BackgroundTo determine the differences of precipitating and relieving factors between migraine and tension type headache.MethodsThis is a cross sectional study. We retrospectively reviewed the records of 250 migraine patients and 250 patients diagnosed as tension type headache from the specialized headache clinic in Dept. of Neurology, Dhaka Medical College Hospital. Data were collected through a predesigned questionnaire containing information on age, sex, social status and a predetermined list of precipitating and relieving factors.ResultsIn this study, the female patients predominated (67%). Most of the patients were within 21–30 years age group (58.6%). About 58% of them belonged to middle class families. The common precipitating factors like stress, anxiety, activity, journey, reading, cold and warm were well distributed among both the migraine and tension type headache (TTH) patients. But significant difference was demonstrated for fatigue (p < 0.05), sleep deprivation (p < 0.05), sunlight (p < 0.01) and food (p < 0.05), which were common among migraineurs. In consideration of relieving factors of pain, different maneuvers were commonly tried by migraineurs and significant difference were observed for both analgesic drug and massage (p < 0.05), which relieved migraine headache. But maneuvers like sleep, rest and posture were used by both groups.ConclusionThe most frequent precipitating factors for headache appear to be identical for both migraine and TTH patients. Even though some factors like fatigue, sleep deprivation, sunlight and food significantly precipitate migraine and drug, massage are effective maneuver for relieving pain among migrianeurs.

BackgroundEpilepsy is a common health problem which carries a huge medical social psychological and economic impact for a developing country. The aim of this hospital-based study was to get an insight into the effectiveness and tolerability of low cost antiepileptic drugs (AEDs) in Bangladeshi people with epilepsy.MethodsThis retrospective chart review was done from hospital records in weekly Epilepsy outdoor clinic of Department of Neurology, Dhaka Medical College Hospital (DMCH) from October 1998 to February 2013. A total of 854 epilepsy patients met the eligibility criteria (had a complete record of two years of follow up data) from hospital database. A checklist was used to take demographics (age and gender), epilepsy treatment and adverse event related data. At least two years of follow up data were considered for analysis.ResultsOut of 854 patients selected, majority of the patients attending outdoor clinic were >11-30 years age group (55.2%) with a mean age of 20.3 ± 9 years and with a male (53%) predominance. Focal epilepsy were more common (53%), among whom secondary generalized epilepsy was the most frequent diagnosis (67%) followed by complex partial seizure (21%). Among those with Idiopathic Generalized Epilepsy (46%), generalized tonic clonic seizure was encountered in 74% and absence seizure was observed in 13%. The number of patients on monotherapy and dual AED therapy were 67% and 24% respectively and polytherapy (i.e. >3 AEDs) was used only in 9%. CBZ (67%) was the most frequently prescribed AED, followed by VPA (43%), PHB (17%), and PHT (8%). CBZ was prescribed in 37% patients as monotherapy followed by VPA in 21% and PHB in 8% patients. Newer generation drugs eg lemotrigine and topiramate were used only as add on therapy in combination with CBZ and VPA in only 2% patients. The treatment retention rates over the follow up period for the AEDs in monotherapy varied between 86 and 91% and were highest for CBZ, followed by VPA. Most of the combination regimens had a treatment retention rate of 100%. The effectiveness of AED in terms of reduction of seizure frequency was highest for PHT (100%) and PHB (98%) followed by CBZ (96%) and VPA (95%). PHB and PHT were the cheapest of all AEDs (42 I$ and 56 I$/ year respectively). The costs of VPA and CBZ were two times and LTG and TOP were six to eight times higher. Adverse drug reaction (ADR) were observed among 140 (24.5%) of those with monotherapy. PHT (64%) was the most common drug to cause ADR, CBZ was at the bottom of the list to cause adverse effect (11.6%). VPA and PHB caused weight gain commonly. Adjustment of drug dose or withdrawal due to ADRs was necessary in 39% with PHT and 26% with PHB.ConclusionThough PHT and PHB are cheapest and efficacious among all, CBZ and VPA are less costly, effective and well tolerated drug for seizure control in context of Bangladesh.

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The priming principle consists of giving a subparalyzing dose of muscle relaxant 3-6 min before giving a second dose for tracheal intubation. We found that priming doses of vecuronium and rocuronium produced greater decreases in oxygen saturation and pulmonary function in the elderly (aged 65-73 yr) than their younger (aged 25-35 yr) counterparts. Priming may not be a safe approach in elderly patients.

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.

The present study was undertaken to evaluate the morphological anatomy of cerebral vessels in patients of aneurysmal subarachnoid hemorrhage. The cross-sectional observational study was carried out in the Department of Neurology, Dhaka Medical College Hospital, Dhaka from January 2013 to June 2013. Adult patients of spontaneous subarachnoid haemorrhage (SAH), diagnosed clinically and confirmed by CT scan of the head were included in the study. However, patients who are not capable financially of undergoing Digital Subtraction Angiography (DSA), traumatic subarachnoid haemorrhage, intracerebral haemorrhage and patients taking antiplatelet and anticoagulant drugs and with comorbidities were excluded. A total of 30 subjects meeting the above eligibility criteria were selected consecutively from the study population. The present study demonstrated that 80% of the patients were 50 or younger than 50 years old (mean age 45.0 ± 9.4 years) with a male preponderance (60%). Sudden headache accompanied by vomiting was invariably complained by the patients at onset of Athe disease. On admission two-thirds (66.7%) of the patients were unconscious. 4 out of 30(16.65%) patients exhibited neurological deficit. Of the risk factors, hypertension and smoking demonstrated their significant presence (around 45%) among the patients studied. Based on Glasgow Coma Scale, 7(23.3%) patients out of 30 in the present study were in grade-v. Our data showed that the common site of aneurysm was anterior communication artery (36.7%) followed by middle cerebral artery (26.7%) and posterior communicating artery (23.3%). Saccular aneurysms formed the main bulk (93%) of the cases irrespective of anatomical distribution of aneurysm. In aneurysmal subarachnoid haemorrhage, aneurysms are mainly located in anterior communicating and middle cerebral arteries and of medium-sized. Majority are saccular type and narrow-necked.Bangladesh Med J. 2015 Sep; 44 (3): 125-129

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.

Headache is a major health problem in school children, apart from other common health issues at this age. With increasing age, the girls more commonly suffer not only from migraine but also with other chronic headache. The direct causal association is yet to be determined.