Background Guillain Barre Syndrome(GBS) is an acute, frequently severe, and fulminant polyradiculoneuropathy that is autoimmune in nature. Our aim is to evaluate the grading of disability and outcome among different variants of GBS. Methods All consecutive patients recruited prospectively in the study were of age ≥16 years and were being admitted in department of Neurology of Tribhuvan University Teaching Hospital, Kathmandu, Nepal from 2016 March to 2017 February. All demographic, historical and clinical data were collected. Nerve conduction study, cerebrospinal fluid analysis along with clinical features were evaluated to assess the diagnostic certainty of Brighton Criteria. Overall disability sum score (ODSS) and GBS disability score were assessed in all patients. The study protocol was approved by the Institutional Review Boards. Results A total of 46 patients were included: male patients being predominant (70% vs 30%), mean age= 36.5±16.2, range = 16 - 80 years. Thirty-two patients (70%) were an axonal variant, acute motor axonal neuropathy being more common (18 patients), and 14 patients were acute motor and sensory axonal neuropathy. Fourteen patients (30%) were demyelinating type, out of which 11 patients had both motor and sensory features, and only 3 patients were pure motor demyelinating type. Axonal variants were found to have higher ODSS during nadir (p=0.024) and discharge(p=0.004), and also higher GBS disability score during nadir (p=0.012) and discharge (p=0.021). Acute motor axonal neuropathy (AMAN) had higher GBS disability score than acute inflammatory demyelinating polyneuropathy (AIDP) at nadir (p=0.034) and discharge (p=0.039). Conclusions Axonal neuropathy variants are predominant among the Nepalese population and are clinically severe than demyelinating variants. Further, prospective study of longer duration to include larger number of patients will be needed.
Myasthenia gravis (MG) has a cosmopolitan distribution and can affect people of all age group. Sometimes atypical presentation causes difficulty in the early diagnosis and management. Our aim is to study the clinical subtypes and manifestations of MG along with serological and electrophysiological diagnostic methods. Patients who were admitted in Neurology department or presented in Neurology outpatient department of Tribhuvan University Teaching Hospital from 2015 March to 2016 November were retrospectively reviewed. Out of 28 patients reviewed, 23 patients were included in the study. Their mean age of onset was 40.4±19.2 years; range=12 – 78 years, and 12 of them were female (52.2%). Eight patients (34.8%) were diagnosed with ocular myasthenia and 15 were patients (65.2%) of General Myasthenia. Seventeen patients (73.9%) were acetylcholine receptor (AChR) antibodies positive, one female patient was found to be muscle specific kinase (MuSK) positive. Decremental pattern in Repetitive Nerve stimulation (RNS) was reported in 11 patients (47.8%) and ice pack test was positive in 16 patients (69.3%). Ophthalmological findings are the most common presentation of MG patients. Icepack test is an easy clinical diagnostic tool for outpatient department which has both high sensitivity and specificity. RNS and antibody tests are the supporting tests useful for confirming the diagnosis.Nepal Journal of Neuroscience, Volume 14, Number 1, 2017, Page: 14-17
Epilepsy is a common and diverse disorder with many different causes. Outcomes are varied with 60—70% of newly diagnosed people rapidly entering remission after starting treatment and 20—30% developing a drug-resistant epilepsy with consequent clinical and psychosocial distress. It is a Descriptive Cross-sectional study which was conducted in Tribhuvan University Teaching Hospital from January 2013 to January 2014.A total of 150 patients participated in the study. There was statistically significant association between numbers of seizures before starting medication and the frequency of seizure after starting medication (p<0.001).DOI: http://dx.doi.org/10.3126/jonmc.v3i1.12234Journal of Nobel Medical CollegeVol. 3, No.1 Issue 6, 2014, Page: 31-34
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