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"ABSTRAKKejang pada neonatus merupakan gejala yang paling sering ditemukan dari gangguan neurologis pada periode neonatus. Kejang pada neonatus dapat terjadi sebagai akibat dari etiologi yang beragam dan ini sering menandakan adanya kerusakan atau malfungsi dari sistem saraf pusat yang belum berkembang sempurna. Penelitian bertujuan untuk mengetahui profil dan luaran kejang pada neonatus serta faktor-faktor yang memengaruhinya. Studi retrospektif dari data sekunder rekam medis Unit Perinatologi RS Cipto Mangunkusumo (RSCM) pada periode Januari 2015 sampai Juni 2019. Semua neonatus di RSCM dengan usia kronologis ≤ 28 hari pada neonatus aterm atau ≤ 44 minggu sejak konsepsi pada neonatus prematur, dengan riwayat kejang atau mengalami kejang minimal satu kali selama perawatan, diikutkan dalam penelitian ini. Subjek dieksklusi bila terdapat kecurigaan kelainan bawaan dan rekam medis tidak lengkap. Pencatatan terhadap subjek meliputi riwayat antenatal, gejala klinis, hasil EEG dan neuroimaging, serta luaran. Studi dilakukan terhadap 108 subjek dan didapatkan jenis kelamin lelaki sebesar 59,3%, usia gestasi aterm sebesar 55,6%, serta berat lahir normal sebesar 52,8%. Kematian terjadi pada 38 (35,2%) subjek. Insidens kejang pada neonatus di Unit Perinatologi RSCM sebesar 3,3%. Karakteristik neonatus yang mengalami kejang adalah jenis kelamin lelaki, aterm, persalinan dengan bedah kaisar, riwayat resusitasi aktif, dan respons dengan pemberian obat anti kejang tunggal. Luaran meninggal pada penelitian ini sebesar 35,2% dengan faktor-faktor yang memengaruhinya yaitu usia gestasi, berat lahir, frekuensi kejang, dan penyakit penyerta sepsis.

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ABSTRACTNeonatal seizures are the most common manifestation of neurological disorders in the newborn period. Neonatal seizures may arise as a result of diverse etiologies and these events frequently signify serious damage or malfunction of the immature developing central nervous system. The study is aimed to determine neonatal seizures profile and factors that influence its outcome. This was a retrospective cohort study from secondary medical record data at Neonatology Unit of Cipto Mangunkusumo General Hospital (CMGH) between January 2015-Juni 2019. All neonates in CMGH with a chronological age of ≤ 28 days in a term infant or ≤ 44 weeks from conception in a preterm infant, with seizure or history of seizure were included in the study. Subjects were excluded if they were suspected of having congenital disorders or incomplete medical records. Data collected from the subjects include antenatal history, clinical symptoms, EEG findings, neuroimaging results, and outcome at discharge. A total of 108 subjects were included in the study and among neonates with seizures, 59,3% were male, 55,6% were born term, and 52,8 % had normal birth weight. Death occurred in 38 cases (35,2%). Incidens of neonatal seizure in Neonatology Unit of CMGH was 3,3%. Neonates who developed seizure characterized by male gender, term birth, delivered by section cesarean, history of active resuscitation, and respons to single antiepileptic drug. The mortality rate in this study was 35,2% with gestational age, birth weight, frequency of seizure, and sepsis being the factors that influence the outcome."

"[Latar belakang. Epilepsi lobus temporal (ELT) merupakan sindrom epilepsi paling banyak ditemukan pada orang dewasa, dimana sebanyak 2/3 berasal dari lobus temporal mesial. Penyebab umum yang sering ditemukan adalah sklerosis hippokampus (SH) dan kelainan ini seringkali refrakter terhadap pengobatan. Dengan anamnesis semiologi bangkitan epileptik yang baik dapat membantu mengetahui letak lesi dan bermanfaat untuk evaluasi persiapan bedah epilepsi. Tujuan penelitian ini adalah untuk mengetahui hubungan antara semiologi bangkitan epileptik yang diperoleh melalui anamnesis dengan sisi lesi pada pasien ELT mesial-SH.Metode. Desain penelitian adalah potong lintang pada pasien ELT mesial-SH di Poliklinik Epilepsi RSCM. Kriteria inklusi adalah pasien ELT mesial-SH yang menunjukkan lokasi yang sama antara aktivitas epileptiform interiktal pada elektroensefalografi (EEG) dan letak SH pada magnetic resonance imaging (MRI). Dilakukan anamnesis pada pasien dan keluarga, mengenai bentuk bangkitan epileptik, kemudian dinilai kesesuaian antara semiologi dan sisi lesi.Hasil. Didapatkan 45 subjek ELT mesial-SH yang memenuhi kriteria inklusi. Sebanyak 26 (57,8%) subjek dengan sisi lesi kanan dan 19 (42,2%) subjek sisi lesi kiri. Gambaran semiologi secara umum adalah aura sakit kepala (62,2%), automatisme manual (62,2%), automatisme oral (57,8%), perputaran kepala akhir (48,9%), dystonic posture (48,9%), aura epigastrium (42,2%), perputaran kepala awal (33,3%), dan aura rasa takut (26,7%). Terdapat empat gambaran motorik yang sesuai lateralisasi semiologi bangkitan epileptik. Automatisme manual dan perputaran kepala awal menunjukkan ipsilateral sisi lesi, sedangkan perputaran kepala akhir dan dystonic posture menunjukkan kontralateral sisi lesi.Kesimpulan. Terdapat kesesuaian antara semiologi bangkitan epileptik berupa automatisme manual, perputaran kepala awal, perputaran kepala awal, dan dystonic posture dengan sisi lesi. Sehingga penting untuk menanyakan 4 gambaran klinis tersebut pada saat anamnesis bangkitan epileptik.;Background. Temporal lobe epilepsy (TLE) is the most common epilepsy syndrome in adults which 2/3 originates from mesial temporal lobe. The most common etiology is hippocampal sclerosis (HS) and becoming drug resistant. Detail anamnesis on seizure semiology helps to know side of epileptogenic foci and evaluate pre epilepsy surgery. The objective of this study is to determine the concordance between seizure semiology based on anamnesis and side of lesion in mTLE-HS.Methods. This was a cross sectional study involving patients with mTLE-HS in Epilepsy Clinic Cipto Mangunkusumo Hospital. Inclusion criterias were patients with mTLE-HS who have same side of interictal epileptiform activity based on electroencephalography (EEG) and HS based on Magnetic Resonance Imaging (MRI). Anamnesis were taken from patient and family member on seizure semiology. Then, concordance between semiology and side of lesion was analyzed.Results. There were 45 eligible subjects of mTLE-HS patients. There were 26 (57.8%) subjects with left side lesions and 19 (42.2%) subjects were right side lesions. Semiology features commonly found are sefalic aura (62.2%), manual automatism (62.2%), oral automatism (57.8%), late head turning (48.9%), dystonic posture (48.9%), epigastric aura (42.2%), early head turning (33.3%), and fear aura (26.7%). Four clinical motoric features have concordance in seizure semiology lateralization. Manual automatism and early head turning showed ipsilateral with side of lesion, whereas late head turning and dystonic posture showed contralateral side of lesion.Conclusion. We found concordance between seizure semiology features of manual automatism, early head turning, late head turning and dystonic posture with side of lesion. Therefore, it was important to ask these features on anamnesis of seizure semiology., Background. Temporal lobe epilepsy (TLE) is the most common epilepsy syndrome in adults which 2/3 originates from mesial temporal lobe. The most common etiology is hippocampal sclerosis (HS) and becoming drug resistant. Detail anamnesis on seizure semiology helps to know side of epileptogenic foci and evaluate pre epilepsy surgery. The objective of this study is to determine the concordance between seizure semiology based on anamnesis and side of lesion in mTLE-HS.Methods. This was a cross sectional study involving patients with mTLE-HS in Epilepsy Clinic Cipto Mangunkusumo Hospital. Inclusion criterias were patients with mTLE-HS who have same side of interictal epileptiform activity based on electroencephalography (EEG) and HS based on Magnetic Resonance Imaging (MRI). Anamnesis were taken from patient and family member on seizure semiology. Then, concordance between semiology and side of lesion was analyzed.Results. There were 45 eligible subjects of mTLE-HS patients. There were 26 (57.8%) subjects with left side lesions and 19 (42.2%) subjects were right side lesions. Semiology features commonly found are sefalic aura (62.2%), manual automatism (62.2%), oral automatism (57.8%), late head turning (48.9%), dystonic posture (48.9%), epigastric aura (42.2%), early head turning (33.3%), and fear aura (26.7%). Four clinical motoric features have concordance in seizure semiology lateralization. Manual automatism and early head turning showed ipsilateral with side of lesion, whereas late head turning and dystonic posture showed contralateral side of lesion.Conclusion. We found concordance between seizure semiology features of manual automatism, early head turning, late head turning and dystonic posture with side of lesion. Therefore, it was important to ask these features on anamnesis of seizure semiology.]"

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Latar Belakang: Kejang berulang berisiko mengganggu kualitas hidup anak dan dapat berkembang menjadi status epileptikus. Sampai saat ini belum ada rekomendasi tatalaksana pasca kejang pada anak untuk mencegah kejang berulang.

Tujuan: Menilai efektivitas fenobarbital intravena pada anak pasca kejang untuk mencegah kejang berulang serta faktor risiko yang memengaruhinya.Metode: Studi observasional kohort prospektif pada 70 subjek sesuai kriteria inklusi. Status epileptikus dan pemberian fenitoin atau fenobarbital intravena sebelumnya dieksklusi. Pada seluruh subjek diberikan fenobarbital 10 mg/kgbb dan dipantau selama 2x24 jam untuk melihat adanya kejang berulang. Faktor risiko yang diteliti adalah etiologi kejang, usia awitan, frekuensi kejang, lama kejang, perkembangan motorik kasar, interval antara kejang dan pemberian fenobarbital, perkembangan neurologi pasca fenobarbital, kadar leukosit dan pemeriksaan EEG.Hasil: Sebanyak 70 dari 79 pasien yang dianalisis, proporsi terbesar laki – laki (61%) dan berusia <3 tahun (46%). Sebanyak 77% subjek tidak mengalami kejang berulang setelah pemberian fenobarbital 10 mg/kgbb. Usia awitan kejang >3 tahun (OR 4,444; p=0,046) dan perkembangan motorik kasar (OR 3,932; IK95% 1,072 – 14,422; p=0,039) merupakan faktor risiko independen terhadap terjadinya kejang berulang.Kesimpulan: Efektivitas pemberian dosis awal fenobarbital untuk mencegah terjadinya kejang berulang sebesar 77,1%. Usia awitan kejang >3 tahun dan keterlambatan perkembangan motorik kasar merupakan faktor risiko kejang berulang.

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Background: Recurrent seizures are associated with poor quality of life of child and at risk of developing into status epilepticus. In Indonesia, there is no recommendation for management post-seizure in child to prevent recurrent seizure.

Aims: To assess the effectiveness of initial intravenous phenobarbital in post-seizure child to prevent recurrence of seizure and identify the risk factors.Method: A prospective cohort observational study of 70 subjects according inclusion criteria. Patients with status epilepticus or administration of intravenous phenytoin or phenobarbital previously were excluded. All subject were given 10 mg/kgbb intravenous phenobarbital and evalute seizure recurrence for 2x24 hours. The risk factors studied were seizure etiology, onset age of seizure, seizure duration, gross motor development, intervals between seizures and phenobarbital administration, neuological development, leucocyte levels and electroencephalography examination.Results: A total of 70 from 79 subject were analyzed, found that the largest proportion were male (61%) and aged <3 years (46%). A total of 77% subjects did not had recurrence of seizure in 2x24 hours monitoring after administration of 10 mg/kgbb intravenous phenobarbital. Onset age of seziure >3 years (OR 4.444; p=0.046) and gross motor development (OR 3.932; 95%CI 1.072 – 14.422; p=0.039) were independent risk factors for seizure recurrence.Conclusion: The administration of 10 mg/kgbb intravenous phenobarbital was effective in preventing seizure recurrence. Onset age of seizures >3 years and delayed gross motor development are the risk factors for seizure recurrence.

"

"Latar Belakang: Mortalitas neonatus global terjadi pada 19/1000 kelahiran hidup dan 35% diakibatkan komplikasi prematuritas dan ketuban pecah dini (KPD) preterm terjadi pada 30-40% dari seluruh kasus. Manajemen KPD preterm memerlukan ketepatan diagnosis, rujukan, dan intervensi agar tidak terjadi morbiditas dan mortalitas ibu dan janin. Di RS Cipto Mangunkusumo terdapat 737 persalinan preterm dari 1524 total kelahiran tahun 2017.Tujuan: Mengetahui hubungan proses rujukan terhadap luaran neonatus pada kasus ketuban pecah dini pada kehamilan preterm.Metode: Kohort retrospektif di RS Cipto Mangunkusumo pada pasien rujukan KPD preterm bulan Januari 2016-September 2017. Analisis statistik dengan SPSS 20.0.

Hasil: Terdapat 214 kasus KPD preterm. Asal rujukan terutama dari rumah sakit dan 36 kasus dirujuk karena tidak ada NICU dan 66 kasus karena fasilitas yang ada tidak mencukupi. Pemeriksaan sesuai standar pada 91 kasus, pemberian antibiotika pada 161 kasus dan pemberian kortikosteroid di tempat rujukan 143 kasus. Terdapat 94 neonatus dengan komplikasi; korioamnionitis klinis(18.69%), APGAR skor menit 1<7(19.16%), APGAR skor menit 5<7 (9.8%), RDS(32.34%), sepsis(37.38%) dan mortalitas(9.8%). Dari analisis multivariat, hubungan didapatkan antara asal rujukan dengan APGAR skor menit 1, usia kehamilan dan kortikosteroid dengan RDS, usia kehamilan, lama rujukan, kortikosteroid dan korioamnionitis klinis dengan sepsis neonatus.Kesimpulan: Alur rujukan KPD preterm berlangsung sesuai alur rujukan berjenjang. Terdapat hubungan antara proses rujukan dengan luaran neonatus.

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Background:  Neonatal mortality rate is 19/1000 live birth worldwide with 35% mortality due to complication of prematurity. Preterm premature ruptured of membrane caused 30-40% preterm birth. In Cipto Mangunkusumo hospital, total of peterm birth in 2017 was 737 cases from 1524 total birth. To prevent neonatal and maternal morbidity and mortality, prompt diagnosis, referral process and obstetric intervention are needed.Purpose: To evaluate the correlation between referral process and neonatal ocutcome in preterm premature ruptured of membrane.Method: This research was conducted in Cipto Mangunkusumo hospital on January 2016 to September 2017 with retrospective cohort study. Referral data and neonatal outcomes who fulfilled the inclusion criteria were collected and analyzed.Result: From data collection from January 2016 to July 2017, 334 cases with preterm premature ruptured of membrane and 214 cases fulfilled the inclusion criteria. Patients most  reffered from hospital due to limited facility (35.29%) and due to NICU was full (64.71%). Administration of antibiotic was found in 75.23% cases and 66.82% cases with corticosteroid administration from the first referral provider. Newborn with complication was found in 43.93%; clinical chorioamnionitis (18.69%), APGAR score minute 1 <7 (19.16%), APGAR score minute 5 <7 (9.8%), RDS (32.34%), neonatal sepsis (37.38%) and early neonatal mortality (9.8%). From bivariate analysis, first care provider has correlation with APGAR score minute 1 < 7 (p=0.00 1), RDS (p=0.003), and neonatal sepsis (p=0.01). Administration of corticosteroid correlated significantly with APGAR score minute 1 < 7 (p=0.003, RR 0.4, CI95% 0.23-0.96), RDS (p=0.002, RR 0.46, CI95% 0.27-0.79) and neonatal sepsis (p=0.001, RR 0.46, CI95% 0.28-0.75). Time of referral correlated significantly with neonatal sepsis (p=0.014, RR 1.7, CI95% 1.2-1.26). After multivariate analysis, correlation found in: first care provider with APGAR score minute 1, gestational age and corticosteroid administration with RDS, gestational age, length of referral and corticosteroid administration with neonatal sepsis.Conclusion: There is correlation between referral process and neonatal outcome."

"Tesis ini membahas mengenai keadaan yang sangat perlu dan mendesak sebagai dasar dalam melakukan tindakan penggeledahan dan penyitaan.Tujuan penelitian tesis ini adalah untuk mengetahui batasan keadaan yang sangat perlu dan mendesak kemudian dikaitkan dengan fungsi kontrol dari Ketua Pengadilan Negeri terhadap tindakan penyidik ketika melakukan tindakan penggeledahan dan penyitaan serta upaya yang dapat dilakukan oleh tersangka atau pihak lain yang merasa dirugikan akibat tindakan penggeledahan dan penyitaan tersebut. Penelitian ini merupakan penelitian yuridis normatif. Hasil dari penelitian didapatkan fakta bahwa batasan keadaan yang sangat perlu dan mendesak dalam melakukan tindakan penggeledahan dan penyitaan adalah selain dikhawatirkan tersangka akan melarikan diri, atau mengulangi tindak pidana atau benda yang dapat disita dikhawatirkan akan dimusnahkan atau dipindahkan juga terdapat penilaian subyektif dari penyidik sehingga dalam pelaksanaannya diperlukan mekanisme pengawasan vertical (built in control) dan pengawasan horizontal. Bahkan, jika dalam pelaksanaan tindakan penggeledahan dan penyitaan itu menimbulkan kerugian bagi tersangka maupun pihak lain maka upaya yang dapat dilakukan adalah ganti rugi. Namun terhadap upaya ganti rugi tersebut harus terlebih dahulu dinyatakan bahwa tindakan penggeledahan dan penyitaan adalah tidak sah tetapi upaya untuk itu tidak dimungkinkan karena pemeriksaan sah atau tidaknya tindakan penggeledahan dan penyitaan tidak termasuk lingkup pemeriksaan praperadilan. Oleh karena itu dalam rangka upaya pembaharuan hukum acara pidana nasional melalui rancangan Undang-Undang Hukum Acara Pidana(RKUHAP) tahun 2012 perlu pengaturan mengenai batasan keadaan yang sangat perlu dan mendesak secara objektif, selektif dan limitatif.

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This thesis discusses concerning the situationwhich are necessary and urgent as the basis for search and seizure action. The purpose of this research is toascertain the frameworkofsituation that are necessary and urgent then to be linked withfunction of control from magistrate judge against the investigator whencarry out the actionof search and seizure,moreover any legal efforts that can be done by the suspect or other partieswho are disadvantaged by the search and seizure actions. The research is done using a judicial normative method. The results of this research is obtaining the fact that theframework of situation which is necessary and urgent when carry out the action of search and seizure is besidesthe worries that the suspect willrun away or repeat doing an injustice or the objectsthat are being seizure will be destroyedor diverted also the subjective valuation of the investigator so that performance required any mechanism controll either vertical nor horizontal. Moreover, if the search and seizure action generates deprivation toward the suspect or other parties then the effort that can be done are through indemnify. Nevertheless the effort through indemnify, shall undergo a process which stated that the search and seizure is illegal in advance yet this process is impossible because the examination of the legality of any search and seizure is not in the scope of the pretrial. For that reason, the effort to renew criminal procedural law through its future replacement with Draft of Criminal Procedural Law Year 2012 need to be regulated the situation which is necessary and urgent become objective, selective and limitedly."

"[ABSTRAK Latar belakang Long QT syndrome LQTS adalah gangguan irama jantung bergejala kejang yang harus dikenali sejak dini karena dapat menyebabkan kematian mendadak Tujuan Mengetahui angka kejadian LQTS pada pasien dengan keluhan kejang serta karakteristiknya Metode Studi potong lintang terhadap anak yang pernah mengalami kejang tanpa provokasi di poliklinik neurologi anak RSUPN Cipto Mangunkusumo Subyek berusia 6 bulan hingga 17 tahun Panjang QT interval diukur menggunakan EKG dan dinilai menggunakan metode Bazzet Hasil Seratus empat puluh enam pasien kejang mengikuti penelitian ini Usia subyek jenis kelamin serta jenis kejang memiliki sebaran cukup merata Pada penelitian ini didapatkan kelainan penyerta kejang seperti tuli sensorineural autisme keterlambatan perkembangan menyeluruh disabilitas intelektual dan sindroma Rett Sebanyak 20 6 mengalami epilepsi intraktabel Tidak ditemukan subyek dengan pencetus kejang aktivitas fisik dan stres emosional dan hanya 2 7 memiliki riwayat keluarga meninggal mendadak Hasil penilaian QTc pada seluruh subyek di bawah 0 44 detik Nilai QTc terpendek adalah 0 333 detik dan nilai QTc terpanjang adalah 0 437 Nilai tersebut masih dalam rentang normal QTc pada anak Simpulan Pada penelitian ini tidak didapatkan pemanjangan QTc baik pada penderita kejang umum maupun fokal ABSTRACT Background Long QT syndrome LQTS is a heart rhythm disorder with symptom of seizures that should be identified early because it can cause sudden death Aim Knowing the prevalence of LQTS in patients with symptom of seizures and characteristics Method A cross sectional study of children who have experienced an unprovoked seizure in child neurology clinic Cipto Mangunkusumo Subjects aged 6 months to 17 years QT interval was measured by ECG and assessed with Bazzet rsquo s formula Results One hundred and forty six patients with seizures were followed in this study The age sex and seizure rsquo s type of subject distributed evenly In this study we found some disorder along with seizure such as sensorineural deafness autism global developmental delay intellectual disability and Rett syndrome A total of 20 6 had intractable epilepsy We didn rsquo t find subject with physical activity and emotional stress as the trigger of seizure and only 2 7 had a family history of sudden death QTc assessment results in all subjects were under 0 44 seconds The shortest QTc values was 0 333 seconds and the longest QTc value was 0 437 seconds This value is still within the normal range QTc in children Conclusion In this study we concluded that we found no QTc prolongation in patients with seizures ; Background Long QT syndrome LQTS is a heart rhythm disorder with symptom of seizures that should be identified early because it can cause sudden death Aim Knowing the prevalence of LQTS in patients with symptom of seizures and characteristics Method A cross sectional study of children who have experienced an unprovoked seizure in child neurology clinic Cipto Mangunkusumo Subjects aged 6 months to 17 years QT interval was measured by ECG and assessed with Bazzet rsquo s formula Results One hundred and forty six patients with seizures were followed in this study The age sex and seizure rsquo s type of subject distributed evenly In this study we found some disorder along with seizure such as sensorineural deafness autism global developmental delay intellectual disability and Rett syndrome A total of 20 6 had intractable epilepsy We didn rsquo t find subject with physical activity and emotional stress as the trigger of seizure and only 2 7 had a family history of sudden death QTc assessment results in all subjects were under 0 44 seconds The shortest QTc values was 0 333 seconds and the longest QTc value was 0 437 seconds This value is still within the normal range QTc in children Conclusion In this study we concluded that we found no QTc prolongation in patients with seizures , Background Long QT syndrome LQTS is a heart rhythm disorder with symptom of seizures that should be identified early because it can cause sudden death Aim Knowing the prevalence of LQTS in patients with symptom of seizures and characteristics Method A cross sectional study of children who have experienced an unprovoked seizure in child neurology clinic Cipto Mangunkusumo Subjects aged 6 months to 17 years QT interval was measured by ECG and assessed with Bazzet rsquo s formula Results One hundred and forty six patients with seizures were followed in this study The age sex and seizure rsquo s type of subject distributed evenly In this study we found some disorder along with seizure such as sensorineural deafness autism global developmental delay intellectual disability and Rett syndrome A total of 20 6 had intractable epilepsy We didn rsquo t find subject with physical activity and emotional stress as the trigger of seizure and only 2 7 had a family history of sudden death QTc assessment results in all subjects were under 0 44 seconds The shortest QTc values was 0 333 seconds and the longest QTc value was 0 437 seconds This value is still within the normal range QTc in children Conclusion In this study we concluded that we found no QTc prolongation in patients with seizures ]"