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"Latar belakang: Epilepsi merupakan salah satu penyebab terbanyak morbiditas di bidang saraf anak, yang menimbulkan berbagai permasalahan gangguan tumbuhkembang, dan kualitas hidup anak dengan insidens terbanyak di bawah usia 1 tahun. Faktor-faktor risiko terjadinya epilepsi di bawah usia 1 tahun seperti herediter, prenatal, perinatal dan pascanatal perlu diketahui sehingga dapat menjadi prediktor kejadian epilepsi dan dapat menatalaksana epilepsi sejak dini.Tujuan: (1) Mengidentifikasi faktor risiko epilepsi pada anak dengan awitan usia di bawah 1 tahun. (2) Menganalisis besar risiko faktor herediter. (3) Menganalisis besar risiko faktor perinatal (asfiksia, BBLR, prematur). (4) Menganalisis besar risiko faktor pascanatal (kejang demam, mikrosefali, keterlambatan perkembangan, tidak ASI eksklusif). (5) Memberikan gambaran probabilitas timbulnya epilepsi berdasarkan skoring prediktor terhadap faktor risiko.Metode: Penelitian kasus kontrol dilakukan pada pasien yang terdiagnosis epilepsi dengan awitan usia di bawah 1 tahun yang datang ke Poliklinik Neurologi Departemen Ilmu Kesehatan Anak FKUI/RSCM dari bulan Januari 2011 hingga Desember 2015. Pengambilan data dilakukan dengan melihat data rekam medis dan wawancara kepada orangtua. Faktor-faktor risiko yang dianggap berpengaruh dianalisis secara multivariat.Hasil: Insidens epilepsi di bawah usia 1 tahun selama 2011-2015 167 pasien. Pada analisis multivariat didapatkan faktor-faktor risiko yang bermakna berupa riwayat keluarga dengan epilepsi (p<0,001 dan OR 9,098; IK 95% 2,002-41,344), mikrosefali (p<0,001 dan OR 20,772; IK 95% 6,041-71,751), kejang demam (p<0,001 dan OR 13,408; IK 95% 3,855-46,636), tidak diberikannya ASI eksklusif (p<0,001 dan OR 9,667; IK 95% 4,607-20,283) serta keterlambatan perkembangan (p<0,001 dan OR 16,042; IK 95% 6,204-41,478). Probabilitas terjadinya epilepsi di bawah usia 1 tahun bila memiliki 1 faktor risiko yaitu 39%, 2 faktor risiko yaitu 86% dan 3-4 faktor risiko menjadi 98%.Simpulan: Faktor-faktor risiko yang bermakna berupa riwayat keluarga dengan epilepsi, mikrosefali, kejang demam, keterlambatan perkembangan serta tidak ASI eksklusif.

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Background: Epilepsy is the most common cause of morbidity in pediatric neurology, which results in delayed developmental problems and decreased quality of life during infancy. Risk factors of epilepsy in infancy such as hereditary, prenatal, perinatal and postnatal should be detected to be able to find the predictors of the incidence and to promptly manage epilepsy.Aim: (1) To identify the risk factors of epilepsy in infants. (2) To analyze hereditary factors. (3) To analyze perinatal risk factors (asphyxia, low birth weight, prematurity). (4) To analyze postnatal risk factors (febrile seizure, microcephaly, delayed development, no exclusive breastfeeding). (5) To find the probability of epilepsy based on the predictor score of risk factors.Method: A case control study for patients diagnosed with epilepsy during infancy who comes to Neurology outpatient clinic Department of Child Health, Faculty of Medicine, University of Indonesia from January 2011 to December 2015. Data was collected from medical records and parent interviews. The risk factors that are considered important are then analyzed multivariately.Result: The incidence of epilepsy in infant from 2011-2015 is 167 patients. In the multivariate analysis, the significant risk factors are family history with epilepsy (p<0.001 and OR 9.098l 95%; CI 2.002-41.344), microcephaly (p<0.001 and OR 20.772; 95% CI 6.041-71.751), febrile seizure (p<0.001 and OR 13.408; 95% CI 3.855-46.636), no exclusive breastfeeding (p<0.001 and OR 9.667; 95% CI 4.607-20.283) and delayed development (p<0.001 and OR 16.042; 95% CI 6.204-41.478). The probability of epilepsy in infants with more than 1 risk factor is 39%, with 2 risk factors is 86% and with 3-4 risk factors is 98%.Conclusion: The significant risk factors are family history with epilepsy, microcephaly, febrile seizure, delayed development and no exclusive breastfeeding."

"ABSTRAKLatar 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.

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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. "

"Latar belakang: Palsi serebral (PS) merupakan gangguan permanen pada perkembangan gerakan dan postur tubuh, bersifat non-progresif, dan dapat menyebabkan keterbatasan aktivitas. Gangguan motorik pada PS dapat disertai dengan gangguan fungsi sensasi, persepsi, kognisi, komunikasi dan tingkah laku, masalah muskuloskeletal sekunder, dan berisiko untuk terjadinya epilepsi di kemudian hari. Jenis PS yang diyakini berhubungan erat dengan kejadian epilepsi adalah PS tipe spastik dengan topografi kuadriplegia. Meskipun terdapat beberapa teori yang diyakini menjadi etiologi spesifik epilepsi pada PS spastik, masih sekitar 70% kasus belum diketahui penyebabnya.Metode: Penelitian ini merupakan studi observasional analitik dengan desain kasus kontrol yang bertujuan untuk menelaah faktor-faktor risiko epilepsi pada PS spastik. Faktor risiko yang terkait kejadian epilepsi pada PS tipe spastik yang akan diteliti adalah mikrosefal, topografi PS spastik, usia pertama kejang < 1 tahun, riwayat kejang periode neonatal, riwayat infeksi SSP di usia < 2 tahun, temuan abnormal CT scan/ MRI, dan temuan abnormal EEG.Hasil: Sebanyak 103 subjek populasi kasus (PS spastik dengan epilepsi) dan 103 subjek populasi kontrol (PS spastik tanpa epilepsi) diikutsertakan dalam penelitian ini. Analisis univariat hingga multivariat dilakukan menggunakan program statistical package for the social sciences versi 27 (SPSS 27). Faktor risiko dianggap bermakna apabila nilai p<0,05. Penelitian ini menunjukkan bahwa faktor-faktor risiko PS tipe spastik yang paling berperan untuk terjadinya epilepsi pada penelitian ini adalah mikrosefal (p=0,003; OR 3,577; IK 95% 1,559–8,209), topografi PS spastik kuadriplegia dan hemiplegia (p=0,005; OR 6,636; IK 95% 1,797–24,509; dan p=0,006; OR 7,888; IK 95% 1,782–34,914), temuan abnormal CT scan/ MRI (nilai p=0,002; OR 4,153; IK 95% 1,715–10,058), dan temuan abnormal EEG berupa gambaran hipofungsi (p < 0,0001; OR 219,338; IK 95% 40,103–1199,63). Kesimpulan: Mikrosefal, topografi PS spastik kuadriplegia, temuan abnormal CT scan/ MRI, dan temuan abnormal EEG terbukti meningkatkan risiko terjadinya epilepsi pada PS spastik, sedangkan usia kejang pertama < 1 tahun, riwayat kejang neonatal, dan infeksi SSP usia < 2 tahun tidak terbukti meningkatkan risiko terjadinya epilepsi pada PS spastik.

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Background: Cerebral palsy (CP) is a permanent and non-progressive disturbance in the development of movement and posture, and causes activity limitations. Motor disturbances in PS can be accompanied by impaired function of sensation, perception, cognition, communication and behaviour, secondary musculoskeletal problems, and the risk of developing epilepsy later in life. The type of CP that is believed to be closely related to the incidence of epilepsy is the spastic type with a quadriplegic topography. Although there are several theories that are believed to be the specific aetiology of epilepsy in spastic PS, the cause is still unknown in about 70% of cases.

Method: This is a case-control study design that aims to examine the risk factors of epilepsi in spastic CP. The risk factors associated with the occurrence of epilepsy that will be involved are microcephaly, topography of spastic CP, age at first seizure <1 year, history of neonatal seizures, history of CNS infection at the age < 2 years, abnormal CT scan/ MRI findings, and abnormal EEG findings.

Result: A total of 103 case population subjects (spastic CP with epilepsy) and 103 control population subjects (spastic CP without epilepsy) were included in this study. Univariate to multivariate analysis was performed using the statistical package for the social sciences version 27 (SPSS 27). Risk factors are considered significant if the p value <0.05. This study showed that the risk factors for epilepsy in spastic CP which were most significant for the occurrence of epilepsy were microcephaly (p=0.003; OR 3.577; 95% CI 1.559 – 8.209), quadriplegia and hemiplegia topography (p=0.005; OR 6.636; 95% CI 1.797- 24.509 and p=0.006; OR 7.888; 95% CI 1.782-34.914), abnormal CT scan/MRI findings (p=0.002; OR 4.153; 95% CI 1.715– 10.058), and hypofunction form of EEG findings (p<0,0001; OR 219.338; 95% CI 40.103–1199.63).

Conclusion: Microcephaly, quadriplegia topography, abnormal CT scan/MRI findings, and abnormal EEG findings have been shown to increase the risk of developing epilepsy in spastic CP. Whereas age of first seizure <1 year, history of neonatal seizures, and CNS infection at age <2 years old were not proven to increase the risk of epilepsy in spastic CP."

"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.

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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."

"Latar Belakang: Epilepsi di negara berkembang dua kali lebih tinggi dibandingkan negara maju. Sekitar 60-70% pasien bebas kejang dengan obat antiepilepsi (OAE) generasi satu, jika tidak respons dan kejang menetap maka dipertimbangkan OAE generasi dua. Keberhasilan pengobatan epilepsi dipengaruhi oleh pelbagai faktor serta bergantung terhadap plastisitas dan maturitas otak hingga usia tiga tahun. Belum ada penelitian yang menilai faktor-faktor keberhasilan terapi OAE generasi dua.Tujuan: Mengetahui faktor risiko keberhasilan keberhasilan terapi OAE generasi 2 pada pasien epilepsi anak usia di bawah tiga tahun.Metode: Studi kasus kontrol dengan data sekunder berupa rekam medis. Sampel penelitian adalah anak epilepsi berusia di bawah tiga tahun yang mendapatkan minimal salah satu OAE generasi 2 berupa topiramat/levetiracetam/lamotrigin. Subyek terbagi kelompok kontrol (dilakukan matching usia) yang kejangnya tidak terkontrol dan kelompok kasus yang kejangnya terkontrol minimal enam bulan. Faktor risiko yang diteliti adalah tipe kejang, status perkembangan, status neurologis awal, gambaran elektroensefalografi (EEG) awal, evolusi klinis dan evolusi EEG.Hasil: Didapatkan 60 subyek pada masing-masing kelompok; pada kelompok kasus paling banyak dijumpai 66,7% laki-laki, 31,7% rentang usia 6-12 bulan, 83,3% usia awitan kejang <12 bulan, dan 93,3% tipe kejang umum. Dari 6 faktor risiko yang diteliti, hanya evolusi EEG berperan independen dalam memengaruhi keberhasilan terapi, nilai p<0,001; aOR 9,53; IK95% 3,39-26,77.Kesimpulan: Pasien dengan evolusi EEG baik memiliki kemungkinan sebesar 9,53 kali lipat lebih besar untuk kerjangnya terkontrol dengan OAE generasi 2, dibandingkan pasien dengan evolusi EEG buruk.

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Background: Epilepsy in developing countries is twice compared developed countries. About 60-70% epilepsy patients had seizure-free with first generation antiepileptic drugs (AED), if there is no response and persistent seizures, second generation AED is considered. The success of epilepsy treatment is influenced by various factors and depends on the plasticity and maturity of the brain until the first 3 years. There are no studies that assess the success factors of second generation OAE therapy.Purpose: To assess the risk factors that affecting the success of second generation therapy in children under 3 years old with epilepsy.Methods: A case control study with secondary data from medical records. The study sample was children under 3 years old with epilepsy who received at least one of second generation AED (topiramate/levetiracetam/lamotrigine). Subjects were divide into 2 groups, control groups (age matching) whose seizure were not controlled and case groups whose seizure were controlled for at least six months. The risk factors studied were seizure type, developmental status, initial neurological status, initial electroencephalography (EEG), clinical evolution and EEG evolution,Results: There were 60 subjects in each group; the most proportion in case group were 66,7% males, 31,7% of the age range of 6-12 months, 83,3% onset of seizures <12 months, and 93,3% general seizures. Of the 6 risk factors studied, only the EEG evolution significantly and independently affecting the success of therapy, with p value <0,001; aOR 9.53; 95%CI 3.39-26.77.Conclusion: Patients with good EEG evolution were 9.53 times more likely to have controlled seizure with second generation AED, compared to patients with poor EEG evolution."

"Latar Belakang: Keterlambatan bicara adalah salah satu bentuk keterlambatan perkembangan pada anak. Untuk meminimalisir dampak negatif keterlambatan bicara, faktor risiko dibutuhkan untuk membantu mendiagnosis pasien, agar intervensi dini dapat dimulai.Tujuan: Identifikasi asosiasi antara jenis kelamin, usia kehamilan, berat lahir, lingkar kepala, penutupan anterior fontanel, perkembangan motorik kasar, periode ASI eksklusif, pengasuh sehari-hari, jumlah saudara kandung, paparan media, interaksi sosial dengan pasien, dan keterlambatan bicara pada anak usia 1 sampai 2 tahun.Metode: Penelitian kasus kontrol pada anak usia 1 sampai 2 tahun di Rumah Sakit Pusat Nasional (RSUPN) Cipto Mangunkusumo dan Klinik Anakku, Pondok Pinang di Jakarta, Indonesia, dari Januari 2018 sampai Maret 2018. Data dikumpulkan dari wawancara orang tua. Data yang diperoleh diolah dengan SPSS Statistics for Mac, dengan uji Chi-Square dan metode logistic regression. Hasil: Jumlah subjek pada studi ini adalah 126 anak, dengan 63 anak dengan keterlambatan bicara, dan 63 anak lainnya dengan perkembangan bicara yang normal. Pada uji multivariat, variabel yang signifikan adalah keterlambatan perkembangan motorik kasar (p < 0.001; OR = 9.607; 95% CI = 3.403-27.122), periode ASI eksklusif kurang dari 6 bulan (p = 0.016; OR = 3.278; 95% CI = 1.244-8.637), dan paparan gadget dan televisi selama lebih dari 2 jam sehari (p < 0.001; OR = 8.286; 95% CI = 2.555-26.871). Kontak sosial yang buruk (p = 0.998) adalah confounding factor pada studi ini.Kesimpulan: Keterlambatan perkembangan motorik kasar, periode ASI eksklusif kurang dari 6 bulan, paparan media selama lebih dari 2 jam, dan kontak yang buruk adalah faktor risiko keterlambatan bicara pada anak.

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Background: Speech delay is one of the most common developmental delay in children. To minimize the negative outcomes of speech delay, risk factors should be explored to help in patient diagnosis, so an early intervention can be initiated. Aim: Identify the association between gender, age, birth weight, asphyxia during birth, head circumference, closure of anterior fontanel, gross motor development, period of

breastfeeding, caregiver, number of siblings, media exposure, social interaction with subject and delayed speech in children between 1 to 2 years old. Method: A case-control study for children between 1 to 2 years old in Rumah Sakit Umum Pusat Nasional (RSUPN) Cipto Mangunkusumo and Klinik Anakku, Pondok Pinang in Jakarta, Indonesia, from January 2018 to March 2018. Data was collected from parent interviews. The data obtained was processed with SPSS Statistics for Mac, with Chi-Square test and logistic regression method.

Result: The total number of subjects in this study was 126, with 63 children with speech delay and 63 children with normal speech development. In the multivariate analysis, the significant risk factors were delayed gross motor development (p < 0.001; OR = 9.607; 95% CI = 3.403-27.122), period of exclusive breastfeeding of less than 6 months (p = 0.016; OR = 3.278; 95% CI = 1.244-8.637), and exposure to gadgets and television for more than 2 hours (p < 0.001; OR = 8.286; 95% CI = 2.555-26.871). Poor social interaction (p = 0.998) was found to be the confounding factor. Conclusion: Delayed gross motor development, period of exclusive breastfeeding of less than 6 months, media exposure for more than 2 hours, and poor are risk factors of

delayed speech development in children."

"Latar belakang. Epilepsi fokal merupakan jenis epilepsi terbanyak pada anak. Kemungkinan untuk terjadinya epilepsi intraktabel pada epilepsi fokal lebih besar dibandingkan dengan epilepsi umum. Data mengenai faktor risiko epilepsi fokal intraktabel masih sangat sedikit. Perlu dilakukan penelitian lebih lanjut untuk mengetahui strategi pengobatan dan konseling bagi pasien dan keluarga. Tujuan. (1) mendapatkan frekuensi terjadinya epilepsi intraktabel pada anak dengan epilepsi fokal. (2) mengetahui karakteristik pasien epilepsi fokal yang kontrol ke poliklinik Neurologi Anak. (3) mengetahui apakah usia awitan, etiologi epilepsi, frekuensi awal serangan, status perkembangan motor kasar awal, respon terapi awal, gambaran EEG awal, dan gambaran CT-Scan/MRI kepala dapat memprediksi kemungkinan terjadinya epilepsi intraktabel pada pasien anak dengan epilepsi fokal. (4) mengetahui apakah evolusi status perkembangan motor kasar, dan evolusi EEG epileptiform dapat memprediksi terjadinya epilepsi intraktabel. Metode penelitian. Desain penelitian adalah kohort retrospektif dan dilakukan poliklinik rawat jalan Neurologi Anak di RSCM sejak November 2013 sampai dengan Februari 2014 terhadap anak epilepsi fokal hingga usia 18 tahun, dengan lama pengobatan minimal 6 bulan. Faktor risiko dianalisis bivariat dan multivariat. Hasil penelitian. Angka kejadian epilepsi fokal intraktabel adalah 35 (39%).Usia subjek terbanyak adalah usia>3 tahun sebanyak 81(90%) subjek. Pada analisis bivariat didapat faktor risiko bermakna adalah etiologi kejang simtomatik (OR 6,12 IK95% 2,08-18,04), frekuensi kejang>5x/hari (OR 3,91 IK95% 1,43-10,75), respon awal terapi buruk (OR 233,14 IK95% 27,40-1983,27), EEG awal abnormal (OR 4,51 IK95% 1,82-11,17), MRI abnormal (OR 10,38 IK95% 2,91-37,06), evolusi status perkembangan motor kasar buruk (OR 21,62 IK95% 2,62-178,1), dan evolusi EEG epileptiform buruk (OR 25 IK95% 7,71-81,03). Pada analisis multivariat didapatkan respon awal terapi buruk dengan nilai OR136,00 (IK95% 14,79 sampai 1250,08), dan evolusi EEG epileptiform buruk dengan nilai OR 10,00 (1,68 sampai 59,35) merupakan faktor risiko yang berperan untuk menjadi epilepsi fokal intraktabel. Simpulan. Angka kejadian epilepsi fokal intraktabel sebanyak 39%. Faktor risiko yang berperan adalah respon terapi awal buruk, dan evolusi EEG epileptiform buruk.

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Background. Epilepsy focal is the most common type epilepsy in children. The chance to be intractable epilepsy is higher than general epilepsy. Therefore, study of the risk factors to predict intractable epilepsy is the utmost importance to conduct the treatment strategy and consult the patients and family.

Objective. (1) to determine the characteristic focal epilepsy in children (2) to determine the frequency of intractable focal epilepsy (3) to identify and analyze the association of early risk factors including the onset of seizure, frequency of seizure, etiology of epilepsy, gross motor developmental status, the response of antiepileptic drugs, the electroencephalogram (EEG), and magnetic resonance imaging (MRI) / computed tomography (CT) Scan findings with intractable focal epilepsy, (4) to identify and analyze the relationship between the evolution factors including the evolution of EEG epileptiform, and the evolution of gross motor development with intractable focal epilepsy.

Methods. Retrospective cohort study was conducted in child neurology outpatient clinics in Cipto Mangunkusumo Hospital Jakarta on November 2013 to February 2014. Inclusion criteria was children with epilepsy focal who was treated with antiepileptic drugs at least 6 month therapy until 18 years old age. Patients with febrile convulsions; central nervous system infections; neurodegenerative, neurometabolic diseases; and catastrophic epileptic syndromes with poor prognosis were excluded from the study. Data were analyzed using the IBM SPSS for Windowsv.17 software (IBM, New York, USA).

Results. The proportion of intractable focal epilepsy is 35 (39%). The most of children is >3 years old 81 (90%). Bivariate analysis showed that significantly early risk factors are symptomatic epileptic (OR = 6.12; 95%CI 2.08-18.04), frequency of seizure >5x/day (OR = 3.91; 95%CI 1.43-10,75), gross motor developmental delay (OR = 233.14; 95%CI 27.40-1983.27), early abnormal EEG wave (OR = 4.51; 95%CI 1.82-11.17), abnormal MRI (OR = 10.38; 95%CI 2.91-37.06), poor gross motor developmental evolution (OR = 21.62; 95%CI 2.62-178.1), and poor the EEG epileptiform evolution (OR = 25; 95%CI 7.71-81.03). Multivariate logistic regression analysis revealed that an initial non response to antiepileptic drugs (OR = 136.00; 95%CI 14.79-1250.08), and the poor evolution of EEG epileptiform (OR =10.00; 95%CI 1.68-59.35) were all found to be significant and independent risk factors for intractable focal epilepsy.

Conclusion. The present study reveals that the early non response to antiepileptic drugs, and poor of EEG epileptiform evolution are strongly associated with intractable focal epilepsy."

"[ABSTRAKLatar belakang: Epilepsi umum merupakan jenis epilepsi yang sering dijumpai pada anak. Data mengenai faktor risiko epilepsi intraktabel pada anak dengan epilepsi umum masih sangat terbatas. Perlu dilakukan penelitian lebih lanjut untuk mengetahui faktor risiko yang berperan dalam kejadian epilepsi intraktabel sehingga dapat menjadi dasar dalam tata laksana serta edukasi pasien dan orangtua.Tujuan: (1) Mengetahui karakteristik pasien epilepsi umum dan frekuensi terjadinya epilepsi intraktabel pada anak dengan epilepsi umum . (2) Mengetahui apakah usia awitan, tipe kejang, frekuensi awal serangan, status perkembangan motor kasar awal, respon terapi awal, gambaran EEG awal, dan gambaran MRI/CT Scan kepala dapat menjadi faktor risiko terjadinya epilepsi intraktabel pada anak dengan epilepsi umum. (3) Mengetahui apakah evolusi status perkembangan motor kasar, dan evolusi EEG epileptiform dapat menjadi faktor risiko terjadinya epilepsi intraktabel pada anak dengan epilepsi umumMetode: Penelitian kohort retrospektif berdasarkan rekam medis dilakukan di poliklinik rawat jalan neurologi anak Departemen Ilmu Kesehatan Anak FKUI-RSCM dan poliklinik anak swasta RSCM antara bulan September sampai dengan Desember 2014 terhadap anak epilepsi umum usia koreksi 1 bulan hingga 18 tahun, dengan lama pengobatan minimal 6 bulan. Faktor risiko dianalisis bivariat dan multivariat.Hasil: Angka kejadian epilepsi umum intraktabel adalah 21 (21%). Usia subjek terbanyak adalah usia >3 tahun sebanyak 85(83%) subjek. Pada analisis bivariat didapatkan faktor risiko yang bermakna adalah usia awitan kejang <1 tahun (OR 11,4 IK 95% 3,45-37,62), frekuensi awal serangan ≥5 kali/hari (OR 8,5 IK95% 2,90-24,80), respon awal terapi buruk (OR 160 IK 95% 19,12-1339,06), evolusi status perkembangan motor kasar buruk (OR 4,9 IK95% 1,79-13,67) dan evolusi EEG epileptiform buruk (OR 10 IK95%3,25-30,92). Pada analisis multivariat didapatkan respon awal terapi buruk dengan nilai OR 144,3 (IK95% 15,47-1345,59) dan usia awitan kejang < 1 tahun dengan nilai OR 9,6 (IK95% 1,78-51,92) merupakan faktor risiko yang berpern untuk menjadi epilepsi umum intraktabel.Simpulan : Angka kejadian epilepsi umum intraktabel sebanyak 21%. Faktor risiko yang sangat berperan adalah respon terapi awal buruk dan usia awitan kejang <1 tahun.

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ABSTRACTBackground: Generalized epilepsy is the most common type of epilepsy in children. Limited datas of intractable epilepsy risk factors are available at present. Therefore, more studies are needed to investigate the risk factors of intractable epilepsy in order to manage and educate both patients and parents.Objective: (1) to describe characteristic and frequency of intractable epilepsy in children with generalized epilepsy, (2) to investigate the role of age onset of seizure, initial seizure frequency, type of seizure, early gross motor developmental status, early therapeutic response, early EEG description and cerebral MRI/CT scan as risk factors of intractable epilepsy in children with generalized epilepsy, (3) to investigate the role of gross motor developmental status evolution and epileptiform EEG evolution as risk factors of intractable epilepsy.Methods: Retrospective cohort study was conducted at neurology outpatient pediatric RSCM and private outpatient clinic between September to December 2014. The inclusion criteria was generalized epilepsy children age 1 month of corrected age to 18 years old which has been treated with antiepileptic drugs for at least 6 months. Risk factors were analyze with bivariate and multivariate analysis.Results: Prevalence of intractable generalized epilepsy is 21%. Most subject are >3 years old 85(83%) subject. Bivariate analysis showed that age onset of seizure (OR 11,4 CI95% 3,45-37,62), initial seizure frequency ≥5 times/day (OR 8,5 CI 95% 2,90-24,80), non-responder of early treatment (OR 160 CI 95% 19,12-1339,06), unfavorable gross motor development evolution (OR 4,9 CI 95% 1,79-13,67) and unfavorable epileptiform EEG evolution (OR 10 CI 3,25-30,92) are significantly associated with intractable epilepsy. The most important among those risk factors based on multivariate analysis are non-responder of early treatment with OR 144,3 (CI95% 15,47-1345,59) and age onset < 1 year old with OR 9,6 (CI 1,78-51,92).Conclusions: Prevalence of intractable generalized epilepsy is 21%. Non-responder early treatment and age onset of seizure < 1 year old are strongly associated with intractable generalized epilepsy.;Background: Generalized epilepsy is the most common type of epilepsy inchildren. Limited datas of intractable epilepsy risk factors are available at present.Therefore, more studies are needed to investigate the risk factors of intractableepilepsy in order to manage and educate both patients and parents. Objective: (1) to describe characteristic and frequency of intractable epilepsy inchildren with generalized epilepsy, (2) to investigate the role of age onset ofseizure, initial seizure frequency, type of seizure, early gross motor developmentalstatus, early therapeutic response, early EEG description and cerebral MRI/CTscan as risk factors of intractable epilepsy in children with generalized epilepsy,(3) to investigate the role of gross motor developmental status evolution andepileptiform EEG evolution as risk factors of intractable epilepsy. Methods: Retrospective cohort study was conducted at neurology outpatientpediatric RSCM and private outpatient clinic between September to December2014. The inclusion criteria was generalized epilepsy children age 1 month ofcorrected age to 18 years old which has been treated with antiepileptic drugs for atleast 6 months. Risk factors were analyze with bivariate and multivariate analysis. Results: Prevalence of intractable generalized epilepsy is 21%. Most subject are>3 years old 85(83%) subject. Bivariate analysis showed that age onset of seizure(OR 11,4 CI95% 3,45-37,62), initial seizure frequency ≥5 times/day (OR 8,5 CI95% 2,90-24,80), non-responder of early treatment (OR 160 CI 95% 19,121339,06),unfavorablegrossmotordevelopmentevolution(OR4,9CI95%1,7913,67)and unfavorable epileptiform EEG evolution (OR 10 CI 3,25-30,92) aresignificantly associated with intractable epilepsy. The most important amongthose risk factors based on multivariate analysis are non-responder of earlytreatment with OR 144,3 (CI95% 15,47-1345,59) and age onset < 1 year old withOR 9,6 (CI 1,78-51,92). Conclusions: Prevalence of intractable generalized epilepsy is 21%. Nonresponder early treatment and age onset of seizure < 1 year old are strongly associated with intractable generalized epilepsy.;Background: Generalized epilepsy is the most common type of epilepsy inchildren. Limited datas of intractable epilepsy risk factors are available at present.Therefore, more studies are needed to investigate the risk factors of intractableepilepsy in order to manage and educate both patients and parents. Objective: (1) to describe characteristic and frequency of intractable epilepsy inchildren with generalized epilepsy, (2) to investigate the role of age onset ofseizure, initial seizure frequency, type of seizure, early gross motor developmentalstatus, early therapeutic response, early EEG description and cerebral MRI/CTscan as risk factors of intractable epilepsy in children with generalized epilepsy,(3) to investigate the role of gross motor developmental status evolution andepileptiform EEG evolution as risk factors of intractable epilepsy. Methods: Retrospective cohort study was conducted at neurology outpatientpediatric RSCM and private outpatient clinic between September to December2014. The inclusion criteria was generalized epilepsy children age 1 month ofcorrected age to 18 years old which has been treated with antiepileptic drugs for atleast 6 months. Risk factors were analyze with bivariate and multivariate analysis. Results: Prevalence of intractable generalized epilepsy is 21%. Most subject are>3 years old 85(83%) subject. Bivariate analysis showed that age onset of seizure(OR 11,4 CI95% 3,45-37,62), initial seizure frequency ≥5 times/day (OR 8,5 CI95% 2,90-24,80), non-responder of early treatment (OR 160 CI 95% 19,121339,06),unfavorablegrossmotordevelopmentevolution(OR4,9CI95%1,7913,67)and unfavorable epileptiform EEG evolution (OR 10 CI 3,25-30,92) aresignificantly associated with intractable epilepsy. The most important amongthose risk factors based on multivariate analysis are non-responder of earlytreatment with OR 144,3 (CI95% 15,47-1345,59) and age onset < 1 year old withOR 9,6 (CI 1,78-51,92). Conclusions: Prevalence of intractable generalized epilepsy is 21%. Nonresponder early treatment and age onset of seizure < 1 year old are strongly associated with intractable generalized epilepsy., Background: Generalized epilepsy is the most common type of epilepsy inchildren. Limited datas of intractable epilepsy risk factors are available at present.Therefore, more studies are needed to investigate the risk factors of intractableepilepsy in order to manage and educate both patients and parents. Objective: (1) to describe characteristic and frequency of intractable epilepsy inchildren with generalized epilepsy, (2) to investigate the role of age onset ofseizure, initial seizure frequency, type of seizure, early gross motor developmentalstatus, early therapeutic response, early EEG description and cerebral MRI/CTscan as risk factors of intractable epilepsy in children with generalized epilepsy,(3) to investigate the role of gross motor developmental status evolution andepileptiform EEG evolution as risk factors of intractable epilepsy. Methods: Retrospective cohort study was conducted at neurology outpatientpediatric RSCM and private outpatient clinic between September to December2014. The inclusion criteria was generalized epilepsy children age 1 month ofcorrected age to 18 years old which has been treated with antiepileptic drugs for atleast 6 months. Risk factors were analyze with bivariate and multivariate analysis. Results: Prevalence of intractable generalized epilepsy is 21%. Most subject are>3 years old 85(83%) subject. Bivariate analysis showed that age onset of seizure(OR 11,4 CI95% 3,45-37,62), initial seizure frequency ≥5 times/day (OR 8,5 CI95% 2,90-24,80), non-responder of early treatment (OR 160 CI 95% 19,121339,06),unfavorablegrossmotordevelopmentevolution(OR4,9CI95%1,7913,67)and unfavorable epileptiform EEG evolution (OR 10 CI 3,25-30,92) aresignificantly associated with intractable epilepsy. The most important amongthose risk factors based on multivariate analysis are non-responder of earlytreatment with OR 144,3 (CI95% 15,47-1345,59) and age onset < 1 year old withOR 9,6 (CI 1,78-51,92). Conclusions: Prevalence of intractable generalized epilepsy is 21%. Nonresponder early treatment and age onset of seizure < 1 year old are strongly associated with intractable generalized epilepsy.]"

"Latar Belakang Epilepsi adalah gangguan neurologis kronis yang memengaruhi jutaan orang di seluruh dunia, termasuk Indonesia, dengan prevalensi 8,2 per 1.000 penduduk. Kejang fokal, yang berasal dari satu area otak, menyumbang sebagian besar kasus epilepsi. Kontrol kejang yang efektif penting untuk meningkatkan kualitas hidup pasien. Oleh karena itu, dibutuhkan penelitian untuk mengidentifikasi hubungan antara faktor-faktor demografi, karakteristik klinis, dan pengobatan terhadap kontrol kejang pasien epilepsi onset fokal untuk mengoptimalkan pemilihan tatalaksana. Metode Penelitian ini dilakukan di RSUPN Dr. Cipto Mangunkusumo (RSCM) dengan tujuan mengidentifikasi faktor-faktor demografi, karakteristik klinis, dan pengobatan yang berhubungan dengan kontrol kejang pada pasien epilepsi onset fokal. Desain penelitian ini adalah studi cross-sectional dengan analisis data sekunder dari rekam medis pasien. Hasil Dari 117 data rekam medis pasien epilepsi onset fokal di RSCM, sebagian besar pasien merupakan perempuan (64(54,7%)) dengan rerata usia 37  12,7 tahun. Sebagian besar pasien (55(47%)) memiliki kontrol kejang yang baik. Gambaran MRI normal (OR = 1,697; 95% CI: 1,134-2,538, p-value = 0,029) dan monoterapi (OR = 1,662; 95% CI: 1,149-2,403, p-value = 0,012) berhubungan secara signifikan dengan kontrol kejang yang baik pada pasien epilepsi onset fokal. Kesimpulan Karakteristik klinis berupa gambaran MRI dan pengobatan berupa jumlah obat antibangkitan ditemukan memiliki hubungan yang signifikan terhadap kontrol kejang pasien epilepsi onset fokal. Pasien epilepsi onset fokal dengan kontrol kejang yang baik berhubungan secara signifikan dengan gambaran MRI yang normal dan monoterapi.

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Introduction Epilepsy is a chronic neurological impairment, affecting millions of people all around the world, including Indonesia, with the prevalence reaching 8,2 per 100.000 people. Focal seizures, which originates from one hemisphere, causes most of epilepsy cases. An effective level of seizure control is needed to improve a patient’s quality of life. Thus, a study to identify the association between demographic, clinical characteristics, and therapy factors and seizure control of focal onset epilepsy patients to optimalize therapeutic decision. Method This research will be done in RSUPN Dr. Cipto Mangunkusumo to identify the demographic, clinical characteristic, and therapy factors associated with seizure control of focal onset epilepsy patients. The research method used here is a cross-sectional study with secondary data analysis from the patients’ medical records. Results From 117 medical records of patients with focal onset epilepsy at RSCM, most patients were female (64 (54.7%)) with a mean age of 37 ± 12.7 years. Most patients (55 (47%)) had good seizure control. Normal MRI images (OR = 1.697; 95% CI: 1.134-2.538, p-value = 0.029) and monotherapy (OR = 1.662; 95% CI: 1.149-2.403, p-value = 0.012) were significantly associated with good seizure control in patients with focal onset epilepsy. Conclusion MRI imaging results from the patients’ clinical characteristics and the number of antiseizure medications taken shows a significant association with seizure control of focal onset epilepsy patients. Focal onset epilepsy patients with a good seizure control is associated with normal findings in MRI and monotherapy."

"Latar belakang. Terdapat 5 domain keterampilan yang harus dicapai sesuai dengan kelompok usia anak. Apabila tidak dicapai hingga melebihi batasan usia yang seharusnya, anak dikatakan mengalami keterlambatan perkembangan. Keterampilan motorik kasar merupakan domain perkembangan dengan tingkat perhatian orang tua tertinggi, sebab keterampilan motorik kasar merupakan penentu otonomi seorang anak. Penelitian mengenai faktor risiko dibuat untuk menyusun strategi intervensi pencegahan keterlambatan perkembangan. Tujuan. (1) Mengetahui faktor risiko yang signifikan terhadap keterlambatan motorik kasar pada anak usia 6-24 bulan. (2) Mengetahui pengaruh antar masing-masing faktor risiko. Metode penelitian. Desain penelitian menggunakan kasus dan kontrol. Data diperoleh melalui data primer hasil penilaian keterampilan motorik kasar yang divalidasi oleh pembimbing dan wawancara orang tua pasien yang ada di Poli Kiara RSUPN Cipto Mangunkusumo dan Pondok Pinang. Anak dengan keterampilan motorik kasar terlambat dimasukkan dalam kelompok kasus dan dilakukan matching usia untuk memperoleh kelompok kontrol. Pengambilan data dilakukan dari bulan Februari sampai Juli 2018. Faktor-faktor risiko dianalisis secara bivariat dan multivariat. Hasil penelitian. Dilakukan analisis terhadap 63 anak dengan motorik kasar terlambat dan 63 anak dengan motorik kasar normal. Faktor risiko yang memiliki hubungan bermakna dengan keterlambatan motorik kasar pada anak, yaitu asfiksia perinatal (P=0,004 ; OR=5,714 ; IK 95%=1,553-21,026), prematuritas (P=0,009 ; OR=3,949 ; IK 95%=1,347-11,574), berat badan lahir rendah (P=0,011 ; OR=3,511 ; IK 95%=1,281-9,625), dan mikrosefali (P<0,001 ; OR=5,128 ; IK 95%=2,332-11,280). Setelah dilakukan analisis multivariat, mikrosefali (aOR=4,613 ; IK 95%=2,023-10,521) dan prematuritas (aOR=3,668 ; IK 95%=1,153-11,673) merupakan faktor yang paling berpengaruh terhadap keterlambatan motorik kasar pada anak. Kesimpulan. Mikrosefali dan prematuritas (usia gestasi < 37 minggu) merupakan faktor prediktor keterlambatan motorik kasar pada anak usia 6-24 bulan.

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Introduction. There are 5 domains of development that has to be accomplished by a child. If a child fails to master a skill according to his age group, he is said to have a delayed development. Gross motor is one of the domain with the highest parental concern as mastering gross motor is an important factor that determine the autonomy of a child. This study is made to arrange a strategic intervention on the prevention of delayed development.

Objectives. (1) To determine the significant risk factors for gross motor delay in children age 6-24 months old. (2) To determine the association between risk factors.

Methods. Case control study design was used. Data was obtained from direct assessment of gross motor skill (validated by supervisor) and parents’ interview in Cipto Mangunkusumo National Hospital and Pondok Pinang. Children with gross motor delay were categorized as the case group and age matching from this group was used to obtain the control group. Data was collected from February until July 2018. Bivariate and multivariate analysis on risk factors were done to find the significant risk factors and predictor factors for gross motor delay.

Results. 63 children with gross motor delay and 63 children with normal gross motor development were being analyzed. Significant risk factors for gross motor delay were perinatal asphyxia (P=0.004 ; OR=5.714 ; CI 95%=1.553-21.026), prematurity (P=0.009 ; OR=3.949 ; CI 95%=1.347-11.574), low birth weight (P=0.011 ; OR=3.511 ; CI 95%=1.281-9.625), and microcephaly (P<0.001 ; OR=5.128 ; CI 95%=2.332-11.280). After multivariate analysis, microcephaly (aOR=4.613 ; CI 95%=2.023-10.521) and prematurity (aOR=3.668 ; CI 95%=1.153-11.673) were the predictor factors for gross motor delay.

Conclusion. Microcephaly and prematurity (gestation age < 37 weeks) are the predictor factors for gross motor delay in children age 6-24 months old."