Interictal EEG changes in patients with seizure disorder: experience in Bangladesh

Abstract The objective of this study was to determine the changes and sensitivity of electro encephalogram during interictal period and to evaluate the finding in the clinically suspected seizure events in a tertiary care hospital of Bangladesh. This cross sectional study was carried out in the Electrophysiology Laboratory of Dhaka Medical College Hospital from July 2010 to July 2011, which included 767 patients. EEG was obtained through scalp electrodes following international 10/20 system. Patient and their attendants were interviewed using a semi structured questionnaire. The EEG findings and clinical seizure events were then compared. Among the 767 epilepsy patients most were children (39.9% less than 10 years old) and young adult (33.2% in 11–20 years age group). Female patients predominantly had seizure than male (57% and 43% respectively). The overall sensitivity of EEG in yielding abnormal interictal epileptiform discharges was 62.7%. About 48.5% of them were diagnosed as localization related epilepsy and 11.7% were generalized epilepsy. Morphology showed spike and wave in 74% and sharp and wave in 11% tracings. Only 2% had slow waves. The presence of an interictal spike/sharp wave helps to confirm a clinical diagnosis of epilepsy, aids in defining the epilepsy syndrome, provides information that assists in planning drug management.</jats:p

Clinical Neurophysiology: An Extension of Clinical Examination

Abstract not available&#x0D; Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 1-2</jats:p

Co-morbidities among epilepsy patients: experience in Bangladesh

Objective: To determine comprehensively all the major comorbid diseases observed among epilepsy patients. Methods: In this observational study, 1168 patients were recruited from outpatient based epilepsy clinic in a tertiary care hospital. Four categories of comorbid conditions namely neuropsychiatric, developmental (mental retardation, cerebral palsy), pain disorder (migraine) and others (hypertension, diabetes, stroke) were evaluated in these patients through a prefilled questionnaire and data were then analyzed. Epilepsy were broadly classified into generalized epilepsy (GE), localization related epilepsy (LRE), symptomatic and unclassified. Result: Among the 1168 subjects we included in this study, 71.5% were male. The most common age group at the time of interview was 11-20 years (36.8%). Only 29 (2.5%) respondents were older than 60 years. Among the listed comorbid conditions, mental retardation was the most common entity (15.5%), followed by psychiatric disorder (12.8%), hypertension (5.6%), migraine (5.4%) and cerebral palsy (5.0%). Only 1.5% had diabetes and 0.6% had stroke. Mental retardation and cerebral palsy were more common and significantly associated (p=0.0001 and 0.005) with GE patients (95 and 44), psychiatric disorder was also common among GE patients (108)) with a p value of 0.0001. But migraine was more common and significantly associated (p=0.0001) with LRE patients (46). Stroke was only present in symptomatic epilepsy group (7) and diabetes was present only in GE patients (19). Both were significant (p= 0.0001 and 0.01). But hypertension among different epilepsy groups was not significant (p=0.08). Conclusion: Neuropsychiatric, developmental and pain disorder are common comorbid associations within different epilepsy syndromes which may need special care during management of epilepsy patients. DOI: http://dx.doi.org/10.3329/bjmed.v24i2.20219 Bangladesh J Medicine 2013; 24 : 65-69</jats:p

Demographic proles of epileptic patients and their awareness towards epilepsy with the inuence on compliance

There are about 2 million epilepsy patients in Bangladesh. The aim of this study was to correlate the demographic parameter of epilepsy patients with their knowledge about the disease and also with the compliance of antiepileptic drugs. This retrospective study was carried out in the Department of Neurology at Dhaka Medical College Hospital, Bangladesh from July 2010 to June 2012. A total of 100 epilepsy patients of any age and sex attending the epilepsy clinic were enrolled of which 50 patients who had experienced one or more seizures over last six months were designated as uncontrolled epileptic patients were in case group and 50 patients who were seizure-free for six months were designated as controlled epileptic patients were in control group. Mean age of case and control groups were 21.84 ±8.70 and 23.94 ±10.28 years respectively. Most of the epilepsy patients were between the age of 11 to 30 years that was 88% in case group and 76% in control group. Male was predominant than female in both group. Among study population 70% and 58% had educational status below Primary level in case and control group respectively. Seventy percent of uncontrolled epilepsy patients were from low income group and 62% of them were unemployed. Maximum (68% in case and 44% in control group) patients were from rural area. Almost all controlled epilepsy patients took drugs regularly, whereas 52% patients with uncontrolled epilepsy did not took drugs regularly and 64% of them had history of missing anti-epileptic drugs. Knowledge about the disease, treatment and prognosis of epilepsy was better in control group than in case group of epilepsy patients. It may be concluded that lower socioeconomical condition, less education and lack of awareness about epilepsy and non-affordability, limited availability of drugs, lack of counseling have contributed to the non-compliance of antiepileptic drugs.Bangladesh Med J. 2016 Jan; 45 (1): 20-24</jats:p

Clinical and Electroencephalographic Pattern and Short-Term Outcome to Treatment in Infantile Spasm: A Randomized Controlled Trial

Background: Infantile spasms (epileptic spasm) is an epileptic encephalopathy with unique clinical and electrographic features, which affects children mostly in the middle of the first year of life.&#x0D; Objective: The aim of this study was to evaluate the clinical and electroencephalographic profile and short-term outcome in infantile spasm.&#x0D; Methodology: This was a randomized controlled trial study done in Department of Pediatric Neurology, National Institute of Neuroscience &amp; Hospital, Dhaka, Bangladesh. The patient of infantile spasm aged 2 months to 2 years were enrolled in the study from June 2017 to May 2018. With parent’s written informed consent, they were randomized into two groups, 25 in each. One group got ACTH only and another group got both ACTH and vigabatrin. Detailed history including seizure pattern was taken. EEG was done before and after2 -3 weeks of starting treatment. They were followed up at 8, 15, 43 days.&#x0D; Results: The mean age of onset of seizure (mean ±SD) was 7.24±4.13 (2 to 19) month on hormonal therapy and 6.84±5.89 (2 to 22) month on combination therapy. Most patient had history of perinatal birth asphyxia, developmental delay, seizure pattern was flexor spasm and EEG pattern were predominantly classical hypsarrhythmia in both groups. After treatment cessation of spasms occurred between 14 to 42 days in 72.0% in combination therapy and 44% in hormonal therapy (P value=0.045). EEG became normal in 60.0% and 32.0% patients in combination and hormonal therapy respectively (P value =0.047).&#x0D; Conclusion: In conclusion combination therapy of ACTH hormone plus vigabatrin has better than ACTH therapy alone in cessation of clinical spasms and electroencephalographic remission.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):130-135</jats:p

Pattern of neurological disease seen among patients admitted in tertiary care hospital

Abstract Background Neurologic disorders are not uncommon at in patient departments of different hospitals. We have conducted the study to see the pattern and burden of neurologic disorders at different inpatient departments of a tertiary care centre. Methodology This retrospective observational study was carried out from the records and referral notes of neurology department of Dhaka Medical College Hospital (DMCH) from July 2011 to June 2012. A total 335 patients were evaluated by consultant neurologists during this period. Result Majority of the patients (59.7%) presented after the age of forty years. The mean age at presentation was 45.11 ± 17.3 years with a male predominance (63.3%). Stroke was the most common condition (47.5%) observed at referral, followed by seizure (9.3%), disease of spinal cord (7.8%) and encephalopathy (6.3%). Even after consultation, 30 patients remained undiagnosed and 6 were diagnosed as functional disorder. Department of Medicine (231, 69%) and Cardiology (61, 18.2%) made most of the calls. More than half (56%) of the stroke patients were referred from medicine and one third (35.2%) from cardiology. Seizure (67.7%), problem in spinal cord (92.3%), coma (50%), encephalopathy (57.1%), motor neuron disease (MND) (72.7%) were common reasons for referral from department of Medicine. Whereas patients with cord disease (7.3%), CNS tumor (40%), seizure disorder (6.5%) and stroke (3.8%) were referred from surgery. Department of Obstetrics and Gynecology sought help for stroke (2.5%), seizure (12.9%), MND (27.3%), coma (16.7%) and encephalopathy (9.5%). Hypertension, diabetes, ischemic heart disease, dyslipidaemia and respiratory problem were significantly associated co-morbid conditions in stroke patients (at 95% CI, p value is &lt;0.001, &lt;0.01, &lt;0.001, &lt;0.05, &lt;0.05 respectively). Hematological disorders were common association among patients with cord problem (&lt;0.05). Conclusion Wide ranges of neurological problems are often managed by physicians and surgeons, especially those from medicine and cardiology. Where ever available consultation from neurologists can help in diagnosing and managing these cases. </jats:sec

Hereditary Neuropathy with Analysis of Electrophysiological Findings: A Case Report

The hereditary motor and sensory neuropathies (HMSN) represent a genetically heterogeneous collection of disorders in which patients develop a progressive muscular atrophy and sensory neuropathy of the distal extremities. There are abnormalities of axons or Schwann cells and their myelin sheaths resulting in peripheral nerve dysfunction. These disorders are also known as Charcot-Marie-Tooth (CMT) disease, which is divided into seven distinct subtypes based on inheritance pattern (dominant, recessive, or X-linked) and whether the primary pathology is located in the myelin or axon. Each of these CMT types are further divided based on their specific molecular and genetic findings. Here we report a case which was diagnosed on the basis of clinical history and neurophysiological testing. Although genetic analysis is the gold standard for diagnosis we could not do it due to lack of availability of genetic testing in our country at this moment.Journal of National Institute of Neurosciences Bangladesh, 2016;2(1): 43-45</jats:p

Neurological Manifestations of COVID-19 patients: An Updated Review and Observations of COVID Patients in the National Institute of Neurosciences and Hospital, Dhaka, Bangladesh

Involvement of the nervous system after viral infection is common. Certain viruses show neurotropism. Recent outbreak of severe acute respiratory syndrome CoV 2 (SARSCov- 2) virus has also exhibited neurotropic properties with various neurological manifestations. The pathophysiology of their neurotropism is not yet clearly known. The details of pathophysiology, clinical manifestation and management are expected to be explored in the near future. Here we review the Neurological manifestations of COVID-19 and the early experience in the National Institute of Neurosciences and Hospital.&#x0D; J Bangladesh Coll Phys Surg 2020; 38(0): 122-132</jats:p