Rattanawong, Wanakorn

Preferred name

Alternative Name

Rattanawong, W.

Main Affiliation

Faculty of Medicine

wanakorn.ra@kmitl.ac.th

Now showing 1 - 10 of 28

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Acute prolonged motor aura resembling ischemic stroke after COVID − 19 vaccination (CoronaVac): the first case report
(2021-12-01)
Rattanawong, Wanakorn
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Akaratanawat, Wasan
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Tepmongkol, Supatporn
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Chutinet, Aurauma
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Tantivatana, Jarturon
Background: We report the first case of a patient who suffered transient focal neurological deficit mimicking stroke following CoronaVac vaccination. However, instead of an ischemic stroke, motor aura was suspected. Case presentations: A 24 year-old Thai female presented with left hemiparesis fifteen minutes after receiving CoronaVac. She also had numbness of her left arm and legs, flashing lights, and headaches. On physical examination, her BMI was 32.8. Her vital signs were normal. She had moderate left hemiparesis (MRC grade III), numbness on her left face, arms, and legs. Her weakness continued for 5 days. A brain CT scan was done showing no evidence of acute infarction. Acute treatment with aspirin was given. MRI in conjunction with MRA was performed in which no restricted diffusion was seen. A SPECT was performed to evaluate the function of the brain showing significant hypoperfusion of the right hemisphere. The patient gradually improved and was discharged. Discussions: In this study, we present the first case of stroke mimic after CoronaVac vaccination. After negative imaging studies had been performed repeatedly, we reach a conclusion that stroke is unlikely to be the cause. Presumably, this phenomenon could possibly have abnormal functional imaging study. Therefore, we believed that it might be due to cortical spreading depression, like migraine aura, which we had conducted a literature review.
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Unusual thalamic mass and subsequent gelatinous pseudocysts in an immunocompetent host: A case report
(2022-01-01)
Watanabe, Apapatra Akiko
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Hemachudha, Pasin
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Rattanawong, Wanakorn
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Pongpitakmetha, Thanakit
Cryptococcal meningoencephalitis often occurs in an immunocompromised host with several known neurological manifestations including space-occupying lesions, meningitis or meningoencephalitis. Here, we describe a 38-year-old previously healthy durian farm owner with cryptococcoma and subsequent development of cryptococcus gelatinous pseudocyst after receiving high doses of intravenous dexamethasone to treat mass lesion presumed to be a malignant process. An MRI scan of the head demonstrated a 2-cm heterogeneous solitary enhancing cystic lesion at the right thalamus. Progression of neurological deficit and another repeat imaging showing typical appearance of gelatinous pseudocyst. Lumbar puncture found markedly elevated pressure and cryptococcal antigen strongly positive confirming the diagnosis. He was immediately started on amphotericin B and flucytosine for cryptococcus meningoencephalitis with partial improvement in his vision. This report highlights consideration of cryptococcal infection in an immunocompetent host to avoid delays in diagnosis and treatment.
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The transition of medication overuse status by acute medication categories in episodic or chronic migraine patients to non-overuse status after receiving anti-CGRP monoclonal antibodies: a systematic review and meta-analysis of phase 3 randomized control trial
(2024-09-01)
Sirilertmekasakul, Chananchida
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Panto, Akkanat
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Lekhalawan, Pattanan
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Panyarachun, Pariyada
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Jindasakchai, Porpim
Objective: The objective of this systematic review and meta-analysis was to determine whether patients with episodic (EM) or chronic migraine (CM), who were treated with anti-CGRP antibodies, showed a reversal from medication overuse (MO) or medication overuse headache (MOH) status at their baseline to non-overuse status. Furthermore, this study aimed to establish which acute headache medication (AHM) categories responded more effectively to anti-CGRP antibodies. Methods: A systematic search was conducted in the PubMed database for relevant studies from January 2013 to September 2023. We included phase three randomized controlled trials to examine the role of anti-CGRP antibodies in patients with EM or CM and their MO status. A meta-analysis was conducted to find the association between anti-CGRP antibodies and the number of EM and CM patients with MO or MOH at baseline that reverted to non-MO status or below the MOH threshold. Results: The initial search yielded a total of 345 studies. After removing duplicates and screening with inclusion criteria, 5 studies fulfilled our conditions. Each study reviewed the response to changes in the MO status of patients after receiving anti-CGRP antibodies, including eptinezumab, fremanezumab, galcanezumab, and erenumab, compared to placebo. Our study analyzed three AHM categories: triptans, simple analgesics, and multiple drugs. The overall relative risk (RR) was 1.44 (95% CI, 1.31 to 1.59; p < 0.001). The RRs for triptans, simple analgesics, and multi-drug groups were 1.71 (95% CI, 1.53 to 1.91; p < 0.001), 1.10 (95% CI, 0.83 to 1.47; p = 0.5), and 1.29 (95%CI 1.14 to 1.46; p < 0.001) respectively. Conclusion: The meta-analysis has shown that anti-CGRP antibodies were statistically significant in transitioning from MO or MOH status to non-MO status or below the MOH threshold (RR = 1.44) for all included studies and all AHM categories except for simple analgesics. Patients from the triptan group had the highest RR of 1.71 with a p-value < 0.001, while the simple analgesics group had an RR of 1.10, however, with a p-value > 0.05. Interestingly, this analysis can be interpreted as that anti-CGRP antibodies might not be effective in reducing simple analgesics use in EM or CM patients. Further studies are needed to investigate these matters.
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Medication underuse in real-life practice: the impact of galcanezumab towards achieving very low frequency episodic migraine in a southeast Asian middle-income nation
(2025-12-01)
Rattanawong, Wanakorn
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Anukoolwittaya, Prakit
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Hiransuthikul, Akarin
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Pongpitakmetha, Thanakit
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Trisataya, Auranee
Background: Migraine progression, particularly from episodic to chronic migraine (CM), increases disease burden and healthcare costs. Understanding the new concept of “Medication Underuse Headache” should encourage the health care provider to consider early intervention with calcitonin gene-related peptide (CGRP) monoclonal antibodies. Galcanezumab given early in the course of the disease, may prevent migraine chronification and have a robust response, moreso than when initiated in later stages of migraine. We aimed to determine the efficacy of galcanezumab in achieving very low-frequency episodic migraine (VLFEM) among patients with high-frequency episodic migraine (HFEM) and CM in a real world-setting in Thailand. Methods: A single-center, retrospective real-world, cohort study was conducted between 2023 and 2024. Adults aged 18 years or more who were diagnosed with HFEM or CM were included in this trial and categorized into two groups: galcanezumab and oral migraine preventive medication (OMPM). In the galcanezumab group, oral preventive medications were slowly tapered off within 3 months. The primary outcome was the differences in percentage of patients achieving VLFEM at months 3 and 6 between the two groups. Secondary outcomes included the differences in migraine class improvement, sustained response, and headache day reduction. Results: A total of 62 patients (31 in each group) were included: median age was 36.5 (IQR: 29.0–48.0) and 82% were female. There were no significant differences in the baseline demographic features between the two groups. The cumulative incidence of patients achieving VLFEM was significantly higher among the galcanezumab group compared to OMPM group (45.2% vs. 19.4% at month 3 and 52.9% vs. 32.4% at month 6, p = 0.03). After 6 months of follow-up, patients with HFEM who received galcanezumab were significantly more likely to achieve any improvements in migraine class compared to those who received OMPM (92.9% vs. 46.7%, p = 0.01). Among 15 patients who achieved VLFEM at month 3, 81.8% (9/11) of those who received galcanezumab and 50.0% (2/4) of those who received OMPM were able to sustain VLFEM at month 6. Conclusions: This study emphasizes the benefit of early anti-CGRP therapy initiation, especially in patients with fewer headache days, and highlights the need for accessible migraine-specific treatments in low- to middle-income countries.
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A case of successive development of possible acute necrotizing encephalopathy after COVID-19 pneumonia
(2022-03-01)
Hemachudha, Pasin
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Pongpitakmetha, Thanakit
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Rattanawong, Wanakorn
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Thanapornsungsuth, Poosanu
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Joyjinda, Yutthana
COVID-19 infection often results in an excessive inflammatory response with a spectrum of neurological manifestations. Here, we describe an 81-year-old female with severe COVID-19 pneumonia and subsequent alteration of consciousness after high-dose intravenous dexamethasone and remdesivir. A non-contrast head computed tomography (CT) demonstrated bilateral hypodensities involving bilateral cerebellar hemispheres, thalami, cerebral peduncles and medial parieto-occipital areas. There was no improvement and repeat CT showed progression with findings suggestive of acute necrotizing encephalopathy. Interleukin-6 levels were initially normal; however, subsequent levels were found to be markedly elevated. Acute necrotizing encephalopathy associated with COVID-19 may occur in the setting of severe pneumonia and may represent an immune-mediated process involving inflammatory cytokines such as interleukin-6.
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Fluorouracil-induced leukoencephalopathy mimicking neuroleptic malignant syndrome: a case report
(2023-12-01)
Hemachudha, Pasin
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Rattanawong, Wanakorn
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Pongpitakmetha, Thanakit
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Phuenpathom, Warongporn
Background: Fluorouracil-induced leukoencephalopathy is a rare complication and has been reported to present as confusion, oculomotor abnormality, ataxia, and parkinsonism; however, there is no previous report of a presentation mimicking neuroleptic malignant syndrome. Acute cerebellar syndrome may occur, which can be explained by the extremely high accumulation of the drug in the cerebellum. However, presentation mimicking neuroleptic malignant syndrome similar to our case has never been reported. Case presentation: Here, we describe a 68-year-old Thai male presenting with advanced-stage cecal adenocarcinoma, as well as symptoms and signs indicative of neuroleptic malignant syndrome. He received two doses of intravenous metoclopramide 10 mg 6 hours before his symptoms occurred. Magnetic resonance imaging scan revealed signal hyperintensity within the bilateral white matter. Further evaluation showed that his thiamine level was extremely low. Thus, he was diagnosed with fluorouracil-induced leukoencephalopathy mimicking neuroleptic malignant syndrome. The concomitant fluorouracil-induced thiamine deficiency eventually leads to rapid depletion of thiamine and was considered a risk factor for fluorouracil-induced leukoencephalopathy. Conclusion: Fluorouracil-induced leukoencephalopathy is believed to be caused by insult causing mitochondrial dysfunction. However, the exact mechanism remains unknown, but our finding suggests that thiamine deficiency plays a crucial role in fluorouracil-induced leukoencephalopathy. Diagnosis is usually delayed due to a lack of clinical suspicion and results in significant morbidity requiring unnecessary investigations.
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Cerebral Gnathostomiasis: An Unusual Course of Recurrent Hemorrhagic Stroke
(2022-07-01)
Rattanawong, Wanakorn
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Hemachudha, Pasin
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Anukoolwittaya, Prakit
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Pongpitakmetha, Thanakit
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The case of an 85-year-old female with acute right hemiparesis with status epilepticus
(2022-07-01)
Sripan, Thunyares
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Rattanawong, Wanakorn
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Efficacy of lasmiditan, rimegepant and ubrogepant for acute treatment of migraine in triptan insufficient responders: systematic review and network meta-analysis
(2024-12-01)
Laohapiboolrattana, Wattakorn
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Jansem, Priabprat
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Anukoolwittaya, Prakit
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Roongpiboonsopit, Duangnapa
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Hiransuthikul, Akarin
Background: Novel abortive treatments for migraine, ditans and gepants, have promising implications in triptan-insufficient responders with minimal existing comparative data. Our study aims to synthesize evidence through a systematic review and network meta-analysis to assess the comparative efficacy of lasmiditan, rimegepant and ubrogepant in triptan-insufficient responders. Method: We searched PubMed, Embase, CENTRAL, and EBSCO Open Dissertations up to May 2024. We included randomized controlled trials (RCTs) that compared novel abortive treatments, including lasmiditan, rimegepant, and ubrogepant, in migraine patients who self-reported insufficient response to triptans. Outcomes are represented using relative risks with corresponding 95% confidence intervals (CI). The surface under the cumulative ranking curve (SUCRA) was used to rank each medication. Results: A total of five phase 3 RCTs involving 3,004 patients were included in the analysis. All three agents were significantly superior to placebo for two-hour pain freedom (RR = 1.93, 95% CI [1.52, 2.46]), freedom from the most bothersome symptoms at two hours (RR = 1.55, 95% CI [1.37, 1.75]), and pain relief at two hours (RR = 1.46, 95% CI [1.35, 1.58]). No statistically significant differences in efficacy outcomes were observed among the three agents. However, lasmiditan 200 mg had the highest cumulative probability for two-hour pain freedom and relief (SUCRA 0.9, 0.8, respective), while rimegepant led in relieving the most bothersome symptoms (SUCRA 0.7). Conclusion: Lasmiditan, rimegepant, and ubrogepant are effective for acute treatment of migraine in triptan-insufficient responders, with high-dose lasmiditan showing the highest efficacy for pain control.
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Awareness, knowledge, and practice towards medication overuse headache in Thailand: A university hospital-based survey in residency training programs
(2024-01-01)
Anukoolwittaya, Prakit
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Pongpitakmetha, Thanakit
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Hiransuthikul, Akarin
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Thanprasertsuk, Sekh
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Rattanawong, Wanakorn
Background: Medication overuse headache (MOH) presents a considerable challenge in patient care, with physicians playing a critical role in its prevention and management. However, awareness, knowledge, and practices regarding MOH among physicians are often found to be inadequate. Methods: A cross-sectional study was conducted at King Chulalongkorn Memorial Hospital to investigate the awareness, knowledge, and practices concerning MOH among residents from family medicine, internal medicine, and neurology specialties. Participants were surveyed using an internet-based questionnaire. Results: Of the 130 residents, 70 participated in the study. Ten percent were unaware that analgesics could exacerbate headaches, a finding particularly notable among family medicine residents. Furthermore, 11.4% of participants were uncertain about the classification of MOH, while 31.4% and 44.3% were uncertain about the frequency with which the use of simple analgesics and migraine-specific drugs could lead to MOH, respectively. This uncertainty was prevalent among residents in internal medicine and family medicine. Additionally, 22.9% of participants, especially those in internal medicine, prescribed opioids for abortive treatment in migraine patients. Residents in neurology generally performed better across various aspects compared to those in other specialties. Conclusion: The study highlights a significant gap in the awareness, knowledge, and practices regarding MOH, particularly in non-neurology residency programs. Addressing these issues may require continuous medical education utilizing a multifaceted approach, encompassing undergraduate courses, postgraduate training, and public outreach.

Rattanawong, Wanakorn

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