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.
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.
Conclusion:Our study brings out the fact that EEG has a reasonable sensitivity and specificity as a diagnostic test and the superiority being the higher specificity of EEG.
BackgroundWe have conducted this study to examine the clinical and morphological pattern of brain arteriovenous malformations (BAVMs) along with their treatment and short term outcome in a tertiary care hospital in Bangladesh. This retrospective chart review was carried out from the records of neuro-endovascular division at Department of Neurology, Dhaka Medical College Hospital (DMCH) from January 2010 to June 2013. A total 60 patients were evaluated. All the necessary information regarding the demographic, clinical, morphologic and treatment profile was gathered through a predesigned questionnaire. To our knowledge, we have the largest cohort of BAVM patients in Bangladesh and this is the first of this kind of study done in Bangladesh.ResultsThe mean age at diagnosis was 30.3 years with a standard deviation of ±14.3 and the majority was teenagers (30 %). Intracerebral hemorrhage was the commonest (70 %) type of presentation at diagnosis, followed by headache (50 %), altered consciousness (50 %), vomiting (40 %) and seizure (40 %). Majority of the AVMs had feeders from anterior circulation (50 %) and most of the AVMs (73.3 %) were supplied from the main feeders, whereas the rest from distal vessels. Regarding venous drainage, AVMs drained mostly either to superficial (43.3 %) or deep (40 %) venous system. AVMs frequently had larger (40 %) nidus size and a slow to medium flow (60 %), through the nidus. An eloquent AVM location was found in 50 % of the patients. Intranidal aneurysm was found in 10 % AVM and angiopathic AVM in 13.3 %. Patients were treated by endovascular embolization (31) or surgical excision (11) or conservative approach. There was one event of death, both in embolization group and surgically treated group before discharge. The patients were followed up for 1.3 ± 0.8 years. The rate of rebleed was 6.6, 30 and 60 % during follow up in endovascular, surgical and conservatively treated group. Though five patients in conservative group died during this time, no deaths reported in intervention group (endovascular or surgery).ConclusionIntracerebral hemorrhages, headache, altered consciousness and seizure are common clinical presentations of AVM at diagnosis. The remarkable morphologic features are larger AVM size at eloquent location, medium to slow flow with frequent feeders from main vessels of anterior circulation and drainage to superficial venous systems. Endovascular embolization or surgical excision of AVM are relatively safe and effective and provides better short term outcome than conservative approach.
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
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