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Background: Bell’s palsy (BP) is the most common cause of lower motor neuron type facial nerve palsy and is one of the most frequently encountered presentations in Neurology. Treatment with corticosteroid and antiviral drugs within 72 hours of onset of symptoms along with supportive treatment is encouraged for better outcome. Despite good prognosis, a significant portion of the patients with BP suffer from disfiguring facial appearance and other complications which remain as great concern of the patients. We aimed to evaluate the factors contributing to favorable outcome in adult with BP. Methods: Data of patients with BP [House-Brackmann (H-B) Grading III and above], who attended and were followed up at the Department of Neurology of BIRDEM General Hospital, Dhaka, Bangladesh between January 2017 and December 2020, were reviewed from hospital records and patients’ personal files. Total 56 adult patients with BP were recruited from hospital records according to eligibility criteria. During recruitment and data analysis, patients of H-B Grade III- IV were considered as lower grade and Grade V-VI were considered as higher grade. During follow up Grade I and II were considered as recovered. Comorbidities including diabetes and hypertension were addressed. Patients with BP who attended within 72 hours of onset of symptoms were prescribed steroid and antiviral drugs, whereas patients attending after 72 hours of onset of symptoms received supportive treatment only. All patients of both the groups received physical therapy for facial asymmetry and medication for eye care along with close monitoring and management of diabetes and other comorbidities. H-B Grades were assessed at onset, after 10 days, at the end of 1st and at 3rd month after facial paralysis and depending upon this Grading patients were finally divided into two groups of favorable (H-B Grade I & II) and unfavorable (H-B Grade III or more) outcome. Univariate and multivariable logistic regression analyses were performed to assess the factors for favorable prognosis. Results: Among the total 56 patients, 45(80.4%) patients had favorable and 11 (19.6%) had unfavorable outcomes at the end of 3rd month. Multivariable logistic regression analysis revealed that younger (at or below 40 year) age group (OR= 1.33; 95% CI, 0.412-4.310, p=0.005), lower H-B Grade at presentation (Grade III – IV) (OR= 2.712; 95% CI, 1.951-3.612, p=0.044) and absence of hypertension (OR=1.14; 95% CI, 0.963- 2.035, p=0.023) were significant. Conclusion: We concluded that younger age group of patients with lower H-B grade at initial presentation and absence of hypertension all are contributing factors for favorable outcomes in adults with Bell’s palsy. BIRDEM Med J 2022; 12(3): 217-222

Background: Acute symptomatic seizures are clinical seizures occurring in close temporal relationship with an acute central nervous system (CNS) insult, which may be metabolic, toxic, structural, infectious or inflammatory. Currently there is dearth of information on the epidemiology of acute symptomatic seizures among adult medical admissions in Bangladesh. This study was designed to determine the frequency of presentation and etiology of acute symptomatic seizures among adults. Methods: This was a cross-sectional study of adult patients admitted with new onset seizure under Neurology Department of BIRDEM General Hospital during the period of January 2019 to December 2020. Clinical assessment and relevant investigations were done and data were collected regarding their etiological diagnosis. Data were analyzed using statistical package for the social sciences (SPSS) version 23. Results: Total admission during the study period was 2920 and among them, 100 patients (male 62, female 38) were having their first symptomatic seizures giving a prevalence of 3.4%. They were between 18 to 82 years of age. The main etiology of acute symptomatic seizure was metabolic encephalopathy (42.0%) .It was followed by acute cerebrovascular disease (31.0%) and acute CNS infection (16%) . Acute cerebrovascular disease and metabolic encephalopathy were predominant causes of symptomatic seizure among the elderly and CNS infections among the middle aged adults. The majority (70.0%) of patients had generalized onset seizures. Focal seizures and focal to bilateral tonic clonic seazure were present in 22% and 8% of the patients respectively. Conclusion: This study showed that metabolic encephalopathy, acute cerebrovascular disease and CNS infections were the prominent causes of acute symptomatic seizures. Treatment strategies should aim for promt identification and management of these conditions as seizures may not recur when the underlying cause has been removed or the acute phase has elapsed. BIRDEM Med J 2022; 12(2): 99-105

Background: Bell's palsy is the most common cause of lower motor neuron type facial nerve palsy and one of the most frequently encountered presentations in Department of Neurology. Initial treatment involves oral corticosteroids, possible antiviral drugs, protection of the eye from desiccation and physiotherapy. But in case of patients with Bell's palsy and diabetes mellitus (DM) decision of prescribing steroid is a major concern due to risk of hyperglycaemia and still a point of conflict. Aim of this study is to observe the outcome of diabetic patients with Bell's palsy with and without steroid therapy. Methods: This retrospective study was conducted from January 2017 to December 2020, in Department of Neurology of BIRDEM General Hospital, Shahbag, Dhaka, Bangladesh. During this period 50 adult diabetic patients with Bell's palsy were recruited retrospectively from hospital records according to inclusion criteria and divided into two groups depending upon the duration of symptoms and prescribing steroid. Group I consisted of patients with Bell's palsy who attended after 72 hours of onset of symptoms and was not prescribed steroid or antiviral drugs, whereas Group II included patients attending within 72 hours of onset of symptoms and received steroid and antiviral drugs. House-Brackmann (H-B) Grading system was used to assess the severity of facial dysfunction. Patients of Grade III and above were recruited in this study and during follow up Grade I and II were considered as recovered. All participants of Group II received prednisolone in divided doses of up to 60 mg for 5 days and then tapered over next 5 days along with the antiviral agents. Patients in the Group I were given supportive care. All patients of both the groups received physiotherapy for facial asymmetry and medication for eye care along with close monitoring and management of diabetes and other comorbidities. H-B Grades at onset, after 10 days, at the end of 1st and at 3rd month after facial paralysis were assessed. Recovery time and the number of patients who demonstrated improvement were compared between the groups. Results: Total 50 adult diabetic patients with Bell's palsy were included. Mean age at presentation was 48.5 ± 13.6 years, 44% were male and 56% female. Hypertension (HTN) was present in 50% cases. A total of 30 patients (60%) received oral steroid with anti-viral drugs and 20 (40%) received only supportive treatment. Significant statistical difference was observed with regard to H-B Grades, recovery time and number of patients between steroid group (Group II) in comparison to patients of non-steroid group (Group I) after 10 days (p 0.007), at 1st month ( p

Background. Diabetic sensorimotor polyneuropathy (DSPN) is a major form of complication that arises in long-term diabetic patients. Even though the application of machine learning (ML) in disease diagnosis is very common and well-established in the field of research, its application in DSPN diagnosis using nerve conduction studies (NCS), is very limited in the existing literature. Method. In this study, the NCS data were collected from the Diabetes Control and Complications Trial (DCCT) and its follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials. The NCS variables are median motor velocity (m/sec), median motor amplitude (mV), median motor F-wave (msec), median sensory velocity (m/sec), median sensory amplitude (μV), Peroneal Motor Velocity (m/sec), peroneal motor amplitude (mv), peroneal motor F-wave (msec), sural sensory velocity (m/sec), and sural sensory amplitude (μV). Three different feature ranking techniques were used to analyze the performance of eight different conventional classifiers. Results. The ensemble classifier outperformed other classifiers for the NCS data ranked when all the NCS features were used and provided an accuracy of 93.40%, sensitivity of 91.77%, and specificity of 98.44%. The random forest model exhibited the second-best performance using all the ten features with an accuracy of 93.26%, sensitivity of 91.95%, and specificity of 98.95%. Both ensemble and random forest showed the kappa value 0.82, which indicates that the models are in good agreement with the data and the variables used and are accurate to identify DSPN using these ML models. Conclusion. This study suggests that the ensemble classifier using all the ten NCS variables can predict the DSPN severity which can enhance the management of DSPN patients.