|Head of Department||Dr Santhi Datuk Puvanarajah
The Neurology Department of HKL was set up in 1971 to provide a more comprehensive neurological service to the citizens of Malaysia. The department is situated in the Institut Kajisaraf Tunku Abdul Rahman (IKTAR) building which was officially opened in 1975. The department at present shares the premises with the Neurosurgery and Psychiatry departments.
The department will be the tertiary referral centre in the diagnosis and management of neurological diseases in this country as well as the centre of excellence in research and training. It will be led by a team of dedicated, committed and skilled health staff, who will be equipped with the latest in knowledge and technology in the care of the patients.
The department will be led by a team who are:
• Dedicated and sensitive to the needs of the patients.
• Knowledgable and skilled in the latest treatment and diagnostics in neurological illnesses.
• Actively involved in training, research, teaching and quality assurance.
The department offers comprehensive diagnostic and therapeutic services for adults with disorders of the central and peripheral nervous system. It is the largest neurology department in the country, and has the highest workload of patient care.
The department has expertise in diverse areas such as epilepsy, stroke, multiple sclerosis, movement disorders, neuromuscular diseases, headaches and pain syndromes, peripheral neuropathies and infectious diseases. Sophisticated neurophysiological evaluations including nerve conduction study and electromyography, electroencephalography,evoked potential testing, polysomnography, video telemetry recording and transcranial doppler are provided. The Neurology Department does not only cater to patients in the Klang Valley but also acts as the tertiary referral centre for patients all over the country. Consultation clinics are also provided on a rotation basis to most major state hospitals in Malaysia by the consultants from this department. A residency and fellowship training program is an important function of the department. We are also involved in the post basic training of neurophysiology clinical and neuroscience for allied health.
The department maintains an active clinical service. Inpatient services are rendered at the Neurology Ward 5B on the second floor (see Service: Neurology Ward). Outpatient clinics cover all areas of general neurology, as well as speciality areas such as Epilepsy, Stroke, Movement Disorders etc.(see Service: Neurology clinics).
Inpatients total nearly 1,000 per year, whilst outpatients in the clinics are more than 12,500 patients per year. More than 1,500 electrophysiology studies are performed annually.
The department also works closely with the various patient support groups and NGOs for the betterment of the patients.
The department offers:
i) Neurology ward inpatient service (Neuro 5B -Bangunan IKTAR)
ii) Outpatient clinics (Level 5 - SCACC)
iii) Neurophysiology services (Level 5 - SCACC)
1) The Neurology ward: is a 28 bedded unit with 2 additional rooms for video-telemetry for epilepsy monitoring and a sleep laboratory for all-night sleep studies. The ward caters to all diseases under the neurology spectrum, and offers diagnostic as well as therapeutic procedures such as lumbar punctures, insertion of ELDs (external lumbar drainages), plasmapheresis therapy (in conjunction with the Nephrology department), intravenous immunoglobulin therapy and acute as well as a short rehabilitative program for stroke patients. Muscle biopsies are also performed for diagnosis of myopathies and muscular dystrophies. Grand ward rounds are done twice a week. On Monday, a sitting rounds and on Wednesday a bedside rounds is conducted.
Neurology consultants, residents, nurses, physiotherapists, occupational therapists, dieticians, speech therapist and social welfare officers are all involved in the care of the patients with a wide spectrum of acute and chronic neurological disorders, and its attendant concomitant complications and needs. Patients or their relatives will be given an introductory pamphlet of the ward rules and schedules to orientate patients.
For any queries regarding the ward, please contact Nursing Sister Balkhis Mohd Zain,Nursing Sister Fizana Suriati Shafie,Nursing Sister Nor Huda bt Saidin, Nursing Sister Zuraini Mustafa at: 603-2615 6174/7296
TOP 5 WARD ADMISSION
2) The Neurology clinics: include 2 general neurology clinics and specialty care clinics (epilepsy, stroke, advanced Parkinson's and Multiple Sclerosis clinic). Patients are seen on a referral basis only. Appointments are given by the clinic staff. Waiting time for the 1st appointment may range from a week to 3 months, depending on the urgency. Emergency cases are seen on the same day, after discussion between the referring doctor and the neurologist on call.
The schedule for the department is as below:
8.00 am - 1.00 pm
1.00 pm - 2.00 pm
2.00 pm - 5.00 pm
General Neurology Clinic
(follow-up and new cases)
Advanced Parkinsons Clinic
General Neurology Clinic
(follow-up and new cases)
General Neurology Clinic
(follow-up & new cases)
Stroke Follow-Up Clinic
Multiple Scelosis clinic (fortnightly)
* Note :-
- Registration for Neurology patient is at 7.30 am
- On-call doctors will treat emergency cases
- Daycare treatment includes IV Immunoglobulin infusion
i) General Neurology Clinic
Two general neurology clinics, which see follow-up as well as new cases on Tuesday/Wednesday, and one clinic for new cases are run Friday.
ii) Epilepsy Clinic
The epilepsy service offers complete epilepsy care which includes:
1. follow up, assessment and diagnosis of epileptic seizures and conditions mimicking seizures
2. medical treatment
3. EEG and digital video-telemetry monitoring tests for diagnosing difficult epilepsy and presurgical evaluation for potential surgical candidates
4. Epilepsy surgery, in collaboration with HKL and Sungai Buloh Hospital neurosurgical departments.
iii) Advanced Parkinson clinic on Wednesday evening involving physiotherapist, occupational therapist and clinical pharmacist.
iv) Botulinum Toxin Injection
Our clinic's services include medical therapy with an array of pharmaceutical therapy including Botulinum toxin injections for various conditions such as dystonias, tics, hemifacial spasms, and blepharospasm.
Any enquiries concerning the Botulinum clinic can be addressed to : Staff nurse Wan or Jusita at +603-2615 5555 ext or 1049/1050.
v) Stroke Clinic
Stroke remains the most common cause of adult neurological disability. Along with care of acute stroke, rehabilitation and the transition back into the community are priorities of the department.
Any queries on the clinic are to be directed to - Nursing Sister Thanakoddi at 03-26155555 ext : 1050/1049
Patient information pamphlets available are:
1. Epilepsy-Common Types and Its Causes
2. Sawan- Jenis-Jenis dan Punca-Punca
3. Living with Epilepsy-Common Questions and Answers
4. Epilepsi- Maklumat Berguna Untuk Ahli Keluarga dan Penjaga(in 4 languages)
5. Understanding Stroke (Persatuan Neurosains Malaysia)
6. What is Stroke? (Great Eastern Life)
7. Apakah Strok? (HKL)
9. Lumbar Puncture
10. Myasthenia Gravis
12. Have you had your Headache Diagnosed ( Headache Society of Malaysia)
13. Various pamphlets on epilepsy and medication/pregnancy/school
3) Neurophysiology Unit
The clinical neurophysiology programme provides comprehensive EEG (electroencephalography), NCS and EMG (nerve conduction studies and electromyography), EP (evoked potentials which include VEP, BAER and SSEP), TCD (transcranial Doppler), VT (video-telemetry), and sleep studies. The Unit also runs a 6 months training programme every year for Assistant Medical Officer working in the various neurophysiology units in other major hospitals nationwide.
For any inquiries may be directed to PPP Rosdi Zainal, PPP Mohd Hapizi Che Hassan and PPP Zamzuki bin Mat Zaki at : 03-2615 5555 ext : 1431
1. Epilepsy Surgery Clinic
Epilepsy patients will be screen and those who are suitable for epilepsy surgery will underwent thorough pre-surgical evaluations which involving multiple disciplinary teams. Up to date, there are quite a numbers of patient who successfully underwent surgery with good outcome.
2. Deep brain stimulation for Advance Parkinson's disease
This treatment is mainly for patients with advanced Parkinson with severe motor complications. These patients will be referred to the specific neurosurgeon after they agreed.
3. Thrombolysis therapy for acute stroke
This service started in July 2013 and patient with acute who fulfilled the criteria for thrombolysis will be given specific medication called recombinant Tissue Plasminogen Activator (rTPA) after careful evaluation by neurologist.
1. Neurophysiology Training Program: This is a 6 month programme in Post Basic Clinical Neurophysiology for Assistants Medical Officer with basic neurophysiology training. A further advanced 3-6 weeks' overseas clinical attachment (scholarship programs awarded by Ministry of Health) is also available for those neuro technicians to further subspecialize. We also accept requests for short neurophysiology training of 1-2 months' attachment from private medical centre.
Any inquiries may be directed to either PPP Rosdi Zainol, PPP Mohd Hapizi Che Hassan and PPP Zamzuki bin Mat Zaki at : 03-2615 5555 ext : 1431
2. Post-Basic Neurosciences Training Programme: This is a 6-month programme in Post-Basic Clinical Neurosciences for the nursing staff from both, Ministry of Health hospitals and private medical centers.
3. Neurology Training Program:
- Medical officers in HKL are posted, on a rotation basis to the department, once every four months, where they will be exposed to a wide variety of neurological disorders and the management. The training will also assist those who are preparing for specialist examinations e.g. M. Med or MRCP.
- The department also has regular attachment of 1 - 3 months for doctors undergoing their Masters Programme studies in Internal Medicine, Ophthalmology, Psychiatry, Family Medicine, Acute Emergency Medicine and Rehabilitation Medicine from local universities.
- Regular undergraduate training is also provided to medical undergraduate students from local public and private universities (with MOU agreements with MOH) and from time to time, elective medical students from foreign universities.
4. Neurology Fellowship Training Program: We are the main training center for the neurology fellowship program for the Ministry of Health. Trainees are required to undergo 2 years’ training locally and one year overseas training, before sitting for an Exit Viva Examination and applying for gazettement and specialist registration.
Current Neurology Fellows:
1. Dr Ahmad Shahir Mawardi
2. Dr Mohd Azman Aris
3. Dr Kok Chin Yong
4. Dr Tan Wee Yong
5. Dr Sally Tee Sow Kuan
6. Dr Teh Pei Chek
7. Dr Stephanie Hung Kar Yan
8. Dr Patricia Loh Chin Tien
For further details on neurology training, please refer to the Ministry of Health Fellowship Guidelines.
Fellowship Training Committee
Professional Development Unit
Medical Development Division
Ministry of Health
50590 Kuala Lumpur
Department staff are also actively involved in research - clinical, pharmaceutical-driven & quality and have had their publications, both inlocal and international journals. Currently, ongoing trials are in the following fields :-
-Botulinum Toxin Injection Therapy
-Department Specific Approach (DSA) Quality projects