The aim of our study was to determine the types of epilepsies and epileptic syndromes along with their treatment strategies among patients attending the outdoor epilepsy clinic in a tertiary care hospital. Methods: We did a retrospective chart review of all 2236 epilepsy patients attending the epilepsy clinic of Dept. of Neurology, Dhaka Medical College Hospital from October 1996 to September 2010. Data were collected through a predesigned questionnaire containing information on age, sex, habitat, clinical features, management, EEG and imaging findings. Result: Most of the patients in our study were in 15-40 year-old group (46%), with a male predominance (59%). Though a large proportion (83%) of patients got prior medical treatment, mainly with phenobarbitone (30%), many took indigenous treatment and had superstitious belief regarding epilepsy (35%). About 36% of the patients were found to have abnormal EEG finding while only 12% had abnormal brain imaging. Among them, 46% of the patients who were classified as IGE mostly presented with GTCS (76%). Within the LRE group 63% had secondary generalized seizure. Carbamazepine (56%), phenobarbitone (35%), sodium valproate (20%) were the commonly prescribed drugs at the epilepsy clinic. Conclusion: Epilepsy is not uncommon in our day to day practice. Most of the patients remained seizure-free with commonly used anti-epileptic drugs. Patients should be adequately advised about the disease and the effect of drug noncompliance.
Background: The National Institutes of Health Stroke Scale or NIH Stroke Scale (NIHSS) is a widely used tool for assessing stroke severity. We conducted this study to determine the severity of stroke patients admitted in a tertiary care hospital.Methods: This is a cross sectional study conducted in involving 91 acute stroke patients.Result: About half (44%) of the patients were older than 60 years of age and mean age of the patients was 60.34(±16.1) years at onset and there is a slight female predominance (51.6%).Majority had hypertension (75.8%) followed by physical inactivity (67%), diabetes (37.4%), smoking (33%), obesity (23.1%), family H/O stroke (20.9%) and dyslipideamia (15.4%). Many patients were found to have hyperglycemia (14.3%) followed by hyperthermia (13.2%), hypotension (4.4%) and low oxygen saturation (3.3%) at the time of admission. Most of them had ischemic stroke (60%), followed by intracerebral hemorrhage (35%) and subarachnoid hemorrhage (5%). After leveling with NIHSS score more than half of the patients (51%) were found to be moderate grade on admission. Although, there was no association between risk factors of stroke and admission NIHSS score level, significant association was found between hypoxia and admission NIHSS score severity.Conclusion: Acute stroke patients, mostly have moderate grade of NIHSS score on admission.Hypertension, physical inactivity, diabetes, smoking, obesity, family H/O stroke and dyslipideamia are common risk factors observed among the patients which have no significant association with admission stroke severity determined by NIHSS score. There is significant association between hypoxia and admission NIHSS score severity.
Background: The aim of our study was to determine whether modified Bangla version (MMSE-B) is as effective as mini mental state examination (MMSE) tool for use in Bangladeshi people. Methods: This descriptive observational study was carried out in Department of Neurology, DMCH from January 2013 to December 2013. A total 200 healthy adults (patient attendants at the clinic) who met the inclusion criteria, were interviewed using a structured questionnaire containing information on age, sex, residence, educational backgrounds and questions set at MMSE English version (MMSE-E) and modified Bangla version for MMSE-B (Figure-1). MMSE and MMSE-B both were applied in 1:1 ration. The literate people were asked whether they are comfortable to answer in English (MMSE-E) or they would like the translated form and we applied the form of MMSE (MMSE-T) according to their wish. But in other group of people the modified Bangla version (MMSE-B) was used irrespective of level of education. Result: The mean age at presentation was 58.1±7.8 and 94% were within 50-70 years of age. Male were more common (80, 66) in both the groups and most of them belonging to rural areas. MMSE-B were mostly employed on people having only primary level of education (up to class five, n=80) or no education (n=2), whereas MMSE-E were employed up on people having a level of education higher than class five (n=96). Every question in each item of cognitive domain correlated well (correlation co-efficient range from 0.801- 0.971) except the 7th (correlation co-efficient 0.418) which had higher mean score for MMSE-B than those of MMSE-E (0.90 versus 0.54). The mean score of MMSEB was greater than the mean score of MMSE-E for most of questions except the 1st question that is related to orientation of time. The mean of total score in MMSE-E and MMSE-B were 24.04 and 24.91 respectively with a correlation co-efficient of 0.940. Conclusion: MMSE-B is adaptable for use in Bangladeshi people irrespective of level of education. Bangladesh Journal of Neuroscience 2016; Vol. 32 (2): 91-97
To detect the changes in electro encephalogram (EEG) and correlate the findings with clinical seizure events among epilepsy patients. This retrospective chart review was carried out in the electrophysiology laboratory of Dhaka Medical College Hospital from January 2011 to December 2013, which included 1154 patients. EEG was obtained through scalp electrodes following international 10/20 system. Information regarding patients was collected from the laboratory register with the help of a checklist. The EEG findings and clinical seizure events were then compared. Among the 1154 patients, age varied from birth to 75 years. The mean age at presentation was 17±11.4 years and most of the patients were less than 10 years old (44.4%). The male (59.2%) female ratio was 3:2 in our study. Clinically diagnosed seizure was present in 970 patients (84.1%), among which Generalized tonic clonic seizure (GTCS) was the most common clinical type of seizure, followed by secondary generalized seizure in 19.4% (n=224) and focal seizure in 2% (n=30) patients and 6.8% (n=79) patients had pseudoseizure. Among the abnormal EEG (59%), generalized epileptiform discharge was found in 29%, whereas focal and secondary generalized discharge was found in 30%. The most common site of origin of epileptiform discharge was temporal lobe (28.3%). There was a negative correlation between EEG and history of seizure events (pearson correlation significance 0.33). Our study brings out the fact that EEG has a negative correlation with clinical seizure events. CBMJ 2014 July: Vol. 03 No. 02 P: 03-08
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