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"Manajemen epilepsi pada lanjut usia memerlukan pemahaman tentang ciri-ciri khas menyangkut aspek biokimiawi dan farmakologi. Keputusan manajemen harus berdasar atas klasifikasi serangan atau sindrom epilepsi, pemeriksaan neurologis menyeluruh untuk mencari faktor etiologi, dan penilaian tentang status kesehatan dan kehidupannya. Penyakit lain yang menyertai misalnya gangguan jiwa, metabolik, jantung dan gangguan saraf lainnya memerlukan perhatian, perencanaan dan instruksi spesifik. Dibandingkan dengan golongan anak, golongan lanjut usia mempunyai berbagai masalah yang sangat berbeda. Masalah-masalah tersebut antara lain penyebab epilepsi yang beraneka ragam, diferensial diagnosis yang lebih bervariasi, penyakit lain yang tidak berhubungan dengan epilepsi, perbedaan farmakokinetik dan farmakodinamik, dan efek psikososial. (Med J Indones 2003; 12: 40-7)

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Management of epilepsy in elderly requires understanding the unique biochemical and pharmacological characteristics of these patients. Management decisions must be based on accurate classification of seizures or epilepsy syndromes, a thorough neurological assessment to define etiology, and a comprehensive assessment of the patient’s health and living situation. Concomitant illnesses such as neurological, psychiatric, metabolic, or cardiac disorders will require individualization of plans and instructions. Specific problems of treatment of epilepsy in the elderly compared to childhood patients are as follows: distinctive range of causes of epilepsy, distinctive differential diagnosis, concurrent pathologies unrelated to epilepsy, pharmacokinetic and pharmacodynamic differences, and distinctive psychosocial effects. (Med J Indones 2003; 12: 40-7)"

"Depression is a significant problem that is common among elderly patients. The prevalence is quite high, effecting approximately 15% of the population of over 65 years.1 Among patients with chronic diseases and those with a longer care the prevalence of depression is even higher, which is 10% to 60%. Several studies demonstrate that the comorbidity of depression and physical diseases a patient suffers creates a worse prognosis and increases mortality.2'3 Disease management becomes more difficult and not optimal because depression could cause the patient to eat less and become less cooperative in following the treatment, thus resulting in a poorer medical condition.Depression is generally commonly found in the elderly. Nevertheless, diagnosing depression in the elderly is not easy. Approximately 60% of depression patients have a co-morbid physical disease.2Detection of depression among geriatric patients is often delayed due to unspecific symptoms. Delayed detection results in delayed management, which has a bad impact on the patient's medical condition and response to treatment. This is also why co-morbidity of diseases and depression has a higher mortality rate. The following are several cases of hospitalized patients suffering from depression and a co-morbid illness"

"Epilepsi merupakan serangan sesaat yang disebabkan oleh aktivitas neuronal yang berlebihan dan menghasilkan infuls listrik yang tidak normal. Epilepsi memberikan dampak terhadap beberapa aspek, yaitu aspek kesehatan fisik, aspek psikologis, aspek sosial, dan aspek lingkungan. Tujuan penelitian ini adalah untuk mengetahui pengaruh edukasi manajemen epilepsi terhadap perubahan kualitas hidup pasien. Metode penelitian ini adalah quasy eksperiment. Sebanyak 86 pasien epilepsi yang melakukan kunjungan ke poliklinik saraf RS. Haji Jakarta yang dipilih menggunakan teknik purposive sampling. Hasil penelitian menunjukkan bahwa ada pengaruh yang signifikan antara edukasi manajemen epilepsi dibandingkan edukasi epilepsi standar rumah sakit dalam meningkatkan kualitas hidup epilepsi (p=0,035). Faktor-faktor yang berhubungan dengan kualitas hidup pasien epilepsi adalah tingkat pendidikan (p=0,001), pekerjaan (p=0,003), dan frekuensi bangkitan (p=0,022). Hasil analisis multivariat menunjukkan faktor yang paling dominan berhubungan dengan kualitas hidup pasien epilepsi adalah tingkat pendidikan (p=0,000; R=0,520; R² =0,270). Penelitian ini diharapkan dapat menjadikan video edukasi manajemen epilepsi sebagai standar intervensi asuhan keperawatan pada pasien dengan epilepsi.

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Epilepsy is a transient occurrence of signs or symptoms caused by abnormal neuronal activity or abnormal synchronization in the brain. The existence of epilepsy will have an impact on several aspects of life, namely the medical aspects, psychological aspects, social aspects, and environmental aspects. This impact will affect changes in the quality of life.

The aim of this study was to determine the effect of epilepsy management education on changes in the quality of life of epilepsy patients. This study was a quasy experiment method. A total of 86 epilepsy patients who visited the nerve polyclinic Jakarta Haji Hospital were selected by purposive sampling technique.

The results showed that there was a significant effect between epilepsy management education compared to hospital standard epilepsy education in improving the quality of life of epilepsy (p = 0.035). Factors related to the quality of life of epilepsy patients were the level of education (p = 0.001), employment (p = 0.003), and frequency of seizures (p = 0.022).

The results of multivariate analysis showed that the most dominant factor related to the quality of life of epilepsy patients was the level of education (p = 0,000; R = 0,520; R2 = 0,270). This study is expected to make epilepsy management education videos the standard of nursing care interventions in patients with epilepsy."

"The present volume is intended to be a synopsis of seizure disorders with a goal of describing key studies in animals and humans. The translation of pertinent findings from animal studies to human studies, and to potential human studies will be emphasized. Specific cogent animal studies/results which deserve exploration in human seizure disorders will be detailed. The current rate of translation is estimated to be from 7‐9 years, and the “success” rate of translation was very recently listed as less than one half. The success rate is defined as results in human studies which were predicted in advance by animal studies. Both the time between animal and human attempts plus the success rate need improvement."

"Penatalaksanaan kasus pemfigus vulgaris pada pasien lansia dengan riwayat penyakit kronis. Pemfigus vulgaris (PV) adalah sekelompok penyakit vesikulobulosa yang dapat mengenai kulit dan membran mukosa. PV merupakan penyakit autoimun dengan karakteristik adanya ikatan antara autoantibodi IgG dengan desmoglein 3 pada desmosom. Lesi PV merupakan bula berdinding tipis yang timbul pada kulit dan mukosa yang terlihat normal. Bula pada mukosa oral sangat mudah pecah dan dan membentuk ulser. Terdapat beberapa faktor yang dapat mencetuskan PV meliputi faktor genetik, usia, pemakaian obat-obatan dan makanan. Tulisan ini melaporkan penatalaksanaan kasus yang diduga adalah PV yang terjadi pada lansia dengan riwayat penyakit kronis. Kasus adalah wanita berusia 75 tahun dengan riwayat adanya lesi bula di kulit sejak 2 bulan dan ulserasi oral yang menetap sejak 1 bulan yang lalu. Ulserasi terlihat ditutupi oleh lapisan fibrin dan erosif eritema pada mukosa labial, bukal, dan gingiva. Terdapat riwayat hipertensi, diabetes mellitus, hepatitis, dan trombositopenia. Diagnosis PV ditegakkan berdasarkan keluhan subjektif dan klinis yang dapat dibedakan dengan penyakit vesikobulosa yang lain. Kortikosteroid sistemik diberikan bersama hepato protektor, obat kumur, terapi suportif, dan krim bibir. Bula pada kulit dan ulserasi yang menetap pada mukosa oral adalah manivestasi PV. Pada pasien lansia ini keadaan sistemiknya membutuhkan penatalaksanaan yang lebih intensif dan komprehensif.

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Pemphigus vulgaris (PV) is a group of vesicobullous disease that affects skin and mucous membranes. PV is associated with autoimmune diseases, characterized by binding of IgG autoantibodies to desmoglein 3 on desmosome. The lesion of PV is a thin-walled bulla arising on the normal skin or mucosa. The bulla of oral mucous are more fragile and rapidly break down, forming irreguler ulcers. There are several factors that can trigger PV including genetic factors, age, drugs and food. The purpose of this paper was to report the treatment of suspected pemphigus vulgaris in elderly patient with history of chronic diseases. A 75-year-old woman with 2 months history of bulla formation on skin and about a month history of persistent oral ulceration. Ulcers were covered with fibrin and erosive erythematous on labial mucosa, buccal mucosa and gingival. The patient has a story of hypertension, diabetes mellitus and hepatitis. On routine complete blood count was found thrombocytopenia. Diagnosis was confirmed by anamnesis, clinical examination and complete blood investigation. It should be distinguished from other vesicobullous disease. Systemic corticosteroid therapy was given concurrently with hepato-protector, mouthwash, supportive therapy and topical lip cream. Bulla on skin and persistent erosive ulcers of the oral mucosa are the manifestations of PV. Elderly patient with history of chronic diseases is a complex care of PV and this require more intensive and comprehensive treatment."

"Background: overactive bladder (OAB) affects 17-41% older adults in community dwelled setting. For several years, antimuscarinics have been validated as the first-line medical treatment for OAB. Despite abundant data obtained from clinical trials provisions the use of antimuscarinics, investigation about the effect of this drug on cognitive function in elderly remains scarce. The objective of this study is to investigate the effect of antimuscarinics therapy on cognitive functions in OAB geriatric patients. Methods: this study design is a systematic review and meta-analysis. Studies were collected using several search engines; those were PubMed, Science Direct, Cochrane, and EBSCOhost using predetermined MeSH keywords with Boolean operators. Selection of studies was done by three reviewers. Studies which fulfilled the inclusion and exclusion criteria underwent full-text review. For every selected full text, we extracted the following data if available: patients demographics, types of antimuscarinics used, placebo, dose, follow-up period, and Mini-Mental State Examination (MMSE) total score. Results: a total of 8 studies from an initial 146 publications were selected. There were 8 antimuscarinic agents evaluated in the studies, including Oxybutynin, Darifenacin, Tolterodine, Trospium, Imidafenacin, Propiverine hydrochloride, Fesoterodine, and Solifenacin. Oxybutynin was shown to have largest effect towards the decline of MMSE score [Mean difference: -2.90; 95% CI: -4.07, -1.73]. Darifenacin and Tolterodine were also shown to be significant in the decline of total MMSE score, although still inferior to Oxybutynin. Conclusion: the use of most antimuscarinics medication has little to no effect towards the cognitive function in the management of overactive bladder in elderly patients. However, Oxybutynin, Darifenacin, and Tolterodine was shown to have significant decrease in cognitive functions, as shown in the decline of total MMSE score."