Background: To examine the pattern and burden of neurologic disorders at electrophysiology lab of a tertiary care centre.

Background: Nerve conduction studies (NCS) are the most objective measure of nerve function, and their use is recommended in the clinical and epidemiological evaluation of diabetic polyneuropathy. Objective: This study was conducted to describe the pattern of electrophysiological abnormality in long-standing type-2 Diabetes Mellitus patients. Methodology: This cross-sectional study was conducted in the Department of Neurophysiology at the National Institute of Neurosciences & Hospital, Dhaka, Bangladesh from July 2017 to June 2019. Among the one hundred and eight consecutive patients of type 2 diabetes with a duration of more than 10 years attending the Neurophysiology laboratory, patients were selected for the study based on the inclusion and exclusion criteria. NCS study of the right upper limb (median and ulnar nerves) and left lower limbs (tibial, peroneal, and sural nerves) were done. NCS of other nerves were also done when indicated. Result: A total number of 92 patients were recruited for this study. NCS was abnormal in 56 (60.9%) patients. 43.5% (n=40) patients were male and 56.5% (n=52) patient were female. Among the 56 (60.9%) patients with abnormal NCS, most [35 (38%)] had mixed types (both sensory and motor) of neuropathy. In 28 (30.4%) patients, both demyelination and axonal involvement were present. The median nerve (46.7%) was the commonest nerve to be involved followed by the Sural nerve. In patients with elevated HbA1C, the axonal loss was more pronounced in the lower limbs’ nerves. Polyneuropathy (28.26%) was more than mononeuropathy (21.74%). Conclusion: Most of the patients of type 2 long-standing DM developed a mixed type of polyneuropathy and elevated HbA1C was significantly associated with the axonal involvement predominantly in lower limbs’ nerves. Journal of National Institute of Neurosciences Bangladesh, January 2021, Vol. 7, No. 1, pp. 10-13

Amyotrophic lateral sclerosis (ALS) is the commonest MND phenotype. Although many of the atypical motor neuron disorders share some features with ALS, they often can be distinguished by their clinical and electrophysiologic characteristics. Here we present five different cases with varied clinical findings. All the patients were referred from outpatient department to neurophysiology laboratory where electrodiagnostic (EDX) correlations helped to come to a conclusion. The nerve conduction study protocol for a suspected atypi¬cal motor neuron disorder is the same as that for ALS. Akin to the nerve conduction studies, the EMG evaluation of patients with suspected atypical motor neuron disorders is similar to that of ALS. An extensive study is indicated, often of all four limbs, the paraspinal muscles, and the bulbar muscles to reach a possible diagnosis. History, clinical findings and electrophysiological correlation often help to differentiate these atypical motor neuron disorders. Correct diagnosis is needed for further evaluation and prognosis. In this case series five (5) cases have described who are referred from outpatient department to neurophysiology laboratory for electrodiagnostic (EDX) correlations. [Journal of National Institute of Neurosciences Bangladesh, 2017;3(1): 57-61]

Panayiotopoulos syndrome is a type of benign childhood epilepsy syndrome characterized by episodic autonomic and mainly emetic symptoms. It predominantly affects children of 3-6 years of age (13% of those with one or more non-febrile seizures). EEG shows great variability, with occipital, extra-occipital spikes or brief generalised discharges alone or in combination; it may also be consistently normal. Despite the high prevalence of autonomic status epilepticus, the prognosis of Panayiotopoulos syndrome is usually excellent and most do not require anti epileptic medications. Remission usually occurs within 1-2 years from onset. One third have a single seizure but 5-10% may have more than 10 seizures or a more prolonged course. We present a 5 year old boy with this condition, who presented with episodes of severe vomiting, deviation of eyes, focal seizure, altered sensorium, characteristic EEG in the form of multiple occipital spikes and normal neuroimaging studies.

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