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Pohan, Fathy Zuandi
Kadar vitamin d pada anak epilepsi yang menggunakan antikonvulsan jangka panjang = Vitamin d level in epileptic children with long term anticonvulsant therapy / Fathy Zuandi Pohan
"ABSTRAK
Latar belakang. Penggunaan antikonvulsan jangka panjang, terutama golongan
penginduksi enzim, berkaitan dengan penurunan kadar 25-hidroksivitamin D
(25[OH]D) dan peningkatan prevalens defisiensi vitamin D. Namun demikian,
hasil yang tidak konsisten ditunjukkan pada penggunaan antikonvulsan nonpenginduksi
enzim seperti asam valproat. Sampai saat ini belum ada penelitian di
Indonesia yang melihat hubungan penggunaan antikonvulsan jangka panjang
dengan kadar 25(OH)D.
Tujuan. Penelitian ini bertujuan untuk mengetahui kadar 25(OH)D dan prevalens
defisiensi/insufisiensi vitamin D pada anak epilepsi yang menggunakan
antikonvulsan jangka panjang serta faktor-faktor yang memengaruhinya.
Metode. Penelitian potong lintang di dua poliklinik neurologi anak di Jakarta
pada bulan Maret hingga Juni 2013 pada anak epilepsi usia 6 – 11 tahun yang
menggunakan asam valproat, karbamazepin, fenobarbital, fenitoin, atau
okskarbazepin, baik tunggal maupun kombinasi, selama 1 tahun atau lebih.
Penelitian menggunakan kontrol matching usia dan jenis kelamin. Pemeriksaan
kadar 25(OH)D menggunakan metode enzyme immunoassay.
Hasil. Terdapat 31 subjek epilepsi dan 31 kontrol dengan rerata usia 9,1 (SD 1,8)
tahun. Sebagian besar subjek menggunakan asam valproat (25/31) dan diberikan
monoterapi (21/31). Rerata lama pemakaian antikonvulsan adalah 41,9 (SD 20)
bulan. Rerata kadar 25(OH)D subjek epilepsi adalah 41,1 (SD 16) ng/mL, lebih
rendah dibanding kontrol dengan selisih 9,7 ng/mL (IK95% 1,6 sampai 17,9).
Tidak ditemukan defisiensi vitamin D pada kedua kelompok. Prevalens
insufisiensi vitamin D pada subjek epilepsi lebih besar dibanding kontrol (12/31
vs 4/31; p=0,020). Berdasarkan analisis multivariat, tidak ada faktor yang
memengaruhi penurunan kadar 25(OH)D pada anak epilepsi yang menggunakan
antikonvulsan jangka panjang.
Simpulan. Kadar vitamin D pada anak epilepsi yang menggunakan antikonvulsan
jangka panjang lebih rendah dibanding dengan kontrol namun tidak sampai
menyebabkan defisiensi vitamin D.
ABSTRACT
Background. Long-term anticonvulsants therapy, especially the enzyme inducer,
are associated with low level of 25-hidroxyvitamin D (25[OH]D) and high
prevalence of vitamin D deficiency. However, studies had showed inconsistent
results on long-term usage of non-enzyme inducer anticonvulsant such as valproic
acid. Until now, there is no study ever conducted in Indonesia to evaluate the
association between long-term usage of anticonvulsant with 25(OH)D level.
Objectives. To investigate 25(OH)D level and the prevalence of vitamin D
deficiency/insufficiency in epileptic children who are using long-term
anticonvulsant and to describe the associated factors.
Method. This was a cross-sectional study conducted at two pediatric outpatient
neurology clinics in Jakarta, between March to June 2013. Subjects were epileptic
children, aged 6 – 11 years old who had been using valproic acid, carbamazepine,
phenobarbital, phenytoin, or oxcarbazepine, as single or combination therapy, for
1 year or more. We performed a matched control for age and sex. The 25(OH)D
level was measured with enzyme immunoassay method.
Results. There were 31 epileptic children and 31 controls. The mean age was 9,1
(SD 1.8) years old. Most of the subjects were treated with valproic acid (25/31)
and administered as monotherapy (21/31). The mean duration of anticonvulsant
consumption was 41.9 (SD 20) months. The mean 25(OH)D level of epileptic
children was 41.1 (SD 16) ng/mL, lower than control with difference 9.7 ng/mL
(95% CI 1.6 to 17.9). There was no vitamin D deficiency found in this study. The
prevalence of vitamin D insufficiency in epileptic children was higher than control
(12/31 vs 4/31; p=0,020). Based on the multivariate analysis, no identified risk
factors were associated with low level of 25(OH)D in epileptic children with longterm
anticonvulsant therapy.
Conclusion. Vitamin D level in epileptic children with long-term anticonvulsant
therapy is lower than control but none have vitamin D deficiency."
Fakultas Kedokteran Universitas Indonesia, 2013
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Dina Siti Daliyanti
Profil kadar vitamin D dan peran terapi suplementasi pada anak epilepsi = Vitamin D profile and supplementation therapy in epileptic children
"Latar belakang : Pemakaian obat anti epilepsi jangka panjang dikaitkan dengan kekerapan terjadinya defisiensi vitamin D,Suplementasi vitamin D dapat meningkatkan kadar 25 OH D sehingga menurunkan angka morbiditasnya.
Tujuan : Mengetahui profil vitamin D pada anak epilepsi dan mengetahui efektivitas terapi suplementasi vitamin D.
Metode : Analisa before and after pada subjek epilepsi politerapi > 1 tahun dan menggunakan>2 obat, evaluasi pre- dan paska suplementasi vitamin D selama 3 bulan.
Hasil penelitian : Dari 51 subjek yang diteliti ditemukan 25 49 subjek sufisien, 19 37,3 pasien insufisien, dan 7 13,7 subjek defisien. Faktor risiko yang memiliki kemaknaan statistik adalah usua pubertas dan prapubertas p=0,004 , busana tertutup p=0,002 ,jenis epilepsi fokal p=0,032 dan frekuensi kejang p=0,047 . Evaluasi pemberian suplementasi vitamin D selama 3 bulan memberikan peningkatan kadar 25 OH D yang bermakna secara statistic p=0,001.
Kesimpulan : Diperlukan pemantauan periodic kadar vitamin D pada anak epilepsi dan peranan terapi suplementasi dalam menurunkan angka morbiditasnya.
Background : in epileptic children, a number of medications are used. Antiepileptic drugs are known to exert deleterious effect on vitamin D metabolism. Reports of vitamin D deficiency associated with anticonvulsant drugs in pediatric patients are conflicting.
Objective : To determine vitamin D status and risk factors in epileptic children and evaluate the effect of vitamin D supplementation.
Methods : A prospective pre and post intervention study was done in 51 epileptic children aged 5 18 years on polytherapy for at least one year in Ciptomangunkusumo Hospital and Bekasi Hospital, over a vitamin D supplementation period of 3 months from January 2017 to May 2017.
Results : Of the 51 patients studied, 25( 49,0%) subjects had sufficient vitamin D levels (>20 ng/mL), 19 ( 37,3%) subjects had insufficient vitamin D levels (12-20 ng/mL), and 7 (13,7 %) subjects had vitamin D deficiency( <12 ng/mL). It was seen that the risk of vitamin D deficiency increased, in the dress used ( full-covered dress) (p=0,002) , pre-pubertal and pubertal age ( p=0,004), focal epilepsy (p=0,032) and in seizure frequency (p=0,047), which was statistically significant. The role of vitamin D supplementation showed beneficial effect in increasing vitamin D level, which was statistically significant( p=0,001).
Conclusion : vitamin D supplementation in epileptic children effectively increases serum 25(OH)D."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2017
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R.M. Indra
Faktor risiko resistensi obat anti epilepsi pada anak epilepsi dengan usia awitan di atas lima tahun: penelitian kasus kontrol = Risk factors of anti epileptic drug resistance in epileptic children with age of onset above five years: a case control study
"ABSTRAK
Latar Belakang. Anak epilepsi dengan usia awitan di atas lima tahun merupakan kelompok dengan karakteristik epidemiologis dan klinis khas yang mungkin memiliki faktor risiko resistensi terhadap obat anti epilepsi OAE spesifik. Penelitian mengenai resistensi obat pada kelompok usia ini masih sedikit. Tujuan. Mengidentifikasi faktor risiko resistensi OAE pada anak epilepsi dengan usia awitan di atas lima tahun. Metode. Dilakukan penelitian kasus kontrol terhadap anak epilepsi dengan usia awitan di atas lima tahun yang berobat di poliklinik RS Cipto Mangunkusumo dan Mohammad Hoesin bulan Agustus-September 2016. Kelompok kasus adalah anak yang resisten OAE sedangkan kelompok kontrol adalah anak responsif OAE berdasarkan klasifikasi ILAE 2010. Faktor risiko yang diteliti yaitu awitan, jumlah kejang dan lama sakit sebelum berobat, etiologi, jenis kejang, status epileptikus, gambaran EEG awal, evolusi EEG, pencitraan otak dan respon awal terapi. Hasil. Sebanyak 32 pasang anak ikut dalam penelitian. Setelah analisis regresi logistik, faktor yang ditemukan berhubungan dengan resistensi OAE adalah etiologi simtomatik adjusted OR 84,71; IK 95 5,18-1359,15 dan respon awal pengobatan tidak baik adjusted OR 72,55; IK 95 7,08-743,85 . Simpulan. Etiologi simtomatik dan respon awal pengobatan tidak baik merupakan faktor risiko resistensi terhadap OAE pada anak epilepsi dengan usia awitan di atas lima tahun yang bersifat independen.
Background. Epileptic children with onset above five years encompass distinct epidemiological and clinical characteristics that may have specific risk factors for resistance to anti epileptic drugs AED . Studies on this age group are limited. Objective. To identify risk factors for drug resistance in epileptic children with age of onset above five years. Methods. A case control study was conducted on epileptic children with onset above five years visiting Pediatric Neurology clinic of Cipto Mangunkusumo and Mohammad Hoesin Hospital between August and September 2016. Cases consisted of drug resistant children while control consisted of drug responsive children according to 2010 ILAE classification. Risk factors studied include onset, number of seizures and illness duration before treatment, cause, seizure type, status epilepticus, initial EEG and evolution of EEG, brain imaging, and initial treatment response. Results. Thirty two pairs of children were included in the study. After logistic regression analysis, symptomatic etiology and failure to achieve early response to treatment were found to be associated with drug resistance with adjusted OR 84.71 95 CI 5.18 1359.15 and 72.55 95 CI 7.08 743.85 respectively. Conclusion. Poor initial response to AED and symptomatic etiology are independent risk factors for drug resistance in epileptic children with age of onset above five years. "
2016
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Deasy Grafianti
Efek samping pengobatan antiepilepsi jangka panjang terhadap tubulus ginjal = Side effect of long term antiepileptic drugs on kidney tubules
"[ABSTRAK
Latar belakang: Obat antiepilepsi (OAE), seperti asam valproat (valproic acid,
VPA) dan karbamazepin (carbamazepin, CBZ) sering digunakan dalam jangka waktu
panjang. Obat-obatan tersebut dapat mengganggu fungsi tubulus ginjal. N-acetylbeta-D-glucosaminidase
(NAG) urin merupakan enzim yang dapat dipakai sebagai
marka fungsi tubulus sehingga diharapkan dapat mendeteksi jejas tubulus. Penelitian
mengenai efek nefrotoksik VPA dan CBZ terhadap tubulus menggunakan penanda
NAG urin ini belum pernah dilakukan di Indonesia.
Tujuan: Mengukur indeks NAG (iNAG) urin pada anak epilepsi yang mendapat
VPA dan atau CBZ jangka panjang untuk mendeteksi efek nefrotoksik kedua OAE
tersebut pada tubulus ginjal.
Metodologi: Penelitian ini menggunakan studi potong lintang yang dilakukan pada
Januari-Maret 2015. Subjek penelitian ini adalah 36 anak epilepsi dengan monoterapi
VPA, 14 dengan monoterapi CBZ, 14 dengan kombinasi VPA dan CBZ, rentang usia
3-16 tahun. Pada seluruh subjek dilakukan pemeriksaan kadar kreatinin urin dan
kadar NAG urin. Sebagai nilai acuan kadar NAG urin, dipilih 30 anak sehat dengan
usia yang disesuaikan dengan subjek penelitian. Untuk menghilangkan variabilitas
harian, maka NAG urin dibagi dengan kreatinin urin, menjadi iNAG (satuan U/g
kreatinin). Indeks NAG dikategorikan meningkat bila nilainya lebih dari rerata NAG
+ 2 SD kelompok anak sehat.
Hasil: Rerata iNAG urin pada kelompok anak sehat, monoterapi VPA, monoterapi
CBZ dan kombinasi VPA dan CBZ berturut-turut adalah 3,01; 5,9; 4,07; 6,9. Tiap
kelompok kasus memiliki rerata iNAG urin lebih tinggi dibandingkan anak sehat.
Proporsi kenaikan iNAG urin ditemukan pada 11/ 36 anak dengan monoterapi VPA,
2/14 pada kelompok monoterapi CBZ, dan 9/14 pada terapi kombinasi VPA dan
CBZ.
Simpulan: Pemberian VPA jangka panjang dapat menyebabkan jejas pada tubulus ginjal dengan parameter kenaikan iNAG urin, dan jejas tubulus ini meningkat dengan pemakaian VPA dan CBZ secara kombinasi.ABSTRACT Background: Antiepileptic drugs such as valproic acid (VPA) and carbamazepine
(CBZ) are often used in the long term manner. These drugs may disrupt the function
of the kidney tubules. Urinary N-acetyl-beta-D-glucosaminidase (NAG) is an enzyme
that can be utilised as marker of tubular function and is therefore expected to be
useful in detecting kidney tubular injuries. There have been no studies conducted in
Indonesia on the nephrotoxic effect of VPA and CBZ to tubules using urinary NAG
as marker.
Objectives: To measure urinary NAG index (iNAG) in epileptic children with longterm
use of VPA and CBZ in order to detect their nephrotoxic effects on kidney
tubules.
Methods: This is a cross-sectional study performed on January to March 2015. The
subject includes 36 patients on VPA monotherapy, 14 patients on CBZ monotherapy,
and 14 patients on VPA-CBZ combination therapy with age ranging from 3 to 16
years old. Urine creatinine concentration and urinary NAG values of all the patients
are measured. Thirty age-adjusted healthy children are included in the study for NAG
value reference. To eliminate NAG diurnal variability, iNAG is calculated by
dividing urinary NAG value and urine creatinine concentration. Urinary iNAG values
that fall above the +2 standard deviations from the mean of healthy children are
considered elevated.
Results: Urinary iNAG values of the healthy children, VPA monotherapy, CBZ
monotherapy, and VPA-CBZ comination therapy groups are 3.01; 5.9; 4.07; 6.9 U/g
respectively. Each case group has higher urinary iNAG mean value than the control
group. Urinary iNAG urine increased proportion is found in 11/36 children on VPA
monotherapy, 2/14 children on CBZ monotherapy, and 9/14 children on VPA-CBZ
combination therapy.
Conclusions: Long-term VPA use may cause renal tubular injuries with increased urinary iNAG value as parameter. Tubular injury is increased with the use of VPA and CBZ in combination. ;Background: Antiepileptic drugs such as valproic acid (VPA) and carbamazepine
(CBZ) are often used in the long term manner. These drugs may disrupt the function
of the kidney tubules. Urinary N-acetyl-beta-D-glucosaminidase (NAG) is an enzyme
that can be utilised as marker of tubular function and is therefore expected to be
useful in detecting kidney tubular injuries. There have been no studies conducted in
Indonesia on the nephrotoxic effect of VPA and CBZ to tubules using urinary NAG
as marker.
Objectives: To measure urinary NAG index (iNAG) in epileptic children with longterm
use of VPA and CBZ in order to detect their nephrotoxic effects on kidney
tubules.
Methods: This is a cross-sectional study performed on January to March 2015. The
subject includes 36 patients on VPA monotherapy, 14 patients on CBZ monotherapy,
and 14 patients on VPA-CBZ combination therapy with age ranging from 3 to 16
years old. Urine creatinine concentration and urinary NAG values of all the patients
are measured. Thirty age-adjusted healthy children are included in the study for NAG
value reference. To eliminate NAG diurnal variability, iNAG is calculated by
dividing urinary NAG value and urine creatinine concentration. Urinary iNAG values
that fall above the +2 standard deviations from the mean of healthy children are
considered elevated.
Results: Urinary iNAG values of the healthy children, VPA monotherapy, CBZ
monotherapy, and VPA-CBZ comination therapy groups are 3.01; 5.9; 4.07; 6.9 U/g
respectively. Each case group has higher urinary iNAG mean value than the control
group. Urinary iNAG urine increased proportion is found in 11/36 children on VPA
monotherapy, 2/14 children on CBZ monotherapy, and 9/14 children on VPA-CBZ
combination therapy.
Conclusions: Long-term VPA use may cause renal tubular injuries with increased urinary iNAG value as parameter. Tubular injury is increased with the use of VPA and CBZ in combination. , Background: Antiepileptic drugs such as valproic acid (VPA) and carbamazepine
(CBZ) are often used in the long term manner. These drugs may disrupt the function
of the kidney tubules. Urinary N-acetyl-beta-D-glucosaminidase (NAG) is an enzyme
that can be utilised as marker of tubular function and is therefore expected to be
useful in detecting kidney tubular injuries. There have been no studies conducted in
Indonesia on the nephrotoxic effect of VPA and CBZ to tubules using urinary NAG
as marker.
Objectives: To measure urinary NAG index (iNAG) in epileptic children with longterm
use of VPA and CBZ in order to detect their nephrotoxic effects on kidney
tubules.
Methods: This is a cross-sectional study performed on January to March 2015. The
subject includes 36 patients on VPA monotherapy, 14 patients on CBZ monotherapy,
and 14 patients on VPA-CBZ combination therapy with age ranging from 3 to 16
years old. Urine creatinine concentration and urinary NAG values of all the patients
are measured. Thirty age-adjusted healthy children are included in the study for NAG
value reference. To eliminate NAG diurnal variability, iNAG is calculated by
dividing urinary NAG value and urine creatinine concentration. Urinary iNAG values
that fall above the +2 standard deviations from the mean of healthy children are
considered elevated.
Results: Urinary iNAG values of the healthy children, VPA monotherapy, CBZ
monotherapy, and VPA-CBZ comination therapy groups are 3.01; 5.9; 4.07; 6.9 U/g
respectively. Each case group has higher urinary iNAG mean value than the control
group. Urinary iNAG urine increased proportion is found in 11/36 children on VPA
monotherapy, 2/14 children on CBZ monotherapy, and 9/14 children on VPA-CBZ
combination therapy.
Conclusions: Long-term VPA use may cause renal tubular injuries with increased urinary iNAG value as parameter. Tubular injury is increased with the use of VPA and CBZ in combination. ]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Tartila
Gambaran gelombang epileptiform pada eeg anak dengan epilepsi kajian pada faktor faktor yang memengaruhi = Epileptiform waves on the eeg of children with epilepsy study of factors influencing the occurence
"[ABSTRAK
Latar belakang Pemeriksaan EEG merupakan modalitas terpenting dalam diagnosis multi aksial pada epilepsi dan pemberian obat anti epilepsi yang tepat Sensitivitas EEG untuk memperoleh gelombang epileptiform cukup rendah sehingga berbagai upaya dilakukan untuk meningkatkan sensitivitas EEG Faktor faktor yang memengaruhi kejadian gelombang epileptiform telah banyak diteliti pada pasien dewasa namun belum ada penelitian yang spesifik pada anak Tujuan Mengetahui proporsi kejadian gelombang epileptiform pada EEG anak dengan epilepsi dan faktor faktor yang berpengaruh Metode Studi potong lintang terhadap 110 anak epilepsi usia 1 bulan 18 tahun yang datang ke Poliklinik EEG Kiara RSCM dari bulan Mei hingga September 2015 Faktor faktor yang dianggap berpengaruh dianalisis secara multivariat dengan uji regresi logistik Hasil Proporsi munculnya gelombang epileptiform sebesar 48 110 43 6 Pada analisis bivariat didapatkan faktor yang berpengaruh terhadap munculnya gelombang epileptiform adalah lama anak terbangun hingga dilakukannya pemeriksaan EEG p 0 034 OR 2 449 IK95 1 071 5 599 dan jarak kejang terakhir dengan EEG p 0 005 OR 3 037 IK95 1 386 6 626 Pada analisis multivariat didapatkan faktor yang paling berpengaruh terhadap kejadian gelombang epileptiform adalah jarak kejang terakhir dengan EEG p 0 016 OR 2 671 IK95 1 198 5 957 Simpulan Jarak kejang terakhir dengan pemeriksaan EEG kurang dari 3 hari dan deprivasi tidur parsial selama 6 jam merupakan faktor terjadinya gelombang epileptiform pada EEG anak dengan epilepsi ABSTRACT Background Top of Form EEG is an important modality in the multi axial diagnosis of epilepsy and therapy Sensitivity of EEG was low so efforts were made to improve it Factors related to the occurence of epileptiform waves has been studied in adult patients but no specific studies in children Top of Form Objectives Determine proportion of epileptiform waves in the EEG of children with epilepsy and identify the factors related to the occurence of epileptiform waves Methods This is a cross sectional study on 110 children with epilepsy aged 1 month 18 years old who came to the EEG outpatient clinic at Kiara Cipto Mangunkusumo hospital from May to September 2015 Related factors was analyzed using multivariate Results The proportion of epileptiform waves was 48 110 43 6 Results in bivariate analysis revealed related factors were the duration of awakeness p 0 034 OR 2 499 95 CI 1 071 5 599 and the duration of last seizure until EEG done p 0 005 OR 3 037 95 CI 1 386 6 626 In the multivariate analysis duration of last seizure until EEG done was the most related factors to the occurence of epileptiform waves p 0 016 OR 2 671 95 CI 1 198 5 957 Conclusion Factors related to the occurence of epileptiform waves are duration of last seizure until EEG done less than 3 days and patial deprivation for 6 hours ;Background Top of Form EEG is an important modality in the multi axial diagnosis of epilepsy and therapy Sensitivity of EEG was low so efforts were made to improve it Factors related to the occurence of epileptiform waves has been studied in adult patients but no specific studies in children Top of Form Objectives Determine proportion of epileptiform waves in the EEG of children with epilepsy and identify the factors related to the occurence of epileptiform waves Methods This is a cross sectional study on 110 children with epilepsy aged 1 month 18 years old who came to the EEG outpatient clinic at Kiara Cipto Mangunkusumo hospital from May to September 2015 Related factors was analyzed using multivariate Results The proportion of epileptiform waves was 48 110 43 6 Results in bivariate analysis revealed related factors were the duration of awakeness p 0 034 OR 2 499 95 CI 1 071 5 599 and the duration of last seizure until EEG done p 0 005 OR 3 037 95 CI 1 386 6 626 In the multivariate analysis duration of last seizure until EEG done was the most related factors to the occurence of epileptiform waves p 0 016 OR 2 671 95 CI 1 198 5 957 Conclusion Factors related to the occurence of epileptiform waves are duration of last seizure until EEG done less than 3 days and patial deprivation for 6 hours ;Background Top of Form EEG is an important modality in the multi axial diagnosis of epilepsy and therapy Sensitivity of EEG was low so efforts were made to improve it Factors related to the occurence of epileptiform waves has been studied in adult patients but no specific studies in children Top of Form Objectives Determine proportion of epileptiform waves in the EEG of children with epilepsy and identify the factors related to the occurence of epileptiform waves Methods This is a cross sectional study on 110 children with epilepsy aged 1 month 18 years old who came to the EEG outpatient clinic at Kiara Cipto Mangunkusumo hospital from May to September 2015 Related factors was analyzed using multivariate Results The proportion of epileptiform waves was 48 110 43 6 Results in bivariate analysis revealed related factors were the duration of awakeness p 0 034 OR 2 499 95 CI 1 071 5 599 and the duration of last seizure until EEG done p 0 005 OR 3 037 95 CI 1 386 6 626 In the multivariate analysis duration of last seizure until EEG done was the most related factors to the occurence of epileptiform waves p 0 016 OR 2 671 95 CI 1 198 5 957 Conclusion Factors related to the occurence of epileptiform waves are duration of last seizure until EEG done less than 3 days and patial deprivation for 6 hours , Background Top of Form EEG is an important modality in the multi axial diagnosis of epilepsy and therapy Sensitivity of EEG was low so efforts were made to improve it Factors related to the occurence of epileptiform waves has been studied in adult patients but no specific studies in children Top of Form Objectives Determine proportion of epileptiform waves in the EEG of children with epilepsy and identify the factors related to the occurence of epileptiform waves Methods This is a cross sectional study on 110 children with epilepsy aged 1 month 18 years old who came to the EEG outpatient clinic at Kiara Cipto Mangunkusumo hospital from May to September 2015 Related factors was analyzed using multivariate Results The proportion of epileptiform waves was 48 110 43 6 Results in bivariate analysis revealed related factors were the duration of awakeness p 0 034 OR 2 499 95 CI 1 071 5 599 and the duration of last seizure until EEG done p 0 005 OR 3 037 95 CI 1 386 6 626 In the multivariate analysis duration of last seizure until EEG done was the most related factors to the occurence of epileptiform waves p 0 016 OR 2 671 95 CI 1 198 5 957 Conclusion Factors related to the occurence of epileptiform waves are duration of last seizure until EEG done less than 3 days and patial deprivation for 6 hours ]"
Depok: Fakultas Kedokteran Universitas Indonesia, 2015
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Roro Rukmi Windi Perdani
Efikasi dan Keamanan Penggunaan Kembali Obat Anti Epilepsi (OAE) Lini 1 sebagai Terapi Subtitusi pada Pasien Anak Epilepsi yang Resisten dengan Kombinasi OAE Lini 2 = Efficacy and Safety of First-Line Anti Epileptic Drugs as Substitution Therapy in Children Resistant to Second-Line Anti Epileptic Drug
"Latar Belakang : Epilepsi resisten obat berkisar 30% dari seluruh kasus epilepsi. Penggunaan kembali OAE lini 1 pada kasus tersebut belum pernah dilakukan meskipun dapat menjadi pilihan terapi karena berdasarkan penelitian sebelumnya OAE lini 1 memiliki efikasi yang sama dengan OAE lini 2 meskipun efek samping lebih sering terjadi. Tujuan : Menganalisis efikasi dan keamanan penggunaan kembali OAE lini 1 sebagai terapi subtitusi OAE lini 2 pada anak epilepsi resisten obat Metode : Penelitian ini adalah penelitian open-label, randomized control trial selama 12 minggu yang dilakukan di 3 rumah sakit yaitu RSUPN Cipto Mangunkusumo, RSAB Harapan Kita dan RSUP Fatmawati pada November 2022 – Mei 2023. Subyek merupakan anak yang didiagnosis epilepsi resisten obat, dibagi menjadi kelompok terapi subtitusi dan terapi standar. Instrumen terdiri dari diary card, kuesioner QOLCE-55 dan rekam medik elektronik. Analisis dilakukan untuk menilai perbedaan proporsi responder sebagai luaran primer. Luaran sekunder terdiri dari karakteristik, perbedaan penurunan frekuensi kejang, kualitas hidup, perbaikan EEG, durasi kejang, waktu penurunan frekuensi kejang, efek samping OAE dan faktor yang memengaruhi penurunan frekuensi kejang. Hasil : Terdapat 70 subyek terdiri dari 32 pada kelompok terapi subtitusi dan 38 pada kelompok terapi standar. Karakteristik kedua kelompok hampir sama. Sebagian besar berusia > 5 tahun, durasi pengobatan ≥ 2 tahun, mengonsumsi ≥ 3 OAE dan frekuensi kejang awal ≥ 20x/minggu. Tidak ada perbedaan proporsi responder antara kedua kelompok dan terdapat penurunan frekuensi kejang sekitar 78% - 80% setelah intervensi. Kualitas hidup subyek tergolong kurang baik tetapi terdapat peningkatan skor fungsi kognitif, sosial dan skor total di kelompok terapi subtitusi setelah intervensi, ada perbedaan perbaikan kualitas hidup antara kedua kelompok. Tidak terdapat perbedaan perbaikan EEG, durasi kejang, waktu untuk mencapai penurunan frekuensi kejang dan efek samping. Efek samping yang terjadi pada derajat ringan hingga sedang dan yang tersering adalah gangguan neuropsikiatri. Faktor yang berhubungan dengan penurunan frekuensi kejang pada kelompok terapi subtitusi adalah perbaikan EEG Kesimpulan : OAE lini 1 memiliki efikasi dan keamanan yang tidak berbeda dengan OAE lini 2, tetapi dapat meningkatkan kualitas hidup pada fungsi kognitif, sosial dan keseluruhan. OAE lini 1 dapat menjadi alternatif terapi subtitusi jika OAE lini 2 tidak.
Background : Drug-resistant epilepsy accounts for around 30% of all epilepsy cases. Repeating the use of first-line AEDs as substitution therapy might be the option since the previous study showed they are as effective as second-line ones. Objectives: To analyze the efficacy and safety of first-line AEDs as substitution therapy of second-line AEDs among drug resistant epilepsy children Methods : It was an open-label, randomized control trial study over 12 weeks period, conducted in Jakarta at Cipto Mangunkusumo Hospital, Harapan Kita Hospital, and Fatmawati Hospital, during November 2022 – May 2023. The participants were 1 – 18 children with drug-resistant epilepsy who were divided into 2 groups, the substitution and the standard group. The instruments were self-reported diary cards, validated QOLCE-55 questionaire, and electronic medical record. The primary outcome was the difference proportion of responders while secondary outcomes were clinical characteristic, the difference of seizure frequency, quality of life, EEG improvement, seizure duration and time to reach seizure reduction, adverse effect and factors that influence the seizure reduction. Results : There were 70 subjects who completed the study, 32 in the substitution and 38 in the standard therapy group. Most of the subjects were > 5 year-old, duration of treatment was ≥ 2 years with ≥ 3 AEDs, and had ≥ 20x/week of seizure. There was no significant difference proportion of responder, and the seizure decreases for about 78% - 80% after intervention. The quality of life was relatively poor, but there were significant improvement in cognitive, social and total score and also significant mean difference of improvement between the two groups. On the other hand, there were no differences of EEG and seizure duration improvement, as well as time to achieve seizure reduction between the two groups. There were mild to moderate adverse effect with neuropsychiatric symptom was the most common one, there was no difference of adverse effect between groups. The EEG improvement was associated with seizure reduction. Conclusion : First-line AEDs demonstrated comparable efficacy and safety to second-line AEDs, but may cause improvement of quality of life particularly in cognitive, social and overall function domains. They could be used as alternative substitution therapy particularly if second-line AEDs are not available."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
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UI - Tesis Membership  Universitas Indonesia Library
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Rosita Febriyanti Chusniah
Faktor-faktor yang Berhubungan dengan Kualitas Hidup pada Anak Epilepsi = Factors Associated with Quality of Life in Children with Epilepsy
"Menurut World Health Ranking 2020, kematian epilepsi di Indonesia mencapai 706 orang dari total kematian dan menempatkan Indonesia pada peringkat 183 di dunia. Kualitas hidup pasien epilepsi dipengaruhi oleh beberapa faktor. Penelitian ini bertujuan mengidentifikasi faktor-faktor yang berhubungan dengan kualitas hidup anak epilepsi. Menggunakan metode cross sectional dengan accidental sampling dan didapatkan 94 responden, yaitu orang tua anak epilepsi berumur 4-18 tahun. Uji yang digunakan adalah Chi Square dengan Quality of Life in Childhood Epilepsy Questionner (QOLCE-16). Hasil penelitian menunjukan rata-rata nilai QOLCE-16 anak epilepsi adalah 42.25 dimana 52.1% anak memiliki kualitas hidup buruk. Faktor yang berhubungan dengan kualitas hidup anak epilepsi, yaitu usia orang tua, tingkat pendidikan orang tua, status pendidikan anak, lama pengobatan, frekuensi kejang, jenis OAE, dan durasi epilepsi. Hasil penelitian ini dapat dijadikan rujukan dalam pengembangan pengkajian keperawatan pada pasien epilepsi terkait kualitas hidup.
According to the 2020 World Health Ranking, Indonesia ranked 183rd with 706 epilepsy-related fatalities out of total deaths. Various factors impact the life quality experienced by those with epilepsy. Finding the variables affecting children with epilepsy's life quality is the goal of this study. 94 parents of children with epilepsy between the ages of 4 and 18 were selected from the population using an unintentional sampling technique. Chi Square with Life quality in Childhood Epilepsy Questionner (QOLCE-16) was the test utilized. The study finds 52.1% of children with epilepsy reported a low life quality, with an average QOLCE-16 score of 42.25. AED type, length of therapy, frequency of seizures, length of parental education, and length of epilepsy are all factors that affect the life quality for children with epilepsy. These findings can be referenced when creating life quality nursing assessments for patients with epilepsy."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2024
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UI - Skripsi Membership  Universitas Indonesia Library
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Epilepsi pada anak
Jakarta: Badan Penerbit Ikatan Dokter Anak Indonesia , 2016
618.92 EPI
Buku Teks  Universitas Indonesia Library
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Maghffira Maura R. A. Dunda
Peran Evolusi Faktor Risiko Dalam Memprediksi Epilepsi Intraktabel Pada Pasien Epilepsi Usia Di Bawah Tiga Tahun: Studi Kasus-Kontrol = Evolution Of Risk Factor Role In Predicting Intractable Epilepsy In Pediatric Epilepsy Patients Under Three Years Of Age: A Case-Control Study
"Epilepsi masih menjadi masalah neurologis pada anak, dengan pertambahan kasus sebesar 75%-80% setiap tahunnya di negara-negara berkembang. Sudah terdapat banyak pilihan Obat Anti Epilepsi (OAE) yang tersedia. Sayangnya, mencapai 30% pasien anak yang menjalani pengobatan tidak mencapai bebas kejang, dan berkembang menjadi epilepsi dengan kejang tidak terkontrol, atau disebut dengan epilepsi intraktabel. Perjalanan pengobatan sangat penting pada keadaan epilepsi anak usia di bawah tiga tahun, yang masih dalam masa perkembangan otak, namun belum banyak penelitian yang melihat evolusi faktor risiko dalam memprediksi kejadian epilepsi intraktabel. Penelitian ini melihat perubahan atau evolusi faktor risiko pasien epilepsi anak usia di bawah tiga tahun pada 3 lokasi penelitian di Jakarta, dengan melakukan studi kasus-kontrol.
Tujuan penelitian ini yaitu untuk mengidentifikasi peran evolusi faktor risiko untuk memprediksi epilepsi intraktabel anak usia di bawah tiga tahun. Penelitian dilakukan secara retrospektif, menggunakan data sekunder, dengan melihat rekam medis pasien epilepsi anak usia di bawah tiga tahun yang diperoleh dari RSUPN Cipto Mangunkusumo, Jakarta Pusat, RS Puri Cinere Depok, dan Klinik Anakku Pondok Pinang Center, Jakarta Selatan. Total subjek sebanyak 102 rekam medis pasien, dengan perbandingan kasus:kontrol yaitu 1:1. Hasil analisis pearson chi-square memperoleh 3 evolusi faktor risiko yang signifikan terhadap kejadian epilepsi intraktabel, yaitu: evolusi kelumpuhan motorik kasar (p<0,001; OR 7,86; IK95% 3,142-19,659); evolusi status neurologis (p<0,001; OR 9,84; IK95% 3,934-24,614); dan evolusi gelombang epileptiform EEG (p<0,001; OR 23,25; IK95% 7,657-70,599). Evolusi tipe kejang menunjukkan hasil tidak bermakna terhadap kejadian epilepsi intraktabel anak. Hasil analisis multivariat kemudian menunjukkan bahwa evolusi gelombang epileptiform EEG baik/buruk memiliki peran paling kuat dalam memprediksi kejadian epilepsi intraktabel (p<0,001; OR 0,075; IK95% 0,022-0,253). Evolusi gelombang epileptiform EEG buruk merupakan faktor prediktor epilepsi intraktabel anak usia di bawah tiga tahun yang paling berpengaruh.
Epilepsy is still a neurological problem among children, with an increase in cases of 75% -80% annually in developing countries. There are already many choices of Anti-Epileptic Drugs (AED) available. Unfortunately, up to 30% of pediatric patients who undergo treatment do not achieve seizure-free, and develop epilepsy with uncontrolled seizures, also known as intractable epilepsy. The course of treatment is very important in the epilepsy of children under three years of age, who are still in the process of brain development, but not many studies have looked at the evolution of risk factors in predicting the incidence of intractable epilepsy. This study looked at changes or evolution of risk factors for epilepsy patients under three years of age in 3 study locations in Jakarta, by conducting a case-control study. The objective of this research is to Identified the evolution of risk factors role in predicting intractable epilepsy in children under three years of age. The study was conducted retrospectively, using secondary data, by looking at the medical records of epilepsy children under three years of age obtained from RSUPN Cipto Mangunkusumo, Central Jakarta, Puri Cinere Hospital Depok, and Klinik Anakku Pondok Pinang Center, South Jakarta. The total subjects were 102 patient medical records, with a case: control ratio of 1: 1. The results of the Pearson chi-square analysis obtained three significant evolution of risk factors for the incidence of intractable epilepsy, namely: the evolution of gross motor paralysis (p<0.001; OR 7.86; 95% CI 3.142-19.659); evolution of neurological status (p<0.001; OR 9.84; CI95% 3,934-24.614); and EEG epileptiform wave evolution (p<0.001; OR 23.25; IK95% 7,657-70,599). The evolution of seizure types showed no significant effect on the incidence of intractable epilepsy in children. The results of multivariate analysis then showed that the evolution of epileptiform EEG waves good/bad had the strongest role in predicting the incidence of intractable epilepsy (p<0.001; OR 0.075; CI95% 0.022-0.253). The bad evolution of EEG epileptiform waves was the most influential predictor of intractable epilepsy among children under three years of age."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Skripsi Membership  Universitas Indonesia Library
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Lady Aurora
Faktor-faktor yang memengaruhi respons terapi pada anak penyandang epilepsi di RSUPN Cipto Mangunkusumo = Factors influencing treatment response in children with epilepsy in RSUPN Cipto Mangunkusumo
"Pemberian terapi yang sesuai, khususnya obat antiepilepsi (OAE) sebagai terapi utama dapat menyembuhkan pasien penyandang epilepsi.Seringkali faktor yang berkaitan erat dengan pemberian OAE kurang diperhatikan.Oleh karena itu, penelitian yang dilakukan penulis membahas bagaimana hubungan antara faktorfaktor yang memengaruhi respons terapi pada anak penyandang epilepsi.Penelitian dilakukan dengan metode cross-sectional, yaitu dengan menggunakan data sekunder dari rekam medis epilepsy registry pada pasien anak di Departemen Ilmu Kesehatan Anak RSUPN Cipto Mangunkusumo dengan tanggal kunjungan 1995-2010. Dari penelitian, ditemukan bahwa dari 174 subyek penelitian, 76,4% mengalami bangkitan umum dan 23,6% mengalami bangkitan fokal. Terdapat 62,1% subyek yang mengalami epilepsi simtomatik dan 37,9% epilepsi idiopatik. Sembilan puluh enam koma enam persen subyek mendapatkan regimen yang sesuai dengan lini pertama, 63,8% mendapatkan OAE dengan dosis sesuai, 77,0% subyek mendapatkan terapi tunggal (monoterapi), dan 70,3% tidak mengalami perubahan regimen selama terapi. Dari analisis bivariat menggunakan uji Chi-Square maupun Fisher's, tidak ditemukan hubungan yang signifikan baik untuk faktor kesesuaian regimen, dosis OAE, kombinasi OAE, maupun perubahan regimen selama terapi (seluruhnya memiliki nilai p > 0,05). Namun, nilai OR masing-masing faktor menunjukkan hasil yang sesuai dengan teori sehingga dapat disimpulkan bahwa secara klinis respons bebas kejang akan didapatkan pada pasien yang mendapatkan regimen sesuai, dosis sesuai, monoterapi, dan tidak ada pergantian regimen. Adapun bila dikaitkan dengan klasifikasi epilepsi yang dialami, pasien dengan epilepsi idiopatik memiliki kecenderungan mendapatkan respons bebas kejang (OR=1,407 95%CI 0,732-2,705). Analisis multivariat menggunakan uji regresi logistik menunjukkan monoterapi menjadi faktor yang terkuat dalam pencapaian respons terapi epilepsi walaupun hasil pada penelitian ini tidak signifikan.
Appropiate therapy admission, especially antiepileptic drugs (AED) as the main therapy for epileptic patients, might help the patients to achieve its maximum recovery. Health care providers don?t pay much attention to factors related to AED admission. Therefore, this research was determined to analyze the association between several factors affecting treatment response in children with epilepsy. This research is a cross-sectional study, using secondary data from epilepsy registry medical record in pediatric patient at Pediatric Health Department of RSUPN Cipto Mangunkusumo during 1995-2010. This study showed that among 174 subjects, 76.4% subjects had general seizure and 23.6% subjects had focal seizure. It is also found that 62.1% subjects had symptomatic epilepsy and 37.9% subjects had idiophatic epilepsy. Ninety six point six percent subjects had appropriate regiment with first-line drugs, 63.8% subjects had appropriate AED dose, 77.0% subjects received monotherapy, and 70.3% did not receive any regiment modification during therapy. Through bivariate analysis using Chi-Square and Fisher?s test: there were no significant association between regiment compatibility, AED dose, AED combination, and regiment modification during therapy (p > 0.05). However, the odds ratio (OR) of each factors showed corresponding result with the theory. In conclusion, seizure-free response will be achieved by patients who had appropriate regiment, appropriate dose, monotherapy, and no regiment modification. Analysis about association between epilepsy classification and therapy response showed that patient with idiophatic epilepsy tended to be easier to be seizure-free. Multivariate analysis using logistic regression showed that monotherapy was the strongest factor affecting therapy response, even though in this study it was not statistically significant."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Skripsi Membership  Universitas Indonesia Library
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