Prevalence of epilepsy in Bangladesh: Results from a national household survey.

OBJECTIVE: To determine the prevalence and types of epilepsy in Bangladesh. METHODS: We conducted a nationwide population-based cross-sectional survey among Bangladeshi population of all ages, except children under one month. We surveyed 9839 participants (urban, 4918; rural, 4920) recruited at their households using multistage cluster sampling. Trained physicians with neurology background confirmed the diagnosis of suspected epilepsy cases identified by interviewer-administered questionnaires. We reported the overall and sex, residence, and age groups-specific prevalence of epilepsy per 1000 populations with 95% confidence interval. RESULTS: The national prevalence of epilepsy per 1000 was 8.4 (95% CI 5.6-11.1), urban 8.0 (4.6-11.4), and rural 8.5 (5.60-11.5). The prevalence in adult males and females was 9.2 (5.7-12.6) and 7.7 (3.6-11.7), respectively. The prevalence in children aged <18 years (8.2, 3.4-13.0 was similar to adults (8.5 (5.4-11.4). Among all epilepsy cases, 65.1% had active epilepsy. Their (active epilepsy) prevalence was 5.8 (3.5-8.1). Of them, 63.4% were not receiving treatment. Moreover, those who received allopathy treatment, 72.5% had low adherence leading to a high treatment gap. SIGNIFICANCE: Our findings out of this first-ever national survey were similar to other Asian countries. However, the prevalence of active epilepsy and treatment gap were considerably higher. This study serves useful evidence for tailoring interventions aimed to reduce the burden of epilepsy-primarily through targeted community awareness program-and access to antiepileptic treatment in health facilities in Bangladesh.

Pattern of neurological disease seen among patients admitted in tertiary care hospital.

BACKGROUND: Neurologic disorders are not uncommon at in patient departments of different hospitals. We have conducted the study to see the pattern and burden of neurologic disorders at different inpatient departments of a tertiary care centre. METHODOLOGY: This retrospective observational study was carried out from the records and referral notes of neurology department of Dhaka Medical College Hospital (DMCH) from July 2011 to June 2012. A total 335 patients were evaluated by consultant neurologists during this period. RESULT: Majority of the patients (59.7%) presented after the age of forty years. The mean age at presentation was 45.11 ± 17.3 years with a male predominance (63.3%). Stroke was the most common condition (47.5%) observed at referral, followed by seizure (9.3%), disease of spinal cord (7.8%) and encephalopathy (6.3%). Even after consultation, 30 patients remained undiagnosed and 6 were diagnosed as functional disorder. Department of Medicine (231, 69%) and Cardiology (61, 18.2%) made most of the calls. More than half (56%) of the stroke patients were referred from medicine and one third (35.2%) from cardiology. Seizure (67.7%), problem in spinal cord (92.3%), coma (50%), encephalopathy (57.1%), motor neuron disease (MND) (72.7%) were common reasons for referral from department of Medicine. Whereas patients with cord disease (7.3%), CNS tumor (40%), seizure disorder (6.5%) and stroke (3.8%) were referred from surgery. Department of Obstetrics and Gynecology sought help for stroke (2.5%), seizure (12.9%), MND (27.3%), coma (16.7%) and encephalopathy (9.5%). Hypertension, diabetes, ischemic heart disease, dyslipidaemia and respiratory problem were significantly associated co-morbid conditions in stroke patients (at 95% CI, p value is <0.001, <0.01, <0.001, <0.05, <0.05 respectively). Hematological disorders were common association among patients with cord problem (<0.05). CONCLUSION: Wide ranges of neurological problems are often managed by physicians and surgeons, especially those from medicine and cardiology. Where ever available consultation from neurologists can help in diagnosing and managing these cases.

Antiepileptic drug utilization in Bangladesh: experience from Dhaka Medical College Hospital.

BACKGROUND: Epilepsy 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. METHODS: This 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. RESULTS: Out 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. CONCLUSION: Though 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.

Interictal EEG changes in patients with seizure disorder: experience in Bangladesh.

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.

Pattern of headache in school going children attending specialized clinic in a tertiary care hospital in bangladesh.

OBJECTIVE: To determine the pattern of headache and its associated symptoms in school going children. METHODS: The data of all the school going children attending the Headache Clinic in the Dept. of Neurology, Dhaka Medical College Hospital were retrospectively reviewed. A total of 1021 patients from October 1996 to September 2011 were selected. Data were collected through a predesigned questionnaire containing information on age, sex, social status, clinical features, opthalmoscopic findings, management, and in selected cases imaging results. RESULT: The mean age of headache in school children was 12.6±1.08 years with relatively older age of presentation among girls. The sex ratio was 1.64:1 in favor of girls at older age. Tension type headache (71.1%) was the most common form of headache, followed by migraine (18.4%) and mixed headache (6.7%). Though the girls had more frequent headache of both tension type (59.4%) and migraine (68.1%) variety, the latter was significantly associated in girls (p<0.001). Headache was of moderate severity in 53.3%, whereas severe headache was experienced by 19.9% of the children. The children commonly had nausea and/or vomiting (47.2%), as well as photophobia (24.7%) with headache. Mental stress (34%) and sunlight (30.9%) were common triggering factors whereas a sound sleep relieved headache in the majority (59.4%). Paracetamol (83.3%) and nortryptyline (62.8%) were the most commonly prescribed drug taken by them. CONCLUSION: 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.

Precipitating and relieving factors of migraine versus tension type headache.

BACKGROUND: To determine the differences of precipitating and relieving factors between migraine and tension type headache. METHODS: This 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. RESULTS: In 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. CONCLUSION: The 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.