|Year : 2016 | Volume
| Issue : 1 | Page : 11-14
Spectrum of neurological disorders: Neurology clinic experience of university tertiary care hospital
Fahd A Al-Khamis
Department of Neurology, Faculty of Medicine, University of Dammam, Dammam; Department of Neurology, King Fahad Hospital of the University, Al-Khobar, Saudi Arabia
|Date of Web Publication||23-May-2016|
Fahd A Al-Khamis
Department of Neurology, Faculty of Medicine, University of Dammam, King Faisal Bin Abdulaziz Road, P. O. Box 1982, Dammam 31441
Source of Support: None, Conflict of Interest: None
Objective: To examine the pattern of neurological disorders that are encountered in the neurology outpatient clinics at tertiary care level. Materials and Methods: This is a retrospective descriptive study carried out in the neurology outpatient clinics of the King Fahd Hospital of Dammam University Al-Khobar over the period of 1-year between October 1, 2014 and September 30, 2015. The data were collected through a pre-designed questionnaire from hand-written registers maintained by neurology consultant at the neurology clinics. Results: Among all patients that visited the neurology clinic over the 1-year period, 2076 patients presented with neurological disorders whereas 51 patients presented with non-neurological symptoms. Epilepsy and seizure disorders (37.71%) were the most common neurological condition followed by headaches (15.51%), stroke (9.29%), and multiple sclerosis (7.41%). The most common age group that visited the neurology clinics was between 21 and 40 years (44%), and the least common were older than 60 years age (4.57%). Conclusion: Our results suggest that neurological disorders are common and vary in scope in neurology out-patient departments. Knowing the spectrum of neurological diseases in neurology clinic at tertiary care level will help to understand the neurological demand and supply in Saudi Arabia.
Keywords: Neurological disorders, neurology clinic, university hospital
|How to cite this article:|
Al-Khamis FA. Spectrum of neurological disorders: Neurology clinic experience of university tertiary care hospital. Saudi J Health Sci 2016;5:11-4
| Introduction|| |
In the developing world, neurological disorders account 20% of global burden of diseases. , About 12% of patients die because of neurological disorders, and stroke is ranked as the second leading cause of death after ischemic heart disease worldwide. , Saudi Arabia is the largest country in the Arabian Peninsula, with a land area of approximately 2,150,000 km 2 .  The estimated Saudi population for the year 2014 was more than 20 million with 69% of the population 15 years of age or above.  Epidemiological studies play an important role in illuminating the disease patterns occurrence in the community. However, there is limited published data on the estimation of the burden and spectrum of major neurological disorders in Saudi Arabia. Currently, there are two community surveys from the Eastern province of Saudi Arabia on the prevalence of neurological diseases. These studies reported overall crude prevalence ratio of 131 and 120.5/1000 population for all forms of neurological diseases. , In these surveys, headache syndromes were more prevalent followed by seizure disorders. There is a paucity of recent data addressing the population per neurologist ratio in Saudi Arabia. According to a questionnaire based survey about neurology expertise in Arab world published in 2010, Benamer reported that there are 61-81 neurologists in Saudi Arabia and population per neurologist was 430000-328000, , which is higher in comparison to some other Arab countries such as United Arab Emirates, Bahrain, Jordan, Algeria, Egypt and Lebanon. , This data might reflect that many patients do not find neurologist's opinion for their neurological disorders or neurologists.
The aim of this study is to find the pattern of neurological disorders seen by neurologists in our outpatients department (OPD) at the King Fahd Hospital of Dammam University Al-Khobar. This study may set a stage for a large-scale prospective database and may help us to know the neurological demand and supply in Saudi Arabia.
| MaterialS and Methods|| |
This is a retrospective descriptive study in which 6 consultant neurologists are running adult neurology clinics 4 days a week in the King Fahd Hospital of Dammam University Al-Khobar, assisted by neurology residents and registrars.
Hand-written registers of all the patients seen in neurology OPD were being maintained with patients' names, medical record number, age and the diagnosis, for each neurology consultant by the nursing staff. The neurology patients were normally referrals from the other hospitals or OPDs or discharges from admissions in the same hospital.
The case record of patients was identified from those hand-written registers over the period of 1-year between October 01, 2014 and September 30, 2015, and information regarding the demographic and neurological disorders of all types was gathered through a pre-designed questionnaire. The diagnosis written in the registers, made by the consultant, registrar, or residents were also obtained.
| Results|| |
In the King Fahd Hospital of Dammam University Al-Khobar, specialized epilepsy, headache and multiple sclerosis (MS) clinics are run in every week parallel to general neurology clinics. There are a total of 8-10 clinics per week, mostly covered by consultants and assisted by neurology registrars and residents.
In a period of 1-year, a total of 4293 patients were seen in the adult neurology OPD, in which 4242 (98.81%) patients had neurological conditions and 51 patients were referred to neurology OPD with internal medicine problems without having neurological symptoms (1.19%). During this period, many patients had followed up visits ranging from 1 to 3 times. Because of more than one visits, data were showing duplicate entry. After duplicate removal, 2076 patients were considered to have neurological conditions. According to the handwritten registers entries, final diagnosis was given to 1868 (89.98%), whereas in 208 (10.01%) symptoms were mentioned without specifying any neurological diagnosis.
The most common age group visiting neurology OPD was between 21 and 40 years (44%), followed by 41-60 years (36%) [Table 1]. Females (n = 1136) accounted for 55%, which is slightly higher than males (n = 940). The most common neurological disease encountered in the OPD was epilepsy and seizure disorders (37.71%) followed by headache disorders (15.51%), stroke (9.29%), and MS (7.41%) [Table 2]. Benign paroxysmal positional vertigo, dementia, myopathies, myasthenia gravis, and Guillain-Barre syndrome were among the less common neurological disorders in patients following neurology OPD [Table 3]. Among 10% of patients that were seen in OPD and their symptoms were mentioned without labeling their diagnosis, neck ache, and low backache were most common symptoms followed by nonspecific vertigo and paresthesia in extremities [Table 4]. Depression and anxiety were the most common non-neurological symptoms that were referred to neurology OPD [Table 5].
|Table 2: More common neurological disorders seen in the neurology out - patients department (n=2076)|
Click here to view
|Table 3: Less common neurological disorders seen in the neurology out - patients department (n=2076)|
Click here to view
| Discussion|| |
The spectrum of the neurological diseases seen in the King Fahd Hospital of Dammam University Al-Khobar is more or less similar to that observed in studies performed in other part of the world. Epilepsy is a universal problem that affects all age groups without racial or national boundaries. The average prevalence rate from other part of the world is 5.16/1000, and in Saudi Arabia, it is 6.5/1000.  In this study, epilepsy and other seizure disorders were the common neurological condition (37.71%). Other centers have reported a similar trend. ,, However, in the United States of America, it is described as the second most common disorder after strokes. ,
Headaches are considered the most prevalent neurological disorder all over the world, and two community surveys in the Eastern province of Saudi Arabia also concurred that they are the most prevalent disorders. , In this study, headaches accounted for second most common neurological condition (15.51%), and migraine was found more common than tension-type headaches. In comparison to Qatar (72.5%), and Oman (83.6%), the prevalence of headaches in Saudi Arabia are reported to be significantly low (8-12%).  The apparent wide variation in the results of these epidemiological studies seems to be due to differences in methodological approaches used to obtain the data.
Stroke in adults has persistence disability and high mortality worldwide. According to World Health Organization statistics, 15 million peoples globally suffer from stroke every year.  In this study, stroke was the third most common disease (9.29%) seen in neurology OPD. Stroke is being observed as rapidly growing neurological condition in Saudi Arabia. However, local population community surveys in Saudi Arabia show that stroke is not common and its prevalence ratio was 1.78, which is significantly lower than the prevalence found in developed countries where it is between 3.8 and 13.6. 
MS remains an uncommon condition in Saudi Arabia with prevalence as low as 25/100,000.  However, the developing impression for MS in Saudi Arabia is that more MS cases are being seen currently than earlier. This is probably related to the increasing number of neurologists as well as free access to medical facilities where they had more neuroimagings, as well as neurophysiological and immunological studies. In this study, MS was the fourth most common neurological disease seen in neurology OPD accounting for 7.41% of cases. This high percentage is different from the other studies carried out in United Kingdom (3.5%)  and Thailand (0.1%).  A community survey performed in Saudi Arabia also reported very low prevalence of MS (0.04%).  The referral bias could explain the high percentage of MS cases, because large university hospitals like the King Fahd Hospital of Dammam University Al-Khobar have specialized MS clinic, serving large parts of the Eastern province population and more than 300 patients are registered in MS clinic.
An interesting aspect of our study was a proportion of non-neurological cases (1.19%). Onwuekwe and Ezeala-Adikaibe,  from Nigeria reported significantly higher nonspecialty cases in their study (47.1%) where neurologists also see general medical cases in the neurology clinic. At the King Fahd Hospital of Dammam University Al-Khobar, neurologists purely practice their own specialty and careful and necessary referral to neurology OPD by family doctors and physician might also be a reason for the relatively low burden of non-neurological cases.
| Conclusion|| |
Our neurology clinics' data from the King Fahd Hospital of Dammam University Al-Khobar suggests that epilepsy, headache disorders, and stroke are relatively more common neurological disorders. MS is the fourth most common neurological disease. This high percentage could be explained by referral bias because of specialized MS clinic in our center. This information will help us in provision and planning of neurological care in Saudi Arabia. No doubt a larger study in this specific area regarding incidence, prevalence, and socio-demographic properties of neurological disorders will help us understand the neurological demand and supply in Saudi Arabia.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Burton KJ, Allen S. A review of neurological disorders presenting at a paediatric neurology clinic and response to anticonvulsant therapy in Gambian children. Ann Trop Paediatr 2003;23:139-43.
Bergen DC, Silberberg D. Nervous system disorders: A global epidemic. Arch Neurol 2002;59:1194-6.
Lopez AD, Mathers CD. Measuring the global burden of disease and epidemiological transitions: 2002-2030. Ann Trop Med Parasitol 2006;100:481-99.
World Health Organization, Regional Office for the Eastern Mediterranean. Demographics and Health Indicators for Countries of the East Mediterranean. Alexandria, Egypt; 1999.
Annual statistics Book 2014: General Authority of statistics, Kingdom of Saudi Arabia.
Al-Rajeh S, Bademosi O, Awada A, Ismail H, Al-Freihi H, Dawodu A, et al.
Community survey of neurological disorders in Saudi Arabia: Results of the pilot study in Agrabiah. Ann Saudi Med 1995;15:32-5.
al Rajeh S, Bademosi O, Ismail H, Awada A, Dawodu A, al-Freihi H, et al.
A community survey of neurological disorders in Saudi Arabia: The Thugbah study. Neuroepidemiology 1993;12:164-78.
Benamer HT. Neurology expertise and postgraduate training programmes in the Arab world: A survey. Eur Neurol 2010;64:313-8.
Bergen DC; World Federation of Neurology Task Force on Neurological Services. Training and distribution of neurologists worldwide. J Neurol Sci 2002;198:3-7.
Al Rajeh S, Awada A, Bademosi O, Ogunniyi A. The prevalence of epilepsy and other seizure disorders in an Arab population: A community-based study. Seizure 2001;10:410-4.
Onwuekwe I, Ezeala-Adikaibe B. Prevalence and distribution of neurological disease in a neurology clinic in Enugu, Nigeria. Ann Med Health Sci Res 2011;1:63-7.
Singhal BS, Gursahani RD, Menken M. Practice patterns in neurology in India. Neuroepidemiology 1992;11:158-62.
Jusoh R. Profile of neurological practice in Malaysia. Neurol J Southeast Asia 1996;1:15-7.
Boongird P, Soranastaporn S, Menken M, Vejjajiva A. Correspondence: Spectrum of neurological diseases in Thailand. Neurol J Southeast Asia 1996;1:65-7.
Stafstrom CE. The pathophysiology of epileptic seizures: A primer for pediatricians. Pediatr Rev 1998;19:342-51.
Benamer HT, Deleu D, Grosset D. Epidemiology of headache in Arab countries. J Headache Pain 2010;11:1-3.
Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. Lancet 2006;367:1747-57.
Robert AA, Zamzami MM. Stroke in Saudi Arabia: A review of the recent literature. Pan Afr Med J 2014;17:14.
Heydarpour P, Khoshkish S, Abtahi S, Moradi-Lakeh M, Sahraian MA. Multiple Sclerosis epidemiology in Middle East and North Africa: A systematic review and meta-analysis. Neuroepidemiology 2015;44:232-44.
Fowler TJ, Scadding JW, editors. Introduction. In: Clinical Neurology. 3 rd
ed. London: Arnold; 2003. p. 1-20.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]