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ORIGINAL ARTICLE
Year : 2018  |  Volume : 45  |  Issue : 1  |  Page : 23-25

Pattern of epilepsy patients visiting in a psychiatry outpatient department


1 Department of Medicine, Chattagram Maa Shishu O General Hospital, Agrabad, Chittagong, Bangladesh
2 Department of Psychiatry, Chattagram Maa Shishu O General Hospital, Agrabad, Chittagong, Bangladesh

Date of Web Publication27-Jul-2018

Correspondence Address:
Rajat Sanker Roy Biswas
Department of Medicine, Chattagram Maa Shishu O General Hospital, Agrabad, Chittagong
Bangladesh
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.JSS_30_18

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  Abstract 


Introduction: Little is known about the epilepsy patients attending in a psychiatry outpatient department (OPD) in the context of Bangladesh. Hence, the aim of our study was to see the frequency and pattern of patients of epilepsy attending in a psychiatry OPD in our context. Methods: One-year patient data were explored from January 2016 to December 2016 recorded in a register book of the psychiatry OPD by consultants themselves and data were extracted manually. The diagnosis was collected, and data were analyzed by Microsoft Xcel. Results: Among the total of 1474 patients visiting the OPD in the year 2016 at the psychiatry OPD, total epilepsy cases were found in 209 (14.2%) patients. Among them, generalized tonic–clonic seizure was found 144 (9.8%), absence seizure 38 (2.6%), partial seizure 5 (0.3%), temporal lobe epilepsy 4 (0.3%), myoclonus 1 (0.1%), and unclassified 17 (1.2%). Electroencephalography confirmation was done in 60 cases which was 4.1% of total patients. Hence, confirmed cases of epilepsy were 4.1%, and probable cases were 10.1% of total patients attending OPD. Conclusion: In conclusion, we can say that visiting of epilepsy patients in a psychiatry OPD is a common behavior and we need to develop expertise in this field more.

Keywords: Electroencephalography, epilepsy, outpatient department


How to cite this article:
Roy Biswas RS, Uddin MG, Mostafa M. Pattern of epilepsy patients visiting in a psychiatry outpatient department. J Sci Soc 2018;45:23-5

How to cite this URL:
Roy Biswas RS, Uddin MG, Mostafa M. Pattern of epilepsy patients visiting in a psychiatry outpatient department. J Sci Soc [serial online] 2018 [cited 2018 Dec 13];45:23-5. Available from: http://www.jscisociety.com/text.asp?2018/45/1/23/237759




  Introduction Top


Epilepsy is a neurological disorder characterized by recurrent unprovoked seizures that are transient symptoms or signs of abnormal, excessive, and synchronous neuronal activity in the brain.[1],[2] About 80% of 50 million people with epilepsy reside in the developing countries such as Bangladesh, Nepal, India, and Pakistan.[3] The prevalence of epilepsy varies among countries from 1.5/1000 in developed countries to 18/1000 in Latin America.[4],[5]

Bangladesh is one of the densely populated countries in the world where infectious diseases, malnutrition, and many chronic neurological disorders are quite common. There is scarcity of national statistics in our country regarding the actual scenario of epilepsy, but there are some hospital-based studies that reflect to some extent the situation of epilepsy in Bangladesh. Studies in abroad showed that the prevalence rate of about 5/1000 populations whereas in developing countries it is higher. Men are more often affected than female and rural populations are affected more than the urban populations. As we have 10/1000 populations of epilepsy, the number of epilepsy patients in Bangladesh is about 1.3 million. The common ages of epileptic patients in Bangladesh are between 16 and 31 years.[6],[7]

Some Bangladeshi people do have superstitions about epilepsy. These lead to a strong barrier for total care of patients with epilepsy. Misunderstanding and negative attitude of the parents, family members and society toward epilepsy are still prevalent. Thus, many patients with epilepsy are still neglected in diagnosis, treatment, education, rehabilitation, and other social needs.[7]

The epilepsy patients usually do late in seeking advice from physicians in our country. Rather they believe epilepsy has no cure and they seek advice from indigenous medicine practitioner “Kabiraj,” snake charmer “Ojha,” and spiritual healers.[7]

Nowadays, patients of epilepsy seek health assistance from internists, neurologists, neurosurgeons, podiatrists, and also from psychiatrists. Chattagram Maa Shishu O General Hospital has a strong outpatient department (OPD) service where thousands of patients attend. All data of patients are recorded and preserved. However, little is known about the epilepsy patients attending in a psychiatry OPD in the context of Bangladesh. Hence, the aim of our study was to see the frequency and pattern of patients of epilepsy attending in a psychiatry OPD in our context.


  Methods Top


This was a retrospective observational study where a 1 year total patients data were collected, retrieved, coded, and analyzed after taking consent from the authority. We explored data from January 2016 to December 2016 which were recorded in the register book of the psychiatry OPD by the consultants of psychiatry. Patients who were noted in the register books as epilepsy clinically were primarily included in the study. Those who had electroencephalography (EEG) confirmation were taken as confirmed case of epilepsy and those who were diagnosed clinically and not had EEG confirmation, taken as a probable case of epilepsy. Different types of epilepsy were done on the basis of clinical history. All data were checked by two of our consultants themselves. After collection data, it was analyzed by Microsoft Excel.


  Results Top


Among the total of 1474 patients visiting the OPD in the year 2016 at the psychiatry OPD, total epilepsy cases were found in 209 (14.2%) patients [Figure 1]. Among them, generalized tonic–clonic seizure (GTCS) was found 144 (9.8%), absence seizure 38 (2.6%), partial seizure 5 (0.3%), temporal lobe epilepsy 4 (0.3%), myoclonus 1 (0.1%), and unclassified 17 (1.2%) [Table 1]. EEG confirmation was done in 60 cases which was 4.1% of total patients. Hence, confirmed cases of epilepsy were 29%, and probable cases were 71% of 209 total patients attending OPD [Figure 2].
Figure 1: Frequency of epilepsy

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Table 1: Different types of epilepsy

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Figure 2: Final diagnosis as per electroencephalography

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  Discussion Top


In the study, among the total of 1474 patients, total epilepsy cases were found in 209 (14.2%). It is quite a big number. These types of patients sufferer most as they visit from door to door of consultants and do not get a proper diagnosis. Hence, psychiatrist should have a good intuition to diagnose the epilepsy. A report of 130 patients from the epilepsy clinic of BSMMU showed that close to 70% of patients visited indigenous medicine practitioners, exorcists, spiritualists before consulting the clinic, only 29% perceived epilepsy as a disease, 50% dropped out from school (58% of whom due to epilepsy), and 52% of patients had to change job because of epilepsy.[6],[7] Hence, it is at least a good habit that patients are referred to or visiting the Department of Psychiatry for their ailments.

Among them, a good number of cases were GTCS 144 (9.8%), and next to which was absence seizure 38 (2.6%). Among the suspected epilepsy cases EEG confirmation was done in 60 cases which was 4.1%. A study done in Pakistan found that generalized seizure is the most common type of seizure which is observed in 77% patients of Pakistan as found in our study. The primary generalized seizure is 59%, secondary generalized seizures are 18%, partial seizures is 9%, myoclonic, and tonic–clonic seizures is 5.8%[8]

Classification of seizure types is largely dependent on the proper history, advanced technology, and neurologist but, still misclassification might be expected. We need further study to know accurately about the prevalence and incidence of epilepsy, and the study must be include people from different ages, races, socioeconomic background to explore the role factors clearly a such age, gender, race, and socioeconomic status on epilepsy.[9]

Hence, here, we can see a good psychiatric OPD should have an EEG facility which is needed to the confident diagnosis of epilepsy. Our center has such facility and patients are getting benefit from it. It is important to conduct prevalence study in those region from which still no data available about the prevalence of epilepsy. To know about the etiology of epilepsy, it is important to carry out more detailed studies about the incidence of epilepsy. The proper consideration of culture of society, health-care policies, and access to health-care system is important to interpret the findings from all studies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Blume WT, Lüders HO, Mizrahi E, Tassinari C, van Emde Boas W, Engel J Jr., et al. Glossary of descriptive terminology for ictal semiology: Report of the ILAE task force on classification and terminology. Epilepsia 2001;42:1212-8.  Back to cited text no. 1
    
2.
Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, et al. Epileptic seizures and epilepsy: Definitions proposed by the international league against epilepsy (ILAE) and the international bureau for epilepsy (IBE). Epilepsia 2005;46:470-2.  Back to cited text no. 2
    
3.
World Health Organization. Atlas: Epilepsy Case in the World 2005. Vol. 1. Geneva: WHO Press; 2005. p. 11-3.  Back to cited text no. 3
    
4.
Mac TL, Tran DS, Quet F, Odermatt P, Preux PM, Tan CT, et al. Epidemiology, aetiology, and clinical management of epilepsy in Asia: A systematic review. Lancet Neurol 2007;6:533-43.  Back to cited text no. 4
    
5.
Jallon P. Epilepsy in developing countries. Epilepsia 1997;38:1143-51.  Back to cited text no. 5
    
6.
Mannan MA. Epilepsy in Bangladesh. Neurol Asia 2004;9 Suppl 1:18.  Back to cited text no. 6
    
7.
Anwarullah AK, Khan MR, Hakim M, Hague A, Mannan MA. Attitude of family and community towards epilepsy. Neuron 2004;4:14-20.  Back to cited text no. 7
    
8.
Aziz H, Akhtar SW, Hasan KZ. Epilepsy in Pakistan: Stigma and psychosocial problems. A population-based epidemiologic study. Epilepsia 1997;38:1069-73.  Back to cited text no. 8
    
9.
Shakirullah, Ali N, Khan A, Nabi M. The prevalence, incidence and etiology of epilepsy. Int J Clin Exp Neurol 2014;2:29-39.  Back to cited text no. 9
    


    Figures

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    Tables

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