Journal of Pediatric Epilepsy 2019; 08(01): 026-028
DOI: 10.1055/s-0039-1684015
Historical Vignette
Georg Thieme Verlag KG Stuttgart · New York

Epilepsy Pioneers in Bangladesh and Current Educational Programs in Bangladesh

Selina H. Banu
1   Neurology, Development and Rehabilitation Unit, MR Khan Shishu Hospital and Institute of Child Health, Dhaka, Bangladesh
,
Mahmood A. Chowdhury
2   Autism and Child Development Center, Chattagram Ma O Shishu Hospital, Chattagram, Bangladesh
,
Muhammad M. Rahman
3   Department of Pediatric Neurology and Child Development, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
,
Narayan C. Saha
4   Department of Pediatric Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
,
Naila Z. Khan
5   Clinical Neurosciences Center, Bangladesh Protibondhi Foundation, Dhaka, Bangladesh
› Author Affiliations
Further Information

Publication History

20 February 2019

21 February 2019

Publication Date:
16 April 2019 (online)

The first pediatric epilepsy center was started in 1992 in a newly established Department of Pediatric Neurosciences at the Bangladesh Institute of Child Health, Dhaka Shishu (Children) Hospital (DSH) by Prof. Naila Zaman Khan ([Fig. 1]). Within the child development center (CDC) of the department, a specialized epilepsy clinic was established. Taking advantage of the multidisciplinary nature of the CDC, all attending children were visited by physicians, developmental therapists and, when needed, psychologists. All children being treated for epilepsy, therefore, were also managed for their comorbidities.[1] To strengthen the epilepsy services, Dr. Selina Husna Banu ([Fig. 2]) was sent for training to the Neurophysiology Unit at the Institute of Child Health (ICH), Great Ormond Street Hospital (GOSH), London, United Kingdom. On her return, she took advantage of a second-hand electroencephalography (EEG) machine donated by GOSH to establish the first pediatric EEG service in DSH.[2] Dr. Banu later went on to obtain a doctoral degree from ICH, United Kingdom, where her path-breaking work showed that monotherapy with phenobarbitone, a drug recommended by the World Health Organization (WHO), had the best outcomes for varied types of first-diagnosed childhood epilepsies.[3] The publication of this paper in the British Medical Journal (BMJ) was commended in the editorial of the same issue by Prof. Emilio Perucca.[4] This led to the remanufacturing of the drug by the local pharmaceutical industries of the country, thereby helping in establishing the rational and sustainable use of antiepileptic drugs for the treatment of childhood epilepsies in a country with limited resources.

Zoom Image
Fig. 1 Prof. Naila Zaman Khan.
Zoom Image
Fig. 2 Dr. Selina Husna Banu.

From 1997 onward, departments of child neurology and neurodevelopment were gradually established in major national institutes across the country,[5] with epilepsy services, constituting a major part of their programs. These included the child neurology department including the autism and CDC of the Chattagram Ma O Shishu Hospital (CMOSH) with Prof. Mahmood Ahmed Chowdhury ([Fig. 3]) at its helm; the Department of Neurology and Child Development under the Paediatrics Department of the Bangabondhu Sheikh Mujib Medical University (BSMMU) with Prof. Mohammad Mizanur Rahman ([Fig. 4]) at its helm; the Paediatric Neurology Department of the National Institute of Neurosciences (NINS), with Prof. Narayan Chandra Saha ([Fig. 5]) at its helm; and the Neurology Development and Rehabilitation Unit of the MR Khan Shishu Hospital (MRKSH) and the Institute of Child Health, with Dr. Banu at its helm. Since 2008, Prof. Khan has established 15 CDCs in major tertiary government medical college hospitals across Bangladesh as the National Coordinator for the Ministry of Health and Family Welfare, Government of Bangladesh, with the epilepsy clinic being one of the most attended services.[6]

Zoom Image
Fig. 3 Prof. Mahmood Ahmed Chowdhury.
Zoom Image
Fig. 4 Prof. Muhammad Mizanur Rahman.
Zoom Image
Fig. 5 Prof. Narayan Chandra Saha.

In conformity with the merging of child neurology and neurodevelopment programs under one department across all major institutes of Bangladesh, postgraduate fellowship (FCPS) in “Child Neurology and Development” has been recognized by the Bangladesh College of Physicians (BCPS) and Surgeons since 2009 and MD degrees on the same subject by the BSMMU.

The way forward is to strengthen the pediatric epilepsy course curriculum and training within the undergraduate (MBBS) courses. In contrast to about 30 government medical college hospitals, there are over 90 nongovernment medical college hospitals across the country. All these services need strengthening. The Bangladesh Society of Child Neurology, Development and Disability (BSCNDD: bscndd.org) has played a central role in organizing teaching sessions, workshops, seminars, and national conferences on various subjected related to childhood epilepsies. The Bangladesh Clinical Neuro Electrophysiology Society (BCNEPS) also conducts regular modular courses for medical graduates and technologists, organizes workshops, seminars, and national conferences, and conducts outreach programs in critical care units of various hospitals across the Dhaka city[7] and in remote populations of Bangladesh by visiting professionals who utilize portable EEG machines to assist them in diagnosis and management of children with varied types of seizure disorders.

Research in molecular genetics related to childhood neurodevelopmental disorders is just beginning, which has been helped by the network of established CDCs.[8] Research on the molecular genetics of childhood epilepsies is also being conducted and is awaiting publication.

 
  • References

  • 1 Banu SH, Khan NZ, Hossain M, Ferdousi S, Boyd S, Neville B. Prediction of seizure outcome in childhood epilepsies in countries with limited resources: a prospective study. Dev Med Ch Neurol 2012; DOI: 10.1111/j.1469-8749.2012.04325.x.
  • 2 Banu SH, Hossain M, Khan NZ. Two year experience of developing paediatric EEG services in Bangladesh: report of the first 1000 cases (abstract). Journal of Electrophysiological Technology 1999; 25 (1, 2): 56
  • 3 Banu SH, Khan NZ, Jahan M, Koli UK, Boyd S, Neville BGR. A randomized controlled trial of phenobarbitone and carbamazepine monotherapy in childhood epilepsy in Bangladesh. BMJ 2007; 334 (7605): 1207
  • 4 Perucca E. Treatment of epilepsy in developing countries. BMJ 2007; 334 (7605): 1175-1176
  • 5 Khan NZ, Ferdous S. Pediatric Neurosciences: Services and Research in Bangladesh. In: Khan Naila Z, Ferdous S. , eds. Dhaka, Bangladesh: Shishu Bikash Network; 2003
  • 6 Khan NZ, Sultana R, Ahmed F, Shilpi AB, Sultana N, Darmstadt GL. Scaling up child development centres in Bangladesh. Child Care Health Dev 2018; 44 (01) 19-30
  • 7 Banu SH. EEG in ICU: an important tool for management of critically ill patients: review article. Bangladesh Critical Care Journal 2014; 2 (01) 28-34
  • 8 Anazi S, Maddirevula S, Salpietro V. , et al. Expanding the genetic heterogeneity of intellectual disability. Hum Genet 2017; 136 (11,12): 1419-1429