Spectrum of Neurological Disorders : Experience in Specialized Outpatient Clinic in Bangladesh

Objective: To examine the burden of neurologic disorder as encountered in a specialized neurology clinic at tertiary care level. Methods: This retrospective study was carried out in specialized neurology outpatient clinic of Dhaka Medical College Hospital from July 2010 to June 2011, which included 3173 patients. Data were collected through a predesigned questionnaire from the hospital database kept at the clinic. Result: Among all the patients attending outpatient clinic, 88.7% had 44 types of neurological disorders. Distribution of disease was similar in all age group from 21-30 years to 51-60 years. Stroke (28.2%) and Headache (24.7%) were two most common neurologic disease, where headache was prevalent among female aged less than 30 years and stroke in male of >40 years. Epilepsy, peripheral neuropathy, Parkinson’s disease, pseudo vertigo were also present in a considerable number of patients. Patients with peptic ulcer (3.02%), anxiety neurosis (2.6%) and other non neurological disease were also given consultation in the clinic. Conclusion: Neurological diseases are not uncommon. Different diseases predominate in different age and sexes. Knowing pattern of disease distribution in community will help managing them properly. Keyword: Neurologic disorder 1. Assistant Professor of Neurology, Dhaka Medical College Hospital 2. Medical Officer (Medicine OPD), Dhaka Medical College Hospital 3. Assistant Professor of Neurology, Dhaka Medical College Hospital 4. Assistant Registrar, Dept. of Medicine, Dhaka Medical College Hospital 5. Resident Physician (General), Dhaka Medical College Hospital 6. Registrar, Dept. of Medicine, Dhaka Medical College Hospital 7. Assistant Registrar, Dept. of Medicine, Dhaka Medical College Hospital 8. Assistant Professor of Medicine, Dhaka Medical College Hospital Correspondence: Dr. Rajib Nayan Chowdhury, Assistant Professor of Neurology, Dhaka Medical College Hospital. Email: rajibchow86@yahoo.com, 01715176567 appropriate treatment. In addition to this, the social and cultural stigma surrounding the neurologic disorders, make the diagnosis and treatment even more challenging. Moreover a large section of population live in rural areas where there is lack of logistic facilities for managing these conditions. They are mostly referred to Medical College Hospitals. We tried to observe the frequency of neurologic diseases in Dhaka Medical College Hospital (DMCH) to get a glimpse of the problem in the community. Material and methods: This is a retrospective observational study. We reviewed the database from specialized neurology outpatient (OPD) clinic of Dhaka Medical College Hospital (DMCH) from July 2010 to June 2011. Study population included 3173 patients from the hospital database over the period of one year. Each patient was received at first by post graduate trainee doctors. They took history and performed proper physical examination. Later J MEDICINE 2012; 13 : 39-42

appropriate treatment.In addition to this, the social and cultural stigma surrounding the neurologic disorders, make the diagnosis and treatment even more challenging.Moreover a large section of population live in rural areas where there is lack of logistic facilities for managing these conditions.They are mostly referred to Medical College Hospitals.We tried to observe the frequency of neurologic diseases in Dhaka Medical College Hospital (DMCH) to get a glimpse of the problem in the community.

Material and methods:
This is a retrospective observational study.We reviewed the database from specialized neurology outpatient (OPD) clinic of Dhaka Medical College Hospital (DMCH) from July 2010 to June 2011.Study population included 3173 patients from the hospital database over the period of one year.Each patient was received at first by post graduate trainee doctors.They took history and performed proper physical examination.Later the patients were evaluated and classified by consultant neurologist in the clinic following the International Classification of Disease (ICD-10, chapter-VI) codes for neurology.Information regarding the demographic and disease profile was gathered through a predesigned questionnaire.

Results:
A total of 3173 patients were seen in neurology OPD in one year, out of which the number of neurologic disorder were 2815 (88.7%) and non neurologic cases were 358 (11.3%).The number of patients was more or less similar and commoner in age group of 21-30years (20.4%), 31-40 years (16%), 41-50 years (19.6%) and 51-60 years (18.8%).But the patients visiting the OPD were very few in both extremes of age, below 10 years (0.53%) and above 70 years (3.7%) (Table-I).Disease pattern was different among the young and older patient.Headache was common below 30 years, whereas stroke was frequent in patients older than 40 years.in each year.About 20% of the stroke victims die within three months of cerebrovascular episode.Though the major burden of stable stroke patients in DMCH is dealt at specialized stroke clinic on every Sunday, it was also the commonest cause of consultation in neurology OPD.This is due to the fact that, a large number of patients who come from distant parts of Bangladesh, fails to reach stroke clinic within the scheduled time of 8:00 am to 11:00 am each Sunday.These patients usually attend the Neurology OPD.Not only in neurology, but stroke also grabbed the top spot among all the emergency hospital admission in Medicine department of DMCH.In the year 2010, a total of 3572 patients were admitted in Medicine department 9 .Similar pattern is also observed in other Asian country 10 .Despite the fact that, Neurology department of DMCH also runs specialized Headache and Epilepsy clinic in every week, the number of these patients were not few either.Reason might also be the same.In a survey of practice pattern in India, Headache and Epilepsy were reported the most common symptoms for neurology consultation 9 .The annual incidence of epilepsy (50 per 100000 population) in developing countries is twice that of the developed world 12 .
In a similar study in Malaysia the order of frequency of neurological disorder were epilepsy (19.4%), headache (13.6%), stroke (9.1%), peripheral neuropathy (8.2%), Parkinson's disease (5.4%) 14 .The result of our study was quite similar to that of Lim et al 10 .In Singapore, he showed that headache, stroke, seizure disorder, neuromuscular disorder and movement disorder were common in neurology OPD.

Conclusion:
All the data obtained from neurology outpatient department had the benefit of categorization by specialist neurologists.So this study accurately reflects the burden of neurologic disorder at OPD.Many physicians think that most of the neurological diseases are not curable.But the most common ailments like stroke and headache are quite easily manageable and sometimes preventable.Pattern of diseases predominance is not same in all age group.This is also true for both sex, where headache predominate in female, stroke is common among male.

Table - I
Socio demographic profile of the patients (N=3173)

Table - I
: Shows the age group and sex distribution of patients.Most common age of presentation was 21-30 years and 41-50 years.Some other conditions eg Transient ischemic attack (TIA), focal seizure, dystonia, dementia, central nervous system tumor etc though not rare, but was seen in a few.Despite all the efforts, 4.7% cases remained undiagnosed (Table-II).