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"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: 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."

"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."

"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.

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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."

"Sebagian anak epilepsi akan mengalami epilepsi intractabledengan berbagai dampak jangka pendek dan panjang yang dapat menyertainya. Salah satu pilihan terapi epilepsi intractableadalah pemberian obat antiepilepsi (OAE) lini II, namun tidak semua pasien mendapatkan luaran positif berupa terkontrolnya kejang. Hingga saat ini belum ada penelitian di Indonesia yang menilai faktor-faktor prediktor terkontrolnya kejang pada anak dengan epilepsi intractable. Penelitian ini bertujuan untuk menilai luaran klinis serta faktor prediktor terkontrolnya kejang pada anak dengan epilepsi intractableyang mendapatkan OAE lini II. Penilitian ini merupakan penelitian kasus-kontrol dengan menggunakan data retrospektif. Sebanyak 60 pasien anak epilepsi intractable yang terkontrol OAE lini II selama enam bulan (kelompok kasus) dibandingkan dengan 60 pasien yang tidak terkontrol (kelompok kontrol) yang telah dilakukan matchingterhadap usia. Sebanyak 29% dari seluruh anak epilepsi mengalami epilepsi intractabledan hanya 43% di antaranya yang terkontrol dengan OAE lini II. Ada empat faktor prediktor yang dinilai yaitu tipe kejang, frekuensi kejang, perkembangan motorik kasar, serta gambaran electroencephalogram(EEG) awal. Hanya gambaran EEG awal yang memberikan hasil signifikan sebagai prediktor terkontrolnya kejang dalam analisis bivariat dan multivariat dengan nilai rasio odds(OR) 4,28 (95% interval kepercayaan=1,48-12,41) dan p=0,007. Dari hasil ini dapat disimpulkan bahwa gambaran EEG awal yang normal merupakan faktor prediktor positif terhadap terkontrolnya kejang pada pasien anak dengan epilepsi intractable.

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Children with epilepsy might have short- and long-term complications if they progress into intractable epilepsy. Seizure remission in intractable epilepsy are sometimes not achieved even after administering second line anti-epileptic drugs (AED). To this day, there were no studies that evaluate the predicting factors of seizure control in children with intractable epilepsy. This research aimed to evaluate the clinical outcomes and predictors factor of seizure control in children with intractable epilepsy who received second line AED. This research is a case-control study with retrospective data. Sixty children with intractable epilepsy patients who had controlled seizure with second line AED for six months (case group) compared with sixty patients who had uncontrolled seizure (control group) with age-matched selection. There were four factors analyzed include type of seizure, frequency of seizure, gross motoric development, and initial electroencephalogram (EEG) feature. Initial EEG feature had significant result in bivariate and multivariate analysis with odd ratio (OR) 4,28 (95% confident interval 1,48-12,41) and p value 0,007. We can conclude that normal initial EEG feature is a positive predicting factor of seizure control in children with intractable epilepsy."

"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."

"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."

"Penggunaan Obat Anti-Epilepsi (OAE) jangka panjang merupakan strategi terapi yang optimal setelah diagnosis epilepsi. Kepatuhan terhadap pengobatan merupakan salah satu masalah utama dalam keberhasilan terapi jangka panjang pada pasien epilepsi. Salah satu faktor yang berpotensi kuat mempengaruhi kepatuhan adalah adanya Reaksi Obat yang Tidak Dikehendaki (ROTD). Epilepsi Lobus Temporal (ELT) merupakan tipe epilepsi fokal yang paling banyak; lebih dari 80% pasien ELT berpotensi resisten obat. Penelitian ini bertujuan untuk melihat ROTD OAE pada pasien ELT dan hubungannya dengan kepatuhan pengobatan. Metode penelitian yang digunakan adalah cross sectional study yang membandingkan ada/tidaknya ROTD menggunakan kuisioner Liverpool Advesre Event Profile (LAEP) dengan tingkat kepatuhan menggunakan kuisioner Morisky Adherence Questionaire (MAQ). Subyek penelitian adalah pasien ELT di Unit Rawat Jalan Departemen Neurologi RSUPN Dr. Cipto Mangunkusumo periode Agustus-Oktober 2019. Hasil penelitian menunjukkan dari 88 pasien, 78.40% mengalami kejadian ROTD dan sebanyak 47.73% pasien memiliki tingkat kepatuhan sedang-rendah. Terdapat hubungan yang signifikan antara kejadian ROTD dan tingkat kepatuhan (p=0.039;OR 4.313). Hasil ini menunjukan pasien ELT yang mengalami kejadian ROTD memiliki kecenderungan untuk tidak patuh terhadap pengobatannya. Faktor lain yang berpengaruh secara signifikan terhadap kepatuhan pengobatan pasien yaitu jenis OAE (p=0,011; OR 0,249)). Jenis OAE yang memperlihatkan hubungan yang signifikan terhadap tingkat kepatuhan pengobatan adalah jenis OAE kombinasi (generasi lama dan generasi baru). Perlu dilakukan intervensi konseling secara berkala oleh farmasis untuk meningkatkan pemahaman mengenai ROTD yang terjadi selama penggunaan OAE dan edukasi terkait pentingnya kepatuhan pengobatan pasien.

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The long-term use of Anti-Epileptic Drugs (AED) is an optimal therapeutic strategy after the diagnosis of epilepsy. Adherence to treatment is one of the main problems in the long-term success of therapy in epilepsy patients. One factor that has the potential to strongly influence adherence is the presence of Adverse Drug Reaction (ADR). Temporal Lobe Epilepsy (TLE) is the most common type of focal epilepsy; more than 80% of TLE patients are potentially drug resistant. This study aimed to explore the ADR of AED in TLE patients and its correlation with medication adherence. The research method used was a cross sectional study comparing the presence of ADR using the Liverpool Adverse Event Profile (LAEP) questionnaire with the level of compliance using the Morisky Adherence Questionaire (MAQ). The research subjects were TLE patients in the Outpatient Unit of the Department of Neurology, Dr. Cipto Mangunkusumo Hospital, August-October 2019.

The results showed that of 88 patients, 78.40% experienced ADR and 47.73% of patients had moderate-low adherence. There is a significant correlation between the incidence of ADR and the level of compliance (p = 0.031;OR = 4.35). Another factor that significantly affected patient adherence was type of AED (p = 0.011; OR 0.249). The type of AED that shows a significant relationship to the level of medication adherence is combination of old and new generation AED. These findings indicate that patients who experience ADR have a tendency to disobey their treatment. Interventions programmed by pharmacists need to be done to increase the understanding of ADR that occurs during AED use and education related to the importance of medication adherence. "

"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.]"