Background: Migraine is one of the most common neurologic conditions in children .Migraine is the commonest cause of severe recurrent headache in children. Clinical presentations of migraine vary according to patient age. Objective: To study demographic, clinical profile and factors associated with migraine of children in outpatient department of a referral neurologic hospital. Methodology: This was a cross-sectional study carried out at the outpatient department of Paediatric Neurology, National Institute of Neurosciences & Hospital (NINS), Dhaka from January to July, 2018. Children of 5-15 years of migraine with / without aura of severe / moderate intensity were included to document demographic, clinical profile and factors influencing migraine. Result: Most of the patients were in the age group of 10-14 years 57 (71.25%). Children of both sexes are almost equally suffered from migraine (M vs F, 51.25% vs 48.75%).Most of the children had ³5 attacks/month. Unilateral headache (55%) was more common than bilateral (45%). Regarding quality of pain aching pain (53.75%) was more prevalent followed by tightening 18.75%, pulsating 17.5%. Aura was present in 27.5%. Nausea was present in 67.5% but vomiting was only in 32% patients. 65% patients had photophobia. Among patients 65% had family history of migraine. 86% patients took abortive drugs during attack. Bright sunshine was the most common precipitating factors for migraine attack followed by stress 37%. Most of the patients relieved from pain by taking rest (78%). Conclusion: Migraine was more common in late childhood and early teen age. Boys and girls were almost equally affected. Most common clinical findings were unilateral aching pain, nausea and photophobia. Bright sunshine, stress are the most common aggravating factors for migraine. J Shaheed Suhrawardy Med Coll 2021; 13(2): 91-93

Background: Migraine is the most common cause of severe recurrent headache in children. Flunarizine (FNZ) is safe and effective drug for prevention of migraine in children. Topiramate (TPM) is also successful as a preventive drug for migraine in children on randomized, double-blind, placebo-controlled trials. Objective: This study was done to observe the efficacy of Topiramate and also perform a comparison TPM and FNZ in patients with migraine of severe intensity in our situation. Materials & Methods: This was a randomized controlled trial done from January to July, 2018. This study was carried out in the OPD of Paediatric Neurology department, National Institute of Neurosciences, (NINS) Dhaka. Forty Children, 5-15 years old diagnosed as migraine with/without aura with severe intensity were randomized either as in study group (TPM treatment group) and control group (FNZ treatment group). Primary end point of the study was to find out the efficacy and safety of both TPM and FNZ after 4 months of treatment. Result: Post-treatment frequency of headache/month was significantly decreased in both groups (within group, p <0.001). There was no significant difference considering pre and post-treatment frequency of headache/month between two treatment groups. (pre-treatment p- 0.333 and post-treatment p- 0.401). Adverse events were not significantly different between the groups p<0.387. Conclusion: Topiramate is equally efficacious as Flunarizine in prophylactic treatment of severe migraine in children. Bangladesh J Child Health 2020; VOL 44 (3) :153-156

Background: West Syndrome (WS) consists of epileptic spasms, hypsarrhythmia on EEG and psychomotor delay or regression in children. Objective: To observe the clinical and laboratory profiles of children with west syndrome. Materials & Methods: This was a cross sectional study and done from July 2017 to June 2018 in Pediatric Neurology OPD, NINS among total 50 cases of WS (age of > 2 month to 2 years). WS was diagnosed by direct observation or video recording of spasm, along with history of developmental delay or regression and EEG change. Collected data regarding demography, detailed of spasm, clinical examination, radiological and EEG findings were analyzed. Results: Mean age of the patients was 12.61 ± 7.11 months. Males (58.0%) were predominant than females (42.0%). Mean age of onset of spasm was 5.88 ± 3.73 months. Type of spasm: Flexor in 88.0% cases, extensor in 6.0% cases, mixed in 4.0% and asymmetric in 2.0%. Microcephaly was present in 90.0% cases and in 64% cases H/o perinatal asphyxia (PNA) was present. In EEG, Hypsarrhythmia was found in 62.0% cases and modified hypsarrhythmia in 38.0% cases. In CT scan of brain, cerebral atrophy was found in 62.5.0% cases, stroke in 6.0% cases. Out of all WS patients 82% were symptomatic and 18% were either cryptogenic or idiopathic. Conclusion: Flexor type spasm was found more commonly in West syndrome. History of perinatal asphyxia (PNA) was present in majority of cases. In EEG findings, hypsarrhythmia was found more than modified hypsarrhythmia. Bangladesh J Child Health 2020; VOL 44 (3) :139-142

Background: West Syndrome (WS) consist of a triad of epileptic spasms, hypsarrhythmia on EEG and arrest or regression of psychomotor development. Although ACTH has been found to be effective in the treatment of WS, questions remain regarding the optimum dosage, type of ACTH, duration of therapy, and its comparative efficacy with other treatment options. Objective: To assess the response and outcome of treatment with moderate dose (100 IU/m2) ACTH in children of west syndrome. Methodology: This was a prospective observational study and done over 1-year period (July 2017 to June 2018) in Pediatric Neurology OPD, National Institute of Neuroscience and Hospital (NINS&H), Dhaka among the patients with West syndrome. All study participants were treated with moderate dose ACTH (100 unit/m2) (I/M) and treatment completed within 12 weeks. Patients were followed up at 2, 4, 6 and 12 WKs of treatment. Results: Total 52 cases were for enrolled. In this study it was found that complete cessation of spasm 21/50 (42%), ≥50% reduction of spasm 12/50 (24%), <50% reduction of spasm 8/50 (16%) and non-responder 9/50 (18%). At the end point of 12 weeks observation resolution of hypsarrhythmia occurred in 19/50 (38%) cases. About 78.0% patients developed any kind of the adverse effect. Conclusion: Moderate dose ACTH is effective in cessation of spasm and resolution of hypsarrhythmia in the studied children. Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 108-112

Background: Seizures after perinatal asphyxia may worsen brain injury. Phenobarbital (PHB) is commonly prescribed anticonvulsant worldwide to control seizure in asphyxiated neonates. The evidence of the best use of maintenance drugs is limited. Objective: To assess the effectiveness of phenobarbitone maintenance therapy in asphyxiated neonates with seizure. Material & Methods: A total of 79 asphyxiated neonates (HIE-II/ III), ³35 weeks were enrolled from January 2019 -January 2020 in this randomized clinical trial where cases were categorized into three groups. Group A received phenobarbitone 4mg/ kg/day twice daily for 6 weeks and Group B received 2mg/kg/day once daily for 2 weeks while Group C didn’t receive any anti-seizure medication after acute management. Clinical and electrophysiological study was done at discharge, one and half month of age. Data were analyzed by SPSS version 20. Result: Mean age in days was 0.96 ± 1.77 in Group-A, 0.66 ± 1.20 in Group-B and 0.55 ± 1.30 in Group-C. Both Group A and C had seizure in 33.34% and 12.5% in group B at 1½ month. During discharge most of the cases had normal EEG, EEG abnormalities were found in 25% cases in group B, 16.67% in group C and 8.33% in group A. At 1 ½ month, EEG abnormality was found more among group C (33.34%) than group A (25%) and B (25%) which was statistically insignificant. Conclusion: This study concluded that early discontinuation of phenobarbitone after acute management may not increase the risk of clinical and electrographic seizure in future. BANGLADESH J CHILD HEALTH 2021; VOL 45 (3) : 162-167