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Distinguishing Spinal Cancer and Degenerative Disease: Enhancing Diagnosis and Treatment Outcomes in Plasmacytoma -, Liana Alviah Saputri; Riyanto Sofyan, Henry; Aninditha, Tiara; Savitri, Irma; Saekhu, Mohammad; Kusuma, Radius
Acta Neurologica Indonesia Vol. 4 No. 01 (2026): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

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Introduction: Spinal lesions commonly exhibit overlapping clinical presentations and imaging characteristics, which can obscure the distinction between malignant and degenerative etiologies. This diagnostic ambiguity may lead to delayed or inappropriate treatment, particularly in uncommon neoplastic entities such as plasmacytoma, a solitary manifestation of plasma cell dyscrasia that often involves the spine. Case Report: We report the case of a 63-year-old male presenting with one month of persistent back pain, progressive bilateral lower limb weakness, and tingling sensations radiating from the inguinal region to the toes. Imaging studies revealed bilateral pedicle destruction at the L2 and L5 vertebrae, along with significant spinal canal and foraminal stenosis. The patient underwent decompression surgery, and histopathological analysis of the lesion confirmed the diagnosis of plasmacytoma. Discussion: Spinal plasmacytoma is a rare neoplastic condition that can clinically mimic degenerative spine disorders, often leading to delays in diagnosis and treatment. Symptoms such as chronic back pain, radiculopathy, and motor weakness are commonly attributed to more prevalent degenerative pathologies, particularly in older adults. Back pain in individuals with a history of malignancy serves as a crucial warning sign, prompting clinicians to urgently assess for potential metastatic disease in the spine. Conclusion: Increased awareness and a high index of suspicion are crucial when evaluating spinal lesions. Pain should be considered a key red flag warranting prompt assessment for possible spinal malignancy. Early diagnosis is critical, as it directly affects therapeutic decisions and overall prognosis.

Multiple Pain Generators and Central Amplification in Chronic Pain: A Narrative Review of Peripheral-Central Mechanism Riyanto Sofyan, Henry
Acta Neurologica Indonesia Vol. 4 No. 02 (2026): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v4i02.122

Background:Chronic pain is increasingly recognized as a complex condition involving interactions between peripheral nociceptive sources and central nervous system amplification mechanisms. Traditional models that focus solely on tissue damage are inadequate to explain the persistence and widespread distribution of many chronic pain conditions. Methods:This narrative review synthesizes current theoretical frameworks and empirical evidence on how peripheral pain sources interact with central amplification mechanisms. Literature from clinical, experimental, and neurobiological studies was reviewed to explore mechanisms underlying central sensitization, neuroinflammation, and patterns of pain comorbidity. Results:Evidence suggests that central sensitization, marked by increased neuronal excitability in central pain pathways, is a key mechanism connecting various chronic pain conditions. Peripheral nociceptive inputs, such as tissue inflammation, nerve injury, and musculoskeletal problems, can trigger and maintain central sensitization. Neuroimmune interactions and changes in descending pain modulation also help amplify and sustain pain. Epidemiological studies show frequent overlap among chronic pain conditions, supporting the idea of shared mechanisms involving peripheral and central interactions. Conclusion:Chronic pain is best understood as the outcome of dynamic interactions between peripheral pain sources and central amplification mechanisms. Recognizing these bidirectional processes has vital implications for clinical assessment and multimodal treatment approaches. Future research should prioritize longitudinal studies, validated mechanistic biomarkers, and integrated models that encompass peripheral, central, and psychosocial factors. Keywords: chronic pain; central sensitization; pain generators; neuroinflammation; pain mechanisms

Reputation Engineering in Neurology: Navigating Clinical Authority, Digital Presence, and Content Strategy in the Information Era Riyanto Sofyan, Henry
Acta Neurologica Indonesia Vol. 3 No. 03 (2025): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v3i03.128

Background: The digital transformation in healthcare has fundamentally altered how neurologists develop and uphold their professional reputation. Although digital professionalism frameworks exist for general medical practice, approaches tailored to neurology remain underdeveloped. Objective: This narrative literature review aims to synthesize evidence exploring the intersection of clinical authority, digital professionalism, and reputation management in neurology and to develop a structured, neurology-specific conceptual framework. Methods: A narrative literature review was conducted by searching PubMed, Scopus, and Google Scholar using terms such as "physician reputation," "digital professionalism neurology," and "online physician reviews,". Studies published from 2008 to 2025 were included if they addressed physician reputation, digital professionalism, online reviews, or health communication strategies relevant to neurological practice. A total of 37 sources were identified and synthesized across eight interconnected themes. Results: This review presents the Neurology Reputation Architecture Model, a three-part framework consisting of Core (clinical competence, ethics, trust), Signal (digital presence, health communication, content strategy), and Shield (risk management, professional boundaries, crisis response). The evidence shows that social media activity, online patient reviews, and digital content strategies significantly influence patient choices, referral patterns, and professional reputation. Neurologists face unique challenges in communicating diagnostic uncertainties and complex neurological concepts in digital settings. Significant gaps remain in neurology-specific empirical research, especially in low- and middle-income countries (LMICs). Conclusion: Effective reputation management in neurology requires blending traditional professionalism with strategic digital engagement. Future research should focus on neurology-specific studies, LMIC contexts, and interdisciplinary methods that combine behavioral science, marketing theory, and sociology of professions.

Pain as a Mental State: A Narrative Review of the Multidimensional Aspects of Pain Riyanto Sofyan, Henry; Hasan, Sandy
Acta Neurologica Indonesia Vol. 3 No. 04 (2025): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v3i04.147

Introduction: Pain is a complex subjective experience that involves not only sensory-discriminative but also affective-motivational, cognitive-evaluative, behavioral and social dimensions. Contemporary perspectives on pain have shifted from simplistic linear models toward a conceptualization of pain as a multidimensional mental state generated by the brain. This narrative review aims to summarize the perspectives of pain within multidimensional aspects by understanding pain as an evolving framework associated with mental health, validated by assessment instruments, and its clinical implications. Material and Methods: A comprehensive literature search was conducted via PubMed and ScienceDirect with keyword related to pain, chronic pain, acute pain, mental status, psychological state, mental health, multidimensional, biopsychosocial model, cognitive, affective, and sensory. A total of fifteen literatures were reviewed and analyzed. Discussion: The literature indicates that pain is a brain-generated phenomenon integrating sensory-discriminative, affective-motivational, cognitive-evaluative, behavioral, and social dimensions. Strong associations were identified between chronic pain and depression, anxiety, and the mental state of pain patients. Validated multidimensional pain assessment instruments are available for adult and pediatric populations as well as for specific clinical conditions; however, gaps remain in cross-cultural validation and in assessments tailored to older adult populations. Conclusion: Pain should be understood as a multidimensional mental state that requires comprehensive assessment and integrated intervention strategies. A biopsychosocial approach combining pharmacological management, psychological interventions, and functional rehabilitation represents best practice in chronic pain management. Future research should strengthen cross-population validation, integrate neurobiological measures with longitudinal psychosocial data, and develop mechanism-based personalized models of pain management.

The Representation of Headache and Pain Through the Lens of Cultural Neuroscience Riyanto Sofyan, Henry; Hasan, Sandy
Acta Neurologica Indonesia Vol. 4 No. 01 (2026): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

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Background: Headache is a universally experienced neurological condition; however, its representation and subjective interpretation vary considerably across cultural contexts. Cultural neuroscience provides an integrative framework for understanding how sociocultural influences shape headache and pain experiences through identifiable neural mechanisms. Objective: This narrative review synthesizes empirical and epidemiological evidence regarding cross-cultural variations in headache presentation, psychophysical pain profiles, and systemic clinical management barriers across diverse global populations. Methods: A structured literature search was conducted across the PubMed and ScienceDirect databases to identify peer-reviewed studies published between 2016 and 2026 focusing on cultural neuroscience, primary headache disorders, and cross-cultural pain perception. A total of 20 articles meeting eligibility criteria were selected for qualitative narrative synthesis. Results: Cross-cultural differences in headache expression are heavily driven by lived experiences of socioenvironmental stress and structural inequities. Chronic exposure to systemic discrimination, lower socioeconomic status, and acculturation stress function as physical stressors that accelerate central sensitization and the chronification of episodic headaches. Furthermore, culturally distinct illness models and expectations of clinical stoicism significantly influence symptom communication, contributing to diagnostic misclassification. Finally, structural healthcare barriers perpetuate profound inequities in patient access to novel, targeted migraine therapies. Conclusion: Nociceptive processing appears to be relatively consistent across populations, whereas cultural factors influence the affective and contextual modulation of headache through identifiable neural circuits. Clinical implications highlight the importance of culturally informed assessment strategies and personalized therapeutic interventions.

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