Care at NUH

Division of Neurology

2024/10/02

As an academic tertiary unit, we integrate clinical care with undergraduate and postgraduate education and research programmes. Our clinical work is organised into three main areas: 

  1. Cerebrovascular Neurology (Stroke) 
  2. General Neurology 
    • Neuromuscular Disorders 
    • Headache Disorders 
    • Epilepsy 
    • Neuroimmunology 
    • Movement Disorders 
  3. Rehabilitation Centre 

     

Additionally, our Neurology Diagnostic Laboratory provides a comprehensive range of specialised diagnostic electrophysiology services to support the diagnosis and treatment of neurological conditions. 

Our Services: Neurology

We provide comprehensive neurology services for both inpatients and outpatient. Our care extends to patients hospitalised under the Neurology Inpatient Service, including the operation of a Neurology High Dependency Unit. We also provide specialist neurology consultations for inpatients from other disciplines. For stroke patients, we offer acute thrombolytic and endovascular therapy.

Our outpatient service caters to patients referred by general practitioners and other specialists for various neurological conditions. The outpatient service includes the following sub-specialty clinics:

Stroke Clinic

We offer follow-up care for stroke patients and work with primary care physicians to manage stroke and cardiovascular risk factors.

Atrial Fibrillation and Stroke Clinic

This clinic focuses on patients who have experienced a stroke secondary to atrial fibrillation.

Neuro-Immunology Clinic

Patients with autoimmune neurological conditions, such as multiple sclerosis, neuromyelitis optica, transverse myelitis and autoimmune encephalitis, are seen here.

Peripheral Nerve Surgery Clinic

A multidisciplinary service providing advanced clinical care for complex peripheral nerve disorders. The clinic involves team members from the Division of Neurology and the Department of Hand and Reconstructive Microsurgery.

This clinic addresses a wide range of peripheral nerve issues, including brachial plexus injury, other nerve traumas, nerve entrapments (such as Carpal Tunnel Syndrome, Ulnar Neuropathy, Meralgia Paresthetica, Tarsal Tunnel and Radial Neuropathy) and inflammatory or tumour-related conditions (e.g., Morton Neuroma, Schwannoma).

Supporting the clinical team are diagnostic tools like high-resolution ultrasonography and MRI, combined with neurophysiological examination techniques (nerve conduction, electromyography (EMG), evoked potentials and autonomic/small nerve fibre tests).

Diagnostic tools

Neurodiagnostic tests for peripheral nerve disorders include:

  • Nerve conduction studies
  • EMG
  • Somatosensory evoked studies (Median and Tibial)
  • High-resolution nerve ultrasound

Autonomic Disorders/Small Fibre Neuropathy clinic

Movement Disorders Clinic

We offer comprehensive care to patients with movement disorders. This includes Botulinum injections for dystonia or contractures, and holistic care for Parkinson’s Disease patients by an Advanced Practice Nurse.

Headache Services

Our specialist outpatient care encompasses various headache and facial pain disorders, such as migraines, tension-type headaches, trigeminal autonomic cephalalgias (e.g., cluster headaches), hemincrania continua, hypnic headaches, trigeminal neuralgia, and more. An inpatient service is available for patients with intractable headaches.

Seizure/Epilepsy Clinic

We provide expert diagnosis and medical management for seizure disorders, aiming to optimise seizure control.

Neuromuscular Disorders Clinic – Nerve and Muscle Programme

Our clinics, run by physicians specialising in neuromuscular diseases, caters to patients with nerve or muscle disorders. Symptoms of these disorders may include weakness, cramps, numbness and pain.

Conditions treated include neuropathies, myopathies, neuromuscular junction disorders, motor neuron disease and spinal cord disorders. Comprehensive electrodiagnostic services and peripheral nerve ultrasound are at the Neurodiagnostic Laboratory.

Management often involves multiple disciplines. We strive to provide optimal care by integrating various resources.

Our Services

  • Neuromuscular Clinic
  • Peripheral Nerve Surgery Clinic <anchor link to Peripheral Nerve Surgery clinic below>
  • Electrodiagnosis for nerve and muscle dysfunction
  • Autonomic and small fibre neuropathy
  • Neuromuscular case discussion/multidisciplinary round

Our Specialists

Programme Co-Directors

Clinical Director, Neurodiagnostic (NDL) Services

  • Dr Quek Zhi Xuan

Section Lead, Autonomic and Small Fibre Neuropathy

Team Members

Neurodiagnostic Laboratory

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Our Services: Rehabilitation Medicine

Inpatient Services 

  • Inpatient consultation services at NUH 
Outpatient Services

General Rehabilitation Medicine clinic; Intervention Clinic 

  • This group practice clinic specialises in interventional spasticity management using botulinum toxin and chemical neurolysis, combined with rehabilitation techniques such as serial casting, functional electrical stimulation and functional retraining. Additionally, pain management interventions such as joint injections and trigger point injections are offered. 

Neuro-Urology Clinic 

  • A multidisciplinary clinic addressing urinary complications in patients with spinal cord diseases. Patients receive coordinated care from a urologist, a rehabilitation physician and a rehabilitation medicine advanced practice nurse, focusing on both functional and genitourinary issues simultaneously. 

Orthopaedic / Rehabilitation Medicine Spine clinic 

  • Operated a rehabilitation physician within the Orthopaedic Clinic, this service provides expert diagnosis and multi-dimensional, non-operative management for patients with neck and back pain.  

Diagnostic EMG Clinic 

Our Facilities

Inpatient services  

Ward 57 (Neurology Ward) 
The Neurology Ward, catering to adult patients, specialises in the care and treatment of those with stroke and neurological conditions undergoing neurological investigations. 

The unit comprises highly trained specialists, nurses and allied health professionals committed to delivering compassionate, multidisciplinary and quality care for a range of neurological conditions. 

The unit is committed to providing comprehensive assessments, holistic treatments, as well as academic and research excellence. 

Facilities include: 

  • 38 general neurology beds (six-bed wards) 
  • A six-bed Neurological High-Dependency Unit for close monitoring and early intervention in patients with unstable neurological conditions, including thrombolysis and endovascular therapy for suitable stroke patients. 
  • A procedure room for transcranial/extracranial ultrasound and electroencephalogram (EEG) 
  • Rehabilitation facilities to help patients maximise their potential and recovery 

Neuroscience Clinic 
Our general neurology clinics attend to patients referred for various neurological conditions by general practitioners and other specialists. 

Specialty clinics  
Our specialty clinics include the Stroke Clinic, Atrial Fibrillation and Stroke Clinic, Neuro-Immunology Clinic, Neuromuscular Clinic, Peripheral Nerve Surgery Clinic, Autonomic Disorders/Small Fibre Neuropathy clinic, Movement Disorders clinic, Headache Service, Seizure/Epilepsy Clinic, and Neurodiagnostic Laboratory.  

Patient Education

​For patient information on Headache Disorders, please click  here. 

Our Education

The Division of Neurology is actively involved in both undergraduate teaching and postgraduate training, encompassing internal medicine residents and senior residents in neurology. 

Current programmes available: 

Neurology 
  • Senior Residency  
  • Honorary Fellowships in: 
  • Stroke 
  • Neurosonology 
  • Fellowship in Laboratory and Clinical Nerve Diagnostics (Neuroimmunology and Neurophysiology) 
  • Clinical Neurophysiology Neurorehabilitation  
  • Epilepsy/Electroencephalography 
  • Headache Disorders 
  • Staff Registrar Scheme Diploma (Neurology) 
  • Resident Physician (Neurology) 
Rehabilitation Medicine 
  • Fellowship in Neurorehabilitation 
  • Staff Registrar Scheme Diploma (Rehabilitation Medicine) 

Our Research

Research plays a crucial role in our mission to deliver evidence-based, personalised and cost-effective care to our patients. We collaborate extensively with both local and international partners, engaging actively in clinical research to improve patient care and facilitate the translation of preclinical and technological advances to clinical practice. 

Peripheral nerve disorders 

Our research extends beyond nerve conduction and autonomic studies, exploring the use of high-resolution ultrasonography to guide medical and surgical treatment of metabolic neuropathies, nerve entrapments and inflammatory nerve diseases. We maintain a close collaboration with SINAPSE (Singapore Institute for Neurotechnology), providing opportunities for collaborative research. For more information, please visit www.sinapseinstitute.org 

 

Stroke 

Stroke, an important cerebrovascular disease, is on the rise globally. Our research focuses on optimising acute reperfusion therapies, using radiologic and sonographic methods to recanalise occluded arteries and improve clinical outcomes. We are also exploring intracranial stenosis in our community, examining its contribution to cerebrovascular reserves, electrographic changes and stroke recurrence. Initiatives using telemedicine assess the incidence of paroxysmal atrial fibrillation, blood pressure control in stroke patients, and explore the use of transcranial magnetic stimulation, brain-computer interface and botulinum injections for rehabilitation. Our laboratory aims to better understand the mechanisms of stroke occurrence, resistance to standard treatment and complications such as cerebral haemorrhage. Collaborations with engineers and scientists in academia and industry are focused on identifying high-risk patients and developing biomarker-based and novel treatment strategies. 

 

Autoimmune Neurologic Disorders 

Increasing recognition of neural-mediated autoantibodies in the pathogenesis of neurologic presentations has led our division to investigate immunological biomarkers. These biomarkers aid in recognising autoimmune neurologic disorders and tailoring individualised therapies. 
 

Headache Disorders 

We are dedicated to advancing headache neurology in Singapore and beyond through clinical trials, epidemiological studies and education research. 

 

Rehabilitation Medicine 

 

  • Rehabilitation robotics: Collaborative clinical studies with the National University of Singapore Faculty of Engineering focus on the development and use of soft robotics and robotic exoskeletons with novel control algorithms for rehabilitation. 

 

  • Enhancement of neuroplasticity using non-invasive brain stimulation: Studies on repetitive transcranial magnetic stimulation and transcranial direct current stimulation aim to enhance recovery in stroke and other acquired brain injuries. 

 

  • Use of technology-enhanced neuro-feedback in neuro-rehabilitation: Collaborations with engineers are exploring brain-computer interface-assisted motor imagery and EEG and EMG biofeedback to enhance rehabilitation performance. 

 

  • Neurophysiological mechanisms of stroke recovery: Functional imaging with MRI (including tractography) and transcranial magnetic stimulation are used to study changes in neuronal networks during natural stroke recovery and with various interventions. This research helps stratify patients for appropriate neuromodulatory interventions. 
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