychiatrist Dr. Lai for further diagnosis. We just visit Dr. Lai 2 weeks ago and after he talked to my son personally for 15 minutes without any machine/equipment test then he confirmed my son has tics and serious in vocal tic. He did prescribe him medicine to take “0.25mg Arit MT” to calm his anxiety to reduce his vocal tic as behavior therapy won’t help for vocal tic. Besides, he told us that the medicine will getting heavy content when he grow then side effect for restless may caused when my son take 1mg Arit MT if he needs heavy content to reduce his vocal tic. My husband and I decided not to let my son take that medicine and trying to calm my son anxiety with accompany him more and give him more relax since it’s school holiday and I also decided to take 2 weeks leave to accompany my son for hoping to keep him calm.
Dr. Lai told us that nothing much we can do and he wants my son to have monthly follow up to monitor his condition for him to prescribe the right medicine content to reduce his tic. Both of us (Husband and I) felt helpless and looking for 2nd medical opinion. So, I google further about tic and Tourette Syndrome since Psychiatrist diagnosed my son has tics, many of medical forum topic in Tourette Syndrome advise to seek for experienced Tourette Syndrome/Tic Neurologist specialist for further diagnose and found the right treatment to reduce the tics. I know the fully recover rate is only 30-40% after age 18, so most of medical site classified this as no cure illness. I won’t put high hope for full recovery however at least I am hoping I can do something for him now to reduce his discomfort from tic.
Doctor Lee, I have no idea is there any Neurology specialist in Penang is expertise tic illness. I have read lots about Tic and TS medical info and education video clip from Youtube. It’s rare illness and Malaysia still not as high awareness as other country such as Taiwan, Australia, Singapore and Western countries about Tic and TS. I really hope to have you diagnose my son but your profile show that you are practicing in KL not Penang. 😦 I know my son illness needs long term frequent medical consultation, so with my working schedule and his schooling schedule, it’s very difficult to make it happen for long term. Can you advise me the right Consultant Neurologist in Penang who able to handle my son’s case?
Appreciate for your help.
From,
Hopeless Mother Michelle
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Dear Dr. Lee,
Can I ask info for my wife?
Her left eye’s nerve is pain about one week..
Her pain is from left eye until her head and then until behind neck..
Can you give any advice?
Is that any recommended place to visit in penang?
Sincerely, Thank you very much!
Regards,
Wong
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SEEN AT PMC
Good day to you, Dr. Lee
I was admitted twice for severe cervical radiculopathy with constant numbness/paresthesia that doesn’t go away on my palmar left index, middle tip and thumb and part of dorsal side. Carpal tunnel was ruled out based on my cervical MRI with disc bulges at c3/c4, c4,/c5, c5/c6 (cervical spondylosis). Pain also appears on my upper back of my spine and lower back as well later on.
Is there anything i can do about the abnormal condition of my hand? It’s been almost 6 months. is it damaged beyond repair? I really need help, been struggling day in day out. Can I seek you for a consult for a possible remedy/tests/procedure?
Thank you very much in advance.
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Dear Dr. Lee,
Good day to you.
Now my son has age nine month . When he was born after six hours ,he has a problem breathing then develops into an explosion in one of the lungs and continued treatment for six days , then he left the hospital
please ,now the problem I doubt he has hypotonia or weakness of muscles . Please this case under your specialty and could I visit your clinic
Thank you so much
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Dear Yakoub
So sorry to know of your child’s condition. He needs the expertise of children’s experts, including paediatric neurologist. For info, I treat adult patients.
Do consult your paediatrician for advice.
Best wishes.
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salam yakoub.. sorry boleh saya tanya macam mana keadaan anak abang sekarang? anak saya pun mengalami situasi yang sama dengan anak abg.. sekarang umurnya sudah setahun 3 bulan… dia masih tak boleh merangkak .. boleh saya tahu dimana abg buat followup doctor bagi memulihkan keadaan anak abg..
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dear dr lee, may i know wer can i find a doctor that special in curing dizzyness in penang island
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Dear Bobby
We can’t help you here. Please consult your family doctor for a recommendation and referral.
Best wishes.
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Dear Dr. Lee
I am having this eyes twitching and above my lips. It’s all happen on the right side of my face. Now it’s getting obvious. I went to see the eyes specialist. Did a scanning and everything was fine. The doctor advised me to see a neurologist. Do you treat this problem?
Thank you.
Regards,
Salina
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Dear Salina
Your symptoms may be caused by hemifacial spasm. Yes, this condition is treated by neurologist.
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Dear Dr.
My daughter is suffering motor disorder since this April. It started from shoulder jerking, then to her right hand and right side of her face. It happens every few minutes but subside when during asleep. She has no other serious health issue except of normal fever which was long before the disorder. I have consulted pediatrician neurologist and the answer was tic disorder. the solution is to stay away from gluten and casein enriched food. However, i would like to seek for second opinion from a neurologist. My daughter has never done any test eg. EEG, CT Scan etc. Hope to hear from you soon.
Best Regards,
Loo
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Dear M Loo,
From the information given, tic disorder is a reasonable diagnosis.
If you wish to have tests done, do contact my clinic staff at the address on this site.
Best wishes.
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Hello Dr Lee,
My father is 69 years old this year. We noticed his hand start shaking and it is getting serious, his movement also getting slower, and he always taking nap, and feel tired easily. This symptom start February last year. He had diabetes for 5 years already, he took medicine to control it, and we control his sugar intake.
We suspect he has parkinson disease, as my grandmother, my uncle had parkinson too.
Are we able to diagnose whether he has parkinson disease and if medicine can prevent the disease getting serious?
Thanks
Jane
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Dear Jane,
Parkinson’s disease is diagnosed based on clinical criteria, supplemented by tests as needed, to exclude other conditions.
Once PD is confirmed, early treatment allows for maximising of motor function and also plays a role in slowing down physical and mental deterioration.
Early studies of Levodopa treatment were able to demonstrate its benefit in prolongation of life expectancy.
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Thank you Dr for your reply. May i know your Clinic address/ contact number? and your clinic operation hours? Thanks
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Dear Ms Jane,
Please call the contact nos. on this site.
Regards.
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Dear Dr. Lee
My wife was diagnosed with vertigo (BPPV) in Feb 2016. She was admitted to hospital and has a full checkup (Blood Test and CT Scan), but not found any unusual inflammation in her nerve systems.
The specialist is only teach her to perform maneuver exercise everyday. However, the exercise doesn’t help to fix the problem. She still experience swaying everyday till today.
Kindly advise what can I do to help her. I’m staying in JB.
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Dear Mr Ho
Epley exercises are the appropriate recommendation for BPPV.
This condition may be quite persistent in spite of the standard treatment.
If there is no significant improvement, you are advised to revert to her doctor, to consider evaluation for other causes of imbalance.
Best regards.
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Dear Dr. Lee,
My husband was diagnosed with Parkinson in 2009 and he was taking Trivastal retard 50 (1 tablet 2x daily) and Madopar 200/50mg ( ¼ tablet 2x daily) during then. He was required to increase dosage 2 years ago but out of frustration he decided to completely stop medication. His movement was deteriorating and April this year I managed to convinced him to go back to his doctor for medical helps.
In 20 April 2016 he started taking the trivastal & madopar with low dosage and slowly increased over the period of 2 months and finally stop at Trivastal retard 50 (1 tablet 3x daily) and Madopar 250 (1/4 tablets 2x daily). His movements improved greatly after on medication we were so happy.
However 1 month later he start having hallucinations. Doctor then cut down his Trivastal from 3 to 2 tablets daily and prescribed him with Seroquel 25mg (1 tablet at night). But he refuses to take Seroquel and the hallucinations got worst and now he is also having delusion. His is now very much like patient who is suffering of schizophrenia. Dr. Lee I urgently need your advice, I am not sure what to do next… should I bring him to see a neurologist or psychiatrist ?
Thank you very much. Best Regards/Ling
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Dear Madam Leong
Your husband is experiencing motor fluctuations of Parkinson’s disease and treatment-related psychiatric side effects.
His susceptibility to medication effects is caused by advancing disease. He is not likely to have schizophrenia, which shares common symptoms.
An experienced neurologist would be able to adjust his medications as appropriate. In severe cases, psychiatrist’s input is needed.
Best regards.
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Dear Dr.Lee,
My wife on arrival at an international airport felt like fainting and rested at the bench. She then felt a burning sensation and felt like an electric shock on her right side of her head. The pain then subsided and we went to the hotel. She felt a slight imbalance but the in-house doctor diagnosed it as vertigo. Later she felt worse and became more imbalanced and started to vomit continuously. Was admitted into emergency and doctors first said nothing showing on MRI later on showed a white speck in the brain which they said was a clot. Heart and neck scans showed no blockages. Can we get a second opinion on whether it was a stroke as those doctors believe it to be. Could it be a nerve compression or something else? She has diabetes controlled poorly with medication. Her current condition is she feels imbalance when walking and facial numbness on one side but her condition seems to improve gradually. Can we get a second opinion on the MRI on whether it is a stroke or something else?
Regards
Jerome
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Dear Jerome
Your wife’s symptoms need detailed evaluation before any recommendation can be made.
The cause could range from the benign, such as acute migraine, to the serious, e.g. stroke.
In case of doubt, another evaluation may provide comfort.
You are welcome to get this 2nd opinion with any neurologist, including myself.
Best wishes.
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Selamat petang doc.
Sy ada soalan berkaitan motor neuron. Ayah sy seorang guru pencen brkemungkinan mghidap TRO Motor Neuron (Prgsve Bulbar Pasly). Simptom yg ayh sy alami sperti tangan kiranya lemah mnkala tangan kanan agak terhad pergerakannya. Bila nk makan susah untuk menelan, mulut kerap mngeluarkan air liur yg banyak, percakapannya pelat, dan sakit bahu & leher. Apakah rawatan yg terbaik utk masalah ni? T Kasih
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Hi Syahmi
Bagi confirmed kes Motor Neuron Disease, hanya suatu ubat yang diluluskan oleh FDA untuk rawatan, iaitu Riluzole. Ubat ini kosnya tinggi and perlu kawalan (monitoring) yang rapi. Jadi, sesuai bagi seorang berpencen menerima rawatan di institusi kerajaan, misalnya Hospital KL, Hospital UKM dan Pusat Perubatan Universiti Malaya.
Sekian, salam.
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Dear M Tan,
Worsening of function in Parkinson’s treatment could be due to any of a number of causes such as inadequate medication, inaccurate diagnosis, progression of disease, appearance of complications, concomitant medical conditions such as arthritis, as well as ageing itself. Do discuss with the treating doctor as to what could be the cause.
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Dear DR Lee
My mother in law suffer pain from mouth till her left eyes since last years. After visit several doctors and therapy or injection, pain did less for short period. And currently she suffer pain again. After discussion with family member, we decide to have better treatment and consult yours expertise.
How can we make an appointment with you? Please advise
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Dear Dr. Lee,
My dad was diagnosed to have Parkinson’s 2 years ago. His condition is deteriorating since then even though he is under medication (madopar & aspirin). He isn’t shaking very much (no noticeable shaking for the first one and a half years) but he has difficulty in movement. His movements are getting very much slower compared to two years ago and he couldn’t open a Tupperware lid by himself.
He is getting skinnier and unable to gain weight even with regular meal and exercise (squatting, cycling, lifting dumbbell). He couldn’t walk even for very short distance and complained his knees are painful. May I know how these symptoms can be improved? We are willing to come for consultation if it is needed.
Thank you.
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Dear Dr Lee,
My mother has Parkinson. She has trouble swallowing and frequently chokes. Her doctor has recommended her to see a speech therapist. Can you recommend any speech therapist in Selangor or Kuala Lumpur that can help her?
Thank you.
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Dear M Ng
Pls see your email for a personal response.
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Dear Kelvin
Your sister needs a precise diagnosis as to whether she suffers from Tourette syndrome, Autism or other developmental disorder. For this,she should be under the care of a Paediatric Neurologist.
Do ask her doctor for the appropriate referral, in order to reduce her suffering and maximise her potential.
Best wishes.
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Dear C,
I am suffering from frequent headache for many days. My age is 29, unmarried and from Bangladesh. I will be visiting Malaysia from August 24 – 29, 2016 and will be staying Kuala Lumpur from August 26 – 29. I want to have a better treatment of headache. I want to know the approx. cost of treatment and way of appointment. Kindly let me know as soon as possible.
Thanks
H M Forhad
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Dear Forhad
Please contact the clinic staff at the tel. numbers on this site and fix an appointment which fits your schedule.
Medication cost without brain scanning will not exceed USD 300 or so.
Best regards.
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Dear Dr.Lee,
I have a 11years old sister who i assume she suffers in deep brain stimulation/Tourette’s Syndrome. She will hit herself without any sign, being aggresively, making weird noise, hyperactive etc symptoms. She doesn’t know how to talk, cannot live independently. We are looking for a doctor who we can consult with, and i wish that our family could visit Dr.Lee. How can we meet Dr.Lee? Looking forward to your respond, this is really important for us. Thank you.
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Dear Dr. Lee Moon Keen,
Saya dari Indonesia. Ayah saya sedang sakit, kondisi nya sekarang seperti anak kecil, tidak lancar berbicara, tidak bisa mengingat nama termasuk nama saya dan keluarga yang lain tapi masih bisa mengenali wajah kami, “buang air” sembarang, tidak bisa tenang, harus berjalan terus-menerus, ingin mencuci tangan terus apabila sedang gugup. Kurang lebih seperti itu kondisi sekarang.
Sebenarnya penyakit tersebut termasuk penyakit apa?
Dan kalau kami bawa berobat ke Penang, apa Rumah Sakit yang specialist untuk penyakit ini?
Thank you in advance for your kind suggestion and view. Many thanks. 😊
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Hi Fergie
Dear Melinda
Sila rujuk kepada National Specialist Register (NSR) dan cari pakar yang berkhidmat di Penang.
https://www.nsr.org.my/list1view.asp?page=1
Salam.
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Helo doctor, how do I contact you? Your clinic address and contact number please.
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Dear Dr. Lee,
Saya mengalami lemahnya vocal cord (left). Suara lemah dan serak. Dr THT setempat menganalisa kemungkinan:
1. Syaraf yg menggerakan pita suara tdk bekerja krn terhimpit organ lain mungkin jantung.
2. Dikarenakan high gastro leak to laryng impact to weakness of voval cord (Gerd).
Sampai sekarang belum ada penanganan yang tepat sehingga suara saya semakin lemah.
My question bila saya berobat ke Penang, ke dokter apa sebaiknya saya consult? Apa Rumah Sakit yg specialist utk THT dan syaraf di Penang?
Thank you in advance for your kind suggestion and view. Many thanks.
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Dear Melinda
Sila rujuk kepada National Specialist Register (NSR) dan cari pakar yang berkhidmat di Penang.
https://www.nsr.org.my/list1view.asp?page=1
Salam.
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hi Dr. Lee Moon Keen
i am Nurul Afifah and i’m 21.. lately my hands keep on shaking..its started with my left hand but now its seems both shaking quite sometimes. my parents dont even have parkinson disease.
im not taking any medicine or smoking but i just consume coffee in my daily routine.
Sometimes my dizziness make me feels like collapsing.. is it can be treat normally by having a healthy diet or is there any specific medication for it? what should i do? thank you in advance 🙂
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Dear Nurul
Shaking of hands and dizziness can be due to a variety of causes.
The symptoms are unlikely to be due to Parkinson’s disease which is very rare below the age of 55.
Do consult your family doctor to get assessed and decide on the appropriate treatment.
Best wishes.
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Hello,
I recently moved to Malaysia and live 20 mins out of Kuala Lumpur.
I suffer from Benign Positional Vertigo and would like to see someone here for it. I was wondering if you could help me or know someone who could as i would like further opinions/advice.
Thank you.
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Hi
Enclosed is link to National Specialist Register.
https://www.nsr.org.my/list1view.asp?page=1
Best regards.
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Morning doktor..
Saya ingin bertanye,suami saya kerap kepala berpusing2..bagai keadaan sekeliling berpusing..dan susah nak bawa kenderaan..apakah puncanya? Dan bagaimane nak hilangkan kepala berpusing2.? Adakah ubat untuk hilangkan nye?
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Puan Wati
Antara punca simtom berpusing adalah vertigo akibat penyakit neuro atau penyakit telinga, serta beberapa penyakit sistem ‘am, termasuk diabetis.
Jadi, suami dinasihat jumpa Doktor Famili (GP) untuk penyiasatan awal.
Salam mesra.
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Dear Dr Lee,
My mom is 68yo, and suffering from Trigeminal Neuralgia (TN) for years. Getting worsen lately. May i know if Gamna knife can help her conditions, and do you perform this surgery, and where?
Thank you very much!
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Dear Catherine
TN can be controlled with medications, of which a large number of effective drugs are now available in our formulary. Since TN is known to go into periods of remission (subside), surgery is reserved for very severe intractable cases. Gamma knife treatment is performed by neurosurgeon.
Best wishes.
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Dear Dr Lee,
Thanks for your reply. Currently she is on carbamazepine but due to her very own fear that long term medicine will bring harm to the kidney, she only take the medicine when it’s painful.
Currently her case is not extremely severe as the pain come and go, but we knew that it has affected her quality of life.
Is there any medicine that is safe to consume? As far as i know, carbamazepine is a medicine to cure epilepsy and eventually it might slow down our neuro system/function. Is that true?
We are still contemplating about the radiosurgery at the moment. Can you recommend any good surgeon in KL or PENANG?
Thank you very much!
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Dear Catherine
Your mother should refer to her doctor about her various concerns.
1. Carbamazepine will not affect her kidney.
2. In the hands of an experienced doctor, all approved medicines can be administered for maximum benefit, with care to avoid harm.
3. Like many medications, Carbamazepine has more than one indication for use. These include epilepsy, nerve pain and mood disturbance.
4. It is not recommended to go for radical option like radiosurgery unless all medication options have been shown to have failed.
Best.
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Thank you very much Dr Lee. I will definitely arrange for mom to travel to KL and see you personally so that we can make an informed decision. If given a choice, i do not want her to go through any type of operation. Convincing her to be on medication for long term will be a tough job but i will try.
Thanks again for your kind and professional advise.
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Dear Dr. Lee,
Happy to see your professional generous advice to the community.
My mom, 77 suffered from multiple lumbar problem … osteo/herniated disc/compression… L3,4 & 5 (MRI done) due to falls some 10yrs back. With her early menopause (at 30), she has medium osteo problem and degenerative knee too….she opt not to go for surgery however, on knee & lumbar.
Despite all these, she’s active at this age, going for tai chi and qiqong 4 times a week, karaoke…a happy lady that drives…..
She has had a severe attack …. swollen knee (light a “ba chang”) with a full huge syringe (can’t remember how many cc) of yellow fluid being extracted from the knee by an orthopaedic Dr.., that was a bad 5 mths in 2014 we barred her from driving and climbing stairs…. as happy person as she is, her face crumpled in pain every time she move a little, even when she was sleeping. She was consulted by orthopaedic surgeon, neurosurgeon, spine surgeon in same or different hospitals during that 3 mths suffering….. some advice surgery but of course, considering the risks, she opt not to do it, we supported her decision.
For no reason, she was ok and walking & driving again after 5 mths…..of course on & off she will feel pain in the knee and she will walk with a stick during bad days….her pain tolerance is very high I must say.
Last week, her knee cap swell again, with heat radiated. She do all sorts by herself …. heat therapy, cold compression, all sorts…. but it is bad though she does not complain…..
This time, problem seems to start with (in this order):
1. Pulling sensation at throat/neck area on the left side (went to see ENT, nothing found)
2. Wake up with numb hands on the left side
3. 7days later she has this swollen knee with heat radiating and a lot of pain
(she has been having these consistent come & go issues – dry eye, mild highblood/cholesterol problem, frequent block nose, and frequent constipation).
Dr. Lee, we are stuck… she can barely walk without struggling in pain ….. which specialist should we bring her to? Neurologist? Neurosurgeon?
(the last round back in 2014 may have been the walkings some 4weeks prior to the severe attack as we brought her on a 8-day long holiday. Yet this time no unusual activity or things she ate….).
Thank you so much in anticipation on your good advice. Much appreciated.
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Dear M Chan
For info, to formulate constructive actionable advice, a proper clinical assessment is mandatory.
On the facts given, your mother appears to have a severe knee problem, most common causes being osteoarthritis (degenerative) and septic arthritis (infective), or even a combination of both.
The other symptoms may be related to the health burden of ageing.
Do consult an orthopaedic specialist to start with.
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Pingback: www.andis.com
Salam Sejahtera Dr. Lee,
Saya berumur 50 tahun. Sudah sebulan kedua-dua tapak kaki saya rasa seperti semut semut atau macam kebas. Adakah ini ada masalah dengan saraf.
Untuk makluman Dr. Saya Baru saja berhenti merokok selama 2 bulan. Harap Dr dapat jelaskan masalah saya Ini.
Terima Kasih
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Dear Ibrahim
Agak rumit untuk dipastikan daripada info yang singkat di atas, apakah punca perasaan kebas begini. Sila rujuk kepada Doktor Famili utk penilaian awal, samada bukan serius atau pun disyaki ada kemungkinan penyakit neuro.
Salam.
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Dear doktor, ibu saya berumur 57thn menghidap MG sejak 2007 dan telah mendapatkan rawatan pakar di HKL. Pelbagai ubat telah diambil as advised by the pakar but keadaannya tidak menunjukkan perkembangan positif. Dia semakin menunjukkan tanda cepat letih walaupun hanya menjalankan aktiviti biasa di rumah eg masak dan of coz di bahagian eyelids semakin drop dan terpaksa menggunakan jari utk menahan. Cermin mata hitam menolong mengurangkan kesakitan dan keresahan yg dialaminya. Dlm masa yg sama ibu saya mempunyai penyakit sampingan iaitu lelah. Kerap ke hosp utk rawatan kecemasan bagi mendapatkan gas. Kencing manis dan darah tinggi juga detected lebih kurang 4 bulan lps. Doktor pakar di HKL memaklumkan penyakit2 ini disebabkan oleh pengambilan prednosolon dlm jangka masa panjang utk cure MG (sorry i dont really know the impact of it it may be wrong). Saya ingin bantu ibu untuk mendapatkan rawatan atau nasihat alternatif dari dear doktor kerana sgt kasihan mendengar keluhan beliau. Harap dear doktor dapat meluangkan masa. Sekiranya perlu appoinment di klinik, kindly advice… Regards… Suhaila
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Puan Suhaila
Setelah diagnosis MG telah dipastikan, prednisolone akan diguna untuk kawalan penyakit ini. Sekiranya kawalan susah dicapai, atau pun muncul komplikasi, makin langkah dibawah akan dipertimbangkan:
1. Bagi pesakit yang muda dan dalam kandungan sihat, pembedahan thymectomy mungkin sesuai. Sebenarnya ianya perlu dijalankan jikalau dipastikan ada tumbuhan “thymoma” di dada.
2. Utk kes yang lain, rawatan immunological contoh Intravenous Immunoglobulin atau Plasma Exchange boleh menghapuskan antibody MG untuk suatu masa yang singkat.
3. Untuk jangka panjang langkah (2) harus diikuti dengan pengubatan immunomodulation: Azathioprine, Cyclophosphamide, Cellcept dll.
Sila membincang langkah tersebut dengan Doktor Puan.
Salam.
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Hi Dr Lee
Good day! My father age 55 is recently experiencing numb on the left side of his face, chin and also sometimes on his arm. This symptoms started about 3 weeks ago and the numb feeling is getting stronger.
He has went over Sunway to perform a brain CT scan last week and confirmed that is has no internal bleeding.
We worried that this might be a nerve damage, are these a symptoms of stroke? How can we check it further?
Seeking for your advice as we are unaware on the field of specialist we could head towards for check up.
Thank you.
Regards
Hann
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Dear Hann
The symptoms described are nonspecific. Causes may range from musculoskeletal strain to stress (hyperventilation) to more serious conditions.
A clinical appraisal is needed. You could start with consulting a neurologist.
Best wishes.
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Dear Dr. Lee,
Good day to you.
I am currently looking for a Neurologist specialized in Parkinson’s Disease for the follow-up of my grandma’s (age 80++) diagnosis for more than 10-15 years ago. Since she was diagnosed, she has not change her medication, Madopar 250 tab. Due to her dizziness/weakness of taking the medication according to the recommended dose, she has been always taking only 1 tab divided in 2 times per day.
I still do notice that her hands tremors especially when she is holding fork & spoon while having meals. However, lately (twice in a month already), she seemed to tripped or fall, once fell and knocked her head resulting with bruises which required stiches, the latest was falling off her bed while sleeping at night. And also, she starts to throw tantrum towards the maid who are taking care of grandpa.
What is your opinion? Should we change newer medication? Or increase dosage? Or need further investigation?
Yours sincerely,
Jean
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Dear Jean
Yes a review of your grandmother’s status as well as her medication needs is advisable after such a long period. She should be assessed for the possibility of other conditions (co-morbidities) which might add to the risk of falls or affect her response to Madopar.
Do arrange for her to meet her doctor / neurologist soon.
Best regards.
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Dear Dr. Lee,
Thank you for your reply. Appreciate it very much.
Best regards,
Jean
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Hi doctor I’m planning to take my niece for epilepsy treatment. Could you assits me on this. Thanks.
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Dear M Sima
Please liase with the staff of Dr Lee Moon Keen at the contact addresses at this site.
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Selamat pagi doc.
Sy Mal, berumur 49 tahun. Sudah bertahun sy mengalami sakit di bahagian belakang lutut kaki sebelah kiri. Susah utk sy discripe mcm mane sakit rersebut. Tapi ianya amat tidak selesa dan mengganggu tidur saya, kerana ianya sering terasa diwaktu tidur. Saya pasti terjaga dan akan menyapu minyak2 berangin/flanil dan mengurut2nya sampailah kewaktu pagi. Sy sudah kerap berjumpa doktor utk rawatan sakit sy ini. Doc yg merawat hanya mengatakan sy mengalami sakit urat dibhg berkenaan/ angin. Dengan ubat sakit urat utk makan dan Flanil utk sapuan. Kesakitan akan hilang buat seketika dan akan kembali semula. Sy sudah tak sanggup lah doc. Boleh kah sy mendapat nasihat doc, apa yg perlu sy lakukan agar kesakitan sy ini tidak wujud lagi dalam hidup saya.
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Dear Mala
Sekiranya disahkan bukan masalah lutut, disyorkan anda dapat penyelidikan uratsaraf Nerve Conduction Study untuk mengesan penyakit neuropathy. Yang kedua, boleh dipertimbangkan Restless Legs Syndrome.
Sekian, salam.
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Saya ICHSAN dari indonesia ingin mengetahui klinik doktor lee bertugas dimalaysia. Saya ingin berobat vertigo yang saya derita. Thank you….
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Dear Ichsan
Vertigo biasanya dirawati oleh Pakar Telinga (ENT). Walaubagaimanapun, sekiranya ingin membuat penetapan appointment, sila menghubungi Puan Suba, email pmcneuro@gmail.com
Sekian, terima kasih.
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Dear Dr Lee,
I have this symptom where i get something like a shock or jerk for split second. This mostly happens when i focus on something or push my self when im tired. this does not happen on daily basis.
However i cant seem to know what is the problem i am having and would it be right for me to consult a neurologist.
Seeking your advise on this.
Thank you!
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Dear Deen
These sensations are a common human experience. It is indeed more prominent when one is tired. You should consult your GP if this is persistent throughout the day, in which case severe exhaustion may be the problem.
Best wishes.
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Dear Dr,
I am having tinnitus and misophonia at all times. I have gone to several ENT and even hynopsis treatment especially for misophonia but seems like not much that they can offer. Does betaserc helps and is there any other clinical treatment especially for the misophonia that you can suggest. Really need the help. Thanks
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Dear Maimuna
Your treatment is best left to the ENT specialists. Betaserc is licensed for vertigo. However, it is a safe drug, so you could ask your doctor to put you on it on a trial basis.
Best wishes.
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Dr Lee,
My mum was diagnosed with radio necrosis on her brain caused by earlier radiotherapy carried out on her brain metastatic from breast cancer.
Are you able to provide consultation or second opinion on this?
Our neuro only prescribed her with steroid now but we would like to explore more options.
If yes, kindly contact me for further discussion.
Many thanks.
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Dear M Low
This complication is handled by the radiotherapist in consultation with neurosurgeon. Please consult your mother’s doctor if you wish to seek for 2nd opinion.
Best wishes.
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Dear Dr Lee,
My father named Ong Chu who is a post stroke patient and had a seizure couple of weeks ago. He consulted you last Sat at Alpha for migraine treatment and relief. He was prescribed a 3-week course of Lyrical. However, the medicine doesn’t seem to relieve his pain. He get very frustrated when he is suffering from the pain. We also noticed that his memory is getting worse.
I would like to seek for your advice if he could take meloxicam 7.5mg or any painkillers to relieve or reduce his migraine.
Hope to hear from you soon. Thanks Dr Lee.
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Dear Ms Ong
Medications like Lyrica take some time to take effect. In the mean time your father can take pain killer such as Meloxicam.
Best wishes.
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Dear doktor, anak saya mengalami benign rolandic seizures. walaupun setiap hari makan ubt carbamaz
epine tetapi sawan ketika permulaan tidur tetap terjadi 4-5x seminggu. sawan berlaku 10-30saat. Apa pendapat doktor. sy merasa sedih dgn keadaan ini. Terima Kasih doktor….
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Encik Kamal
Ada sebab-sebab tertentu kenapa sawan tidak berhenti:
– Diagnosis bukan sawan
– Punca sawan bukan Benign Rolandic Seizures (BRE), iaitu syndrom epilepsi yang lain
– Ubat Carbamazepine tidak diberi dengan dos yang betul
– Jenis BRE yang serang anak anda perlu ubat epilepsi yang lain daripada Carbamazepine.
Sila rujuk kepada pakar kanak-kanak mengenai isu-isu di atas.
Semoga mencapai suatu penyelesaian.
Terima kasih.
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Dear doc,
I’m Arfah and I’m 16 years old. Idk why but i’m suffering with colours in my life.
1)Everytime i open books i see colours on letters and numbers and shapes. It makes me hate math so much because it make my head dizzy. i don’t like it very much.
2) I can’t tell left or right but i can tell the directions with days ex: Go straight and turn “monday” and my friend just like ‘ What the heck you’re talking about’?
3)I don’t like squeky chair cause it “taste” horrible. Yes taste it
4)Everytime i hear sounds ex: guitar it taste like blue. When they asked me, how it taste? ” I just blue. it’s a blue taste” . See, i can’t describe the taste. Unthinkable taste to others
5) Please people , everytime i cross streets please don’t horn cause it is horrible colours.I sometimes turn down car radio volume cause it so bright
6) I have severals paintings of songs. I painted what i heard
This is very hard for me cause i see colours everywhere and can’t tell the colours same what others see(colourblinded?) . Of course my friends call me crazy.Some of them said i have mental disorder (but i’m not). I talked to my biology teacher and she said maybe something wrong with the brain. So maybe you can help me?
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Dear Arfah
Your experiences need further analysis for accuracy. Nevertheless, what you describe may well be an extraordinary ability in which the five senses intermingle, called “synaesthesia” http://news.bbc.co.uk/2/hi/health/4375977.stm
You can consult your family doctor if you need confirmation.
This condition is NOT and illness and I very much much doubt if you are crazy.
It may turn out that this “gift” will make you creative and achieve more with your life.
Best wishes.
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Hi doc,
My dad has been suffering from epilepsy for more than 10 years now and he has been on medication ever since. But lately we noticed that the attacks were quite frequent as compared to before (almost 3 to 4 times a week). We arr clueless on what could be the cause, perhaps insufficient dosage or lack of rest. What do you suggest on this? Should we go and meet the specialist to seek for further advice?
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Dear Nabilah
Your Dad appears to have late onset epilepsy. It would be good to know what is the cause, so that you know what to expect of its future development. Common causes are an old stroke, scar from infection or injury, and disturbances of body metabolism. Once stabilised, it is unusual for fits to get worse if the underlying condition is not advancing (e.g. scar).
The usual triggers for increase in fits are exhaustion, stress, sleep deprivation, interference of medication effect by other drugs (drug-drug interaction) or supplements, and diarrhoea/vomiting.
If this is not the case, adjustment of medication doses may be considered.
Alternatively, change to newer drugs may provide more effective seizure control.
Best wishes.
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Thank you so much for the detailed reply doc. Much appreciated
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Dear Dr Lee
I am a 58 year old Chinese woman. I have this generalised tremor (whole body) : arms hands, legs, face muscle, chest muscle – all visually obvious and severe. People hugging me can feel me trembling! I am a professional and can still function mentally with NO deficit. Only problem is trying to write and text in fact feeding myself is a problem with this severe tremor; awfully debilitating. I am wondering if this may be an onset of Parkinsons Disease.Will be most obliged if you can advise me
Many thanks
Mrs Lee
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Dear Mrs Lee,
Tremor may be due to conditions other than Parkinson’s disease, some of them having a benign course.
You need a clinical evaluation, perhaps supplemented by tests, in order to arrive at an accurate diagnosis. This will allow for appropriate guidance for prognosis and treatment.
Do see your GP for a neurological referral.
Best wishes.
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Dear Dr
I have a condition of chronic pain in my right side radiating to the feet. The pain area is from the back , pelvic , buttock , hip joint and insertion of the feet. Each step I walk is like sending electric shock to the feet. like some wire being electrocuted. I was admitted in pantai in 2013 and The MRI and CT scan showed negative on everything related to orthopedic problem. So i given 13 steroid injections and lumbar symptectomy. Despite the painkillers and medications I still had same problem till now and it got gradually got worse. So I started going to KL GH and with only doing an xray the doctor diagnosed its Spinal Degenerative Disease. So I am not sure what is my exact problem as I am not properly diagnose for further treatment. I have tried therapies, yoga, ayurvedic, acupuncture , Chinese mediaction but all gives only temporary relief. at times the pain switches sides to the left with the same amount of pain. This debilitating oain has changed my lifestyle and im not working at the moment due tot he extreme pain 24/7. I’m in a quandary to what to do next . Thanks DR .
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Dear Anjali
You have a complex situation where the cause of chronic pain is unclear and the standard pain therapies are not successful. If the CT and MRI were “negative” for spinal disease, it is not so likely that the X-ray would refute these results.
Now that you have a situation where it has been deemed impossible to identify the source of pain (and thereby tackling it), you would then have to focus on managing the pain itself. KLGH has a comprehensive pain service which I believe would have all the modalities needed for your treatment.
Finally, controlling the psychological component of the pain suffering is important at this stage. Do work with the psychologist on this.
Best wishes.
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Dear Dr.
Am taking methycobal for my spyres problem.
leg bottom heel pain when walking.
wonder methycobal helps. Am using plastic sole inserts in shoe when walking
regards
chang
.
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Dear M Chang
Methycobal is used as a general purpose nerve tonic. Your spine problem, once confirmed, requires specific treatment according to medical advice. This may take the form of any or all of the following: postural adjustment, physiotherapy, exercises, medications or surgical procedures. If you have pain in the soles on walking, this may be either a separate foot problem or alternatively, a complication of the spine condition.
Please consult your doctor for more precise advice and prescriptions.
Best wishes.
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hv a nice day dr lee,
saya disahkan oleh dr pakar saraf
bahawa saya mengalami penyakit hemifacial spesm.antara solution nya samada treatment botox ataupun pembedahan.ada tak rawatan pembedahan di klinik dr Lee.
thanks for yr feedback.
nazri-puchong
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Dear Encik Nazri
Memang rawatan Hemifacial spasm adalah botox (untuk kes sederhana) dan pembedahan (kes serius yang tidak dikawal dengan botox).
Rawatan biasanya disyorkan selepas kajian kes individu yang terlibat.
Best regards.
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Hi Dr.Lee
Sudah 2 bulan saya mengalami simptom terasa pusing2,mual,terasa susah bernafas.Adakah ini vertigo?
Adakah vertigo boleh di ubati? Dr.Lee ,ada tak apa2 cadangan bernas untuk saya. 😦
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Hi Syazwan
Antara punca simptom anda adalah vertigo, hyperventilation atau pun penyakit yang lebih serius menglibati otak. Oleh itu, sila rujuk kepada Doktor Keluarga (GP) untuk tujuan penilaian peringkat awal.
Kebanyakan kes Vertigo adalah kerana radang “vestibular neuronitis” dan penyakit telinga.
Best wishes.
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Hi Dr Lee. Yesterday night i began have this numbness feeling at my butt area. Feel weak, numb and a bit pain while i squat. Hard to sleep since yesterday. May I know what is the problems and solutions? Thanks and very well appreciated.
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Dear Hin
Thank you for your enquiry. Your symptoms need further assessment with clinical information and examination. Your first stop should be your family doctor. He/she would be advise if there is any cause for concern.
Best wishes.
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Hi.i’m suffering from brain fog,short term memory loss,sleeping problems and waking up in the morning,gastritis,thin saliva ,and frequent headache.i don’t know where to seek help from and how.please guide me.
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Dear Ummay
Your symptoms may be due to a variety of causes including brain disorder, medical illness or extreme stress.
Do start by consulting your family doctor for guidance on your treatment, and whether specialist referral is needed.
Best wishes.
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Hi Dr Lee
Do you treat cases of epilepsy? We found that our 6 year old child is displaying symptoms of seizures similar to symptoms of “absence seizures” which we read is a mild form of epilepsy. We are concerned and wonder on the treatments if any for a minor. Your reply and recommendation is most appreciated.
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Dear Jo
Thank you for your enquiry. Your child’s symptoms can be confirmed or refuted by doing EEG recording. He/she should be seen by a paediatric neurologist (I treat adult patients).
Do consult with your GP, or you can look up the National Specialist Register https://www.nsr.org.my/list1view.asp?page=1
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Noted and thank you so much for taking the time to reply to us.
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Dear Dr Lee,
I’m 27 years old. Recently i often headache and difficulty to breath. Sometimes will feel dizzy also. Wishes to seek for your opinion what should i do.
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Dear Ms Ooi
Your symptoms are nonspecific and may be due to a variety of reasons ranging from over-strain to more serious medical or neurological conditions. Since you need further assessment, you are advised to see your family doctor for initial check up.
Best wishes.
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dr lee,
saya ada penyakit nf1,dan berumur 31 tahun,
biji biji di badan semakin banyak,dan plexiform ada di tepi mata..
apa pendapat dr tentang rawatan nya..
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Hi Aliju
Tumbuhan Neuroma perlu di assess. Ianya mungkin perlu dibedah jikalau berdekatan dengan organ yang penting umpamanya orbit mata, saraf yang penting dll. Harus menguruskan pertemuan dengan pakar neurologi untuk nasihat yang wajar.
Best wishes.
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Dear Dr.Lee,
I have a friend. He is 42years old. He got a second stroke attack, which happened three months after the first stroke attack. There is blockage in the brain stem that caused limited movement of the right side hand and leg. A week after the second stroke, he carried out the DSA procedure. What I want to know is:
1. How is the possibility for a stroke patient to get recovery as before the stroke attack?
2. Could you please give me some medical advices about what we should do to get recovery?
3. I ever heard about stem cell that can regenerate the damage cell. How is the possibilty of this stem cell procedure and how about the cost compared to the possibilty of healing stroke patient?
4. What is the do'(s) and don’t(s) for a stroke patient to prevent the possibilty of the subsequent stroke attack?
5. How DSA procedure helps the stroke patient?
Appreciate your kind advice. Thank you very much Doc.
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Dear Yanthy
Appreciate your concern for your friend who is a case of Young Stroke. To answer your queries:
1. Recovery from Stroke depends on the cause, size and location of the area of blockage, and whether there are any other illnesses. In the past, there was a “rule of thirds” with stroke – one third will die; one third will be left permanently disabled; and one third will recover. With modern treatments, the outcome should be more positive than previously.
2. Once stabilised, therapy consists of medications and physiotherapy. The underlying cause (if detected) also needs treatment.
3. Stem cell treatment for stroke is under active research. As of now, the results are still unpredictable, hence it is not approved for routine treatment outside of research studies under experimental conditions.
4. This goes to (2) – treat the underlying cause, if it can be identified.
5. DSA is a radiological investigation to locate the position of any blockage or other abnormality of the blood vessels supplying the brain.
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i been suffering with migraine about 6 years and it getting serious, i did look for many medication but still not really work for me.
I did when to specialist at hospital, the doctor advice me to get ‘sibelim’, at first it works and can rest well for my sleeping. it medicine took around 2 or 3 years but now seems like not work to me anymore, but if i stop it, the migraine will keep attack me. so i still continues this medicine everyday with 1 tablet
last year i went to china, and the china medical doctor gave me 2 boxes of medicine for 3months, he said will fully recover after the treatment. It is really works, i stopped migraine attack for 3 months and later when i stopped the medicine, it comes back.
Currently i go hospital for acupuncture once a week for 3 months, but still didn’t see the improvement much.
And now hope you can help me, and give me some advise, Thank you
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Dear May Yee
If you have been confirmed to suffer from migraine, it is necessary to determine the reason(s) for its relapse. If these cannot be eliminated, then prophylactic (preventive) medications are helpful. Beyond Sibelium, there are a number of effective medications. Do consult your specialist again.
Best wishes.
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Kepala saya sakit sudah kurang lebih 5 bulan ini. Setiap hari bahkan setiap jam, sakit seperti ditekan-tekan diatas kepala Dan terkadang seperti ditarik-tarik dari sisi atas Dan samping kepala. Serta seperti rasa diikat. Dalam posisi tidur pun saya merasakan sakit kepala ini. Tetapi walaupun sakit, saya tetap bisa tidur dengan pulas walau harus menunggu dalam waktu agak lama untuk jatuh tertidur. Sakit apakah saya? Dan apakah saya bisa diobati?
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Cik Nirmala
Antara punca sakit kepala adalah penyakit yang ringan seperti Migraine dan Stress. Bahagian kecil disebabkan jangkitan kuman, radang saluran darah atau tumbuhan tumor. Oleh yang demikian, Puan dinasihat jumpa dengan doktor supaya diuruskan penyiasatan medical yang sesuai, dan terus menerima pengubatan yang tepat.
Salam.
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Dr Lee,
Lately I was diagnose from my dental surgeon with Trigeminal Nerve Palsy. Half my face encounter numbness (feeling like after dental work done n those drugs abt to wear off but exactly off) 1/2 my face, gums n palet is affected. The worrying issue is I had subdurial haematoma n bengnin hypertention diagnosed 13 yrs back. Recently 2 yrs back i had an implant ..all of these are on the same side. I am also a breast cancer survivor.
Would u be able to recommend any advise or recommend any medical help. I have been on a form of steriods for the last 3 weeks..which i hope its not a long term.
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Dear Angie
You have quite a complex set of issues which require a thorough clinical evaluation. Do request your dental surgeon to refer you to the appropriate specialist in your area. You need to establish whether there is any serious medical condition or not.
Best wishes.
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Good day! My father ages 74 is suffering trigeminal neuralgia for more than 3 years. He is now taking a medicine named “carbamazepine” (1 pill, 2 times per days), recommended by doctors to control the pain, but the result is not so good.
I was understand from doctor, “carbamazepine” is the common medicine used for trigeminal neuralgia, if the medicine does not work any, the surgery is the only option.
I would like to seek for advise on the alternative options, beside “carbamazepine” and surgery. If surgery is the only option, how much is the cost for this type of surgery.
Kindly advise.
Thank you!
Regards,
Kelly
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Dear Kelly
carmbamazepine is one of the first line medications indicated for Trigeminal Neuralgia (TN). There are a number of other medications which can be used for control of the neuropathic pain. If and when there is failure of medication control, surgery can be considered.
Best regards.
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Dear Dr. Lee: One of my family member having OCD, Schizophrenia & Misophonia, I have checked through the online web that EEG treatment would be an effective way for treating these disorder problems. Please advise whether will it possible to fully recovered after the treatment?How many session of EEG needed? Please let us know, so that we can contact you for this EEG treatment. Thanks!
Best wishes,
Christy
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Dear Christy
Thank you for your enquiry.
EEG (Electroencephalography) is a diagnostic tool designed to record brain activity. It has no applications for treatment. It is licensed by the Ministry of Health strictly for diagnostic purposes only. In other words, EEG is not permitted for any treatment indication.
Best regards.
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Dear doctor. My mum was admitted to GH taiping on Friday night due to stroke, bleeding in left brain. She was transferred to Ipoh GH for opeartion to clear the bleeding and reduce the pressure in her brain.
She is awake this morning, we are planning to transfer her to private hospital in Taiping ( preferable ) , or Ipoh. So you have any suggestions to that?
Thank you .
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Dear Giselle
Your doctors in the Ipoh/Taiping area are familiar with the local facilities and therefore are in the best position to advise on which hospital should take over the further care of your mother.
Best wishes for her recovery.
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Dear Dr Lee,
A very good morning to u doctor.
Actually, I’m at my wits end as to where to go for help. I’m a diabetic for 4 years now and have been having cervical spondylosis for the past 23 years.Then about 1 year back I was diagnosed having lumbar spondylisis.
Lately, about 3 weeks now I noticed my legs were swollen and the pain is so excruciating. I was given medication for diabetes with all the nerve suppliments but it only worsens. I also have sciatic nerve pain that travels all the way down to my knees and toes. This time I truly need a nerve specialist who I believe will not do any guessing work on my symptoms.
Dr Lee, please help me get the right diagnosis and treatment. I’m having nightmares about losing my legs due to nerve death. Thank you.
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Dear Santhi
Your symptoms require a thorough analysis for proper diagnosis and formulating treatment. Do request your doctor for referral to a specialist. He/she would be in a better position to decide which specialty department should be called upon.
Best regards.
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Dear Dr. Lee,
My father just had a spine surgery on 20/5/2015 because of compression. He is having pain on his shin and a bit on his thigh after the surgery. We have returned to the surgeon and met a few doctors but no one could firmly diagnose whether his pain is a muscle pain or nerve pain. This seriously affect his recovery process.
Could you help us on this ?
Thanks !
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Dear M Lee
The surgeon who operated on your father is in the best position to answer your query about the pain. Was it present before the operation?
The surgeon would have (1) assessed him pre-operatively, (2) performed the technical operation and (3) monitored the post-operative recovery. Do request for follow up assessments and any relevant tests to determine the cause.
Best wishes.
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Hi…dr.lee…
Suami saya umur 38 tahun pernah terkena pukulan benda tumpul dikepala bagian belakang.bbrp tahun kemudian ada reaksi tangan kram jarinya kesemutan sampai ke lengan lama kelamaan badan ikut jadi kaku.dokter menyatakan dia terkena penyakit parkinson.diberi obat stalevo,sifrol dan arkine dan reaksinya membaik.tetapi jika obatnya telat diminum atau tidak minum obat badannya kembali jadi kaku.sekarang reaksi yang nampak sudah parah karena muncul gerakan2 yang sulit untuk dikontrol.sering merasa sakit dikepala bagian belakang hingga ke leher. Apakah ada cara penanganan yang llebih baik yang tidakbisa menimbulkanefek yang besar? Terima kasih.
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Puan Metty
Jika suami dipasti terkena Penyakit Parkinson, ubat anti-Parkinson akan membantu. Akan tetapi, apabila kesan ubat telah habis, gejala Parkinson akan kembali.
Jadi, suami harus makan ubat seperti dinasihat oleh Doktor. Ubat boleh diubahsuai oleh Doktor sampai gejala Parkinson dihapuskan.
Best wishes.
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Dear Dr Lee,
When I was 28 years old, I had hemorrhage and diagnosed AVM. Since then I’m having epilepsy till now. The AVM had been excised in 2009, right side weak, but epilepsy still occurs in 2-3 weeks once.
Because of regular of fits, dr increase my a dosage of Keppra to 1.5 g bd. however this situation remain same. I have tried many additional AED in additional of Keppra, but can’t tolerate to the side effect.
Previously, after seizure I was able to recover and move around in 30 mins. In April, I start to on Gabapentin, but because of slurred speech, body lost coordination and insomnia, I stopped Gabapentin in June.
Recently the latest few times, it’s getting worst, I have severe fit, I lost my cognitive, not able to talk and lost memory after the fit. It takes whole day to recover.
I feel something not right with me, my vision and hearing like cover with fog, and sometimes blurred too. I find I’m hard to concentrate, to read and comprehend even two sentences and easily diverted to blank state, previously didn’t experience it.
Is it caused by stopping Gabapentin? I went to see a private neurologist today, the dr just give me Tebonin. My GH appointment on December, the nurse didn’t allow me to arrange the appointment earlier than that but told me if any emergency just go to A&E.
How can helps with the seizure? EEG helps my condition? And how much it cost? I hope it doesn’t cost too much and really hope I can afford it. I’m staying in Ipoh, I am tired of my condition without work and life, it’s been 8 years and it’s getting worst. I can reach with my email.
Thank you very much Dr Lee. God bless.
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Dear Adam
In cases of epilepsy, EEG is important to document whether a person’s symptoms are due to seizures or some alternative cause. Examples of these are low sugar, stress, and nonepileptic seizures (NES). If indeed seizures are active, then you would be in discussion with your neurologist about which is the appropriate drug(s). Choice of drug is based on the type of seizure, age, presence of other illnesses and other determinants such as body weight, occupation and allergies. Your doctor would be in the best position to advise.
Best regards.
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Dear Dr Lee ,
My little brother , aged 13 is currently in hospital . He has been beaten up in the head and doctors said he had severe injury in head and right hand side brain damaged . Doctors said he will be in coma stage for 6 months … I just wants to ask if he could recover back to normal or is there any ways to cure him ? Please advise …. Thanks .
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Dear Jay
The doctors who are treating your brother would be in the best position to provide prognosis for his chances of recovery. Do consult them for regular updates in order to track his progress.
Best wishes.
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Hi Dr. Lee,
My father has been diagnosed with PSP. As the name predicts, the progression of the disease is rather fast and we have seen him deteriorate in the pas 6 months. He has been seeing his neurologist regularly, who has prescribed him Levodopa. We’ve noticed the med does help with the falls but it doesn’t prevent them altogether. The reason Im writing to you is to inquire 3 things:
1 – He is currently in Canada, I am thinking of asking my parents to move to Malaysia because of the weather ( winters can be rather harsh and given his condition, its not safe for him to be walking out on ice). Before i think about this any further I need to be certain if there are any neurologists who specialize in PSP here? Also What kind of help / facilities are available here for him?
2- He has been on Levodopa for just about 8 months now. Will he be able to find the right medication here? The last thing we want is for another round of experimentation.
3 – Are there any treatments ( I understand there is no cure) in Alternative medicine, particularly in Chinese medicine for his condition? While we are not ready to experiment with chemical compounds, we are open to natural alternatives. In fact Im hoping there is a natural alternative.
Please advise.
Thank you
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Dear Ms Fariha
PSP is indeed a tough condition to manage. There is variable response to levodopa so it is worth persisting. You need to work with his doctor to increase the dosage to the maximum tolerated.
The pathophysiology of PSP is still not understood so there is no obvious “target” to form the basis for drug development. To date, no other drug (Western or Eastern) or surgical therapy has been proven to be of benefit.
Nevertheless, significant relief can be obtained from physiotherapy and gait and balance training.
There are specialists in Movement Disorders serving in Malaysia. Though the climate is pleasant and warm, there is no evidence the weather has any effect on PSP and we do see substantial numbers of PSP patients.
Hope this helps.
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Thank you Dr. Lee, Do you have a clinic in Downtown KL? or would you be able to recommend a specialist – the best in town. He will be in Malaysia within the next 2 months. I want to make sure i know who to take him too once he is here.
Thank you,
Regards,
Fariha
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Please see your email for a personal reply.
Best wishes.
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what would be your call on the possibilities of cure for TLE, as i’ve read few neurological calls+posts in saying that it is incurable; period…:)
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Hi Dr Lee,
I am having tremor over my head neck and shoulder for certain time, especially during eating or writing while sitting. The shaking seem worsen when I’m nervous. Is it the sign of essential tremor? It’s been a long time and it’s affecting my daily life and work. Where can I seek for medical help? How can I reach you?
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Dear lee
Tremor analysis requires study of the tremor characteristics, considered in the context of the person’s age, medical background and occupation. Your GP can provide a preliminary assessment and provide guidance for the next steps.
Best wishes.
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Thanks for the advice. How can I make appointment with Dr Lee?
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Hi, you can contact the clinic at the tel. nos. on this site.
Best wishes.
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Hi Dr, a colleague of mine just found out that her twin daughters aged 5 have been diagnosed with Neurofibromatosis. She needs to see a specialist for this matter. Can I recommend to her to pay you a visit?
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Dear Kiran
Your friend needs to consult with a Paediatric Neurologist, since I care for adult patients.
You can search on the NSR site http://nsr.org.my/list1view.asp?page=1
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Dear Dr. Lee,
My elderly father in Ipoh has abnormal gait, mild dementia, occasional incontinence.
Would it be best to see a Geriatrics doctor or a neurologist?
He is also very stubborn and has been refusing to see any doctors. If possible, please advise on what we should do to convince him to see a doctor.
Thank you.
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Dear M Lo
Well trained doctors in either specialty would be able to assess your father’s problem. The goals are to identify a treatable condition, if any, and then to improve function, whether the cause is advanced age or medical illness. In the initial phase, he will need tests which can be arranged by any kind of specialist. Since he dislikes medical encounters, it may be more important to select someone he can relate to. Other patients have been reassured by being told that the proposed visit is a routine check up, and then it is up to the doctor to engage the patient using his/her experience with difficult situations.
All the best.
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Dear dr.lee , nama saya su.. saya didapati menghidapi migrain yang kronik. Hari2 kepala saya rasa berat dan vertigo .. rasa terlalu pening sampai nak pengsan ,, semua testdah dibuat mri, ct scan dan lumbur punture.. semua adalah normal.. pls help me
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Dear Sandhya
Sekiranya telah disahkan diagnosis adalah Migraine, makin kes yang serius perlu mengambil ubat pencegahan (prophylactic). Sila rujuk kepada pakar neurologis untuk cara pengubatan ini.
Best wishes.
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Hai dr. Lee.. im sumitra.. i ada sakit kepala kronik… segala test dan mri ct scan adalah normal.. lumpur punture test pun dah dibuat didapati normal… saya terasa hari hari sakit kepala .. dan rasa ayun badan dan terasa terapung .. kedua dua kaki saya rasa terapung dan melayang masa posisi tidur dan bersandar .. minta advice … i dah pernah ambil ubat amytripline .. tapi ianya tak berkesan dan terus mengalami kesakitan yang berterusan… pls advice me.. i nak buat appointment dengan kamu dr.lee.
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Dear Sumitra
Sekiranya tiada response selepas mengambil ubat 1st Line Therapy, boleh dipertimbangkan consultation di klinik kami. Sila rujuk kepada nombor talipon di laman web.
Best wishes.
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Hi Dr.Lee,
My mom(61yo) she is having very bad pain in both legs at night. Can’t sleep well. The pain only at night. She taking pain killer bt the pain killer doesn’t work fully. Please advice.
Thanks Dr.lee
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Dear Visnu
Your Mom needs to be assessed by her doctor to find out the source of the pain. Causes include amongst many others, circulatory problems, joint disorders, neuropathy and Restless Legs Syndrome. Each of these conditions requires specific treatments. Her doctor may recommend specialist consultation if indicated.
Best wishes.
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Hi dr lee
I am 42 years old. I develop pain on my right side of my body.
I wish to know the source of my pain. Symptoms are
1) trigger point pain on my head right temple
2) trigger point pain on my neck and shoulder right side
3) trigger point pain on my lower pain pain, right side
4) hip trigger point paint, right side
5) ankle stiffness and certain area with trigger point pain, right side of body
6) knees stiffness
7) Overall feeling weakness on lower part of body fr knees to ankle due to prolong muscle stiffness, joint pain, and poor circulation and pain effect of the whole right side of the body.
Just to check, are you the doctors I should see?
Last the doctors classified my symptoms as mayofasiol pain put I think my symptoms is more than that …. So I wish to find out more so I can be treated properly
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Dear Dr Lee,
I father is 72 years old and had been diagnosed as PSP in 2014 and currently he is on Madopar 250 mg BD. His fall is still frequent , i.e once a week. His speech had slow down and he speaks softly.He can walk with assistance. Able to eat by his own but he l get’s choked in between his meal after hs cough to clear he will continue his meal.
Appreciate your professional opinion on acupuncture treatment for PSP . Will it help to slow down the progress of PSP.
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Dear Jothy
Acupuncture is not standard treatment for this neurodegenerative condition. In specific cases, it may be helpful for relief of muscle pain. As for the tendency to choking, this may indicate early malfunction of the airway protective reflexes and consequent risk of aspiration of food into the lungs. Do discuss with your doctor whether swallowing assessment is needed.
Best wishes.
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Dear Dr Lee,
My friend is having a problem regaring bell’s palsy.Wat is the immediate action i should take? please hel me…
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Hi Dr Lee
Both of my parents complain pain at the back of their right big thigh. My father says he has difficulty lifting up the leg and it’s worse when he wakes up in the morning. Is that your specialty or should I bring him to see a bone specialist? Many thanks.
Regards
Amy
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Dear Dr Lee
My son is 6 years old and has suddenly started having tics. It is not very severe but certain days at certain times it gets bad.
Can you please advice me what i can do to help him. Do i need to change his diet? Do i need to avoid any certain type of food?
Do you also see patients with tics? If yes, can you please tell me where are you based.
Hope to hear from you soon.
Thank you.
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Dear Kavitha
Tics are common in young children and most are benign. In some cases, stress may trigger the tics.
You should first consult your son’s paediatrician, to get an opinion on whether further assessment is necessary or not.
Best wishes.
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I brought my dad to see you, for a few follow ups after he had a surgery done in Pantai due to an accident which till today we are unclear of, as there was no signs of an accident. You mentioned he had an atrophy to the brain. Which the hospital did not immediately detect, as they did not do a CT Scan on his brain when he was brought into the ER – however decided to make more money out of it, and put him through surgery.
This site speaks about your expertise in Parkinson, which I highly doubt now. 4 years ago you were unable to advise you of the possible options of why his movement, speech was deteriorating, but proceed to prescribe Neurobion. 6 months ago, he was diagnosed with a rapidly declining Parkinson, where the signs were obvious 4 years ago.
You have just wasted 4 years of my dad life, and today he is in a CCU, while the family wonders what could have possibly saved him before.
I believe now that Malaysian doctors don’t genuinely care about their patients. Every consultation I attended with him, made me think less of you as a doctor at that time as I was not sure if you were just not interested in helping him or if you were just a racist doctor.
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Dear Dr Lee,
Hi, I am 38 years male having giddiness/imbalance/vertigo problems as well as headache (area above left ear) and the following is what happened to me last year, currently I am suffering the chronic major symptoms as described below:
1.I had ONLY one episode of vertigo attack in Aug 2013, happened in midnight and the vertigo just last for about one minute followed by very intense dizziness and nausea, and vomited badly. Bedridden for 3 days and ever since then I always feel dizzy (to the extent of feeling nauseous), lightheaded, and off-balance during walking (even within short distance of 100m), particularly feel dizzy if I move my head in different positions along walking (such as looking left and right when about to cross the road, or turning my head to the back when doing reverse parking, or even looking at mobile phone screen when walking), rocking feeling when in still. All these symptoms are 24/7 and still exist even after one and the half year from the first episode of the vertigo attack.
2.Feeling like I am moving even when I am not (such as when stopping the car in front of traffic light). I can even feel dizzy if watching my kids jumping on the sofa.
3.Feeling very dizzy and unbalanced when I move my eyes quickly, or if there are lots of things moving around in my field of vision, for example, will get very giddy when watching some cars moving very fast in the TV show, or sometimes might feel dizzy in a busy supermarket/shopping mall.
4.Feeling head pain and very discomfort feeling 24/7 at the area above the left ear and the back part of left brain. When I put my hand on the area where I feel pain , I can feel it is like jumping up and down.
5.Feeling of motion sickness (like just step out from a boat) most days.
Several tests have been done before:
1.MRI and IAM for brain: Result is normal
2.BPPV check: normal
3.Saccade test/Gaze Test/Tracking Test/Optokinetic Test/ Roomberg Test/ Bithermal Caloric / Fuduka Stepping test: Results show potential bilateral vestibular weakness
Medicine taken before:
1.Betaserc: 4 tablets per day for continuous 6 months, don’t see any improvement
2.Tebonin: 120 mg per day, just started for one month
I have consulted five ENT specialists but none of them is able to advise what actually went wrong except one doctor advised it is most likely the after effect due to acute vestibular neuritis but he further commented that the compensation should not take longer than 6 months. All ENT only prescribed betaserc to me so far no other type of medicine given to me.
As I am feeling very depressed about this problem and it has affected my work and personal life. I am afraid of traveling and I am not able to have any physical exercise at all. Way too sensitive to any movement which can easily trigger intense dizzinessI would like to know if any further investigation to find out the root cause of my dizziness can be done in Dr Lee clinic .
Looking forward to receiving your advice.
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Dear Mr Tan
Analysis of your complex situation requires a thorough evaluation of your clinical status. Arriving at an accurate diagnosis may or may not need further testing.
Causes to consider include cerebellar conditions, stress and post vertigo anxiety.
Best wishes.
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Dear Dr Lee,
Thanks very much for your medical advices, I really appreciate it. I desperately like to know the root cause of dizziness and imbalance , and believe that a thorough evaluation at your clinic is essential. I have made an appointment to consult you face to face on 18th Dec at Sunway hospital.
Once again thank you Dr Lee.
Regards
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Hi iam having the exact symptom of yours my result are normal .mri shows i have cervical spondylosis c4,c5,c6 have slight degeneration.
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Hi Dr. Lee,
My wife was experiencing right eye bottom part twitching for about a month already, I would like to seek for your generous advise on possible treatments and diagnosis? We had been visiting few doctors and they say it might been caused by stress. We are based in Kuala Lumpur.
Thank You.
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Dear Eric
Muscle twitching around the eye can indeed be caused by stress and fatigue / eye strain. More precise diagnosis requires a proper clinical assessment.
Best wishes.
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Hi Dr. Lee,
I’m Whitney, now i facing vertigo problem since last year november. The problem is cause me inconvenience on my work. I cant concertrate 100% on read something, always forget and very hard to think. Sometime will feel dizzy…
My problem become seriously on May 2014, the vertigo will happen a week a time or two week a time. I been in and out hospital for so many treated. MRI taken, result is sinus problem. Blood test normal. My Sinus OP just completed on 23rd Oct. Unfortunately, the happen came over on this Monday evening.
Is appreciate doctor can advise me.
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Dear Whitney
It is not possible to provide sensible advice based on the information provided. You should discuss with your ENT specialist about the persistent symptom. Other causes of giddiness include migraine, stress and anxiety.
Best wishes.
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Dear Dr. Lee,
My friend (31 years old) was admitted to hospital on 7/10/14 for dengue. She was discharged the following week. However, she was admitted again on 17/10/14 for severe fever and was in ICU for 4 days (she was in coma). After she was transferred to the normal ward section, she could not remember things, could not walk, and could not urinate/defecate. The doctor said she was experiencing the effects of a virus infection of the brain. She is still in the hospital (KPJ Kajang Hospital). She has regained her memories and could walk a little. However, she still has difficulty urinating/defecating. She has to use a tube and pills to help her to do the 2 things above. She has the urge to urinate/defecate but she just couldn’t without the use of tube or pill. Her doctor was at a loss. Her hands also tremble at times and the headache that has been plaguing her from the day she has dengue has not ceased. She now wants to seek a second opinion. However, she is not sure if she should see a neurologist or an urologist. What do you think, doctor?
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Dear Esther
For someone who was in coma, your friend has responded remarkably well to her treatment.
She should discuss her queries with her doctor, together with the need for further referral to other specialists.
It should be noted that recovery from such a severe attack of dengue will take time. This includes regaining control of the bladder and bowel functions as well as relief from the many post-infectious symptoms.
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Dear Dr. Lee,
May i know which field of specialists to refer?
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Dear Esther, your friend’s doctors would be in the best position to recommend any specialist referral.
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hi Dr. a very short question if u dont mind : do u treat/diagnose chronic fatigue syndrome ?
would appreciate a lot if u can reply me..
thanks
Jacob
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Dear Jacob
We don’t manage chronic fatigue syndrome. You could consider consulting a rheumatologist.
Best wishes.
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Dear Ms Lee,
I am Sri wijaya 44 Years Old, Male from Indonesia, since a last 3 months a go, i feel my head always dizzy and it is like vertigo. i cannot concern to read something, always forget and very hard to think. Last week i check my blood pressure 170 – 90 and the doctor give me medicine, now become 130 – 80.
Can you advice me your address seem i like to meet you for direct consult
thanks
Cheers
Sri wijaya
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Dear Wijaya
Thank you for the enquiry. If you need a neurological assessment, please contact my clinic staff at Sunway Medical Centre by phone (numbers are on Contacts page of our website) or email us at sunmedneuro@gmail.com.
Best wishes.
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Dear Dr Lee,
My name is Girija. my mother is 69 years old. she was diagnosed with parkinsons 4 or 5 years ago. she is slowly deteriorating.
she used to be a very active person but is not able to do anything now days. its heart breaking to see her that way.
I feel that she is not improving because she has not seen the right dr. but i cant afford to take her to a big establishment like Sunway Medical.
is there any other clinic that she can see you at that would be more affordable?
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Dear Girija
Your mother can be assessed in an outpatient clinic like Alpha Specialist Centre (contact is on website). For info, the costs may not be too heavy if she does not need complex tests or procedures.
Best wishes.
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Dear Dr Lee,
My wife is always feel headache, dizzy and vertigo. Sometime her foot like no function she can’t walk at all. It happened 3 times in the past 1 week. We been went in/out hospital but examination show everything was normal. She often unaware of doing something, For example while working she will out of sudden walk around doing something unusual action like scolding people, looking for something missing etc.
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Dear Mr Teoh
It is not possible to be exact based on the limited information you have provided. Your wife’s doctors would likely be looking for unusual forms of seizure in which awareness of surroundings is altered. If the tests are persistently normal, they would probably then explore the psychological angle.
Best wishes.
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Dear Dr.Lee,
My brother has been admitted to GH Kuala Terengganu on 7/9/2014 until today due to infection in his brain. Doctor confirmed that he has meningoencephalitis. Unfortunately doctor, to date, there is no sign of recovery. At the moment of typing this, my brother’s temperature has gone up again to 38.8. He has difficulty in breathing and on oxygen support. His eyes are still looking up. Initially his brain pressure was 45 according to LP result. However it has gone down to only 38 based on second LP result. His blood pressure is very high, 171-198 over 100-120. Right now he has phlegm and been coughing. FYI, he was intubated on 11/9 and extubated on 16/9. Below is brief chrono of what’d transpired:
7/9 – Fever. Severe headache. Doctor gave panadol. Drip. Normalsaline and antibiotic doxycline.
8/9 – still in pain. Continue with same medication. Add injection, ceftriaxone.
9/9 – still in pain. Same medication
10/9 – still in pain. Developed mental confusion. Odd behaviour. Eyes were looking upward. Undergo CT scan. Result shows brain swelling. Doctor gave injection, acyclovir and injection mannitol
11/9 – Developed seizures. Brain pressure was 45. Admitted to acute stroke ward. Patient intubated. Doctor conducted LP. Continue with medication, injection ceftriaxone, injection acyclovir and injection mannitol.
12/9 – 16/9: Intubated. Patient was extubated on the 16th. Patient is having phlegm and started to cough. Suffering shortness of breath. Before patient was extubated, second LP was conducted. Brain pressure only went down to 38. Same medication was given. Blood pressure is very high 171-198 over 100-120. Although fever has subsided, patient was sweating heavily. Oddly, left side of the patient’s body is colder.
17/9 – Mannitol discontinued. Patient is now given azetozolamide. Patient has slight fever and developed headache. Also shows sign of developing seizures. Doctor gave injection velium. Patient has difficulty breathing. BP is still high. Patient not showing any sign of recovery.
Patient was also given flagyl
It is heartbreaking to see him like this doctor and we felt like he has not been given the care and attention that he deserves despite his critical condition. We are thinking of transfering him to KL to seek for better treatment. We are wondering whether there is a chance for my brother to recover and honestly we are not given a satisfactory explanation. even the answer to every question was vague. we also would like to know whether the treatment is what it is supposed to be. Really2 hoping for your reply. This is indeed a difficult time for us
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Dear Rifhanrozi
Very sorry to hear of your brother’s devastating illness. From your info, the diagnosis of meningoencephalitis seems to be appropriate. It is not proper to provide advice without examining the patient or access to the medical records. Having said that, the treatments provided appear to be thorough and in keeping with practice guidelines for this condition. It is impossible to guarantee good outcome in this serious condition. Prognosis depends on the causative organism and the patient’s state of health. Risk of death can be up to 50% in the best centres, and those who survive have high chance of permanent disablity. It looks like your brother is not fit for transfer over long distance. Since he is receiving quality treatment in Terengganu, this should be continued. If he needs neurosurgery to relieve high fluid pressure in the brain, I am sure this will be arranged.
Best wishes.
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Dear Dr. Lee, thank you for your repy. A lot has has happened within the 2 months. Currently my brother is 100% awake. He was in coma/vegetative state for quite some times and the doctors (despite having some hopes), based on his previous condition thought it was very unlikely that he’d get out from the vegetative state. Miracle is definitely the most valuable gift that only God is able to provide. My brother managed to come out from the veg state and he is now 100% aware. His cognitive ability seems intact (he can recognise faces, he can read, he can spell, etc). His kidney is functioning again. He is now able to move upper part of his body slowly. He can now lift up his hands. Tho he still can’t lift his body up but we can see progress. However he is unable to feel lower part of his body. His temperature sometimes would go up to 38. But after that it’d go down to normal again. And he is still on ventilator. He is also unable to breathe on his own. Doctors are trying to wean him off from the ventilator gradually. But he’s still weak to be able to breathe on his own. So everyday he’ll undergo a breathing exercise. Since my brother now has gotten bck some senses, he can feel the pain around his neck where the trache is placed. He is also not able to swallow the secretion due to the trache.
Our concern is Dr., for this type of cases, how long does it usually take for a patient to be able to breathe on his own? What are the factors to be considered? What actually causes the difficulty in breathing? We noted that his brain stem and right side of the brain are severely affected based on the MRI report.
Moreover, what is the process of rehabilitation when one’s brain/nerve system is severely affected? Is there any good supplement that can be given to a patient to stimulate the growth of brain’s cell?
Appreciate ur reply Doc. Thank you so much
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Dear Rifhanrozi
It is a miracle that your brother is awake.
It would appear that the breathing problem is due to damage to the brainstem control of respiration.
Extent of recovery is determined by the degree of nerve damage; the rate of improvement is unpredictable.
The doctors have been doing all the right things to rehabilitate him. Good nutrition is obviously necessary; there are however no proven supplements to speed up his recovery.
Do allow space for the doctors to care for your brother. What you can contribute are your love and prayers.
All the best.
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Dear Dr Lee, a year ago my dad had multiple infarcts in the brains and his sight was affected (he had double vision). He has since regained his sight but not his mental state of mind. We have visited you once as he was complaining of extreme sleepiness and wanted to seek clarifications on his condition which you have clearly explained to him that his “multiple” infarcts were so minute that he was not required to be hospitalized. But there was an inconclusive observation on his shaking fingers, which you mentioned that will be addressed later. Along the way he was diagnosed with myasthenia gravis (currently on mestinon) and over these few months he complained of his shoulders were numb and we noticed he had trouble swallowing / and slurred speech. Recently he had frequent urination problem (could be due to his diabetes)
it would be great if you could advise me on what I could do to make him feel better. Should we address his shaking fingers ? I’ve told him that we will be visiting you soon.
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Dear Ms Lim
A number of illnesses are mentioned in your update. It is therefore not possible to provide advice based on this limited information. Let us study his options after your father has had a clinical assessment.
Best regards.
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Dear Dr Lee,
I need help or solution, Am a student of Infrastructure University Malaysia, I have been passing trough pains of life for 15 years now. Is it seizure or epilepsy or what? It has all the symptoms of Epilepsy but it happens only when am sleeping(ones a month or twice a month) never happen to me while am awake. I do everything in life that other normal human being do. I drive everyday, i swim always, i cook, i climb mountings and trees.I did MRI test and Brain Wave test but all the result is negative, both epilepsy and seizure and others. I have been receiving treatment only on taken tablet(CARBARAZEPIN) with UKM Hospital in Malaysia for 2 years now but no changes. Pls i need your help, solution or next option my studies has been disturbed.
Thanks.
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Dear Geoffrey,
Your doctors have decided to treat your attacks as seizures with antiepileptic drug (AED), i.e. Carbamazepine. If there is no improvement, the possibilities are (1) the medication is inadequate in dosage, (2) it is not the correct choice of AED for your type of seizure, or (3) the diagnosis is not epilepsy. At times it can only be decided with certainty with a video EEG recording. Do please discuss these issues with your doctors.
Best wishes.
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Dear Dr Lee
I would like to get your kind opinion on my mom’s parkinson disease. Doctor diagnosed her to have parkinson since last year, whereby her hand shaky and struggled but still can walk. I give her medicine call “Sinnemet” daily and also send her fisio to control it.
Last week she was brought to hospital due to fever and now was recovered, problem is laying 4 days straight on the bed without any movement have make her unable even to stand now, let alone to walk. May i know why it’s getting worsen? Is it somemore neuron has been effected that make her unable stand ? Or is it plainly 4 days without any movement caused it ? Really hope you can provide opinions.
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Dear M Chew
PD can be worsened by many factors including concurrent illness, prolonged bed rest, change in the medication schedules or feeding patterns, etc. You should consult her doctors for an appropriate solution so that she can revert to previous level of functioning.
Best wishes.
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Dear dr lee,
Dokter nama saya lussetiadi dari indonesia sudah terkena stroke 6 bulan dan akan bertemu dokter nanti di tgl 1 juli 2014. Semoga dokter bisa berikan treatment terbaik buat saya. Help me please dokter…
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Dear Encik Lussetiadi
Laporan penyiasatan darah di Sunway Hospital segalanya telah disahkan NORMAL. Maksudnya, tiada risiko dijumpai, yang mungkin menyebabkan stroke akan berulang.
Setakat ini, dengan cara fisioterapy dan rawatan ubat, Encik Lussetiadi telah mengalami progress menyembuh. Jadi kita harap penyembuhan akan bertambah lagi pada masa hadapan.
Best wishes.
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Hi Dr Lee,
Just wanting your opinion. One of my relatives has Parkinson’s and lives in a country in SE Asia that doesn’t offer DBS. If this relative had the ability to stay in Malaysia for long periods of time and attend follow up with you every few months, could DBS be an option if she was an eligible patient?
Thanks,
Fahim
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Dear Mr Fahim
Thank you for your enquiry. Yes, the situation you described seems to be workable. Do let us know if there is a decision to opt for DBS.
Best regards.
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Dear Dr. Lee,
My name is R Lee from Indonesia. I would like to ask for your kind favour to sort of giving me some advise with regards to my medical problem. I am experiencing a pain in my scrotum, it started when I had my haemorrhoid surgery in 2009, the surgery brought problem after a week. I could not defecate and I returned to the doctor and he did some small surgery which ended up by giving me a pain in my coccyx. The pain lasted for two years.After that I started feeling painful in my scrotum. But when I masturbate the pain was relieved, and it occurred every 2 days. Now it is almost everyday I have to masturbate to relieve the pain. Fyi, I have visited 2 urologists in Penang and they confirmed that I have no varicocele problem which was different from my Indonesian doctor’s diagnose asking me to do the surgery for the varicocele.
Can you please provide me an advice regarding to my health problem? is it a varicocele problem? or Should I make a further check up for it? And if I have to make a check up, should I find a neurologist instead of a urologist?Pls adv and thank you very much.
Best Regards,
Lee, R
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Dear Mr Lee
I am sorry to hear you have a complex problem arising from the pelvic region. This may require advice from the colorectal surgeon or urologist, not the neurologist.
Best wishes for a solution to this pain.
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Hi Dr. Lee,
My brother in law sustain thigh muscle atrophy since 2002. Now he still manage to walk but unable to stand up by himself.
I would really hope can get any respond from you about information such as possible recovery treatment , etc.
Best regards,
Marcus Wong
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Dear Marcus
Atrophy of the thigh muscle may be due to either injury or nerve and muscle diseases. He will need a clinical neuromuscular assessment by a neurologist, followed by blood tests (muscle enzymes, inflammatory markers, etc) and probably nerve conduction studies and electromyography.
Prognosis for recovery depends on the cause, as well as the duration of disease.
Best wishes.
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Good day Dr.Lee,
Thanks for your reply.
As per reply from Dr, duration of my relative for this atrophy did affect the chance of getting recover. It had been 12 years since discover the infection, for your opinion, is they any chances? I know further analyze needed to give a correct estimation, but as per doctor experience, anyone can recover back after a 10 years atrophy who did not receive proper treatment in hospital.
Thanks and regards,
Marcus
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Dear Marcus,
It is not possible to be comment on the outlook for recovery, since the diagnosis is unclear. You are right to surmise that chance of recovery is lower with prolonged delay in treatment.
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Hi dr
I read about tic and Tourette syndrome. I notice that my 6 yo son has all the symptons. It started a year ago.
Should I see pediatrician first or neurologist.
Tq.
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Dear Puan Anida
The spectrum of Tics ranges from benign transient habit spasms to Tourette syndrome. You are advised to first consult your son’s paediatrician who is familiar with his motor and social behaviour during his development. This doctor is in the best position to detect any deviation from normalcy.
Subsequently, the need for Neurologist opinion can be determined.
Best wishes.
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Hi Dr. Lee,
My uncle recently had an episode of Subarachnoid Hemorrhage. He had a coiling procedure done on the aneurysm detected and is now recovering. Right now, the doctors in the hospital are attempting to put his blood pressure under control. His motor, cognition and learning ability post-stroke have yet to be assessed.
My family member would like to appoint a doctor for follow ups regarding his recovery after being discharge from the hospital. I believe that this case is both CVS and CNS related. Do you specialize in this? Or rather, can you recommend any other doctors who specialize in this field?
Thank you in advance!
Regards
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Dear Kordelia
Every patient’s situation is unique. The follow up treatment depends on your uncle’s clinical status, area of residence and medical facilities located close by.
You are best advised to consult his doctors for the most appropriate after-care for him, post-discharge from hospital.
Best wishes.
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Dear Dr Lee,
My mother is having tachycardia problem since 20 years back. Last year, she had an operation on Electrophysiology and Radiofrequency ablation of Tachycardias.
After the operation, the fast heart beat problem seems like going to worst then previously. Before operation, it was happened few months once, but now it is happened so frequent and it may up to twice a week.
Can I know your advice on this. Or could you recommend any experts who treat this condition?
Thank you and All the best.
Caren
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Dear Caren
Besides tachycardia, a perception of “fast heart beat” may be caused by stress/anxiety. Your mother needs to be evaluated whether the tachycardia still persists post-operation. If it can be ascertained that the heart rate is now normal, her doctors can look into other causes. Medications can allay the sensation of palpitations.
Best wishes.
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Dear Dr. Lee
I want to ask about nph (normal pressure hydocephalus. How to distinguish it from Alzheimer’s or other illnesses? Is it risky thing to put shunt? My father have diagnosed with parkinson in early 2000, In April 2013 he suddenly unconscious. Until now he cannot communicate with others and almost sleepy. Glaucoma in the right eye. Our neurologist doesn’t agree about shunt. How the way of thinking to handle this kind of condition.
Drug list :
Neuroaid (3×1)
Zeufor(2×1)
Aricept 10mg(1×1)
Exelon patch(1×1)
dylantin (150 mg in the morning, 200mg at night)
keppra (3x 250 mg)
salt capsule 500mg (4×2)
gabus fish oil for albumin (3×1)
Thank you
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Dear Yohanes
Diagnosis of NPH is based on a set of clinical criteria, taken together with characteristic features on brain scan. The scan will distinguish it from Alzheimer’s Disease. Usually the neurosurgeon will provide advice on the treatment after joint consultation with the neurologist. Sometimes it may be decided that measurement of CSF pressure or trial of CSF drainage may aid further in the diagnosis.
Do please discuss your concerns with the relevant specialists, with regard to the diagnosis and appropriate treatment for your father. It is worth checking whether the drowsiness might be related to sedative effects of medications.
Best wishes.
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Dear Dr. Lee,
diagnosis : stroke ?
normal presure hydrocephalus ?
early aging ?
neuro degenerative ?
last stage parkinson ?
condition : his consciousness still the same, there is no clearly improvement
the question : How should we do ?
The story :
My father was born in 29 October 1943. He was diagnosed with parkinson’s in early 2000.
The attack (sudden drop / cannot talk / cannot stand / unconcious) happened at April 2013 in Lembata, East Nusa Tenggara. We allowed to take him to Kupang, East Nusa Tenggara at May 2013 by local doctor. And after 12 days treatment in Kupang General Hospital (a.k.a Prof. Johannes Hospital), we allowed to go to Surabaya. In June 7, 2013 we arrived in RKZ Hospital Surabaya (a.k.a St. Vincentius a Paulo Hospital Surabaya) and get treatment until July 22, 2013. And until now we have regular visit to dr. Paulus 2 week/ 1 month with laboratorium check.
In Kupang doctor found seizure sign and gave him phenytoin 3×1 and diazepam when needed. In Surabaya at June 13, 2013 there was seizure attack (whole body) and doctor gave him valium and dopamin. And arrange Keppra 3×1/2 and dilantin ( 150mg morning, 200 evening) and dilantin injection if needed.
His condition now is sleepy with no interaction with others, cannot talk, can swallow but using feeding tube, his eyes can open but almost sleep along day, his hand and foot movement is strong (before is weak and cannot stand but can move hand and foot slowly). He can be seated in a wheelchair by others. He cannot roll by himself while sleep and cannot sit by himself. He react when we touch or move.
His right eye diagnosed with glaucoma in October 2013.
neurologist medication :
neuroaid 3×1 (three times one capsule daily)
zeufor 500mg 2×1 (change from brainact 500mg 2×1)
Aricept 10mg 1×1(night only)
exelon patch 5 (one time daily in the morning)
dilantin (morning 150mg, night 200mg)
keppra 500mg 3x 1/2 (three times in 250mg doze)
salt capsule 500mg 3×2
oil from fishing cork to increase albumin
eye doctor medication :
hialid 0,1 eye drop (four times a day, right and left)
timol 0.5 eye drop (twice a day, right and left)
azopt eye drop (twice a day, right and left)
If there any suggestion for medicine or action we can use to improve his condition? And what is his conditiion analyse?
What we should do? Any new drugs or technology in medical? Thank You.
Our neurologist does not agree with surgery. So we don’t call the neuro surgeon when still in the hospital. After that a neurosurgeon said nph other neurosurgeon said early aging. When we came to hospital it is stroke.
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Dear Dr. Lee,
My name is Eric, a 28 years old Indonesian male living in Jakarta, Indonesia. I am currently experiencing several symptoms for about 2.5 months now (starting from early November 2013). The symptoms are: (a) itchiness in my left index finger, (b) severe weakness in my left leg, causing me a bit limping and not able to run, and (c) sensation of burned or like stung by needles in my left stomach, a little above the waist, that comes and goes frequently. Those symptoms appear gradually, first one was symptom (a), then a week later symptom (b), then 2 weeks later my left stomach was starting to feel itchy then became symptom (c).
I went for consult with a neurosurgeon and one neurologist in Jakarta, Indonesia, and they both diagnosed me with Multiple Sclerosis (MS). I have had MRI scans for cervical, thoracal and brain MRI/MRA. The MRI scans show that i have one lesion in my right brain, two in spinal C5 and C7, as well as in thoracal (not quite sure of the details in thoracal).
I would appreciate it greatly if you can advise me on whether those really are MS symptoms, or is it too early to tell? If it strongly indicates as MS, what is the best course of treatment? The doctors i went to have told me to get steroid treatment with interferon. I am still considering to get second opinion from other qualified doctors (maybe abroad), and i was hoping you could help me.
After 2.5 months now, although the symptoms are still there, they are not as damaging/severe as the first month. Despite the ongoing symptoms, i have been working as usual in my profession as a lawyer (who deals with quite stressful matters), and i was quite a heavy smoker (one pack every two days) until i get diagnosed.
Looking forward for your kind response. Thank you.
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Dear Eric
It is not possible to make a definite diagnosis without clinical examination and view of your scans. One can only say that based on the information provided, multiple sclerosis (MS) is a reasonable conclusion. If in doubt, you could consider getting second opinion.
A definite diagnosis is imperative for planning of treatment. The MS guidelines recommend early treatment to prevent continuing damage to the nervous system. Finally, you should be aware that MS attacks are often brought on by stress (via disturbance of the immune system).
Best wishes.
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Hi Dr. Lee,
What treatment can be used for CIDP?
How much does it cost?
Chances of recover high?
Do you provide any treatment for CIDP?
Thanks!
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Dear Sir
Every patient’s case is unique. If you are being assessed by a neurologist, he/she would be in the best position to answer your concerns about confirming if the diagnosis is CIDP, and if so, what is the appropriate treatment.
Best wishes.
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hi doctor,
abang saya adalah penghidap kencing manis sejak umur 7 tahun. semasa umur 28 tahun, dia telah bermula dialysis kerana hanya 20% buah pinggang dia berfungsi. umur dia sekrang adalah 32 tahun.
2 hari lepas, dia telah kehilangan penglihatannya. selepas menjalani rawatan di hospital kerajaan doctor telah menyatakan (suspect) ada gumpalan darah dia saraf melalui CT scan.
mohon nasihat dan maklumat dari doctor untuk pakar atau hospital yang bersesuaian untuk merawat abang saya.
sekian terima kasih.
dev
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Dear dr lee,
I have a problem with my hands where they always shaking. This problem happened since i was at the age of 17. And now i am 20. It is hard for me to do my work especially when it comes to writing. As a student, i have to write a lot. Due to this, it also gives problem to my lecturer to read my handwriting. When i was in stress, it became worst. My question is, is it parkinson? Can it be cured?
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Dear Nur
Tremor may be due to common causes such as stress / anxiety, physiological tremor and essential tremor. At your age, the likelihood of Parkinson’s disease is extremely low. You should see your GP for assessment, and you will be advised on whether specialist opinion is needed.
Best wishes.
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Dear Dr. Lee,
I am 38 year old with 2 kids. I am suffering back ache & knee pain for quite some times. It was getting bad until i felt a slight numb on lower back one time while i am driving, I started chiropractic treatment since April 2013. I were getting better for few months. I have no idea what happen, (as there were nothing special happen like i felt down or twisted my body etc), out of sudden, my condition from bad to worst. Now i bend, stretching also the back will pain, my both knee pain for up & down staircase; normal walk the pain is standable; my right ankle is very pain too.
There is only one special happen before all this happen was my period resume after 23 months (from pregnant until it resumed – as i breastfed). I am very confuse and lost. Please advise.
Thank you.
Best regards,
Carmen Ng
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Dear Carmen
Your symptoms at first glance appear to be related to the musculoskeletal system. You should see your GP and get advice about the need for a specialist assessment, and if so, whether it should be rheumatologist or orthopaedic surgeon.
Best wishes.
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Dear Dr Lee
Papa saya baru saja didiagnosa terkena penyakit multiple sclerosis. Hasil MRI nya menunjukkan terdapat beberapa penyumbatan pembuluh darah di otak dan dokter menduga bahwa papa saya terkena penyakit multiple sclerosis
Beberapa symptom seperti sering lelah, kesulitan untuk berjalan, kesulitan untuk menelan makan, suara menjadi aneh etc. Symptom ini kadang menghilang seperti papa saya bisa berbicara normal beberapa saat kemudian kembali menjadi aneh.
Minggu depan kami berencana akan berangkat ke Malaysia untuk menemui ahli saraf dan mencari pengobatan terbaik
Saya ingin bertanya bagaimana pendapat dokter mengenai penyakit papa saya?
Regards
William
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Hi William
Keadaan Bapa agak rumit, hanya mungkin jelas sekiranya ada siasatan klinikal (periksa saraf dan badan keseluruhannya serta keadaan psikologi) tambah mengkaji gambar MRI scan.
Sebenarnya, multiple sclerosis jarang timbul selepas umur 60 tahun.
Sekian, terima kasih.
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Dear Dr.Lee,
Few days ago , my friend has experienced a movement disorder. She woke up one day on her bed and wasn’t able to move her legs, few days later after she went through a rehabilitation session she’s able to walk again but slowly. I’m myself not really sure what is she diagnosed(I believed it was Chronic Fatigue Syndrome, but I’m not sure) with , and I’m very worried about her. I tried asking her about it but I have this feeling that it’s either she doesn’t want to tell or she doesn’t know about what she experienced (some doctors prefer to tell the parents instead) . Lately , her legs begin to stutter(sometimes) and sometimes feels that one of her legs is very tiring and hard to move. Is this something I should be worried about doctor? Is there some possibility that she is diagnosed with a Motor Nervous Degeneration disease? I’m very worried as she also sometimes tried to act strong.. currently I’m keeping an eye for her from a distance, please help me Dr.Lee , she’s still very young to be diagnosed with such disease 😦
I’m sorry for the emotions involved , but I’m very worried. She’s still very young and haven’t even set for her graduation exam in High School .
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Dear Haris
I can understand your concern about your friend’s condition. However, it is not so likely to be motor neuron (degenerative) disease, since this illness is of slow and chronic onset.
Your friend’s doctor would have discussed her status with her, while keeping her parents informed. Perhaps you can offer her support and help, until she is ready to discuss her condition with you.
Best wishes.
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Dear Dr,
My mother was diagnosed with Parkinsons 7 years ago. At the early stage she was given madopar 1/2 tablets twice a day.To date she is taking stalevo 150mg and 200mg 5 times a day which is 200, 200, 150, 200 and 150 together with pramipexole 0.5mg 3 times a day. Recently her conditions got bad as she can’t walk, or even get up from bed. She has to have assisstance. That lasts till the afternoon dosage which is about 1.30 pm. By 2pm she ok and experiences a mild ‘Off’s during her next dosages which is at 4.30pm and 8.30pm. She is at her worst at the middle of the night when she wakes up for toilet. She is also taking Sinemet CR at night before bed. Adding to that, she is using the Rotigotine Palster in the morning. My mother is having very severe pain from her waist to leg which makes her atanding difficult even when she’s at her ‘On”. This pain makes her ‘Off’ periods worst. Can you please help as is very hard to bring her out to the hospitals.
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Dear Jasimah
I’m sorry to hear your mother is having suffering hardship from Parkinson’s disease (PD). Assuming she is late-onset (after age 50), the condition is usually not so devastating as young-onset PD. Your mother is already on a number of quite new and powerful medications, hence it is not clear why she is getting little benefit.
In such a case, for meaningful advice to be given, there is no alternative to a visit to the doctor, for detailed consultation and clinical assessment to be carried out. For instance, it may be detected that PD is aggravated by other medical conditions.
You may therefore wish to review her treatment with her doctors. Keeping a 24-hour PD diary would be helpful:
Click to access Medication_Diary.pdf
Best wishes.
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Dear Dr.,
Thank You very much for your advice. Just was wondering could this not be Parkinson’s? I wonder… Hope I can make it to see you. I’ll try my best because travelling for my mom is hard.
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Dear Jasimah
To clarify, your mother’s condition does indeed appear to be late-onset Parkinson’s disease.
Best regards.
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Greetings Dr.,
I have consulted you in 2013. my mother have been seeing Dr. Arjun Deepak in India and seems to be OK at first. She was thought some physiotherapy and given Levodopa 165mg 5 times daily, Parkin 1 tablet 3 times, Pramipexole 1 tablet 3 times, and Entacapone 1 tablet 3 times. After a year visiting the Dr, she started having offs which are not predictable (any time) with extra movements(dskynessia). The latest review with Dr. Arjun, he asked her to reduce Parkin into half. A few days after doing so, she is experiencing so many offs at different time in a day and body ache while the offs. I regularly ask her to exercise and walk but he is always hesitating to do so. One thing that I noticed is that when lately she went for a walk after long time not doing, she went into off mode after 20 minutes of walk. After that, whenever she walks, she will become off. Is she deteriorating fast? Is there anything that I can do? Dr. Arjun gave us a letter for us to continue consultation with you. I will find the right time for me to bring my mother as I am working and staying at Penang. Thank You so much for your advices and truly you help a lot. Thank You!
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Dear Jasimah
Any dosage adjustment by your mother’s doctor may require follow up, in order to fine-tune the dosage as well as medication schedule. In the mean time, efforts at exercise will promote general health and release of brain-derived neurotrophic factor (BDNF) in her system.
Best wishes.
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Dear Dr.,
My mum now falls too often (imbalance). Although there are people around her at times but the moment she falls is so unpredictable and we can’t do anything. Dr. Arjun said there’s nothing to be done as this is because of Parkinson’s. I am so worried….Please help
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Dear Dr.
My mother is far more better but the tendency to fall is greater. In fact she has fell a few times. Thank God she didn’t hurt anything that much. Just normal pain. I just want to ask for your advice what can I do to avoid her from falling down. Even when people are around her, we cant predict when she will fall. I’m so miserable and helpless… Please your advice will boost my spirit
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Dear Jasimah
It’s good that your mother is better. Falls prevention consists of improving balance through physio and exercise, and Fall Proofing your home. Some good advice provided here http://nihseniorhealth.gov/falls/homesafety/01.html
Best regards.
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Greetings Dear Dr.,
My mom is an idiopathic Parkinson patient. Recently she had fever and pain at her hips and stomach. She was diagnosed with severe Urine infection. The doctor gave some medication and antibiotics. Before the treatment, she started having very bad involuntary movements until she can’t walk. After the treatment, the fever and pain was gone but she is very weak. She barely can lift her legs to walk and complains of weak grip of her hands to even hold a mug of water. Her speech is also effected and becomes unclear as the words she speak gets halfway. She says she feels short breathed. Any advice. As we are currently consulting Dr Deepak Arjun Dass at Chennai, India, my mother is taking the medicine he have prescribed. Those medicines are not registered here at KKM. We have several times tried consulting neurologists here in Malaysia (Government and private hospitals) yet the medication did not show any difference. What is your advice if I were to bring her to consult you. By the way the medicines she’s taking currently is Syndopa 110mg ( 1 1/2 – 5 times/day), entacapone (3/day), Sydopa CR (1/day – night), Pramipex (3/day) and parkin ( 1/2 – 3/day). Please Advice. Thank you in advance.
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Dear Ms Jasimah
I am sorry to hear of your Mother’s difficult situation. She needs a thorough assessment before any advice can be offered. Her medication schedule appears to be in order, so it is not clear why there is no benefit. If you would like an evaluation, pls contact my staff at the addresses on this site.
Best wishes.
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Dear Doctor Lee
My mum is recently diagnosed with Parkinson by a Geriatrician in Fatimah Hospital, Ipoh. Her MRI show loss of brain cells. It’s early stage and she is only 58 yrs old. She is on low dose medication that is taken twice daily. She has incontinence and recently, she has bout of diarrhea especially early morning. She seems to be not aware and it dirtied her pants though she is wearing adult pampers. By any chance, the diarrhea is caused by the medication?
Is there any treatment that can improve her condition? My brother consulted a specialist in a Parkinson Dept in a hospital in China. He confirmed that Parkinson can be treated/clearly improved via a combination of traditional & western medicine. The treatment will take 15 days to be effective and after which, would require yearly visit only and we are thinking to send her there.
Appreciate your advice.
Thanks,
Wendy
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Dear Ms Wendy,
Early stage Parkinson’s disease (PD) does not affect cognitive function, so incontinence would not be expected.
Your mother needs to have review of her diagnosis to ascertain whether she has either (1) Parkinson’s disease + another neurological condition, or (2) atypical Parkinsonism, a group of conditions with additional features besides slowing of movements.
Treatment can then be planned depending on the precise diagnosis.
Both of the above conditions are managed in Malaysian hospitals. Long term illnesses like PD require more frequent monitoring and a yearly visit to China would seem to be impractical.
Best wishes.
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Hi Dr Lee,
We have shown her MRI to a Neuro Specialist in Ipoh and he thinks that my mum has PSP. I have read about PSP and the symptoms are familiar. She has not started her treatment in China (coz the Dr there thinks she has OPCA rather than Parkinson). I am arranging for her to be back so that we can consult this Neuro in Ipoh. Seems like he can only provide symptomatic treatment. I am staying in KL. Urgently in need of your advice. If she is confirmed PSP patient, would you be able to see her?
Rgds,
Wendy
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Dear Wendy
OPCA is the old name for a form of Multiple System Atrophy, another variety of Parkinisom-Plus syndrome. Therefore if your mother’s diagnosis is PSP, symptomatic and supportive treatment in Ipoh is the appropriate care for her.
Should you wish to bring her to see me, please be in touch with my clinic staff at the contacts provided in this website.
Best wishes.
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Hi Dr Lee,
My mum was diagnosed with Atypical Parkinsonism. Her condition is deteriorating fast. Besides giving her dopamine, is there any other treatment that can ease her condition. I am getting worried.
Rgds,
Wendy
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Dear Wendy
Levodopa does provide benefit for many patients with Atypical Parkinsonism. The other treatments consist of support for the affected systems, whether they be gait instability, bladder control or orthostatic hypotension. Your doctor would be paying attention to these issues.
Best wishes.
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Hi Dr Lee,
She does not have hypotension problem but yes, incontinence is very serious. We are using catheter to help her empty the bladder every 3-4 hours daily. However, she has serious problem with swallowing, often choke, movement is not possible, sudden freeze and etc. Is there any other medications or surgery etc that can improve her situation?
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Dear Wendy
Levodopa confers benefit for stiffness (rigidity) and slowing (bradykinesia) but is not effective for other features of Atypical Parkinsonism.
Catheter therapy is the appropriate treatment for bladder atony.
As for swallowing problem, she should have assessment by speech therapist. Tube feeding may have to be considered if choking poses a threat to life. Once the choking problem is reduced by this method, there will be improved intake of food, much reduction in discomfort and improved quality of life.
You can discuss these issues with her doctors.
Best wishes.
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Dear Dr. Lee,
Can you advise your working hours at Alpha Specialist? I tried going into the website today but it’s down. I would like to bring my dad to seek treatment from you. Thanks.
Mrs. Choong
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Dear Dr. Lee,
My mom is 78 years old and on regular medication for diabetes and high-blood pressure.
She was recently diagnosed to have Trigeminal Neuralgia at V1 and V2 branches. CT scan of the brain does not reveal any anomaly. She had started medication for more than a week now of lyrica (daily dosage 150mg) and tegretol CR/carbamazepine (daily dosage 200mg), and a 3-day dosage of decan (Dexamethasone) (daily 3mg). Medicine was helpful in reducing the pain during the first few days but pain later re-appear in a new facial location (still within V1 branch).
I noted from a discussion forum of a case where anti-depressant Amitriptyline and luvox is prescribed and that neuralgia patient (not sure if it is TN) is off-medication after 6 months. There is also discussion that Gamma Knife surgery for a permanent solution could be an alternative. I am hoping to get some advice and second opinion wrt the treatment direction or if my mom should continue with current medication possibly at a higher dosage. She looked so much in pain when it strikes.
Thank you so much in answering.
Best Regards,
Jake
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Dear Jake
Every patient with trigeminal neuralgia needs individualised treatment with medications selected to suit her needs. That is, there is no one size fits all solution. Do work with her doctor with this medication adjustment.
Neurosurgery and gamma knife therapy are reserved for the rare intractable case where medication has failed.
Best wishes.
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Hi Doc,
I need to seek your professional advise for my wife. She is 28 years of age, she is suffering from series of distraction ( illness ) she got very severe back pain and neck pain. Whole day she feels dizziness, weakness , hard in breathing constantly.Numbness in legs and and hands too. Lately she nasal ear ( around her back of the ear spot ) and numbness at her tongue and the throat. She feels pain at her upper left ribs beside the left breast. Nausea also.
We went to orthopedic and X-Ray her neck, the doc says is scoliosis. We went under some medication for a month but is not helping. We have seen Pulmonologist , Physician and Eye Specialist .
I sincerely hope that you could guide me how to help my wife to see a correct doctor to cure this symptoms and not to stop for a while.
Best regards,
Kenneth
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Dear Kenneth
Your wife has multiple symptoms which cannot be easily pin-pointed to any specific body system. She should be assessed by a general physician. If no abnormality is found, a period of observation may allow the condition to subside or otherwise, to declare itself. Occasionally, anxiety disorder may mimic a physical illness.
Best wishes.
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Good day Doc,
Thanks for the reply. We have seen a GP and he prescribe my wife betaserc 24mg once a day. She has been taking that for the past 3 months. That don’t really help her dizziness,hot sensation and flying sensation. So my wife decided to stop the medication. Is there a possibility that her blood circulation not proper. She get tired very fast and feel weakness most of the time. Please recommend us the right doc to see or we have to see you ?
Looking forward to your soonest reply.
Best regards,
Kenneth
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Dear Kenneth,
I believe you wife’s sickness is due to the back & neck pain. I am currently suffering from stiff neck and I have some of the symptoms that you wife is having. I was given similar medicine by the ENT specialist but it didn’t help. I am currently undergoing treatment for my neck in a spine specialist centre and things have been improving.
I believe your wife must solve the neck & back pain first.
Good luck.
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Dear Dr Lee,
My right eye often twitching and getting worse at some time like when i feel nervous or at bright area, i cant control the blinking and cant hold to shut my eyes really hard..is this blepharospasm ? any treatment ?
Thanks,
Lisa
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Dear Lisa,
Twitching of the eyes may be due eye strain or some forms of involuntary movement disorders. You need to see your GP for assessment, and to be advised on whether neurological consultation is needed.
Best wishes.
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I am Dr . Lee patient in Pantai under treatment for epilepsy and anxiety, and i must say that Dr.Lee is one of the best Neurologist i have ever met.
Regards,
Mohammad Asfoor Rana
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Dear Dr Lee. Out of sudden, my sister felt her left portion face was slightly palsy. She went to consult clinic doctor immediately after this. Dr informed that most prob is Bell’s Palsy. I plan to bring her to consult specialist on the condition. I would sincerely need your advise which field of specialist to refer for this disease? DO you have any recommendation for penang specialist?
Thanks in advance.
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Dear LJK
Your sister should consult neurologist. You can check with our National Specialist Register for those specialists who are in Penang http://www.neuro.org.my/index.php?sc=publication&id=1
All the best.
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Thanks Dr Lee for the advise.
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Dear Dr Lee,
I am currently suffering from stiff neck, back and should pain when I try to turn to left or right. I also experience light headed and footed. During the turning or up and down neck exercise, I experience the “cricking ” sound, stiffness and pain or I had gone to see Chinese physiotherapist in Thong Shin Hospital where I was treated with massage, neck traction and acupuncture. After about 8 sessions, there was little improvement or the relieve was only temporary, I decided to see ENT Specialist in Sunway Hospital where I had CT scan on Brain, X-ray on ear and MRI on neck and everything was normal except my neck is a bit too straight. I was given Nootropil & Betanistine dihydrochloride by the ENT Specialist for the last 2 weeks including regular 3 times a week physiotherapy and again there is hardly any improvement. The physiotherapy said that I have a very stiff neck joints at C4 & C5 which require longer term treatment. My questions are as follows:
1. What is most likely sickness that I am suffering?
2. Should I continue with the physiotherapy and ENT treatment or do I need to get consultation to Neurologist, Orthopedic or Spine Surgeon?
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Dear Ben
It is not possible to make a precise diagnosis without clinical examination. You could consult your ENT surgeon about the need for another expert’s opinion, and if so, which area of speciality.
Best wishes.
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Dear Dr. Lee,
My brother, 32 years old, was diagnosed having syringomyelia, caused by the tumor. Now, he can’t walk anymore, one of his leg is even numb. The doctor advised us to have a surgery to get it removed, but the chance that it will be back is quite high. Could you please give us some advice what we should do? Is surgery the only choice that we have? Because having this kind of surgery isn’t cheap at all in my place (Jakarta). Thank you Dr. for your time.
Regards,
Dreamers
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Dear Dreamer,
Thanks for your email. Here is reply from neurosurgeon:
Intra medullary spinal cord tumors with syringomyelia are usually astrocytomas or ependymomas. Surgical removal by microneurosurgery under Intraoperative neurophysiological monitoring is the best definitive treatment.
In a lot of cases we can see a plane of demarcation between tumour and spinal cord tissue in my experience. The chances of improvement of function of limb power can be expected.
Radiation treatment with Cyberknife is not helpful.
I hope you find these information helpful.
Regards.
Dr. Lee Foo Chiang
MBBS, FRACS (Neurosurgery)
Consultant Neurosurgeon
Sunway Medical Centre
Malaysia
+603-74910777 603-74919191ext 15519
fclee.neurosurg@gmail.com
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Hi Dr,
I had suffered dizziness for all the time. The serious one is few days before my period come. But I don’t know which type of doctor I should consult. Sometimes my heart feel anxious in a sudden then will suffering dizziness.
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Dear Angie
Dizziness can be due to a number of causes such as anaemia, vertigo, low sugar, anxiety, etc. You are recommended to consult with your family doctor, who can advise on the appropriate treatment, and whether any specialist consultation is needed.
Best wishes.
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Dear Dr Lee,
My friend just got accident and now he is currently in Hospital Tunku Fauziah, Kangar. He still alive after the hospital gave shock therapy but he has internal injury inside his skull.
Can you come to Perlis, I will cover all your cost.
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Dear Dr Mk Lee,
My father was in coma since last month 8th May 2013, he was getting 2 head shot through his brain (Brain traumatic injury) in Penang.
The doctor had taken out one of the bullet and some pieces of the bullet but still left one bullet in deeper position which was not easy to take out during the operation.
After the operation he been fever non-stop at (37’C to 38’C) until today.
He had been tried various type of antibiotic and way to heal his fever but failed.
Doctor decide to take my dad so called ‘backbone water’ or lumbar puncture for check what is the root cause of the fever. But end up nothing found.
His eye had start to open but not able to react as what i request to.
I have search in google and find out my father situation are more likely on mild level of coma.
I found out his hand and eye can be move when he is feeling pain.
Doctor was telling me to prepare his bed and suction machine at home, and my father maybe will always need to be like this.
I am not giving up ,try to get more information and looking for any specialist who willing to help my father.
Dr Lee, do you have any idea what is the best way i can do now?
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Dear Dr Lee,
I am a Type 1 Juvenile Diabetic for almost 17 years. Recently, I felt numbness, pain & cold from the right buttock till the upper tight area. I went to see an Orthopedic Specialist last month but he said my pain have nothing to do with slipped disc or any nerve pinching problems. He said it might be due to my nerve very sensitive that might be the cause of these symptoms. He gave me Neurobion & Arcoxia for my pain.
However, my numbness & pain still there. I tried to google on my symptoms & read some article about Peripheral Neuropathy which look like what I am having. I am not sure if this is the problem I am having or I might be having but not sure how severe it is on my case.
I currently in a lost situation on whether I should go back to see the Orthopedic Specialist or a Neurology Specialist on my condition as most article mentioned Peripheral Neuropathy need to see a Neurology Specialist.
While I’m browsing the internet for Neurology Specialist, your website appears and I hope you can guide me on what I should do. Hope to hear from you soon.
Thanks & Regards,
Ho
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Dear Aurora
Your concerns need to be discussed with the doctor who is treating the Type 1 Diabetes. If necessary, tests can then be performed. Numbness and other sensations can be due to a variety of reasons, including neuropathy, and might turn out to be from trivial causes such as transient nerve compression.
Best wishes.
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Dear Dr. Lee,
My 7 year girl is having uncontrollable movements. She started with blinking eye early this year, the nose and mouth. Lately, she starts to have shoulder movement. Is this Tics? What could be the cause? She is a healthy kid since baby. Is there a treatment? Pls advise. Thanks.
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Dear M Lee
Your child’s paediatrician would be able to confirm whether this is a form of Tic Disorder, and whether any intervention is needed (since many cases are benign and transient).
Best wishes.
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Dear Dr. Lee,
Lately, I am experiencing uncontrollable eyes closing while I am driving during day time but once I stopped and get back to house, my eyes get back to normal. I will only experience this condition during day time. Could this be related to focal eyelid dystonia due to daylight? Is there any remedy or treatment for this? Thank You.
Regards
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Dear Ivy
A clinical evaluation would be helpful. Nevertheless, it does indeed sound like you have blepharospasm which is triggered by glare. Some measures which may help:
– Wear sunglasses (wrap-around type)
– Shield the eye area with a hat or sun visor (also good for avoiding sun damage to the delicate skin around this area!)
– Get a heavier tint for you windscreen.
– Minimise aggravating factors: eye strain (prolonged reading, use of tech devices); mental stress; poor sleep.
All the best.
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Dear Dr Lee,
Mr mother (50+ of age) suffers from hypertension for years and she has headache quite often despite the medication that she’s on. In the daytime, she always has ‘migraine’ when she comes back from outside or when she travels to a few places continuously to do her stuff. Sometimes, her severe headache also causes her to feel like vomiting and she needs to take panadol to relieve the pain which is mainly on the left side of her head. May I know if there’s any treatment or test available for her case? Is there a possibility that there are some other reasons or illnesses that lead to her headache? Thank you.
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Dear M. Gan, yes the symptoms could be due to migraine. Your doctor would be able to confirm this. Migraine is diagnosed by a set of clinical criteria. If there is any untypical feature, tests may be advised.
Best wishes.
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Dear Dr Lee,
Wife has migraine for few years and get worsen lately. GP prescribed drugs which relieves it but get it again soon after that…. happens more apprantely around menstrual ( pre or post).How do I help to get this root caused and treated?
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Dear Mr Dass, if confirmed to be migraine, the persistent attacks may require preventive medications as well as thorough study of the trigger factors which provoke migraine in her particular case. Please discuss these issues with your GP.
Best wishes.
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Dear Dr Lee,
My mother suffers from hypertension and she has headache very often, Currently she’s taking Imidapril HCI. She’ll take extra panadol whenever she suffers from severe headache. During daytime, she’ll have headache when she comes back from outside.Is this due to migraine? Sometimes she even feels like vomiting and her ‘migraine’ causes sever pain to the left part of her head. Does she require special treatment or check-up to identify the causes? Is it possible that there are problems other than hypertension? Thank you.
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Hi Doctor,
My mother has Shingles rash for past 7 days and she treated with antiviral medicines. The rashes is getting less. but the pain in nerve is getting more at other parts of her body. The rashes is at the waist, and the pain stated at waist also. But now the pain happen at chest, back and even fingers. Is it something to do with Postherpetic Neuralgia ? Do you think visit a Neurology Doctors will help ?
Pls advise.
Thank you.
Chee
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Dear Chee, the pain is due to acute virus infection affecting the dorsal root ganglion portion of the nerve.
Postherpetic neuralgia refers to pain which persists after the rash has cleared. Your mother now requires medications for pain relief. These can be prescribed by your GP. A neurologist is involved when this neuropathic pain cannot be controlled with standard medications.
Best wishes.
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Thanks Doctor
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Hi Doctor,
I suffered a right stiff shoulder and neck pain 2 years ago. I am now 42. 6 months ago when I went for massage, I was told that my left back was very much higher than my right side. I went to see a GP and was told not to worry as it is just a muscle problem. However lately, about 2 weeks already, I feel numbness on my left hand 2 fingers (Thumb and Index finger) quite frequently everyday. I am worry that this has something to do with my swollen back. Someone suggest me to go for a MRI scan.
Is it the correct scanning for my problem and how much will it cost to do the scan?
Thanks,
Arvin
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Dear Arvin,
Your GP is in the best position to advise on the next step for your problem, including whether a test is necessary and if so, which form of imaging. MRI scan is indicated for specific reasons and the cost varies according to zone(s) of scanning, private or public hospital and location of scanner.
Best wishes.
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Dear Dr Lee,
My mom in law is suffering from Parkinson’s Plus disease for almost 5 years. It seem like nothing we can do for her except taking madopa. Can we make an apointment with you to consult on her current condition?
Regards
Bonnie
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Dear Bonnie,
Please see your email for a private reply.
Best regards.
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My mother in law who lives in Johor who like to visit you to conduct a test to determine if she is suffering from Parkinson’s disease. Would like to normally what are the procedures involved?Basically we like to know how many days she has to be in kl so that we can make the necessary arrangement.
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Dear M Khong, there is no confirmatory test for Parkinson’s disease. It is diagnosed from clinical criteria. Tests such as brain scans and blood investigations may be done to rule out any other condition. These would not take more than a few days.
Best wishes.
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Dear Dr Lee,
I am 38 years old female and I’ve spasm problem with my left face half year ago, doctor gave me APO-TRIHEX medicine but it cannot works and I feel tired.
May I know any treatment can cure my sick?
Your advise is much appreciated.
Thank you very much.
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Dear Willow
The cause of the facial spasm needs to be diagnosed. If it is due to hemifacial spasm, treatment includes medications or Botox injection, depending on the severity.
Best wishes.
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Hi Dr Lee,
I stumbled upon your page as I was looking for neuro specialists in KL. Just half an hour ago my dad had an abnormal episode of just losing himself while watching tv. My father has a history of mild epilepsy since about 20 years ago and has been on carbamazepine tables daily. Now he is on a 200mg dosage daily but so far the most recent seizures occurred last November and just last sunday he had a mild attack again. But yesterday night, while he was writing something on his notebook, he suddenly got up looking for something and when my mom asked me what he was looking for, he did not appear to be responding normally and was mumbling away.. he then just sat on the sofa before falling asleep. Today he was normal throughout the day and while watching the news on tv, again we noticed that he was behaving abnormally, no clasping of the jaw, just staring around and moving his hands before shutting himself out to sleep again. These new developments is causing some worry. I also found out that he just got the new stock of pills last week from the clinic upon finishing the previous pills given.
I would sincerely appreciate if you could advise us on what is best to do at this point of time.
Thank you.
Regards,
Maya
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Dear Maya, your father needs a review of his seizure disorder and reassessment of medications and dosages. In addition, other factors like concurrent medical conditions and medications/supplements could reduce the effectiveness of his seizure medication. Please arrange for him to consult his neurologist.
Best wishes.
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Dear Dr Lee,
Your response is much appreciated. Just this morning he had another episode of abnormal behaviour and it’s high time we do a review on his condition. I have arranged for him to consult a specialist closer to where we are now in two days time.
Thank you.
Maya
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Dear Dr Lee,
Its a pleasure to know of you even though we have never met in person. I and my wife are based in Penang and we have read about your extensive profile in neurology practice and I can’t say the least we are very impressed. We hope you are the right doctor to help us.
My wife, 37 yrs old now, developed brain abscesses in Aug 2010 and traced the source of infection to be infective endocarditis. She has mitral valve prolapse.
She suffered a right temporal celebral haemorrhage due to mycotic aneurysm in Sep 2010 and underwent craniotomy surgery to remove the blood clot and clipping of aneurysm. The haemorrhage has resulted in hemianopia and a mild left hemianaesthesia.
She developed a seizure in Oct 2011 and her epilepsy is currently controlled with Tegretol CR 100/200mg per day.
Since then she has experienced unexplained burning (cutting) pain on her head, neck, & back, mostly on her left side of body and have not responded well to much drugs treatment like anti-epilepsy drugs and anti-depressants (e.g like Neurontin, Lexapro, Ultracet, Xanax, Lyrica, Lignocaine patch, acupuncture etc) so far.
She’s still on Lyrica 75mg per day now and taking Ativan 0.5/0.5mg daily as per needed to help with her pain & sleep.
Lately about 1-2 months back she is also experiencing extreme numbness with coldness to the touch especially on both her limbs (hands & legs) coupled with chronic tingling pain (pins & needles) sensation over her whole body daily the moment she wakes up till she sleeps at night. She had difficulty in balancing while walking as result of the burning pain and numbness in the limbs and also affected her appetite in eating.
She is also having problem with her eye focusing on things and shallow breathing.
We have seen many specialists including pain clinics and they advise this is a life-long pain & recommend her to go for physiotherapy which may take months or years to see any results & may not guarantee any reduction in her pain.
Could all these symptoms be pointing to another unruptured aneurysm or auto-immune disease? Please advise what we can do in the meanwhile, thanks in advance
Yours sincerely,
Daniel
(I can be contacted via my email and we can go visit you if there is a need)
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Dear Daniel, you queries have been dealt with through personal email. All the best.
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Dear Dr Lee,
I notice whenever i use my finger to press on the left head skull it feels pain, is it normal? Beside I do not face any headache. Any recommenation where to do check up.
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Dear Ms Liew, most diseases cause spontaneous pain rather than pain upon pressure. For assurance, a check by your GP should be the first step.
All the best.
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Dear Dr Lee,
My Aunt’s legs have become increasingly weak – she’s 75 years old. I suspect this muscles atrophy may be due to the worsening of a disc bulge. She had an MRI of the cervical and thoracic spine in 2009; findings are as follows: C5/6 reduced in height, with disc bulge, associated mild central canal stenosis and narrowing of the neuroforamina bilaterally, bilateral nerve root impingement noted. C3/4 and C4/5 small posterior central protrusion. L1/2 mild disc bulge, prominent left posters lateral protrusion and annular tear, narrowing of left lateral recess noted.
Although weak, she was still mobile and able to walk slowly on her own. However recently not only has the weakness worsened, she is also experiencing dizziness, which has been diagnosed by the local GP as vertigo. The only symptom is dizziness – no ringing in the ears, nausea etc. This dizziness has affected her mobility greatly as she is no longer confident in walking and would increasingly ask for the wheelchair. I would like to get a specialist’s opinion on this. What would you recommend as the next course of diagnosis/treatment? I’m also torn between seeing a neurologist vs an ENT specialist for the vertigo (my aim is to treat the vertigo and then move on to treatment of muscle atrophy). Would appreciate your advice.
Many thanks,
Ooi.
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Dear M Ooi
Your aunt’s symptoms can only be fully evaluated with a thorough clinical assessment. At this age, she may well have multiple causes for the disabilities. You could certainly start with a proper ENT examination.
Best wishes.
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Dear Dr Lee,
Thanks for your prompt response. Will it be suitable for my aunt to consult a neurologist like yourself for the vertigo? Some people seem to strongly recommend a neurologist for this. If so, then we will be able to follow up with the same neurologist regarding the weakness in her legs. However if this is something not for neurologists, then I will consult an ENT first.
Many thanks in advance,
Ooi.
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Hi doctor lee,
Good day to you. I am your sunway patient Lee Sin Wah daughter. Who admintted sunway medical center at Aug 2012, discharge at Sept 2012, due to stroke. need your advise.
After few months acupuncture and chiropractic, now my dad can sit on the wheelchair. Left and right hand can hold thing. Just till now he can’t talk and turn himself.
Recently, my dad start to learning eat porridge / rice with soup. When we start to feed him, he will open his mount, and start to chewing, sometimes he will swallow. Sometimes can’t. For fruits will no problem on this. It’s because the feeding tube still there? And make him hard to swallow ? When we can removed his feeding tube?
Please give us some advice.
Thanks,
Stacey
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Dear Stacey
It is very good to know that Mr Lee has shown significant improvement. He would benefit from a swallowing assessment so that we can plan a gradual return to some form of oral feeding. The step-up in feeding should not stress his reflexes and risk choking and aspiration into the lungs. In addition, he would need a review of his motor function. We would be happy to see him for a check-up, and this should have swallowing assessment tied-in. If you should decide to do so, please contact the clinic staff to make the arrangements.
Best wishes.
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Thank you doctor! I will arrange the time table with the clinic staff
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Dear dr. Lee
My husband went for spinal cord operation in april 2012 to remove disc at neck part. Before operation his left shoulder was so painful and his left hand numb.
After few months later, he started painful on his neck,shoulder, headache (sometimes), heart pain (sometimes) ,finger numb all the time.
He went for check up and x-ray . Doctor told him everything is fine. But my husband was so painful around the left shoulder .doctor advise him to go for second operation on the shoulder part. But he refused to operation again.
He went for Accupuncture, after few treatments. His headache solve.
Recently his neck is so painful. He went UH .he went for x ray. Doctor said everything is fine. Would be the neuro problems.
Now he is taking painkiller everyday. He is 34 years old. I dont wish he take painkiller for his life.
We need your advice.
Thank you
Regards
Py chong
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Dear Ms Chong, if your husband is suffering from pain and the imaging tests are normal, he may benefit from consulting a Pain Specialist. There are medications and other procedures for pain relief. This service is available at UH.
Best wishes.
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Hi,
I have question around my fast heart beat. My Specialist advice me to see neurologist
Today I had a heartbeat of 115-138 when I was just sitting or laying down and had chest pain, upper left back-shoulder pain and I feel dizzy.
My background situation:
Im 32 years old men with Asymmetrical chest, my left chest is smaller and my right chest bone is bigger. I eat very healthy, fish, vegetables, nutrition and exercise every day.
I exercise 3 times a week for 1 hour intensive weightlifting interval training, all the other days of the week I swim 1km every day.
My average heart rates:
When I exercise my heartbeat is between 120-165…
When I sleep 60-75/ when I lay down 78-95/
when I sit down 95-115 and when I stand without moving around allot 98-125
When I feel stress 128-139
Im concerned about the fast heartbeat, my whole family has a very low heartbeat everybody in my family.
Sometimes I have very slight chest pain and un comfort, like a stinging feeling on my left chest and a bit pressure on my chest and my upper back shoulder. Every once in 2 weeks I get a nerve cramp in my chest…
I went to do full checkup at 3 specialist center and did all following test:
– full blood test (all perfect)
– stress test (very good, achieve level 7 without any problem)
– x-ray (all good)
– Echocardiogram (all good)
– bloodpressure (all good)
– ECG ( all good)
All the 3 specialist told me everything is good can not find anything…
Then I have done a spine adjustment for a few times at Chiropractor see if that helped but very little change average it went down 5-10 beats…so it helped very slightly…
But still my heart rate is fast 95-110 when I sit down average over the week,
But today it was 115-138 and chest, back uncomfort stays…my partner helped me to massage my back where it hurts and my heart rate dropped to 95
One of the specialist told me I can best visit a ELECTRO-PHYSIOLOGIST
What can you advice me? Will this be something you can help me with? Then I would love to come over for consultation.
What can I do to reduce my heart rate? Will this bring me any complications or danger if I keep walking with this fast heart rate?
Can I still exercise? Is this to do with my spine or nerve system? Or any other reasons?
Thank you!!
Frederik
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Dear Frederik,
Since you have been confirmed not to be suffering from a cardiac condition, then do consider whether the tachycardia (fast heart beat) might be due to stress.
If indeed that is a possibility, I would be happy to provide a list of the experts who treat this condition.
All the best.
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Dr Lee thank you so much for helping me 😉 I have done the test and my anxiety is mild.
After doing more test the doctors until now they belief its Inappropriate sinus tachycardia, do ou have experts you can recommend in Malaysia?
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Please refer to your email for a reply.
Best wishes.
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Dear Dr Lee Moon,
I have question around my fast heart beat. My specialist recommended to see a Neurologist
Today I had a heartbeat of 115-138 when I was just sitting or laying down and had chest pain, upper left back-shoulder pain and I feel dizzy.
My background situation:
Im 32 years old men with Asymmetrical chest, my left chest is smaller and my right chest bone is bigger. I eat very healthy, fish, vegetables, nutrition and exercise every day.
I exercise 3 times a week for 1 hour intensive weightlifting interval training, all the other days of the week I swim 1km every day.
My average heart rates:
When I exercise my heartbeat is between 120-165…
When I sleep 60-75/ when I lay down 78-95/
when I sit down 95-115 and when I stand without moving around allot 98-125
When I feel stress 128-139
Im concerned about the fast heartbeat, my whole family has a very low heartbeat everybody in my family.
Sometimes I have very slight chest pain and un comfort, like a stinging feeling on my left chest and a bit pressure on my chest and my upper back shoulder. Every once in 2 weeks I get a nerve cramp in my chest…
I went to do full checkup at 3 specialist center and did all following test:
– full blood test (all perfect)
– stress test (very good, achieve level 7 without any problem)
– x-ray (all good)
– Echocardiogram (all good)
– bloodpressure (all good)
– ECG ( all good)
All the 3 specialist told me everything is good can not find anything…
Then I have done a spine adjustment for a few times at Chiropractor see if that helped but very little change average it went down 5-10 beats…so it helped very slightly…
But still my heart rate is fast 95-110 when I sit down average over the week,
But today it was 115-138 and chest, back uncomfort stays…my partner helped me to massage my back where it hurts and my heart rate dropped to 95
One of the specialist told me I can best visit a ELECTRO-PHYSIOLOGIST
What can you advice me? Will this be something you can help me with? Then I would love to come over for consultation.
What can I do to reduce my heart rate? Will this bring me any complications or danger if I keep walking with this fast heart rate?
Can I still exercise? Is this to do with my spine or nerve system? Or any other reasons?
Thank you!!
Frederik
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Dear Dr Lee,
My mom is 67 years old and she is diagnosed with Cervical Dystonia. She is advised to go for either Botox Injection or oral medication. Can I know your advice on this. Thank you.
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Dear Esther,
Cervical dystonia is managed with medications +/- physiotherapy for any aggravating factor. If this is not effective, the next line of treatment is indeed botulinum toxin (of which Botox is one of the brands).
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dear Dr Lee,
Thank you very much for your reply.
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Dear Dr. Lee,
My husband is suffering on his burning sensation on his right feet for past 3 months. At times he felt numbness too. Have visited Dr.***** at ****** Medical center and he was given Lyrica and Neurobion to consume. It helps for couple of days but as time goes it doesn’t helps as well. Now his left upper part of his feet is having the same problem now.
Please advice.
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Dear Veni
As you know, your husband has improved substantially on treatment for compressive neuropathy caused by strain and over-use.
Best wishes for his complete recovery.
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Dear Dr. Lee,
My mum has been diagnosed Parkinson’s Diseases more than 5 years ago and has been taking the Sinemet (carbidopa and levodopa, MSD) since then. However, she has not taking any MRI scan for brain etc, the diagnosis is just by doctor observation from GP and general hospital. Lately she think that the medicine couldn’t help much as she is having more severe tremor on hand and rigidity on toes that stops her from walking smooth. I would like to visit you for a more detailed checking (recommended by one of your existing patient). Please PM me via email if possible.
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Dear Daphne, please see your email for a private reply.
Best regards.
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Dear Dr. Lee,
I have poor sense of taste and touch since two months ago. I can only recognize food with strong taste like chilli. I felt my body became very light even though my body weight did not drop. When my hand got hit, i can feel a little pain on my hand and the pain stayed only few seconds. I almost forgot i got hit before later on. I recalled it when i found a big bruise (black) on my hand. My Dr. gave me methycobal 500 and neurobion. But it did not improved my situation. I would like to know whether dr can give some advice on my situation. Thanks
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Dear Ms Tee, your symptoms are rather nonspecific and could arise from various body systems. Do consult your doctor for advice about the next steps, such as building up physical fitness, and whether you need medical tests.
Best wishes.
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Dear Dr.Lee,
I am sufering from my left hip joint pain for about 2 months. I was threated by some Docter in Jakarta but it seem not realy cure the root cause of the pain.
My last treament with high dose methil prednisolone was going quit well for about a month but when it went to tappering off the dose, the pain come again.
My queries on how to find the root cause of my pain and cure it
I will be having a meeting in KL, on 6-8 Nov 2012, kindly advise if I can visit your clinic preferably on 6 or 8.
Thanks
Dion
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Dear Dion, please see your email for a private response. Best wishes.
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Hi Dr. Lee,
My husband MRI results show fluid between his brain organ and nerve behind his neck cause a severe giddyness and imbalance. May I know the estimate cost for the operation to take out the fluid from his head? What happen if no operation done at earlier stage?
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Dear Nurul, your questions need to be answered by the surgeon who has assessed his condition. He/she would be able to advise whether operation is needed, what are the benefits/risks and what is the expected cost. All the best.
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Hi Dr Lee
My mother has been diagnosed with neuralgia. I was wondering whether this is within your scope?
thanks.
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Dear Sofia, yes indeed, neuralgia is managed by neurologists. It is also handled by many experienced GPs. All the best.
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i understand you have clinics in both alpha specialist center and sunways.
which would u recommend i make the appointment?
does alpha specialist center has mri?
thanks!
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Dear Dr. Lee: My daughter Tan May May consulted you last November about her sickness (Multiple Sclerosis). She has been taking the Gilenya pills for one year & her conditions remain the same. Please advise whether there are any new developments in Malaysia?However,Canada approves patient study of controversial treatment for MS that involves widening jugular, azygous veins(CCSVI) clinical trial to begin in British Columbia soon.It will take years before May May has the chance for the trial in Canada.If we go back to Malaysia can you recommend her for the MRI; Ultrasound (doppler) in order to find out is there any blockage in her veins? It can be done in BC,but will have to wait for a long time.Please let us know, so that we can plan to go back to Malaysia. Regards, David Tan
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Dear Mr Tan
Gilenya has just been approved in Malaysia.
CCSVI is not accepted by neurologists as having any evidence of benefit. It is not recommended here and there are no initiatives to study it because of lack of scientific merit.
Since Multiple Sclerosis is expected to relapse/progress, therapy which can prevent this is considered to be therapeutically effective. Therefore, please adhere to your neurologist’s advice on Gilenya, which is a valuable and expensive drug.
Do stay positive and hopeful – there are newer, possibly better, treatments in the research pipeline.
Best wishes.
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Dear Dr Lee,
My dad of 72 yro often has tremors in his hands, walks slower than b4 since few years back, numbness in lower leg, has slow urination difficulties, but more worrying had 2 falls backwards while standing recently. We brought him to a private clinic n was told ‘probably’ he’s got Parkinson plus. At this juncture, would u advise for 2nd opinion b4 we start the medication for him as was told treatment for Parkinson is different from plus n didn’t sound convincing or comforting to prompt to start immediately. Thank you very much Dr Lee.
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Dear Monica, in order to arrive at a diagnosis, clinical examination is required. If you are not comfortable with the present diagnosis, a second opinion could provide more certainty so that you can proceed with treatment for your Father. Best wishes.
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Dear Dr Lee,
Please read about this baby named Adam. Can his disease be treated/cured or at least reduce the pain he had to endure? Please help. This is the link http://www.facebook.com/AhmadAdamSyukri/info
Thank you.
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Dear Raudhah, it appears that Adam has suffered brain damage at birth, resulting in cerebral palsy. It may or may not improve as the nervous system grows with age. The management consists of intensive physiotherapy and brain development programmes. These require long term treatment and are best done in his home town. The pain can be relieved with physio and massage, and medications for pain control and muscle relaxation can be prescribed by his doctor.
Best wishes.
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Tq very2 much Dr. The mother was so happy that she cried to hear the answer from you. At least the baby still has hope. All these whiles, the doctors in Sibu hospital only gave negatives comments and seems that they didn’t want to take any responsibilities as the disease was due to hospital negligence during delivery . Only thing we need is hope and now we have that. We will cling on that and won’t give up for this baby sake. Tq again. Btw, what happened to adam’s eyes?
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Dear Dr Lee, my mother of 65 year woke up one morning with the left side of her eye drooping .Had see an eyes doctor who confirm it is nothing wrong with her eye. Please advise what to do or which doctor we can go to in Pj or Seremban. Thank you
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Dear Chris, it is not clear if your eye doctor confirmed there is no medical problem, or that neuro opinion is advisable. You can access the National Specialist Register for accredited Ophthalmologists and Neurologists. Best wishes.
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Dear Chris, it is not clear if your eye doctor indicated there is nothing wrong, or that neuro assessment is needed. You can access the National Specialist Register for accredited Ophthalmologists and Neurologists. Best wishes.
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Dear Dr Lee,
My husband is 34 yrs old. He started having epilepsy 5 yrs ago. His epilepsy situation is lip smacking, which used to occur daily. Then eventually once every 2 weeks. He has done MRI and all the scans at a private medical centre. The neurologist said there is no tumor. Hence gave him medication. But his lip smacking still occurs once in 2 weeks, or the best was once in 4 weeks.
But this epilepsy has affected his life tremendously. We don’t allow him to drive or work. So he just takes care of my son at home, as a home carer.
I am just wondering, under medications, should epilepsy be at least controlled, means no attacks under medication? Can you pls help us, on how we should move forward to help him at least control the epilepsy? I really appreciate your reply. Thank you, Dr Lee…
Liew
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Dear Eileen, from the description, your husband may have temporal lobe seizures. Good control consists of using the right drug(s) at the appropriate dosage and dosing regimen. Perhaps you could start with a review of his medications. All the best.
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Hi Dr. Lee,
I am Ying and I am 30 years old. I grown up with two pairs of uneven eyes where one of the eyelid is slightly dropping and my mouth is slightly twitched. I did ask my parents about this and I had been told that the incident happened on a windy evening when my mum carried me for an evening walk beside a lake nearby our house. If I am not mistaken, I was only one or two years old back then. I cannot recall if I had been treated by any doctor on this, and until today, I am actually unsure of what disease is this which had caused one of my eye to appear slightly smaller than the other and my mouth muscle seems weak and hence it appeared to be twitched at one end.
During my schooling days, unavoidable, some naughty students did make fun of me because I looked abnormal especially when I smiled. After some time, I tend to ignore all the teasing and at some point in time, I came to realise that the unevenness of my face structure had became less obvious – which i do not know why.
I had a medical check-up last year for my new job and the lady doctor asked if I have had palsy problems with my face which I had avoided her question by answering her that I was borne as such. I have been avoiding these kind of questions for many many years due to my low self-esteem. I started to research on the so called ‘palsy’ mentioned by the lady doctor and I would like to take a step further to ask for more advices on my conditions and if possible to undergo treatment on it; or to at least repair the unevenness of my facial espression. Can I then seek for your kind advice in respect of the following?
1. I am not sure what should I do next. Should I have decided to consult a specialist, is it correct for me to talk to a neurologist and if yes, how much will they be usually charging me for consultation and any other foreseeable procedures that such specialist might need me to undergo before he/she came into a conclusion about my conditions?
2. I am not sure if my face can be cured given that no intensive treatment had been taken to tackle the problems since i was young. However, I found some articles talking about botox for treating these kinds of palsy problems on face. Do you mind explaining this to me, as to how does it work? And how much would it cost?
Last but not least, thank you so much for your kind attention doctor. I hope to hearing from you soon.
Regards
YY
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Dear Ying, your condition may be due to facial palsy; a clinical examination is needed to confirm this. The treatment options are Botox or plastic surgery. A preliminary consultation would cost RM 100-200. You could consider seeing a specialist in a government hospital. Best wishes.
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Dear Dr. Lee,
i’m 25 years old, 178cm height and 73kgs weight. i did a functional endoscopic sinus surgery on 11th Feb 2012. A month after the surgery around April i felt very dizzy, blur vision and nausea. I did MRI brain. According to the report, my brain is fine except theres an ethmoid sinus, however my ENT dc said it will drain itself. as for the dizziness, he gave me betaserc 24mg. however the giddiness still there after taking the medicine. I went to see for another ENT doc on early of May and he gave me Betahistine 24mg for 3weeks and Piracetam 800mg (nootropil) for 2weeks. A month after that i went back to see him and he couldn’t figure out why am still dizzy and ask me to go back to see the doctor that brought me for operation or go to seek for a neurologist . Meanwhile, during early of May i started to noticed that i could hear vibration and echo of my voice when i speak and i feel pain inside my ear. I decided to go back and seek for my ENT doc and he suspected that theres virus infection in my inner ear (labyrinthitis) that makes me heard my own voice vibration. I heard the vibration of my own voice through my left ear and after that it seems that my right ear also. He ask me to wait a month and see how. Few days ago i feel that my hand especially my left fingers are numb and i have been experiencing tingling over my hand down to my leg and back too. I feel that my head is heavy too. P/s. I’m still having mild dizziness and heard vibration when i speak and occasional headache.
Appreciate your kind advice.
Thanks,
Simon.
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Dear Simon, as we had discussed, it is possible your symptoms are aggravated by repetitive strain affecting the eyes as well as neck and arm muscles. Let’s review after a period of reduced strain. All the best!
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Dear Dr.Lee Moon,
I’m writing this to you seeking another medical opinion (currently under Dr. *****).. our concerns raised up lately after knowing that our son situation is becoming worse due to more left frontal lobe atrophy compared to the right since 2011..
your kindness is highly appreciated and if you would like us to come to you it will be our pleasure and if not you can recommend a Doctor who you think he/she can help us
BIRTH HISTORY AND PRESENT COMPLAINTS
1. our son (Laith) was born on 25/5/2010 with a complicated abnormal condition .
2. his mother had a miscarriage once before he was born by around a year .. the embryo stopped growing and developing in the second month of pregnancy .. as the doctor said the cause is lack of hormones and a D&C was carried on. His delivery was by C-sec ( breech ) .
3. first months of his life he didn’t cry and if he did it will be without noise .. not reacting to sounds or objects …. But now he is much more better ..
4. as a pediatric doctor told me : even though my son is 14 months old but his activities are as if he is a 6 moths old baby ..
5. now he reacts well to hot & cold objects , reach out to things near him .. but still cant sit or support his back and his head..
6. he seems like a hypotonic baby but he has power .. he grabs things strongly sometimes its hard to take a thing from his hands…
7. he always suffers from constipation.
8. His hearing loss is still sever but better then early months of his life.. ABR and hearing assessment shows that.
9. has a cleft palate (soft palate)and the surgery was done on 4/8/2011.
10. A myringotomy surgery was done on December 2011.
11. pierre robin syndrome was expected by some genetic doctors here , so a primary chromosome study was done and the result was NORMAL .. the genetic doctors told me to do another test which is (Peroxisomal Plasmalogen).. but i didn’t do it yet.
12. we were worried more because his reaction to things around him was null he couldn’t react to sounds or objects specially in his first 8-9 months .. now he is bit improved .
13. eye specialist tests shows that he is far-sighted and the diagnosis shows a global development delay , Hyperopia (+5.00 DS) in each eye and a Cortical visual impairment (April 2011)
14. an Audiology test was made for his hearing showed that his hearing is from moderate to severe and the left ear is worse then the right ear.
15. MRI was done on 28/6/2010 and it shows :((No evidence of SOL. Gray-White differentiation is consistent with age , no abnormal white matter signals , Mild prominence of CSF space in the frontal lobed bilaterally but the gyri are still present , Differential:mild atrophy of the frontal lobes or a variant of prominent CSF. )) and they suggested a follow up MRI scan to be carried on in few months later .
16. he is now 13KG .. and his height is 90CM … he was 3.36KG when he was born – he was delivered by a C-Sec (breech) .
17. ultrasound scan for the KUB and brain was held on 8/12/2010 finds everything as normal.
18. X-ray (Aug 2010) were made for his whole body and it reports that its normal and the Skull (AP) : mandible and the maxilla appear dysplastic , no bony lesion .
19. EEG test (July 2011) was done and it shows that he has Subclinical seizures and no medication is taken for it.
20. ABR (8/12/2011) examination result was: (otoscopic examination indicated clear ear canal and there is no reflexes of light from the ear drum for both ears . impedance audiometry was attempted but the child was moved and cried . review of test and consideration to continue withobjective assessments were explained. Objective test with sedation using syrup chloral hydrate were carried out. Impedance test results indicated type B tympanogram in left ear, consistent with reduced middle ear mobility and type As (shallow) tympanogram of reduced compliance in right ear. It was not possible to elicit the acoustic reflexes by either ipsilateral or contralateral simulation. Brain Auditory Evoked Potential showed sever hearing loss in both ears at least at higher frequencies) …… Note: ABR test was done before the myringotomy operation which took place on late Dec of 2011.
21. Latest MRI (8/june/2012) showed that (there is slightly more prominence of the asymmetry of the left frontal lobe with more CSF surrounding it. This is suggestive of more left frontal lobe atrophy compared to the right since 2011).
LIST OF LAITH’S PRESENT MEDICATIONS :
1. Efalex (DHA).
2. Nootropil (20% oral solution 125ml) .. takes 1 ml once a day (since 26 June 2011).
3. Bio-Quinone Q-10 (Ubidecarenone 30 mg) .. takes 3 capsules a day at once (since 26 June 2011).
4. Vitamins.
5. Has subclinical seizures but not taking any medications for it .. and the seizures are unnoticeable .. he didn’t even take any injections for seizures when undergoing both of the surgeries he underwent (cleft palate & myringotomy surgeries) .
LIST OF ANY ALLERGIES
1. Eating eggs in hot weather develops rashes on the chest.
Yours,
Laith’s parents
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Dear Dr. Lee,
my son is a patient under Dr. sophia i really need another medical opinion here specially that his left frontal lobe atrophy is increasing now more then before .. if you can help we will pay you a visit and if not then you can also recommend a doctor for me …
• birth history and present complaints
1. Laith was born on 25/5/2010 with a complicated abnormal condition .
2. his mother had a miscarriage once before he was born by around a year .. the embryo stopped growing and developing in the second month of pregnancy .. as the doctor said the cause is lack of hormones and a D&C was carried on. His delivery was by C-sec ( breech ) .
3. first months of his life he didn’t cry and if he did it will be without noise .. not reacting to sounds or objects …. But now he is much more better ..
4. as a pediatric doctor told me : even though my son is 14 months old but his activities are as if he is a 6 moths old baby ..
5. now he reacts well to hot & cold objects , reach out to things near him .. but still cant sit or support his back and his head..
6. he seems like a hypotonic baby but he has power .. he grabs things strongly sometimes its hard to take a thing from his hands…
7. he always suffers from constipation.
8. His hearing loss is still sever but better then early months of his life.. ABR and hearing assessment shows that.
9. has a cleft palate (soft palate)and the surgery was done on 4/8/2011.
10. A myringotomy surgery was done on December 2011.
11. pierre robin syndrome was expected by some genetic doctors here , so a primary chromosome study was done and the result was NORMAL .. the genetic doctors told me to do another test which is (Peroxisomal Plasmalogen).. but i didn’t do it yet.
12. we were worried more because his reaction to things around him was null he couldn’t react to sounds or objects specially in his first 8-9 months .. now he is bit improved .
13. eye specialist tests shows that he is far-sighted and the diagnosis shows a global development delay , Hyperopia (+5.00 DS) in each eye and a Cortical visual impairment (April 2011)
14. an Audiology test was made for his hearing showed that his hearing is from moderate to severe and the left ear is worse then the right ear.
15. MRI was done on 28/6/2010 and it shows :((No evidence of SOL. Gray-White differentiation is consistent with age , no abnormal white matter signals , Mild prominence of CSF space in the frontal lobed bilaterally but the gyri are still present , Differential:mild atrophy of the frontal lobes or a variant of prominent CSF. )) and they suggested a follow up MRI scan to be carried on in few months later .
16. he is now 13KG .. and his height is 90CM … he was 3.36KG when he was born – he was delivered by a C-Sec (breech) .
17. ultrasound scan for the KUB and brain was held on 8/12/2010 finds everything as normal.
18. X-ray (Aug 2010) were made for his whole body and it reports that its normal and the Skull (AP) : mandible and the maxilla appear dysplastic , no bony lesion .
19. EEG test (July 2011) was done and it shows that he has Subclinical seizures and no medication is taken for it.
20. ABR (8/12/2011) examination result was: (otoscopic examination indicated clear ear canal and there is no reflexes of light from the ear drum for both ears . impedance audiometry was attempted but the child was moved and cried . review of test and consideration to continue withobjective assessments were explained. Objective test with sedation using syrup chloral hydrate were carried out. Impedance test results indicated type B tympanogram in left ear, consistent with reduced middle ear mobility and type As (shallow) tympanogram of reduced compliance in right ear. It was not possible to elicit the acoustic reflexes by either ipsilateral or contralateral simulation. Brain Auditory Evoked Potential showed sever hearing loss in both ears at least at higher frequencies) …… Note: ABR test was done before the myringotomy operation which took place on late Dec of 2011.
21. Latest MRI (8/jun/2012) showed that (there is slightly more prominence of the asymmetry of the left frontal lobe with more CSF surrounding it. This is suggestive of more left frontal lobe atrophy compared to the right since 2011).
list of Laith’s present medications :
1- Efalex (DHA).
2- Nootropil (20% oral solution 125ml) .. takes 1 ml once a day (since 26 June 2011) .
3- Bio-Quinone Q-10 (Ubidecarenone 30 mg) .. takes 3 capsules a day at once (since 26 June 2011).
4- Vitamins.
5- Has subclinical seizures but not taking any medications for it .. and the seizures are unnoticeable .. he didn’t even take any injections for seizures when undergoing both of the surgeries he underwent (cleft palate & myringotomy surgeries) .
• list of any allergies
1- Eating eggs in hot weather develops rashes on the chest.
yours,
Rafael Suud
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Dear Mr. & Mrs. Suud, thank you for the detailed information. Please refer to your email for a private response.
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Dear dr lee,
I would like to get some advice from you regarding my mum’s condition. She is 54 yrs old. She has been complaining that her nerves in shoulder, arms and fingers experiencing numbness, sore for few years and now she cant fully bent her fingers. Cannot carry too heavy thing, hardly able to hold small thing within fingers. Tried acupuncture, seeked few family drs before. Not improving. Medications prescribed before such as pain killer meloxicam, naproxen. Relieve pain for a while then symptoms still come back each time. I bought her neurobion and viatril-s. condition not improve. My mum got high cholesterol n pre diabetic taking statin n metformin. Last year went for a uterus cyst remove surgery and on hormone oestrogen therapy for few months then now stop taking already. She has been complaining everyday tat the numbness is killing her. I don know how to help beside buying her nerve vitamins like methylcobalamin, lots lots of capsicum/ ketoprofen/detox plaster.
I would like to know if I want to bring her to see dr. Should I bring her to a neuro specialist ? Because some dr say is arthritis, some say is normal nerve damage, ask her don do house work. She went for blood test, the uric acid is within normal range, so suggest not arthritis?
If It under neuro, can I bring her to see u? I really hope u can help me with this cause I can’t find a way to figure it out what’s happening to her while seeing her suffer everyday.
From
Ms addy pang
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Dear Addy, there are some features of arthritis in your mother’s clinical condition, e.g. not able to flex the fingers. Elevated uric acid is not the only cause of arthritis; more detailed assessments and tests are needed. Sometimes dull pain – ache – is inaccurately translated as “numbness”, thereby wrongly implying a nerve problem.
As such, you should ask your GP to nominate a joint specialist, who would be able to confirm or exclude arthritis, before looking for a neurological condition. Best wishes.
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Dear Dr Lee,
I have been experiencing tingling down my left arm. After consultation with a neurosurgeon, he informed me that I have c5 c6 herniated disc that flatten the spinal cord. He said surgery for artificial disc replacement is the only way I will recover. Is this true? Do I have other options?
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Dear Stephanie, for information, your condition is not treated by the neurologist. You need to seek consultation with another surgeon if you wish to explore other options. All the best.
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Dear Dr. Lee,
I need your advice on the case of syringomyelia.
My boyfriend having scoliosis around 10 years ago but he actually never feel anything wrong with it. However, about 5-6 year ago he can feel his left arm is getting weak, and the condition is getting worse as time goes by. Now he is unable to lift up his arm over the shoulder level and even less sensitivity to hot and cold. After he gone through MRI and doctor from Spinal Orthopaedic pre-diagnose that he is suffering from syringomyelia but the doctor said he need to consult doctor from Neurologist. To prevent the condition getting worse, he must do surgery. Need your advice on this type of sickness. Is it risky to do the surgery? We are wondering in Malaysia which doctor from Neurologist is good and which doctor have the experience in handling this kind of operation with success story. Do you have any recommendation?
Besides, may i know is it exercise can help in reduce the hand weakness or it might cause the condition getting worse? What type of exercise is recommended?
Is there any other way can help in reduce the symptoms?
Thanks.
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Hi VS, please see your email for a private reply.
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Dear Dr. Lee,
Thanks for your professional advice on this case.
You are so kind to provide us with professional advice and guide to the correct direction. 🙂
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Dear Dr Lee,
I hope you are well.
I am a 50 years old male, height 175cm and 94kg. Blood pressure normal with no diabeties. I have been fortunate that I never experience major health issues nor involved in any trauma.
Over the past six years I have this Movement Disorder condition that has deteriorated. Initially, there were numbness at both sides of my soles, now feeling it creeping towards my calf. Ever since five years ago, people around me commented that I walk as though I have pain in my leg (spasticity). Now my balance and walking(gait) has worsen. I can’t do Tandem walk and also sway towards toppling when I stand with eyes closed. However, I do not have headache, double-vision or pain in my limbs or back. My hand and fingers coordination are fine. I had Vertigo episodes starting last year and were examined by ENT Specialist (not the cause). The fingers on my right hand developed numbness but according to doctors is due to Carpal tunnel.
Over the years, I have undergone MRI of whole Spine (Cervical, Thoracic and Lumbar), Brain and Knee. Last year, I have done several EMG and SSEP, also MRA. A full blood test and also screening for SCA ( blood sample sent to Singapore). I have been examined by leading Specialist, Consultant Neurologist, Neurosurgeon, Orthopedic Spine Surgeon at UM, UKM and Private Hospitals. Apart from slight delay in my EMG signals the other screening results are considered normal. Nine months ago, through a Dynamic X-Ray of my Neck, I was advised to undergo fusion of my cervical column. It was thought that it MAY solve my movement issue. C4,5&6 were partially removed and implanted with Titanium rods. Immediately after the surgery, I regained a lot of my balance up to two weeks, I was wearing neck brace. Unfortunately, after six weeks the symptoms came back (balance and gait). The doctors are not able to diagnose the real reason for my condition.
I was inclined to suspect, blood circulation problem. Maybe insufficient blood flow to my Cerebella (VBI) due to narrowing or blocked blood vessels within the cervical region.
Reasons:
1) It was pointed out by a Neurosurgeon that two blood vessels at the back of my neck going up to my brain appears large. Possibility of it becoming large to compensate blockage upstream?
2) I feel throbbing pulse and pushing me to the verge of Vertigo when I turn my head to my extreme right. No effect when I turn my head to left.
3) My balance and gait more pronounce when I am in a rush or stressed. Blood pressure related?
4) When I was wearing Neck brace my balance and gait improved (evident during the period after surgery). Also now if I wear neck brace to sleep, I wake up with better balance. My blood vessels are not impeded with movements?
5) My balance and gait problems are intermittent, on some days they are worse off and some days balance and gait not as bad. The numbness in my feet however, are consistent throughout.
However, when the Doctors looked at my MRA, they said my blood vessel around my cervical region are good. Could it be that movement of my neck cause the blood vessels to be constricted?
I am now at loss to where should I seek to get my condition diagnosed. I apologize for a lengthy description of my condition, I hope others can benefit from my experience and your advice.
Thank you for your kind attention and noble efforts.
Sincerely, Nik.
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Dear Encik Nik, without a clinical evaluation, it is not possible to provide specific advice. From the information given, I would investigate for cerebellar condition, and the DNA tests would be very useful. Conditions to consider would be spinocerebellar ataxia (SCA) and Friedreich Ataxia.
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Dear Dr Lee,
Millions of thanks if you can provide me your professional advise about my current health condition, I’m helpless as this problem has been affected my life.
Please allow me to share my story which happened since last 3 months:
Its suddendly happened to me at first week on Feb. That week i worked consecutive 5days of night shift .. (Wed to Sunday) On the 4th days (4th Feb)– Sat, i discovered my first symtom when i prepared to work is headache but i still drive to work. I only feel one times of headache during worked 12 hours. When offwork On the next morning ( 5th Feb ), after i reached home, instantly i ate 2 capsules of panadol activefast and went to sleep. After i woke up at 4pm evening, i found my eyes is difficult to focus and see double images. Again, i still drive to work on the last days of night shift ..
When i offwork on the next morning (6th Feb – Monday) at 630 am, i found i have fever and i went to see my company’s panel clinic. I told the doctor that i have headache and fever. After the doctor checked , he only gave me the fever medicine.When i reached home, immediately i ate the fever medicine and went to sleep. After woke up at evening, my eyes still difficult to focus and see double images. The next day, my wife fetch me to see another panel clinic. This doctor also gave me fever medicine. Continous 4days I meet my company’s panel clinic’s doctor. Monday to Thursday.
On 8th Feb (Wed), i meet the same panel clinic but different doctor, This doctor said normally is nerves problem and he gave me nerves medicine and dizzy medicine. After i ate that medicine, still unable to solved my problems. So i went to the same panel clinic ( for the last on 9th feb- Thursday) and the same previous doctor. This time the doctor wrote letter for me transfer to specialist. I desired to go the first hospital Penang Lam Wah Ee. At this hospital, I still can walk, no dizzy and smooth speaking..
This doctor just assumed I’m a normal fever and stress in work patient.. Since this doctor unable to solved my problem, my wife ask and requested for CT Scan but unfortunetly there’s No neuro doctor at this hospital can see the CT scan report..
On 13th — Monday morning, I was attended by this doctor again and still said I’m OK And can discharged.
Since he unable to do anything, i transfer to another speacilist Called Penang Loh Guan Lye speacilist. I stayed at this hospital from 9th Feb midnight until 13th morning..
On 13th — Monday afternoon. I have reached Penang Loh Guan Lye speacilist..
Doctor advised better refer to MRI Rather than CT Scan.. During awaiting for MRI, I was fall sleep. My wife told me that at the evening only is my turn. I woke up at night on bed, I found there’s many dot dot dot on my body .. I was In HDU (High definition Unit)
That night after the doctor saw my MRI Scan report , they declared my illness is called ‘Brain Abscess’ .. My neuro surgeon said I Cannot do operation otherwise will affect my breathing. Another neuro doctor ask my wife to stay back because i have life threathen,, So doctors only can gave a strong antibiotic for me. Therefore, I have been injected antibiotic continous 2 weeks.. After they found me already stable, doctor ask nurses send me to normal wards..
I stayed 2weeks at normal wards. Total I stayed 1 month at Penang Loh Guan Lye speacilist..
Before I Discharged , Doctor requested me to Scan the MRI For the last …
Based on my latest MRI on March , doctor said OK And allowed me to discharged. I have discharged on 14th March ….As of today I Still follow up with my neuro physician.. 1 month per time. He provided me the medicine called 60 Nootrophil Tablet 1200 MG (1tablet 2times a day)… 90 Dilantin Capsules 100 MG PHENYTOIN SOD ( 3CAPSULES once a day at night) and 60 Arcalion Tab 200 MG Sulbutiamine(1 tablet 2times a day) Once in a while go for physiotheraphy and meet Chinese doctor ( zhong yi– acupuntre )
Dr said i can recover but takes time .. not sure when …..He also suggested me to wear a spectacles (no degree) with closing on one side ..
As of today, I still feel dizzy and dizzy on my head, eyes can see but still unable to focus clear and see double images.. can speak but not smooth .. feel nomb on my face, inside my nose, inside my mouth, my tounge and also both hands , feel my left side less movement (have movement but looks abnormal and uncontrollable ) I can eat, can drinks,can go toilet.. I Also can walk but slow and unsteady.. like A Drunker…
Still cannot pursue my work and my driving.Before I Walk, i have to grab or hold something (make it balance) otherwise i willl easily fall down.This round really have changed my life styles..
p/s: i used one hand and one eye–right side to type this mail ..
Your comment is much appreciated please.
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Dear Mr Leong, your queries have been dealt with through private email. Best wishes.
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Hi Dr Lee
Is very good to see there is someone out there to share their professional advice which many layman has no where to find solution to. Thank you.
Please allow me to share my mom condition with you.
My mom has this nerve problem that troubled her and myself for many years and i felt helpless now. She always complaint when she sleeps, certain sleeping posture ‘compress’ on her nerve esp around the shoulder and neck area hence she couldnt sleep well. Or if she carries heavy stuffs, wear even half an inch of heel shoe also she feel ‘nerve’ pain. i really couldnt describe how pain or discomfort she was but all these years of torturing has turned her to an unhappy, crumpy, sorrow woman. Every single second i see her rub her shoulder, or rub her waist and neck on some sharp edges to relieve her ‘nerve’ problem. This happens every days for numerous years already. she tried taichi, qigong, physiotherapy, chiropractic, hot water bag, wear neck collar, take pain killer, neurobion, TCM etc etc. Have spent a lot of money but never seen improvement till the extent i think she has some form of depression/anxiety symptoms. She tends to think negatively. It could be partly due to family/financial problem that make her emotionally unease too. She has done an operation to remove her uterus two years ago and following that was given atenolol 25mg as Dr found her BP reading was high post surgery.
Can you give some professional advice on her current condition?Is there any neurologists in Klang valley that i can bring her to?
Many million thank you in advance
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Dear Joey
This sounds like a chronic problem, hence you should consult your family doctor to decide if there is any possibility of rheumatic or orthopaedic cause for the aches and pains, in addition to considering a “nerve” problem. Generally, if the condition is of many years’ duration, it is less likely to be due to any of these serious diseases. Finally, it is indeed possible for depression to manifest as chronic pain, with the mood disturbance in the background, so this diagnosis should also be explored. All the best.
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Dear Dr,
How are you . Hope you are well in good health. I would like to ask a question regarding my brother . He is a dieapetic patient. Recently he has an eyes stroke on the right and left eyes . The right eyes can eyes, treatment on going for the left eyes. Last week he see Dr at GH hospital and did a dopling test. They confirm he has block for about 50% at his neck. At GH hospital, the dr say if the bolcking is 70%, only then they will do the operation. My quaetion is, can he do an operatin with 50% bolck at the neck. If yes where can he do this operation and the cost of the operation, consultant and medicine. Thank you in advance dr and have a great day a head!
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Dear Fatimah
It is not clear whether the “eye stroke” referred to blockage of the retinal or ophthalmic arteries. This will determine whether the carotid artery blockage in the neck is the actual source of the stroke.
Second, it is indeed generally accepted that carotid artery procedures are recommended when the blockage exceeds 70%. Less severe blockage is treated with “best medical therapy”, i.e. combination of the most effective medications for stroke prevention.
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Dear Dr Lee,
I am having pain on right side of head (at temple and back of head) + right eyeball pain (and feeling swollen) + abit of ear pain on right ear + also slight tooth pain/discomfort on right side & also feel abit dropping of facial muscle on right side.
I have consulted a GP, she says i am having migrane related to sinus / block nasal (which i do have nose allergy). The first time the headache n all the other pain attacked me was 1 mth ago and it lasted for 3weeks. Now the symptoms are back, my right side head having slight pain, my eyeball is feeling swollen & tooth abit pain.
Should i be consult a specialist soon before the whole severe pain attack me again? If yes, then should i see you or it is related to other areas (ENT)?
Please advice. TQ
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Dear CSP,
You need to consult with your GP whether based on your symptomes, you need to see a specialist, and if so, either ENT consultant or neurologist.
All the best.
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Hi dr lee,
2 days ago i was admitted into an hospital due to persistent headaches which I been suffering for the past 10 days . They run a MRI scan and blood test to find the caused. Everything seems to be normal apart that they found an arachnoid cyst at the right side of medulla. The doctor said it’s harmless . However, he recommended me to see the neurologist for further investigation whether it might be the reason for my headaches. I wonder if the cyst can grow and clog my blood vessel that transport the blood to the brain? Is it really something that I should be worried about since this is the first time I had persistent headaches. For information, I do suffer from migraine occasionally . However, it’s the weather that trigger it . Kindly advice
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Dear Diana
Your brain scan needs to be reviewed in order to assess whether the arachnoid cyst might cause any problem. You could consult a neurologist if in doubt. At the same time, if the headaches are deemed to be unrelated, and the cause is actually tension headache or migraine, these could be treated.
All the best.
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Dear Dr Lee,
I had severe toothache about 1 week ago and shortly after that, i experienced the numbness on my left chin even way before the extraction. I’d completed the antibiotics but the numbness is still there and i was advised to try neurobion. I had never experienced such pain & numbness and i’m a bit worried that it would be permanent. What might be the cause of this and is there anything i can do to speed up the recovery as I also learnt some cases reported permanent.
Please advise, thank you.
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Dear Sheryne
It is not clear whether your symptoms are due to the dental problem. Perhaps you should consult your dentist for an accurate assessment.
All the best.
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Dear Doctor Lee,
First of all, thanks for your sharing of neuro knowledge thru your website. I believe this will help those who are suffering neuro problems. I’m writing this email to seek your opinion on my father’s condition.
My father is 73 year old this year. He fell down last year April and there was a blood clot in his brain and confirmed by doctor was TBI . We sent him to a private hospital in J.B and one of the neuro doctor suggested to do an operation on him immediately to clear the blood clot. However another neuro doctor who performed the operation suggested that we can wait 48 hours to see whether the blood clot will clear it or not.So finally no operation was done for the “golden period”. Later we sent him to govt hospital in JB as the neuro doctor actually is from govt hospital. Last year Nov, we went to another private hospital “regency hospital” in Masia, to consult another neuro doctor’s advice. This is because my father right now is cant walk, talk or eat(using tube feeding)and we do not know whether he is conscious or not. But he can open his eyes, move a bit of his hands and legs and response to the pain. The neuro doctor said my father was suffering “hydrocephalus” and need to perform a shunt operation. However my father is unfit for the operation due to bed sores in his bottom and low protein, sodium and HB level(7.8). We did consult nutritionist to build up his health condition before operation and right now only left bed sore and low HB problem. Now he is staying in nursing home for rehab.
As he is unfit for the operation, the neuro doctor suggested that to do another operation on his tummy to take out the excessive CSF from his brain. Is this operation very dangerous? Do you think that based on my father’s condition, he can undergo such operation? The govt doctor asked us to give up hope on my father as he cant has any improvement at all.Can I forward the CT scan to you for your review? Any medicine needed to cure the water in brain? Currently we are giving him to consume “Neuro aid” beside the normal medicine given by govt hospital.
I really hope that you can give us your advice.
Many thanks in advance.
Best Regards
Hwee Ken
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Dear M. Chong
This appears to be a complex issue; a thorough assessment of your Father’s clinical status is needed in order to arrive at a proper recommendation. If you wish, you could send a copy of the brain scans for study (please do not send original films), and a tentative opinion might be given by the neurosurgeon. For information, I am a neurologist, i.e. internist.
Best wishes.
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Dear madam lee,
thanks for your reply. I will email to you all the relevant documents.
Many thanks in advance.
Best regards
hwee ken
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Dear Dr Lee
My mom, 73 years old, has been suffering dizziness (all day) since 2 years ago.
ENT treated her for about 2 months suggested not due to ‘ear imbalance’ problem. Brain CT scan shown no tumor, heart scan also good.
Psychiatrist treated her with Lexapro/escitalopram and Xanax/Alprazolam for 6 months, no improvement at all, now changed to Valdoxan/Agormelatine (1 month), also no effect. She has no sleeping problem.
She was very healthy other than high blood (under control / medication for 20 years). Currently taking Exforge, Tenormin & Storvas. She has glaucoma, need eyedrop daily.
Could this be related to other brain or neuro problems? Any other tests suggested?
Thanks in advance for your advice.
Christine
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Dear Christine
My apologies for the delayed response – your comment was caught by the spam filter. Your mother, like many seniors, has nonspecific symptoms with no definite finding on the tests. It looks like she is being treated for anxiety which may be a cause for vague dizziness. It is not possible to give meaningful advice based on this summary as there is no alternative to a good clinical assessment. If you feel the medications are not helping, do speak to her doctors to explore other options.
Best wishes.
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Hi Dr. Lee,
Multiple Sclerosis
My mom lately diagnosed with Multiple Sclerosis. Started with her right eyes, then later both legs (unable to walk now) and now attacking her left eyes. She was admitted to UH for a month but no improvement at all. Prescribed steroid drips for for 7 days, also no improvement. She’s very depressed and emotional unstable too.
Is there any medicine? Can we arrange a date to meet you?
Really appreciate your prompt advice. I desperately need help! Pls. help her!
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Dear May,
As we had discussed today, onset of multiple sclerosis (MS) after the age of 50 is unusual. However, review of your Mum’s records suggests she had optic neuritis and transverse myelitis, both of which are among the features of MS. Her brain MRI changes are also consistent. The vasculitis seems to be in remission. As for the left eye, she needs prompt therapy for the visual disturbance. Best wishes for her treatment and progress.
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Thanks Dr. Lee, due to urgency I’ve sent her to UMSC. Hopefully she can discharge by this week.
Thanks so much for your advice.
MC
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Hi Dr Lee,
My mother had suffered from insomnia and serious anxiety 10 years back and since then she has been taking Lorazepam to relieve her anxiety and overcome her insomnia. she now becomes dependent on the medicine and experienced severe withdrawal symptoms such as muscle cramp. i m wondering if withdrawL of the medicine is possible since she has been taking for more than 10 years though i m aware that this medicine is used for short term treatment. i would appreciate if you could advise and recommend if there is any specialist doctor in klang valley could help my mother with the withdrawaltaking for more than 10 years though i m aware that the medicine is for relieving
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Dear Alvin
This sounds like you are facing a difficult problem. Please see your email for a private reply.
Best wishes.
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Dear Dr Lee,
I am 2 months post natal, and after the first week of delivery, i started getting a numb sensation in the last 2 fingers of my left hand. over the next week, my thumb and second finger also developed numbness. I cannot feel if a cloth is wet or dry. After about 5 weeks, the same thing happened to my right hand, in the same fingers – the last finger on both hands work fine. This week, i developed pins and needles in my fingers and when i hold a phone for over 10 mins, the hand starts to hurt. what do you think this is, and is there any remedy? I hope this is not a permanent condition and hope it will go away. My gynae says it may just do so after 3 months but i am worried it will become worse.
Your comment is very much appreciated.
Thank you, CIM
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Dear Ms CIM
The symptoms may be due to benign causes such as compression of the nerves from carrying baby over long periods, or repetitive strain from increase in household chores. You could test this out by adjusting your activities. If there is no improvement, it is wise to consult your GP about the need for specialist opinion on whether there is any neurological problem. All the best, and hope you can find a solution.
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Dear Dr. Lee
I need some advice for a good neurosurgeon in Malaysia, my dad is in a critical condition and i am in need of a good neurosurgeon. Currently my dad is in ICU in a hospital in Penang.
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Dear Jess
I hope that you have noted the suggestions which were sent to your personal email. Best wishes for a positive outcome in your Dad’s critical condition.
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Hi Dr. Lee. I am 27 female and i have been smoking for 10 years now. In 2009 i got Bell Palsy and it recover accept that at certain time when i am tired my eye seem to be very small and my face seem to be a little numb.
Early this year start to have very fast heart beat and i feel sivering (once in a while) and i did stress test as well and some scan and everything seem to be find with my heart. And also did MRI i for my brain and it seem to be find to. Some times in the middle of the night i woke up feeling scare, heart palpulating very fast and feels shiver all over. I do feel at times that my left arms is at little painfull so when i see a neurologist i was told that i got stiff neck.
Yesterday i felt there is some pain on my bottom left head, i ignored it as i seem to have pain here and there. Then when i come to night i feel the pain even more and my left hands and legs seem to be very tight and i feel week. Also the same i got my heart palpulating fast and i keep on feeling like going to the ladies.
I took 1 Neurobion and Synflex felt a sleep for while and when i woke up feeling a little better. But today i still dont feel comfortable with my arms.
I am worried will i have stroke or anything serious… i am currenlty trying to quit smoking. What should i do i worried .. and my doctor always tell me its nothing.
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Hi, good to know your tests were normal. If your doctors are satisfied that there is no physical illness, you should discuss whether you need to be evaluated for stress and panic disorder. The correct treatment would give you relief from the symptoms.
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Dear Dr Lee,
My Father is 64 years old. He was admitted to university hospital on 27/sept/11, and dr’s from university hospital diagnosed my dad was Transverse myelitis. Immediately dr’s put my dad on steroid drips and my dad has recover since after the drips. Initially my dad can’t even move his leg but after the steroid drips for 2weeks my dad able to regain strength and walk about 12ft distance with walker. After steroid treatment, my dad was put under rehab Dr’s . Inside 3weeks rehab, my dad recover a lot but towards the fourth weeks my dad encounter his leg got cramp and burning sensation. We mentioned to Dr , and we was prescribe to take neurontin. Started with 1 tablet a day of 300mg and add to 3 tablet a day. Before we was discharge from hospital we kept mentioning to the Dr that my dad’s cramp and burning sensation is still coming more frequently then before. So dr increase the dosage to 6 tablets a day. We were told that is common that patient with transverse myelitis to have such feeling. Now my dad is at home and he are taking nuerontin 6 tablets daily. The pain, cramp and burning sensation became more and more severe!!. Is there any other way to help my Dad?? I am afraid that the situation will become more worst. Kindly advice.
Your kind opinion is very much appreciated.
Thank you very much
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Dear Adrian
Patients with transverse myelitis can experience abnormal sensations, as well as cramps and muscle spasms, when the nerves are recovering. These symptoms should improve with anti-neuropathic medications, of which Neurontin is an example. Your father should obtain benefit from a combination of such medications. I hope you could discuss this further with his neurologist.
All the best.
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Dear Dr Lee,
Thank you very much for your kind advice. My Dad has seen another specialist and he has prescribed 2 new medication ( Trileptal 600mg, 2 tablets a day and Keppra levetiracetam 500mg, 4 tablets a day). My Dad situation has improved with the new medication. May i know, Is the two new medication is also anti-neuropathic medication and usually how long does it take for nerves to recover? Please advice. Thank you very much.
Regards
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Dear Adrian
I am happy to note there is improvement with treatment. It is not possible to answer specific questions about the recovery or the purpose of medications in a particular patient without knowledge of his clinical condition. Since your father is getting better, you could discuss these issues with his doctor.
Best wishes.
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Dear Dr Lee,
Thank you very much for your kind advice.
Thank you.
Regards
Adrian
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Hi Adrian,
Can you share more info about your dad situation? My mom has Multiple Sclerosis similar to TM.
Hope to get some advice from you.
MC
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Dear May,
My dad situation did not improve much till now. Since after discharge from hospital about 2 months, my dad’s right leg totally lost strength. His right leg hardly can move but the left leg is getting better. We went back to UH and dr’s said it could be relapse and immediately put on steroids drips agains.Till now no sign of improvement. Really not sure what else can do？
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Hi Adrian,
Yah, I understand ur feeling. We had the same feeling right now. Really don’t know what else we can do. I agreed what Dr. Lee said, we have to stay strong and support them. They need our care and love.
I just created a new gmail, hope u can share more info> mayc.misc@gmail.com. I hope Dr. Lee don’t mind 🙂
Once again, thanks Dr. Lee.
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Hi, I am 27 years old and I’m experiencing persistent headache on my right and back sides of the head. The tense radiates to my neck and shoulder as well. Been having this symptom for about a month. And sometimes, my left index finger twitches. Am quite worried. Been to seek advice from gp and my conditions were diagnosed as anxiety. I’m worried sick. Doc, should I seek specialist advice? I couldn’t sleep soundly thinking about the worst could happen. Thanks.
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Dear Hazwan
If you are worried about these persistent symptoms, you could request to see a specialist (i.e. neurologist). They may indeed be due to migraine or anxiety. A precise diagnosis would provide reassurance and enable you to obtain appropriate therapy. Best wishes.
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hi Dr Lee;
I would like to ask about Bell Palsy. It hit my husband last few days, age 31, asthmatic. I wan to know is there any possibilities the it will affect the other side of face? Is it permanent or temporary? What is the best remedy to it. He has lost his confidence to meet people and working under tremendous stress.
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Dear Shahanaz
A private reply has been sent to your email address. Regards.
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Dr.Lee,
My wife develop footdrop after total knee reconstruction. This problem remain about 2 month now. The doctor say she have common peroneal nerve injury and hard to recover. The doctor told us can’t do anything.
She start to have mild sensation at first & second toe and lower part of foot lately. No numbness and pain recorded. Would she able to recover from this problem? It is very distressing us.
Regards.
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Dear Mr Chan
You could consider a nerve conduction study to determine if the nerve damage is permanent. This should help you to assess the situation. Please discuss this with your surgeon.
All the best.
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Dear Dr. Lee,
I happen to come to this site when I was browsing for a doctor/centre that helps with sleep problems/insomnia. Ever since my father passed away in February, my mother has had difficulty sleeping at night and has since been suffering from sleep deprivation and anxiety. She seems to have become reliant on lexotanil. I am very worried as I lost my father early this year and want to help my mum get some normal sleep without any medication. Would greatly appreciate your guidance on this. Thank you and best wishes.
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Dear Ms Saw
The features would seem to be consistent with migraine. There are many sources of information about managing the headache, e.g. American Headache Society http://www.achenet.org/tools/triggeravoidanceinformation.asp
If the pain does not settle with trigger factor avoidance, you could consult your GP about more intensive medications and/or neurologist consultation.
Best wishes for overcoming the migraine.
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Hi Dr.Lee,
I am having headache with eye aching on my left side of head, been going-on almost everyday (Example: 5days out of 8days). It occur every morning between 10am-12pm when the bright sunlight shines, told by family doctor that this is migraine. Been given Caffox pill to recover the aching when it appear. Is this a migraine? please advice for the next steps. Thank you and have a nice day.
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Hi Dr. Lee,
I was in your clinic this morning regarding neck stiffness. I have another issue which I overlooked. I passed out a number of times. Looking back it happened a few times after exercises and recently as a result of low sodium intake (as a result of a dr’s advice). I have seen a cardiologist who diagnosed it as vasovagal. This explains why if I stand for long periods and walking, I get lightheadedess. Now I have anxiety over this issue. I have since up my intake of water and salt. However, I do get the lightheadedess still. I have no problem when sitting or lying down. The cardiologist thinks that I do not have heart problem as I have no issues when exercising. I wonder if there is a neurological problem to that. Please advice whether I should see you on this. Thank you
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Hello Dr.Lee:
My daughter was borned in Kuala Lumpur in 1973 and was diagnosed with MS in 2005.now she has brain damage and bowel movement problem.Is it safe to go for stem cell treatment?
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Dear Mr Tan
A recent study was reported to show some success for stem cell treatment (SCT) for MS in small number of patients (n=35). To date, data are not yet conclusive, hence SCT is viewed as experimental. Currently it may be considered for aggressive forms of MS, when the patient is still in the early, inflammatory phase. You need to discuss with your daughter’s physicians if SCT is at all feasible at this stage. SCT may be safe but not helpful at this stage of her illness.
Best wishes.
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Dear Dr. Lee:
My daughter May and I will be going back to KL in October/November.2011.She is very keen to make an appointment to consult you of her sickness.Would you like to see her?Please reply.
Regards
David Tan
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I had an emergency c-section because my sons umbilical cord was wrapped around his neck. When he was 2 he was developmentally delayed and now Dr’s are placing him on the autism spectrum. He often complains that his legs are wobbly. At night when in bed he says he cannot hold still or his legs will get cold. I told his neurologist, who didn’t even address my concerns. Is it possible that he has nerve damage. My son is in constant motion because of this problem. Do you have any experience with this? I am searching for answers to improve my sons life. Thank you for any advice or help you can give.
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Dear Ms Chelsea
This is a difficult situation and you will need multi-modality help. It is necessary to determine if your son sustained some damage to either the brain or nerves. He needs to see a paediatric neurologist for neuro-developmental assessment. Spasticity and weakness might make the legs “wobbly”; Restless Legs Syndrome can occur in children and could be considered.
Best wishes.
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Hi Dr Lee. My mum is constantly having heavy head for the past few months. She is 85 years old and is on high blood medication. Notice that the chin area is always shaking – parkinson? Would really love to bring her to your clinic for a check up. Which hospital should we booked for an appointment.
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Dear Ms Yap
Other than Parkinson’s disease, the shaking could be due to senile tremor. I would be happy to assess. Please call our staff at the hospital of your choice; the nos. are as listed here https://mkleeneuro.wordpress.com/contact-us/
Best Regards.
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Dear Dr Lee,
My mom aged 73, complained of dizziness, blackout and fell to the floor, hitting her head against the wall on 24/3. She hurt her back and could not walk for few days. No fractures from X-ray result. She can move about now albeit slowly. She still experienced sharp pain when getting out of bed.
She complained of dizziness consistently and on 4/4, we took her for CT Scan as recommended by her physician. Radiology report indicating “focal lacunar infarct right basal ganglia”.
Her medical history includes, hypertension and suffering from Osteoporosis.
Appreciate your kind advice.
Thanks, Kathy
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Dear Kathy
The findings on the brain CT scan may not account for all the symptoms felt by your mom. Do please discuss with her physician whether to look for other possibilities such as vertebrobasilar insufficiency, low sugar, heart irregularity and ENT problems.
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Drear Dr Lee,
I m 59 yrs old.male. few months ago i experience stiffness n pain on my left shoulder down to my arm..
at first i tough it is just a normal muscle pain,,…done a couple of massage and also chiropractic but still no improvement… i m now seeking your kind advice . fyi i live in Ampang,selangor.
Thank you in advance
Regards..ali
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Dear Encik Liyackat
These symptoms could be due to neck problem such as disc bulge and bone spurs. Much less commonly, a nerve condition may be the cause. Please consult your family doctor.
Hope you have a good recovery after treatment.
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Selamat malam Dr. Lee Moon Keen,
Saya Esterlita dari Tangerang, Indonesia, saya mau bertanya, selama ini, di indonesia, kata dokter neurology, suami saya terkena penyakit pengentalan darah (sesuai hasil laboratorium). Namun akhir-akhir ini, suami saya sering kesemutan di kedua kakinya, terkadang terasa nyeri/sakit, setelah digerak-gerakkan hilang, tapi kadang sering muncul kesemutan lagi. Mencari informasi di internet, berbagai macam indikasi dari kesemutan sungguh membuat saya shock, apakah saya bisa membawa suami saya untuk berobat kepada Dr. Lee Moon Keen. Kalau bisa, di rumah sakit mana dokter praktek? Dapatkah saya minta no telpon rumah sakit dimana dokter berpraktek? Kira-kita berapakah biayanya? Mohon balasannya Dr. Lee Moon Keen. Terima kasih banyak.
Salam hormat,
Ibu Esterlita
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Hi Ibu Esterlita
Terima kasih atas pertanyaan Puan. Sila rujuk kepada email Puan untuk cadangan kami.
Salam, Dr M K Lee
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My father is around 60 years old. He is suffering from stroke with effect that he unable to talk, left and right hand shaking. Currently, I notice his movement problem, he complains about weakness of his legs and losing weight. Please advise and help.
Thank you.
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Dear Sher Reen
Your father’s symptoms could be due to either a general body weakness or neurological problem. He should have a clinical assessment by his doctor. Only then can the appropriate treatment be decided.
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HI Dr Lee,
Am from Indonesia and my mother is having severe back pain for the last 2 years. After taking MRI last year, doctor diagnosed her that she is having HNP in L4 and L5. Orthopaedist suggested her to have therapy (traction) and it only make her pain worse. We visited 2 neurosurgeon lately and they advised her to have surgery.
However, some people said that surgery might caused her paralyse if it failed.
I am also considering of taking her to KL to take other doctor’s opinion and would like to avoid surgery if possible.
She had coronary stenting 2 years ago and her cholesterol level is 400+. Physically, I dont think that she is that strong to get through surgery. But it seems like the pain is getting worse
Need your advice.
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Dear Ms Wang
Yes it does appear that your mother is a high risk case for surgery. Certainly, non-surgical treatments for severe pain should be explored. For information, combination of medications and physiotherapy has helped many people. In some cases, nerve block can be effective.
All the best.
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Hi Dr Lee, my father had a stroke in year 1986, he had a high blood pressure and is on medication all this while for high blood pressure. Recently he has had some stroke symptom for about 4 separate episodes in the pass 2 weeks. His symptom is like having numbness on his right leg which cause him not able to walk or put on a slipper, giddiness, blurness and also sweating alot. I already brought him to perform a CT scan in gov hospital and the diagnosis is TIA and was refer to perform dobbler and echo. But the appointment date they give is too far away which is end of march and april. Just a moment ago, he had another episode of numbness on his right foot. I am scare and due to the appointment in gov hospital is too far away, I would like to bring him to private so that he can have a faster treatment incase he really is having stroke. Do advise me what to do and where to go if i want to go private…thanks..
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Dear Cheryl
So sorry to hear your father has new symptoms. Diagnosis could be TIA or some other condition affecting either the nerves to his leg or its blood supply. You didn’t indicate where your father lives. Do ask your GP or the government doctor where is the nearest private hospital if you can’t wait for the hospital test appointments. All the best.
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Dear Dr. Lee,
I was diagnosed facial tics for few months. I saw GP and he gave me the Alpo-Carbamezepine and apo-lorazepam to eat at night. I can not sleep at night also eventhough my body feel tired. My condition is the right eye bottom part twitchs uncontrolly. May I know how much for the treatment and medication fees ? and need how long to cure it. Thanks
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Dear Ms Hoh
Please see your email for a private reply.
Best regards.
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Dear Dr Lee,
My husband is 46 years old. He is experiencing numbness in his hands, more so in his last 2 fingers on both hands. He has done a scan one year ago and it showed possible cervical spondylosis (C5). This is likely the reason for the numbness.
However, lately he began to feel muscle fatigue in both his legs and arms and complains of wobbly legs. He also complains of body ache. I am worried that these symptoms are indicative of some serious disorder.
Please advise.
Thank you.
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Dear Ms Foo
The symptoms you have described are rather nonspecific. Causes may range from simple over-strain to neuromuscular diseases or organ malfunction. If there is concern, please consult your family doctor about the need for further tests.
Best wishes.
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Dear Dr. Lee:
My mother is suffering below symptoms lately. Hope you can advice me what to do.
i. Blood pressure is up every few days though she is under medication. Has been visiting cardiologist from Sunway quite often and change medicine few times.
ii. When blood pressure is not stable, her head is heavy & she complaint wind blowing noice in the ear.
iii. Occasional stomach bloat. When this happen, her blood pressure is shotting up.
Could this be related to brain or neuro ?
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Dear Wayne,
Ref. your Mother’s condition, please refer to your email for a private reply.
Best regards.
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Dear Dr Lee,
My father has been slight headache on the left hand side of the brain, associated with the giddiness. He also comes across neck stiffness on both side of the neck (back). This has been on for about 2-3 years. He has been on medication on betaserc and arcoxia (90 & 120mg).
He wishes to seek for your kind opinion what he should do as this problem has been nagging him and affected his work & life.
Your comment is much appreciated please.
Yours truly,
YMC
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Dear YMC
The symptoms could arise from the head or neck area. Please consult your GP as to whether specialist opinion is indicated, and if so, which speciality is needed.
All the best.
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Dear Dr. Lee,
Millions of thanks for your kind feedback. Will be awaiting for your email then.
Kind regards.
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Dear Dr. Lee,
It’s a pleasure to know we have such a talented specialist in M’sia. I’m very impressed to read Dr’s contributions to the area which will help alot of patiens to cure from such sickness.
Dear Dr. Lee,
May I please share my father’s story to you if you could help?
My father was detected with a mild stroke which causes his legs and arms to be very weak. He now can hardly walk for 10 steps.
Is there any medicine to help him in this?
Many thanks.
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Dear Mr Yap,
Thanks for your kind comments. Please see your email for a private response to your enquiry. Best regards.
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Thank you very much for your interest. Best regards, M K Lee.
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