Objective: To report on epidemiology, clinical and laboratory features of patients diagnosed with anti-N-methyl-Daspartate receptor (NMDAR) encephalitis admitted to Singapore general hospital over the period of four years. This is the first study for the local population. Introduction: Anti –NMDA receptor encephalitis is a severe form of encephalitis that associates with antibodies against NMDA receptors resulting in a neuropsychiatric syndrome. It has been considered as a Paraneoplastic syndrome. Methods: Nine patients (6 female and 3 male) admitted to neurology unit from March 2010 to Oct 2013 were studied retrospectively. Diagnosis of anti-NMDA receptor antibody encephalitis was based on encephalitis plus positive CSF serology. Result: Younger age group affected more (range 16 to 65 years). Clinical presentation usually involves the triad of psychotic (100%); seizures (66%) and movement disorder (45%). Autonomic instability observed in two third (66%) of patients. Serum serology is positive only in 55% patients. CSF analysis was variable. MRI brain was largely unremarkable (77%). Tumour occurrence was seen in 66%; 83% in females, 33% in males. The outcome was favourable in two third patients with the best prognosis in female patients when the tumour was found and resected and worst in male patients with tumour unresected. Conclusion: Results are consistent with the current literature in terms of epidemiology, investigations and outcome. However, it requires the larger number of patients with longer follow-up to prove its association with a tumour in patients who has no evidence of malignancy at diagnosis.

For many years, several studies have been conducted to investigate the effect of stress on the onset of Parkinson’s disease (PD), which is characterized by the loss of dopaminergic (DA) neurons in the substantia nigra pars compacta (SNpc). de Pablos et al. reported that stressed animals were associated with a higher rate of death of dopaminergic neurons in the substantia nigra, and that this effect was dependent on glucocorticoids

Background:Cholinesterase inhibitors have been reported to reduce falls in a double blind pilot study. The mechanism by which cholinesterase inhibitors reduce falls is unknown. Methods: A pilot, double-blind, placebo-controlled, crossover study examined the effects of donepezil on posturography and frontal executive function. Participants received 6 weeks of treatment with placebo and donepezil in random order, separated by a month washout. Inclusion criteria were an MMSE > 27 and balance impairment on clinical and sensory orientation posturography (SOT) assessments.

Results: Ten participants completed the study. Donepezil improved postural sway in SOT condition 4 (C4, eyes open, sway referenced surface) (p<0.03). The change seen in executive performance (measured by the Trail B-A time) when on donepezil correlated with improvement in SOT C4, r=0.80, p=0.001.

Conclusion: Cholinesterase inhibitors improved two functions related to fall risk, standing balance on an unstable surface and executive set-switching in subjects with PD. We hypothesized that the cholinesterase inhibitor, donepezil, affects fall risk by improving sensory orientation set-switching for balance related to improvements in executive setswitching.

Background: Many clinicians and researchers believe that “craving” an abusable substance is a central phenomenon related to addiction. Craving for alcohol appears to be intimately related to the loss of control over consumption and to compulsive alcohol use.

Aim: To compare the scores of obsessive compulsive drinking scale with visual analogue scale, severity of alcohol dependence questionnaire and addiction severity index.

Materials and Methods: Literate patients who met DCR-ICD-10 criteria for alcohol dependence syndrome were taken in the study and they must have been drinking alcohol daily till 1 week ago and the subjects were required to consume at least 6 standard drinks per day over the last month. Instruments used in this study were Obsessive Compulsive Drinking Scale– OCDS, Severity of Alcohol Dependence Questionnaire– SADQ, Addiction Severity Index– ASI, Visual Analogue Scale– VAS, Mini Mental Status Examination– MMSE, Timeline Method– TL

Results: Among 40 patients, the mean age of these patients was 38 yrs (38.55 ± 9.60). 95% of them were Hindus and 5% christians. 82.5% were married. And 50% of patients has the income between Rs.15000-20000 per month. The correlation matrix of OCDS variables (OCDS-T,OCDS-O,OCDS-C),ASI-A,SADQ,VAS variables (G,F,I) and TL on all four follow-ups were measured. All correlations were positive and significant at p<0.001. Obsessive compulsive drinking scale total score in 2 drinking outcome groups during 8 week treatment period was seen in which there is a difference between in two patient groups at baseline i.e., abstinent group had lower score than relapse group. This difference was consistently observed between the groups over the entire period of follow-up.

Conclusion: Craving was higher among those who relapsed than those who did not. Craving did predict high alcohol consumption and high index of severity at baseline and all through the follow up.