The questions below were raised by visitors to the STOMP (Straits Times Online Mobile Print) website in the AskST section of the website. eMenders doctors provided the answers to the questions raised as a public health education project. The information provided below is of a general nature and should not be treated as a replacement for medical advice. You should seek consultation from a medical or healthcare professional about your specific medical condition.


Warfarin reduces stroke risk from atrial fibrillation by about 85%, and is probably the most effective stroke prevention treatment for your father.

However, having hypertension and diabetes, he could still have a stroke from other mechanisms such as the blockage of a blood vessel in the neck/brain from the formation of a blood clot in the vessel wall (atherothrombosis).

If there is indication of significant stroke risk from atherothrombosis, then an addition of an anti-platelet drug such as clopidogrel may be useful.

However, combining warfarin with clopidogrel may increase the risk of brain haemorrhage, so a lower dose of warfarin may well be safer.

As such, it is imperative that your father control his hypertension and diabetes to prevent further strokes.

We recommend that you consult a neurologist for more specific advice concerning your father’s condition.

Contributed by Dr Nei I-Ping, eMenders Neurologist.

This is a common symptom and harmless. It usually goes off by itself with reduction of stress.

If it persists, it may be necessary to rule out a simple dry eye problem. If the twitching of your eyelid is accompanied by a twitching of the mouth, then a neurological consultation would be most appropriate.

Contributed by Dr Nei I-Ping, eMenders Neurologist.

There is not enough information given in your question above. In order to give a proper answer, we would need to know your age, duration of symptoms, whether there is any family history, etc.

As the treatment depends on the likely cause of the shaking hands, it is best that you consult a neurologist for a proper examination, tests, and treatment.

Contributed by Dr Nei I-Ping, eMenders Neurologist.

Tension headaches are usually caused by anxiety, depression, lack of sleep and other psychological factors. Chronic eye strain may also cause over-contraction of the muscles around the eyes and in the frontal areas.

Effective treatment requires careful history and examination, reassurance, and advice on how to cope with stress. It may be necessary to proceed with laboratory tests and a brain scan when the headache does not respond to treatment.

Effective medications include simple analgesics such as paracetamol. Chronic headaches may also respond to small doses of amitriptyline.

Contributed by Dr Nei I-Ping, eMenders Neurologist.

Yes, unfortunately Central Hypoventilation Syndrome is very rare. Another name for this syndrome is “Ondine’s curse” after Greek mythology.

Central hypoventilation syndrome may be congenital (from birth) or acquired (as a result of disease or insult to the respiratory centre of the brain). It is usually diagnosed on an overnight polysomnography or sleep study – this would show periods of cessation of breathing with no chest or abdominal effort and accompanying dip in oxygenation of the blood. Essentially, breathing is under both voluntary (ie. one can choose when to breathe) and automatic (do not have to keep thinking of breathing) control. When one sleeps, one loses voluntary control of breathing and the automatic control of breathing takes over – this is dysfunctional in patients with central hypoventilation syndrome. Brain imaging, blood and other relevant investigations may be performed to exclude secondary causes. Differential diagnoses to be considered would include conditions that could cause weakness of the muscles used for breathing. The following link helps to understand this condition better

Treatment for this syndrome includes, as mentioned in the question, BiPAP therapy and also diaphragmatic pacing (only available in very specialized centres). The best physician(s) to treat the girl (assuming she is still a child) would be a paediatric pulmonologist cum sleep medicine specialist – there are good ones in KKH and NUH.

Contributed by Dr Andrew Pan, Neurologist.