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Maghffira Maura R. A. Dunda
Peran Evolusi Faktor Risiko Dalam Memprediksi Epilepsi Intraktabel Pada Pasien Epilepsi Usia Di Bawah Tiga Tahun: Studi Kasus-Kontrol = Evolution Of Risk Factor Role In Predicting Intractable Epilepsy In Pediatric Epilepsy Patients Under Three Years Of Age: A Case-Control Study
"Epilepsi masih menjadi masalah neurologis pada anak, dengan pertambahan kasus sebesar 75%-80% setiap tahunnya di negara-negara berkembang. Sudah terdapat banyak pilihan Obat Anti Epilepsi (OAE) yang tersedia. Sayangnya, mencapai 30% pasien anak yang menjalani pengobatan tidak mencapai bebas kejang, dan berkembang menjadi epilepsi dengan kejang tidak terkontrol, atau disebut dengan epilepsi intraktabel. Perjalanan pengobatan sangat penting pada keadaan epilepsi anak usia di bawah tiga tahun, yang masih dalam masa perkembangan otak, namun belum banyak penelitian yang melihat evolusi faktor risiko dalam memprediksi kejadian epilepsi intraktabel. Penelitian ini melihat perubahan atau evolusi faktor risiko pasien epilepsi anak usia di bawah tiga tahun pada 3 lokasi penelitian di Jakarta, dengan melakukan studi kasus-kontrol.
Tujuan penelitian ini yaitu untuk mengidentifikasi peran evolusi faktor risiko untuk memprediksi epilepsi intraktabel anak usia di bawah tiga tahun. Penelitian dilakukan secara retrospektif, menggunakan data sekunder, dengan melihat rekam medis pasien epilepsi anak usia di bawah tiga tahun yang diperoleh dari RSUPN Cipto Mangunkusumo, Jakarta Pusat, RS Puri Cinere Depok, dan Klinik Anakku Pondok Pinang Center, Jakarta Selatan. Total subjek sebanyak 102 rekam medis pasien, dengan perbandingan kasus:kontrol yaitu 1:1. Hasil analisis pearson chi-square memperoleh 3 evolusi faktor risiko yang signifikan terhadap kejadian epilepsi intraktabel, yaitu: evolusi kelumpuhan motorik kasar (p<0,001; OR 7,86; IK95% 3,142-19,659); evolusi status neurologis (p<0,001; OR 9,84; IK95% 3,934-24,614); dan evolusi gelombang epileptiform EEG (p<0,001; OR 23,25; IK95% 7,657-70,599). Evolusi tipe kejang menunjukkan hasil tidak bermakna terhadap kejadian epilepsi intraktabel anak. Hasil analisis multivariat kemudian menunjukkan bahwa evolusi gelombang epileptiform EEG baik/buruk memiliki peran paling kuat dalam memprediksi kejadian epilepsi intraktabel (p<0,001; OR 0,075; IK95% 0,022-0,253). Evolusi gelombang epileptiform EEG buruk merupakan faktor prediktor epilepsi intraktabel anak usia di bawah tiga tahun yang paling berpengaruh.
Epilepsy is still a neurological problem among children, with an increase in cases of 75% -80% annually in developing countries. There are already many choices of Anti-Epileptic Drugs (AED) available. Unfortunately, up to 30% of pediatric patients who undergo treatment do not achieve seizure-free, and develop epilepsy with uncontrolled seizures, also known as intractable epilepsy. The course of treatment is very important in the epilepsy of children under three years of age, who are still in the process of brain development, but not many studies have looked at the evolution of risk factors in predicting the incidence of intractable epilepsy. This study looked at changes or evolution of risk factors for epilepsy patients under three years of age in 3 study locations in Jakarta, by conducting a case-control study. The objective of this research is to Identified the evolution of risk factors role in predicting intractable epilepsy in children under three years of age. The study was conducted retrospectively, using secondary data, by looking at the medical records of epilepsy children under three years of age obtained from RSUPN Cipto Mangunkusumo, Central Jakarta, Puri Cinere Hospital Depok, and Klinik Anakku Pondok Pinang Center, South Jakarta. The total subjects were 102 patient medical records, with a case: control ratio of 1: 1. The results of the Pearson chi-square analysis obtained three significant evolution of risk factors for the incidence of intractable epilepsy, namely: the evolution of gross motor paralysis (p<0.001; OR 7.86; 95% CI 3.142-19.659); evolution of neurological status (p<0.001; OR 9.84; CI95% 3,934-24.614); and EEG epileptiform wave evolution (p<0.001; OR 23.25; IK95% 7,657-70,599). The evolution of seizure types showed no significant effect on the incidence of intractable epilepsy in children. The results of multivariate analysis then showed that the evolution of epileptiform EEG waves good/bad had the strongest role in predicting the incidence of intractable epilepsy (p<0.001; OR 0.075; CI95% 0.022-0.253). The bad evolution of EEG epileptiform waves was the most influential predictor of intractable epilepsy among children under three years of age."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Skripsi Membership  Universitas Indonesia Library
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Awidiya Afiati
Faktor risiko epilepsi intraktabel pada pasien anak dengan epilepsi fokal = Risk factors of intractable childhood focal epilepsy
"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.
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."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014
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UI - Tesis Membership  Universitas Indonesia Library
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Ginting, Jenny Br.
Faktor risiko keberhasilan obat antiepilepsi generasi 2 pada pasien epilepsi anak usia di bawah 3 tahun: Studi kasus kontrol = Risk Factor Affecting the Success of Second Generation Antiepileptic in Children under 3 Years with Epilepsy: Case Control Study
"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.
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."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tugas Akhir  Universitas Indonesia Library
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Gendis Ayu Ardias
Faktor-faktor risiko terjadinya epilepsi pada anak dengan Palsi Serebral Tipe Spastik: studi kasus kontrol = Risk factors of epilepsy in children with Spastic Cerebral Palsy: a case control study
"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.
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."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
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UI - Tugas Akhir  Universitas Indonesia Library
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Tartila
Gambaran gelombang epileptiform pada eeg anak dengan epilepsi kajian pada faktor faktor yang memengaruhi = Epileptiform waves on the eeg of children with epilepsy study of factors influencing the occurence
"[ABSTRAK
Latar belakang Pemeriksaan EEG merupakan modalitas terpenting dalam diagnosis multi aksial pada epilepsi dan pemberian obat anti epilepsi yang tepat Sensitivitas EEG untuk memperoleh gelombang epileptiform cukup rendah sehingga berbagai upaya dilakukan untuk meningkatkan sensitivitas EEG Faktor faktor yang memengaruhi kejadian gelombang epileptiform telah banyak diteliti pada pasien dewasa namun belum ada penelitian yang spesifik pada anak Tujuan Mengetahui proporsi kejadian gelombang epileptiform pada EEG anak dengan epilepsi dan faktor faktor yang berpengaruh Metode Studi potong lintang terhadap 110 anak epilepsi usia 1 bulan 18 tahun yang datang ke Poliklinik EEG Kiara RSCM dari bulan Mei hingga September 2015 Faktor faktor yang dianggap berpengaruh dianalisis secara multivariat dengan uji regresi logistik Hasil Proporsi munculnya gelombang epileptiform sebesar 48 110 43 6 Pada analisis bivariat didapatkan faktor yang berpengaruh terhadap munculnya gelombang epileptiform adalah lama anak terbangun hingga dilakukannya pemeriksaan EEG p 0 034 OR 2 449 IK95 1 071 5 599 dan jarak kejang terakhir dengan EEG p 0 005 OR 3 037 IK95 1 386 6 626 Pada analisis multivariat didapatkan faktor yang paling berpengaruh terhadap kejadian gelombang epileptiform adalah jarak kejang terakhir dengan EEG p 0 016 OR 2 671 IK95 1 198 5 957 Simpulan Jarak kejang terakhir dengan pemeriksaan EEG kurang dari 3 hari dan deprivasi tidur parsial selama 6 jam merupakan faktor terjadinya gelombang epileptiform pada EEG anak dengan epilepsi ABSTRACT Background Top of Form EEG is an important modality in the multi axial diagnosis of epilepsy and therapy Sensitivity of EEG was low so efforts were made to improve it Factors related to the occurence of epileptiform waves has been studied in adult patients but no specific studies in children Top of Form Objectives Determine proportion of epileptiform waves in the EEG of children with epilepsy and identify the factors related to the occurence of epileptiform waves Methods This is a cross sectional study on 110 children with epilepsy aged 1 month 18 years old who came to the EEG outpatient clinic at Kiara Cipto Mangunkusumo hospital from May to September 2015 Related factors was analyzed using multivariate Results The proportion of epileptiform waves was 48 110 43 6 Results in bivariate analysis revealed related factors were the duration of awakeness p 0 034 OR 2 499 95 CI 1 071 5 599 and the duration of last seizure until EEG done p 0 005 OR 3 037 95 CI 1 386 6 626 In the multivariate analysis duration of last seizure until EEG done was the most related factors to the occurence of epileptiform waves p 0 016 OR 2 671 95 CI 1 198 5 957 Conclusion Factors related to the occurence of epileptiform waves are duration of last seizure until EEG done less than 3 days and patial deprivation for 6 hours ;Background Top of Form EEG is an important modality in the multi axial diagnosis of epilepsy and therapy Sensitivity of EEG was low so efforts were made to improve it Factors related to the occurence of epileptiform waves has been studied in adult patients but no specific studies in children Top of Form Objectives Determine proportion of epileptiform waves in the EEG of children with epilepsy and identify the factors related to the occurence of epileptiform waves Methods This is a cross sectional study on 110 children with epilepsy aged 1 month 18 years old who came to the EEG outpatient clinic at Kiara Cipto Mangunkusumo hospital from May to September 2015 Related factors was analyzed using multivariate Results The proportion of epileptiform waves was 48 110 43 6 Results in bivariate analysis revealed related factors were the duration of awakeness p 0 034 OR 2 499 95 CI 1 071 5 599 and the duration of last seizure until EEG done p 0 005 OR 3 037 95 CI 1 386 6 626 In the multivariate analysis duration of last seizure until EEG done was the most related factors to the occurence of epileptiform waves p 0 016 OR 2 671 95 CI 1 198 5 957 Conclusion Factors related to the occurence of epileptiform waves are duration of last seizure until EEG done less than 3 days and patial deprivation for 6 hours ;Background Top of Form EEG is an important modality in the multi axial diagnosis of epilepsy and therapy Sensitivity of EEG was low so efforts were made to improve it Factors related to the occurence of epileptiform waves has been studied in adult patients but no specific studies in children Top of Form Objectives Determine proportion of epileptiform waves in the EEG of children with epilepsy and identify the factors related to the occurence of epileptiform waves Methods This is a cross sectional study on 110 children with epilepsy aged 1 month 18 years old who came to the EEG outpatient clinic at Kiara Cipto Mangunkusumo hospital from May to September 2015 Related factors was analyzed using multivariate Results The proportion of epileptiform waves was 48 110 43 6 Results in bivariate analysis revealed related factors were the duration of awakeness p 0 034 OR 2 499 95 CI 1 071 5 599 and the duration of last seizure until EEG done p 0 005 OR 3 037 95 CI 1 386 6 626 In the multivariate analysis duration of last seizure until EEG done was the most related factors to the occurence of epileptiform waves p 0 016 OR 2 671 95 CI 1 198 5 957 Conclusion Factors related to the occurence of epileptiform waves are duration of last seizure until EEG done less than 3 days and patial deprivation for 6 hours , Background Top of Form EEG is an important modality in the multi axial diagnosis of epilepsy and therapy Sensitivity of EEG was low so efforts were made to improve it Factors related to the occurence of epileptiform waves has been studied in adult patients but no specific studies in children Top of Form Objectives Determine proportion of epileptiform waves in the EEG of children with epilepsy and identify the factors related to the occurence of epileptiform waves Methods This is a cross sectional study on 110 children with epilepsy aged 1 month 18 years old who came to the EEG outpatient clinic at Kiara Cipto Mangunkusumo hospital from May to September 2015 Related factors was analyzed using multivariate Results The proportion of epileptiform waves was 48 110 43 6 Results in bivariate analysis revealed related factors were the duration of awakeness p 0 034 OR 2 499 95 CI 1 071 5 599 and the duration of last seizure until EEG done p 0 005 OR 3 037 95 CI 1 386 6 626 In the multivariate analysis duration of last seizure until EEG done was the most related factors to the occurence of epileptiform waves p 0 016 OR 2 671 95 CI 1 198 5 957 Conclusion Factors related to the occurence of epileptiform waves are duration of last seizure until EEG done less than 3 days and patial deprivation for 6 hours ]"
Depok: Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Agung Triono
Faktor prediktor relaps dan luarannya pada epilepsi anak yang terkontrol dan setelah penghentian obat antiepilepsi: case control study = Predictors for relapse and outcomes in children with controlled epilepsy and after antiepileptic drug withdrawal: case control study
"Penghentian obat antiepilepsi OAE dengan terburu-buru meningkatkan risiko relaps pada epilepsi. Risiko resistensi obat pada epilepsi relaps sangat tinggi. Belum ada kesepakatan umum kapan OAE dapat dihentikan dengan aman sehingga tidak terjadi relaps. Penelitian ini bertujuan untuk mengetahui angka kejadian relaps pada anak dengan epilepsi terkontrol danyang belum terkontrol kejangnya, mengetahui karakteristik anak dengan epilepsi terkontrol yang mengalami relaps, mengetahui faktor prediktor epilepsi relaps, mengetahui luaranepilepsi relaps, mengetahui perjalanan EEG anak dengan epilepsi relaps. Penelitian dilakukan pada Juni-Desember 2016. Desain studi adalah kasus-kontrol, retrospektif, multisite dari rekam medis tahun 2012-2016. Studi rekam medis dilanjutkan dengan wawancara dan pemeriksaan EEG untuk kelompok kasus. Kelompok kasus adalah anak-anak dengan epilepsi relaps sedangkan kelompok kontrol adalah epilepsi remisi komplit. Analisis bivariat dan multivariat dilakukan untuk mengidentifikasi faktor prediktor epilepsi relaps. Angka kejadian epilepsi relaps pada penelitian ini adalah 13,6 . Dilakukan analisis terhadap 63 subyek epilepsi relaps dan 63 subyek epilepsi remisi komplit. Faktor prediktor epilepsi relaps pada analisis bivariat yaitu: epilepsi simptomatik P
An inappropriate antiepileptic drugs AED withdrawal increases the risk of relapse. The risk of drug resistance in epilepsy relapse is very high. There is no consensus when the AED is safely withdrawn, so that epilepsy will not relapse. This study aims to know the incidence of relapse in children with controlled and uncontrolled epilepsy, the characteristics, predictors, outcomes, and EEG evolutions in children with epilepsy relapse. This study was held from June December 2016. This was a case control study with retrospective, multi site medical record evaluation from 2012 2016, followed by interview and EEG examination for the case group. The case group was children with epilepsy relapse, while the control was children with epilepsy complete remission. Bivariate and multivariate analysis was done to identify predictors of relapse. The incidence of epilepsy relapse in this study was 13,6 . We analyzed 63 epilepsy relapse and 63 epilepsy complete remission subjects. Relapse predictors in bivariate analysis were symptomatic etiology P"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2017
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Epilepsi pada anak
Jakarta: Badan Penerbit Ikatan Dokter Anak Indonesia , 2016
618.92 EPI
Buku Teks  Universitas Indonesia Library
cover
Lady Aurora
Faktor-faktor yang memengaruhi respons terapi pada anak penyandang epilepsi di RSUPN Cipto Mangunkusumo = Factors influencing treatment response in children with epilepsy in RSUPN Cipto Mangunkusumo
"Pemberian terapi yang sesuai, khususnya obat antiepilepsi (OAE) sebagai terapi utama dapat menyembuhkan pasien penyandang epilepsi.Seringkali faktor yang berkaitan erat dengan pemberian OAE kurang diperhatikan.Oleh karena itu, penelitian yang dilakukan penulis membahas bagaimana hubungan antara faktorfaktor yang memengaruhi respons terapi pada anak penyandang epilepsi.Penelitian dilakukan dengan metode cross-sectional, yaitu dengan menggunakan data sekunder dari rekam medis epilepsy registry pada pasien anak di Departemen Ilmu Kesehatan Anak RSUPN Cipto Mangunkusumo dengan tanggal kunjungan 1995-2010. Dari penelitian, ditemukan bahwa dari 174 subyek penelitian, 76,4% mengalami bangkitan umum dan 23,6% mengalami bangkitan fokal. Terdapat 62,1% subyek yang mengalami epilepsi simtomatik dan 37,9% epilepsi idiopatik. Sembilan puluh enam koma enam persen subyek mendapatkan regimen yang sesuai dengan lini pertama, 63,8% mendapatkan OAE dengan dosis sesuai, 77,0% subyek mendapatkan terapi tunggal (monoterapi), dan 70,3% tidak mengalami perubahan regimen selama terapi. Dari analisis bivariat menggunakan uji Chi-Square maupun Fisher's, tidak ditemukan hubungan yang signifikan baik untuk faktor kesesuaian regimen, dosis OAE, kombinasi OAE, maupun perubahan regimen selama terapi (seluruhnya memiliki nilai p > 0,05). Namun, nilai OR masing-masing faktor menunjukkan hasil yang sesuai dengan teori sehingga dapat disimpulkan bahwa secara klinis respons bebas kejang akan didapatkan pada pasien yang mendapatkan regimen sesuai, dosis sesuai, monoterapi, dan tidak ada pergantian regimen. Adapun bila dikaitkan dengan klasifikasi epilepsi yang dialami, pasien dengan epilepsi idiopatik memiliki kecenderungan mendapatkan respons bebas kejang (OR=1,407 95%CI 0,732-2,705). Analisis multivariat menggunakan uji regresi logistik menunjukkan monoterapi menjadi faktor yang terkuat dalam pencapaian respons terapi epilepsi walaupun hasil pada penelitian ini tidak signifikan.
Appropiate therapy admission, especially antiepileptic drugs (AED) as the main therapy for epileptic patients, might help the patients to achieve its maximum recovery. Health care providers don?t pay much attention to factors related to AED admission. Therefore, this research was determined to analyze the association between several factors affecting treatment response in children with epilepsy. This research is a cross-sectional study, using secondary data from epilepsy registry medical record in pediatric patient at Pediatric Health Department of RSUPN Cipto Mangunkusumo during 1995-2010. This study showed that among 174 subjects, 76.4% subjects had general seizure and 23.6% subjects had focal seizure. It is also found that 62.1% subjects had symptomatic epilepsy and 37.9% subjects had idiophatic epilepsy. Ninety six point six percent subjects had appropriate regiment with first-line drugs, 63.8% subjects had appropriate AED dose, 77.0% subjects received monotherapy, and 70.3% did not receive any regiment modification during therapy. Through bivariate analysis using Chi-Square and Fisher?s test: there were no significant association between regiment compatibility, AED dose, AED combination, and regiment modification during therapy (p > 0.05). However, the odds ratio (OR) of each factors showed corresponding result with the theory. In conclusion, seizure-free response will be achieved by patients who had appropriate regiment, appropriate dose, monotherapy, and no regiment modification. Analysis about association between epilepsy classification and therapy response showed that patient with idiophatic epilepsy tended to be easier to be seizure-free. Multivariate analysis using logistic regression showed that monotherapy was the strongest factor affecting therapy response, even though in this study it was not statistically significant."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Skripsi Membership  Universitas Indonesia Library
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Lenny Syukriati Asmir
Perbandingan pemberian premedikasi melatonin dengan prosedur deprivasi tidur untuk persiapan perekaman elektroensefalografi pada pasien epilepsi anak = Comparison between oral melatonin and partial sleep deprivation procedure for electroencephalography preparation in epilepsy children
"Latar belakang: Elektroensefalografi EEG adalah suatu prosedur untuk mendukung diagnosis dan evaluasi pengobatan pada penyakit epilepsi. Perekaman EEG ideal dapat dicapai bila anak mengalami tidur alamiah, yang sampai saat ini masih sulit untuk dilakukan. Melatonin, merupakan hormon tidur alami yang dihasilkan oleh kelenjar pineal, mulai dikembangkan sebagai premedikasi EEG yang diharapkan memiliki efek samping lebih kecil dibanding prosedur deprivasi tidur parsial DTP dan obat sedasi.
Tujuan: 1 mengetahui perbandingan awitan tidur, makrostruktur tidur, dan lama tidur pada anak epilepsi yang diberikan melatonin oral dengan yang dilakukan prosedur DTP, 2 mengetahui perbedaan efek samping pemberian premedikasi melatonin dibandingkan prosedur DTP pada anak epilepsi yang direncanakan EEG
Metode: Penelitian uji klinik acak tersamar tunggal secara paralel dilakukan pada 76 subyek berusia 1-18 tahun yang melakukan pemeriksaan EEG di Laboratorium Elektrodiagnostik IKA-RSCM selama periode November 2016 ndash; Januari 2017. Seluruh subyek tersebut dibagi menjadi 2 kelompok, satu kelompok diberikan premedikasi melatonin per oral, sedangkan kelompok lainnya dilakukan prosedur DTP.
Hasil: Rerata awitan tidur kelompok DTP adalah 42,39 menit sedangkan kelompok melatonin 33,97 menit p le;0,01 . Rerata lama tidur kelompok DTP adalah 22,58 menit, sedangkan kelompok melatonin 25,09 menit p=0,144 . Gambaran makrostruktur tidur p>0,05 dan efek samping prosedur p>0,05 pada kedua kelompok subyek tidak berbeda bermakna.
Simpulan: Awitan tidur pada kelompok melatonin lebih cepat dibandingkan kelompok DTP, dengan durasi tidur yang serupa antar 2 kelompok. Makrostruktur tidur kedua kelompok mirip dengan tidur alamiah. Tidak didapatkan perbedaan efek samping antara kelompok DTP dan kelompok melatonin. Melatonin dapat digunakan sebagai premedikasi EEG pada anak untuk praktik sehari-hari.
Background Electroencephalography EEG is a procedure to support and evaluate therapy in children with epilepsy. Ideally, EEG result can be achieved if the child fell on a natural sleep, but this phase was difficult to gain. Melatonin, a natural sleep hormone that is produced by the pineal gland, was started to developed as a premedication following EEG procedure to produce natural sleep with minimal side effects compared to partial sleep deprivation PSD and other sedative agents.
Aim 1 to discover sleep onset, sleep duration, and sleep macrostructure in children with the oral administration of melatonin compared to partial sleep deprivation, 2 to discover side effects of oral melatonin EEG premedication in epilepsy children
Method In a parallel single blinded randomized clinical trial, 76 children who were referred to EEG Unit of Cipto Mangunkusumo Hospital from November 2016 to January 2017 were evaluated. The children were randomly assigned into two groups to receive PSD procedure control group and oral melatonin treatment group.
Results Mean sleep onset in PSD group was 42.39 minutes, while in melatonin group was 33.97 minutes p le 0,01 . Mean sleep duration in PSD group was 22.58 minutes, while in melatonin group was 25.09 minutes p 0,05 . There were no significant differences in both sleep macrostructure p 0,05 and procedure rsquo s side effects p 0,05 in both groups.
Conclusions Sleep onset was more prompt in melatonin group compares to PDS group, while sleep duration was similar between each groups. Both of sleep macrostructures were similar to natural sleep process. There were no significant differences of side effects in both groups. Melatonin can be use as premedication for EEG examination in epilepsy children."
Depok: Universitas Indonesia, 2017
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Dina Indah Mulyani
Faktor risiko epilepsi intraktabel pada anak dengan epilepsi umum = Risk factors of intractable childhood generalized epilepsy
"[ABSTRAK
Latar 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 umum
Metode: 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.
ABSTRACT
Background: 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 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% 19,121339,06),
unfavorable
gross
motor
development
evolution
(OR
4,9
CI
95%
1,7913,67)
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%. 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 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% 19,121339,06),
unfavorable
gross
motor
development
evolution
(OR
4,9
CI
95%
1,7913,67)
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%. 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 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% 19,121339,06),
unfavorable
gross
motor
development
evolution
(OR
4,9
CI
95%
1,7913,67)
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%. Nonresponder early treatment and age onset of seizure < 1 year old are strongly associated with intractable generalized epilepsy.]"
Fakultas Kedokteran Universitas Indonesia, 2015
T58637
UI - Tesis Membership  Universitas Indonesia Library
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