Sriwijaya Journal of Neurology

Burning Mouth Syndrome: Exploring the Role of Central Sensitization and Neuropathic Pain Mechanisms in Bandung, Indonesia

2025-01-24T02:42:35+00:00

Introduction: Burning mouth syndrome (BMS) is a chronic pain condition characterized by a burning sensation in the oral cavity without any identifiable clinical or laboratory findings. While the etiology of BMS remains unclear, central sensitization and neuropathic pain mechanisms are increasingly recognized as potential contributors. This study aimed to investigate the role of central sensitization and neuropathic pain in BMS patients in Bandung, Indonesia.

Methods: This cross-sectional study involved 40 participants diagnosed with BMS according to the International Association for the Study of Pain (IASP) criteria and 40 healthy controls. All participants underwent comprehensive assessments, including: (1) clinical oral examination, (2) quantitative sensory testing (QST) to assess thermal and mechanical sensitivity, (3) questionnaires to evaluate pain intensity, quality of life, anxiety, and depression, and (4) measurement of salivary cortisol levels as a marker of stress.

Results: BMS patients exhibited significantly higher thermal and mechanical sensitivity compared to healthy controls (p<0.001). They also reported significantly higher pain intensity, poorer quality of life, and increased levels of anxiety and depression (p<0.001). Salivary cortisol levels were significantly elevated in the BMS group (p<0.05). Correlation analysis revealed significant associations between pain intensity and QST parameters, anxiety, depression, and salivary cortisol levels.

Conclusion: The findings of this study suggest that central sensitization and neuropathic pain mechanisms play a significant role in the pathophysiology of BMS in Bandung, Indonesia. These findings highlight the need for a multidisciplinary approach to BMS management, incorporating strategies to address both peripheral and central factors contributing to pain.

Oral Health Status and its Association with Disease Severity in Parkinson's Disease: A Longitudinal Study in Semarang, Indonesia

2025-01-31T02:27:53+00:00

Introduction: Parkinson's disease (PD) is a neurodegenerative disorder that affects motor and non-motor functions, including oral health. This longitudinal study aimed to investigate the oral health status of PD patients in Semarang, Indonesia, and its association with disease severity over time.

Methods: A cohort of 100 PD patients diagnosed according to the UK Parkinson's Disease Society Brain Bank criteria were recruited from the Neurology Clinic of Private Hospital, Semarang. Oral health assessments, including Decayed, Missing, and Filled Teeth (DMFT) index, periodontal status, and oral hygiene habits, were conducted at baseline and annually for three years. Disease severity was assessed using the Hoehn and Yahr (H&Y) scale and the Unified Parkinson's Disease Rating Scale (UPDRS). Data were analyzed using descriptive statistics, correlation analysis, and regression models.

Results: The majority of PD patients exhibited poor oral hygiene and a high prevalence of dental caries and periodontal disease. DMFT scores and periodontal indices worsened significantly over the three-year follow-up period. Disease severity, as measured by H&Y stage and UPDRS scores, was significantly correlated with poorer oral health status. Regression analysis revealed that higher UPDRS scores at baseline predicted a more rapid decline in oral health over time.

Conclusion: PD patients in Semarang, Indonesia, experience significant oral health challenges that are associated with disease severity and progression. These findings highlight the need for integrated oral healthcare in the management of PD to improve patients' overall quality of life.

Development and Validation of the Jakarta Post-Infectious Neurological Complication Risk Score (JPINCoRS) for Children

2025-03-13T03:35:25+00:00

Introduction: Post-infectious neurological complications (PINCs) in children represent a significant burden, particularly in developing countries like Indonesia. The early identification of high-risk children is crucial for timely intervention and resource allocation. We aimed to develop and validate a clinically applicable risk stratification score for PINCs in a Jakarta-based pediatric population.

Methods: A prospective cohort study was conducted at three major tertiary hospitals in Jakarta, Indonesia, between January 2020 and December 2022. Children aged 1 month to 18 years admitted with a primary infectious diagnosis were eligible. Potential risk factors were collected through detailed medical history, physical examination, and laboratory investigations. The primary outcome was the development of a PINC, defined as any new neurological deficit persisting for at least 24 hours after the acute infectious phase, and categorized using a modified Rankin Scale (mRS). Multivariable logistic regression was used to identify independent predictors and develop the Jakarta Post-Infectious Neurological Complication Risk Score (JPINCoRS).

Results: A total of 1250 children were enrolled, with 188 (15.0%) developing a PINC. The final JPINCoRS model included six independent predictors: (1) Type of infection (Central Nervous System [CNS] infection: odds ratio [OR] 4.5, 95% CI 3.2-6.3; Systemic infection with sepsis: OR 2.8, 95% CI 1.9-4.1), (2) Duration of fever >5 days (OR 2.2, 95% CI 1.5-3.2), (3) Presence of seizures during the acute infection (OR 3.5, 95% CI 2.4-5.1), (4) Altered mental status (Glasgow Coma Scale [GCS] <13) at admission (OR 3.0, 95% CI 2.1-4.3), (5) Thrombocytopenia (platelet count <100 x 10^9/L) (OR 1.9, 95% CI 1.3-2.8), and (6) Elevated C-reactive protein (CRP) >50 mg/L (OR 2.1, 95% CI 1.4-3.0). The JPINCoRS demonstrated good discrimination (area under the receiver operating characteristic curve [AUC] = 0.85, 95% CI 0.82-0.88) and calibration. Risk categories were defined as low (0-3 points), moderate (4-7 points), and high (8-12 points), with corresponding PINC rates of 3.5%, 18.2%, and 48.6%, respectively. Internal validation confirmed the model's robustness.

Conclusion: The JPINCoRS is a simple, clinically applicable tool for predicting PINCs in children in Jakarta, Indonesia. It can aid clinicians in identifying high-risk patients who may benefit from closer monitoring, neuroimaging, and early intervention strategies. Further external validation in other settings is warranted.

Developing and Validating a Novel, Culture-Fair Assessment of Fluid Intelligence: A Multimodal Approach Combining Neuroimaging and Behavioral Measures in Indonesia

2025-03-13T05:31:59+00:00

Introduction: Fluid intelligence (Gf) is a critical cognitive ability, but its assessment is often biased by cultural and educational factors. Existing Gf tests developed in Western contexts may not be valid in diverse populations like Indonesia. This study aimed to develop and validate a novel, culture-fair Gf assessment tool (the "Indonesian Fluid Intelligence Scale" - IFIS) for Indonesian adults, utilizing a multimodal approach combining behavioral testing with neuroimaging (fMRI and EEG).

Methods: A mixed-methods design was employed. Phase 1 involved the development of the IFIS, drawing on culturally relevant materials and minimizing reliance on language and formal education. Phase 2 involved a cross-sectional study with 300 Indonesian adults (aged 18-45) with varying educational backgrounds and socioeconomic statuses, recruited from urban and rural areas. Participants completed the IFIS, a standardized Gf test (Raven's Progressive Matrices - RPM), and underwent fMRI and EEG recordings during cognitive task performance. Statistical analyses included correlational analyses, confirmatory factor analysis (CFA), and machine learning techniques to explore the relationship between IFIS scores, RPM scores, and neural activity patterns.

Results: The IFIS demonstrated good internal consistency (Cronbach's alpha = 0.85) and test-retest reliability (r = 0.88). CFA supported a single-factor structure for the IFIS. IFIS scores correlated significantly with RPM scores (r = 0.68, p < 0.001), but showed weaker correlations with years of education (r = 0.35, p < 0.001) compared to RPM (r = 0.52, p < 0.001). fMRI revealed that higher IFIS scores were associated with increased activation in the frontoparietal network (FPN), particularly the dorsolateral prefrontal cortex (dlPFC) and posterior parietal cortex (PPC), during task performance. EEG analysis showed increased theta and alpha power in frontal and parietal regions during IFIS task performance, correlating with higher scores. Machine learning models, using combined fMRI and EEG data, could predict IFIS scores with high accuracy (AUC = 0.89).

Conclusion: The IFIS provides a promising, culture-fair assessment of Gf in Indonesian adults. The multimodal approach, combining behavioral and neuroimaging data, provides strong evidence for the construct validity of the IFIS. The findings highlight the importance of considering cultural context in cognitive assessment and demonstrate the potential of neuroimaging to validate cognitive measures.

Predicting Meningioma Risk: The Role of Hormone-Related Molecular Markers and Intracellular Signaling Pathways

2025-03-27T04:53:25+00:00

Introduction: Meningiomas are common intracranial tumors with an established association with hormonal factors. This study aimed to comprehensively evaluate the predictive value of hormone-related molecular markers and their associated intracellular signaling pathways in meningioma development.

Methods: A retrospective case-control study was conducted, including 200 patients with histologically confirmed meningioma (cases) and 200 age- and gender-matched controls. Tumor tissue and serum samples were analyzed for the expression of estrogen receptor (ER), progesterone receptor (PR), androgen receptor (AR), and growth hormone receptor (GHR) using western blot and ELISA, respectively. The activation status of the PI3K/AKT/mTOR and MAPK/ERK signaling pathways was assessed by analyzing the levels of phosphorylated proteins in the pathways.

Results: Elevated expression of ER, PR, and GHR was observed in the tumor tissue of meningioma cases compared to controls (p<0.05). Serum levels of ER and PR were also significantly higher in cases. Analysis of signaling pathways revealed increased activation of both PI3K/AKT/mTOR and MAPK/ERK pathways in meningioma cases. Multivariate analysis confirmed that ER and PR expression, both in tumor tissue and serum, were independent predictors of meningioma risk, along with age and female sex.

Conclusion: Our findings suggest that ER, PR, and GHR may serve as potential predictive markers for meningioma risk. The involvement of PI3K/AKT/mTOR and MAPK/ERK signaling pathways further underscores the complex interplay between hormonal factors and intracellular signaling in meningioma development. These findings may contribute to improved risk assessment and the development of targeted therapeutic strategies for meningiomas.