Mansur Habib

Precipitating and relieving factors of migraine versus tension type headache

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.

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

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

Pattern of Disorders in Neurology Outpatient Department: Experience from a Tertiary Care Hospital in Bangladesh

and 56 I

Clinical and morphological pattern of brain arteriovenous malformations (BAVMs) in a Tertiary Care Hospital in Bangladesh

/ 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.

Major co-morbidities in stroke patients: a hospital based study in Bangladesh

Objective: To determine the pattern of neurologic disorder in the specialized neurology out patient at tertiary care level. Methods: This observational study was carried out in specialized neurology outpatient clinic of Dhaka Medical College Hospital from July 2015 to July 2016, which included 8892 patients. Data were collected through a predesigned questionnaire from the hospital database kept at the clinic. Result: A total of 8892 patients were seen in neurology OPD in one year. About one third of the patients presented at 21-30 years of age. There was a male dominance (53%) with a male to female ratio of 1.12:1. Most of the patients had hypertension (3201, 36%) followed by diabetes and ischemic heart disease (1956, 22%; 1423, 16%) as co-morbid condition. Majority had Headache (4090, 46%) followed by vertigo (1067, 12%); vomiting (711, 8%) and neck and/ back pain (702, 8%) as presenting symptom at onset. Majority of the patients (46%) were diagnosed as headache disorder (Tension type headache in 33.5%, Migraine 7.5% and mixed headache in 5%) followed by ischemic stroke (896, 10%); polyneuropathy (446, 5%); vestibular disorder (441, 5%); movement disorder (267, 3%) and anxiety/depression (254, 3%). About 15% (1346) patient were undiagnosed at initial visit. Conclusion: Neurological diseases are not uncommon even at middle aged patients. Headache, vertigo, neck/back pain are common presenting symptom. Headache disorders and stroke are the commonest neurologic diagnosis at OPD.