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"Latar belakang: Salah satu masalah perempuan dengan epilepsi (PDE) saat ini adalah infertilitas. Prevalensinya sendiri mencapai sepertiga dari PDE. Penelitian ini bertujuan untuk mengentahui faktor-faktor apa saja yang memengaruhi kejadian infertilitas, khususnya pada populasi PDE di RS Cipto Manungkusumo (RSCM).Metode Penelitian: Studi potong lintang pada pasien PDE rawat jalan di poli epilepsi, dilakukan telusur rekam mendis dan pengisian kuesioner. Analisis bivariat menggunakan uji Chi Square dan Mann Whitney, dilanjutkan dengan analisis multivariat regresi logistik.Hasil: Prevalensi PDE yang mengalami infertilitas di RSCM ada 51,1% dengan usia rata-rata 35,57 ± 5,53 tahun. Disfungsi seksual (p=0,020), gangguan orgasme (p=0,042) dan gangguan nyeri seksual (p=0,005) berhubungan dengan kejadian infertilitas pada PDE. Pada analisis multivariat regresi logistik, tidak didapatkan adanya faktor independen yang memengaruhi kejadian infertilitas pada PDE.Kesimpulan: Prevalensi infertilitas pada PDE di RSCM cukup besar yakni 51,1%. Faktor yang memengaruhinya adalah disfungsi seksual, gangguan orgasme dan nyeri seksual. Oleh karena itu, penting bagi klinis untuk mendeteksi dini faktor-faktor tersebut pada PDE untuk mencegah dampak lebih lanjut yang dapat ditimbulkan.

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Background: Infertility is one of the issues facing women with epilepsy (WWE) today. Its prevalence alone reaches one-third of WWE. The purpose of this study is ti determine what variables affect the prevalence of infertility, particularly in the group of WWE at Cipto Mangunkusumo Hospital (RSCM)

Method: Outpatient WWE at epilepsy clinic were the subject of this cross-sectional study. A questionnaire was completed and medical records were searched. Chi square and Mann Whitney tests were employed in bivariate analysis before multivariate logistic regression analysis.

Results: In our study, the prevalence of WWE with infertility is 51,1%, and their average age is 35,57 ± 5,53 years old. Sexual dysfunction, orgasmic disorders and sexual pain disorders are associated with infertility in WWE. There were no independent factors affecting the infertility in WWE in multivariate logistic regression study.

Conclusion: 51,1% of WWE at RSCM are infertile, which is a significant prevalence. Sexual dysfunction, orgasmic disorders, and sexual pain are all factors that might affect it. In order to limit any negative effects such as infertility, it is crucial for clinicians to detect these factors early in WWE."

"Latar Belakang. Pemberian obat anti epilepsi (OAE) generasi pertama dalam jangka waktu lama sering menimbulkan efek samping seperti perubahan kadar lipid plasma yang akan meningkatkan resiko penyakit kardiovaskular dan serebrovaskular. OAE ini banyak digunakan di poli neurologi RSCM. Diharapkan dengan diketahuinya gambaran kadar lipid plasma pada penggunaan OAE generasi pertama tunggal dan prevalensi dislipidemia, dapat dilakukan penapisan dini dan preventif timbulnya penyakit kardio dan serebrovaskular. Metode. Desain penelitian berupa studi potong lintang (cross sectional). Subyek penelitian adalah orang dengan epilepsi yang mendapat karbamazepin, fenitoin, fenobarbital dan valproat tunggal minimal 6 bulan. Subyek diperoleh secara konsekutif, kemudian dilakukan wawancara data medis, recall makanan, pemeriksaan fisik dan kadar lipid darah. Pemeriksaan kadar lipid dilakukan setelah puasa minimal 8 jam. Hasil. Diperoleh 59 subyek, 27 karbamazepin, 16 fenitoin, 10 fenobarbital dan 6 valproat. Prevalensi dislipidemia sebesar 20.3%. Rerata kadar kolesterol total 193.5 ± 31.9; LDL 115.3 ± 23.9; HDL 59.5 ± 18.8 dan trigliserida 117.0 ± 63.6. Rerata kadar kolesterol total, LDL dan trigliserida fenitoin lebih tinggi dari OAE lain. Rerata HDL terendah ditemukan pada valproat. Didapat perbedaan bermakna secara statistik rerata kolesterol total, LDL dan trigliseria berdasarkan jenis OAE. Didapat hubungan bermakna secara stastistik antara durasi penggunaan OAE dengan tingginya kadar HDL pada karbamazepin dan fenobabital. Kesimpulan. Rerata kadar lipid dibawah rerata kadar lipid populasi. Dislipidemia lebih banyak ditemukan pada kelompok fenitoin. Durasi penggunaan OAE berhubungan dengan kadar HDL tinggi.

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Background. Longterm therapy with first generation of antiepileptic drugs (AED) has been associated with adverse effects, such as serum lipid profile changes which can increase the risk of cardiovaskular and cerebrovascular disease. These AEDs are commonly used in outpatient clinic at Cipto Mangunkusumo hospital. The aim of this study is knowing lipid profile in first generation AEDs consumption.

Method. This was cross sectional study. The subjects of this study were epilepsy patiets receiving carbamazepine, phenytoin, phenobarbital and valproate as monotheraphy for more than 6 months. This study used concecutive sampling. All subjects were interviewed, food recalled and underwent physical examination and measurements serum lipid profile. Blood samples for serum lipid profile were collected at least after 8 hours overnight fasting.

Result. There were 59 patients, 27 with carbamazepine therapy, 16 phenytoin, 10 phenobarbital, 6 valproate. Prevalence of dyslipidemia is 20.3%. Mean of total cholesterol is 193.5 ± 31.9; LDL 115.3 ± 23.9; HDL 59.5 ± 18.8 and triglyseride 117.0 ± 63.6. Patients with phenytoin showed the highest mean of total cholesterol, LDL and triglyseride. Patients with valpoate showed the lowest mean of HDL. There was significant difference in mean of cholesterol total, LDL and triglyseride according to AEDs. The duration of AEDs therapy was significantly associated with higher HDL in patents with carbamazepine and Phenobarbital.

Conclusion. Mean of lipid profile among people with epilepsy was lower than population. Dyslipidemia were more frequent in phenytoin. The duration of AEDs therapy was significantly associated with higher HDL."

"Latar belakang - Untuk menentukan sindrom epilepsi selain anamnesis juga diperlukan adanya bukti gelombang elektroensefalografi EEG yang spesifik Salah satu cara dengan melakukan teknik hiperventilasi HV untuk membangkitkan abnormalitas gelombang EEG Stimulasi hiperventilasi dapat menimbulkan bangkitan umum dan parsial Dengan mengetahui hal tersebut dapat menentukan terapi dan prognosis pasien epilepsi Tujuan - Mengetahui waktu terjadinya gelombang epileptiform tertinggi selama durasi HV 5 menit pada pemeriksaan EEG untuk meningkatkan manfaat pemeriksaan penunjang yang mendukung kearah diagnosis epilepsi Metode - Penelitian ini merupakan penelitian prospektif secara historis menggunakan teknik hiperventilasi selama 5 menit saat pemeriksaan EEG untuk mencari aktivitas epileptiform pada EEG pasien epilepsi dan atau dengan bangkitan epileptik di Rumah Sakit Cipto Mangunkusumo Hasil - Dari 70 subyek penelitian didapatkan paling banyak tipe bangkitan parsial dengan sindrom epilepsi lobus temporal sebagai jenis sindrom terbanyak Pada menit ke 2 stimulasi hiperventilasi terjadi aktivitas epileptiform paling banyak sedangkan pada menit ke 1 dan ke 5 terdapat aktivitas epileptiform paling sedikit Terdapat hubungan yang bermakna antara bangkitan terkontrol obat dengan aktivitas epileptiform dan atau dengan bangkitan epileptik p 0 043 Pada subyek yang tidak terkontrol obat mempunyai resiko mengalami aktivitas epileptiform 0 22 kali lebih besar dibandingkan dengan yang terkontrol obat Sedangkan faktor lainnya seperti jenis sindrom tipe onset dan frekuensi bangkitan tidak menunjukkan perbedaan yang bermakna p 0 119 p 0 392 p 0 636 p 1 000 Simpulan - Penelitian saat ini menunjukkan aktivitas epileptiform paling banyak terdapat pada menit ke 2 stimulasi hiperventilasi Terdapat kecenderungan pasien epilepsi yang tidak terkontrol obat mempunyai resiko mengalami aktivitas epileptiform 0 22 kali lebih besar dibandingkan dengan yang terkontrol obat pada pemeriksaan hiperventilasi selama 5 menit

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Background - Diagnosis of epilepsy syndrome beside clinical judgement is also required specific wave evidence from electroencephalography EEG One of the method is to perform the hyperventilation techniques HV which can generate wave EEG abnormalities Stimulation of hyperventilation can cause general and partial seizures By knowing these things we can determine further treatment and prognosis of the epilepsy patients

Objective - To determine the highest timing of the wave emergence during 5 minutes hyperventilation in the EEG to improve the benefits of supporting the investigation towards the diagnosis of epilepsy

Methods - The study was conducted using a historical prospective study design All samples were collected in Cipto Mangunkusumo Hospital and undergo EEG with 5 minutes hyperventilation technique to look for epileptiform activity

Results - From 70 subjects obtained most of it are partial seizures with temporal lobe epilepsy syndrome as the most syndrome types In the 2nd minute of hyperventilation stimulation occurs epileptiform activity most widely while at minute 1 and 5 are less epileptiform activity There is a significant relationship between controlled drug patients with epileptiform activity and or with epileptic seizures p 0 043 In subjects who are at risk of uncontrolled drug had epileptiform activity 0 22 times larger than the controlled drug While other factors such as the type of syndrome type onset and frequency of seizure showed no significant difference p 0 119 p 0 392 p 0636 p 1 000

Conclusions - The present study showed epileptiform activity are most common in the 2nd minute stimulation hyperventilation There is a tendency of uncontrolled epilepsy patients who are at risk of experiencing epileptiform activity 0 22 times greater than the drug controlled patients during 5 minutes hyperventilation techniques"

"ABSTRAK Tujuan: Menentukan prevalensi excessive daytime sleepiness (EDS) pada pasiendengan epilepsi dan faktor-faktor yang berhubungan di Rumah Sakit CiptoMangunkusumo (RSCM).Metode: Studi potong lintang deskriptif ini menggunakan kuesioner EpworthSleepiness Scale (ESS) pada pasien epilepsi yang diambil secara konsekutif dipoliklinik neurologi RSCM, pada bulan Oktober-November 2015. Faktor-faktoryang dianalisis meliputi usia, jenis kelamin, jenis bangkitan, sindrom epilepsi,etiologi epilepsi, frekuensi bangkitan, bangkitan nokturnal, risiko ObstructiveSleep Apnea (OSA), depresi mayor, gangguan cemas menyeluruh, obat antiepilepsi, dan potensial resistensi obat. EDS ditentukan jika skor ESS > 10. RisikoOSA ditetapkan dengan kuesioner STOP-Bang; depresi mayor ditentukan dengankuesioner Neurological Disorders Depression Inventory for Epilepsy (NDDI-E)versi Indonesia; gangguan cemas menyeluruh ditentukan dengan kuesioner MiniInternational Neuropsychiatric Interview for International Classification ofDiseases-10 (MINI ICD-10). Hasil: Diantara 93 pasien epilepsi, prevalensi EDS adalah sebanyak 32.3%;wanita lebih banyak dari pria. Faktor-faktor yang berhubungan secara signifikandengan EDS adalah usia kurang dari 35 tahun, frekuensi bangkitan dalam 1 tahunlebih dari sama dengan 8 kali, depresi mayor, dan potensial resisten obat. Darianalisis multivariat, terdapat 2 faktor independen yang berhubungan dengan EDSyaitu depresi mayor dan potensial resisten obat. Kesimpulan: EDS umum dijumpai pada pasien epilepsi dengan prevalensi32.3%. Depresi mayor dan potensial resistensi obat merupakan faktor yangberhubungan dengan EDS pada pasien epilepsi ABSTRACT Purpose: To determine the prevalence of excessive daytime sleepiness (EDS) inepilepsy patients and its related factors at Cipto Mangunkusumo HospitalJakarta, Indonesia.Materials and Method: This cross-sectional descriptive study using EpworthSleepiness Scale (ESS) questionnaire to identify EDS in epilepsy patients visitedour neurology clinic during October-November 2015 consecutively. Relatedfactors that had been analyzed were age, sex, seizure type, epilepsy syndrome,etiology, seizure frequency, nocturnal seizures, risk of Obstructive Sleep Apnea(OSA), major depression, general anxiety disorder, anti epileptic drug, andpotentially drug resistant epilepsy (DRE). EDS was determined if ESS score > 10.Risk of OSA was assessed by STOP-Bang questionnaire; major depression wasassessed by Neurological Disorders Depression Inventory for Epilepsy (NDDI-E)Indonesian version; general anxiety disorder was assessed by Mini InternationalNeuropsychiatric Interview for International Classification of Diseases-10 (MINIICD-10). Data analysis was done using SPSS 17.0.Results: Among 93 subjects, prevalence of EDS was 32.3%; female was morecommon than male. Related factors that significantly influenced to EDS were age< 35 years old, seizure frequency within 1 year >8 times, major depression andpotentially DRE. From multivariate analysis, there were 2 independent factorsthat related to EDS that were major depression and potentially DRE.Conclusions: EDS is common in epilepsy patients (32.3%). Major depression andpotentially DRE were related factors of EDS in epilepsy patients.;Purpose: To determine the prevalence of excessive daytime sleepiness (EDS) inepilepsy patients and its related factors at Cipto Mangunkusumo HospitalJakarta, Indonesia.Materials and Method: This cross-sectional descriptive study using EpworthSleepiness Scale (ESS) questionnaire to identify EDS in epilepsy patients visitedour neurology clinic during October-November 2015 consecutively. Relatedfactors that had been analyzed were age, sex, seizure type, epilepsy syndrome,etiology, seizure frequency, nocturnal seizures, risk of Obstructive Sleep Apnea(OSA), major depression, general anxiety disorder, anti epileptic drug, andpotentially drug resistant epilepsy (DRE). EDS was determined if ESS score > 10.Risk of OSA was assessed by STOP-Bang questionnaire; major depression wasassessed by Neurological Disorders Depression Inventory for Epilepsy (NDDI-E)Indonesian version; general anxiety disorder was assessed by Mini InternationalNeuropsychiatric Interview for International Classification of Diseases-10 (MINIICD-10). Data analysis was done using SPSS 17.0.Results: Among 93 subjects, prevalence of EDS was 32.3%; female was morecommon than male. Related factors that significantly influenced to EDS were age< 35 years old, seizure frequency within 1 year >8 times, major depression andpotentially DRE. From multivariate analysis, there were 2 independent factorsthat related to EDS that were major depression and potentially DRE.Conclusions: EDS is common in epilepsy patients (32.3%). Major depression andpotentially DRE were related factors of EDS in epilepsy patients."

"Ruang Lingkup dan metodologi: Alat bantu kerja yang bergetar untuk mempencepat proscs produksi di industri sangat banyak digunakan dan rutin digunakan setiap harinya. Oleh karena itu, perlu diketahui prevalensi hand-arm vibration syndrome (HAVS) pada pekerja ini serta melihat pula faktor-faktor yang berhubungan. Penelitian ini menggunakan desain potong lintang. Dengan teknik total sampling didapatkan 105 responden.Setiap responden dilakukan anamnesis, pemeriksaan fisik, pengukuran tingkat akselerasi alat yang digunakannya dengan vibration meter. Diagnosis HAVS dinilai pada dua tangan berdasarkan klasifikasi Stockholm. Penelitian dilakukan di bagian assembling PT X, Jawa Barat. Hasil dan kesimpulan: Dari hasil 105 responden bagian assembling PT X, Jawa Barat didapatkan 28(27,l8%) orang mengalami HAVS dalam berbagai stadium menuzut klasiiikasi Stockholm. Jenis alat yang digunakan responden terdiri dari berbagai jenis di setiap bagiannya. Bagian dengan alat yang paling besar dan berat terdapat di bagian chassis dengan rata-rata scberat 2,19 kg dengan SD 0,79 kg. Demikian juga dengan tingkat akselerasi alat yang bervariasi di tiap bagiannya dan bagian chassis pulg yang berakselerasi paling besar yaim sebesar 31,68 m/sz dcngan so 15,91 rn/s. Pekerja yang tidak mendapatkan pelatihan akan memiliki risiko sebesar hampir 7 kali untuk menderita HAVS (95% CI 2,18 - 2l,68, OR=7,44 dan p=0,00I). Penggunaan alat berakselerasi 12 m/sz atau lebih tinggi memiliki risiko HAVS sebesar hampir 6 kali lebih besar dibandingkan dengan yang berakselerasi kurang dari 12 m/s (95% Cl 0,68 - 48,26, OR= 5,74 dan p=0,l08). Dari penelitian ini dapat disimpulkan bahwa tidak adanya pelatihan tentang cara penggunaan alat bergetar merupakan risiko HAVS yang terkuat.

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Vibrating tools are commonly instruments used in the industrial sector because of their effectiveness in shortened the time needed in the industrial process. Therefore, it is necessary to know the prevalence of Hand-Arm Vibration Syndrome as well as its association factors. This study used cross sectional design. Sample selection used total population technique. Interview, physical examination and tool acceleration measurement with vibration meter, were administered in every respondent. HAVS was diagnosed for each hand according to Stockholm classification. The study was conducted in assembling department of car factory *X* in West Java near the workers workplace.

Results, conclusion and suggestion: Out of 105 respondents, 28 (27.l8%) suffered from HAVS according to Stockholm classification. The respondents use many types of tools in each sub department. Chassis sub department showed the heaviest vibrating tools (mean 2.19 kg, SD 0.79 kg) as well as the highest acceleration (31.68 m/sz, SD 15.91 m/sz). Statistically, there were not any significant association between tools weight and the occurrence of HAVS. However, training program showed significant association with HAVS (OR=7.44 95% Cl 2.41 - 22.98, p<0.00l). The absence of training increased the risk of HAVS almost 7 times than those who joined the training (95% CI 2.18 - 21.68, 0R=7.44 and p=0.001). The usage of tools with acceleration 12 rn/sz or higher increased the risk of HAVS almost 6 times than those below 12 m/sz (95% CI 0.68 _ 48.26, oR= 5.14 and p=o.1os). n is concluded that the absence of training program was the strongest risk factor of HAVS."

"Latar belakang: Status epileptikus non konvulsif (SENK) dapat ditemukan padacedera kepala sedang-berat (CKS-B). Timbulnya kejang pascatrauma dapatmemperberat cedera otak yang sudah terjadi, sehingga dapat mempengaruhi luaran.Gejala klinis SENK tidak spesifik, sehingga membutuhkan pemeriksaanelektroensefalografi (EEG) dalam penegakkan diagnosis. Penelitian ini bertujuanmengetahui angka kejadian SENK, faktor yang mempengaruhi, gambaran demografi(usia, jenis kelamin dan luaran), gejala klinis, gambaran pencitraan dan EEG padapasien CKS-B dengan SENK.Metode penelitian: Penelitian ini menggunakan desain potong lintang dengan sampelterdiri dari data primer, yaitu semua CKS-B dari bulan Juli-Desember 2019 secaraconsecutive sampling dan data sekunder, yaitu subjek CKS-B dengan klinis kecurigaanSENK dari bulan Januari 2017-Juni 2019 di Rumah Sakit Umum Pusat Nasional CiptoMangunkusumo (RSUPNCM), Jakarta. Penegakkan diagnosis SENK dilakukan melaluikriteria modified salzburg consensus criteria for non convulsive status epilepticus(mSCNC).Hasil penelitian: Sebanyak 39 sampel CKS-B masuk ke dalam penelitian yang terdiridari 14 data primer dan 25 data sekunder. Sebanyak 19 dari 39 sampel terdiagnosisSENK. Proporsi insiden SENK pada CKS-B dari Juli-Desember 2019 sebesar 21,4% (3dari 14 sampel). Pada kelompok SENK didapatkan usia lebih tua, laki-laki lebih banyakdari perempuan (3:1) dan kecelakaan lalu lintas sebagai mekanisme utama. Manifestasiklinis SENK, antara lain penurunan kesadaran (23,1%), agitasi psikomotor (12,8%),delirium (5,1%) dan gangguan persepsi (5,1%). Lobus frontal dan SAH merupakandaerah lokasi cedera dan patologi terbanyak. Hanya didapatkan 2 sampel dengan kriteriadefinit SENK dan selebihnya possible SENK. Sebagian besar bangkitan SENK berasaldari lobus temporal. Analisis multivariat menunjukkan lokasi cedera lobus temporalbermakna berhubungan dengan kejadian SENK (p = 0,036, OR 11,45 (95% IK 1,17-111,6).Kesimpulan: Proporsi insiden SENK pada CKS-B di RSUPNCM sebesar 21,4%.Penurunan kesadaran merupakan gejala klinis SENK terbanyak. Lobus temporalmerupakan faktor yang berhubungan terhadap kejadian SENK.

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Background: Non convulsive status epilepticus (NCSE) can be accounted by moderateseveretraumatic brain injury (TBI). Posttraumatic seizure can aggravate the previousinjury and produce poor outcome. Electroecephalography (EEG) was employed asdiagnostic tool because unspecified clinical symptoms. This study was aimed to findincidence proportion, associated risk factors, demographic profiles (age, gender,outcome), clinical symptoms, imaging and EEG patterns of NCSE in moderate-severeTBI patients.Method: Cross-sectional design was applied ini this study. Data is consist of primarydata which include all moderate-severe TBI since July-December 2019 by consecutivesampling and secondary data which include moderate-severe TBI since January 2017-June 2019 with highly suspicious NCSE symptoms in Cipto Mangunkusumo Hospital,Jakarta. EEG was employed as diagnostic tool by using modified salzburg consensuscriteria for non convulsive status epilepticus (mSCNC) as a criteria.Result: Of 39 samples, 19 moderate-severe TBI samples (14 primary data, 25secondary data) were diagnosed as NCSE. Incidence proportion of NCSE from July-December 2019 is 21,4% (3 from 14 samples). Older age, man gender, traffic accidentand worse outcome are the most common NCSE demographic profiles. Loss ofconsciousness (23,1%) is a main symptom, followed by psychomotor agitation (12,8%),delirium (5,1%) dan perception disturbance (5,1%). Frontal lobe and SAH areconsecutively as the most common injury location and pathologic finding. Only 2samples have definite NCSE diagnosis and the remaining as possible NCSE. Most ofNCSE discharges were originated from temporal lobe. Temporal lobe injury locationhas significance relation toward SENK occurance (p = 0,036, OR 11,45 (95% CI 1,17-111,6).Conclusion: Incidence proportion of NCSE in moderate-severe TBI is 21,4%. Loss ofconsciousness is the most finding symptoms. Temporal lobe is a factor relates to NCSEoccurance."

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Latar belakang: Prevalensi wanita dengan epilepsi (WDE) usia reproduktif di Rumah Sakit Pusat Umum Nasional Cipto Mangunkusumo (RSCM) adalah 61,7% pada tahun 2019. Pada sebagian WDE, frekuensi bangkitan dipengaruhi oleh perubahan hormonal. Fungsi reproduksi WDE di RSCM sampai saat ini belum diketahui secara pasti. Penelitian ini bertujuan untuk mengetahui gambaran karakteristik gangguan fungsi reproduksi pada WDE di RSCM.

Metode Penelitian: Penelitian ini menggunakan desain potong lintang dengan data primer. Kriteria inklusi adalah WDE berusia diatas 18 tahun, yang didiagnosis epilepsi oleh spesialis saraf, yang berobat di RSCM dari bulan September 2020 – November 2021. Ganguan fungsi reproduksi terdiri dari ganngguan siklus menstruasi, infertilitas, gangguan kehamilan atau gangguan persalinan.

Hasil Penelitian: Dari 136 subjek penelitian yang didapatkan, 41,2% mengalami gangguan fungsi reproduksi. Gangguan siklus menstruasi didapatkan pada 31,6% subjek. Subjek yang sudah menikah sebanyak 34,6%, dengan gangguan fertilitas didapatkan pada 45,5% subjek. Dari subjek yang sudah menikah, 77,3% pernah hamil. Gangguan kehamilan didapatkan pada delapan (47,1%) subjek, berupa riwayat abortus sebanyak 23,5%. Perubahan frekuensi bangkitan selama kehamilan ditemukan pada 94,1% subjek, berupa frekuensi bangkitan meningkat (23,5%), frekuensi menurun (23,5%) dan bebas bangkitan (47,1%). Lima belas (68,2%) subjek pernah melahirkan, dan sebanyak 66,7% melahirkan dengan sectio sesaria. Dua subjek mengalami gangguan saat persalinan, berupa persalinan prematur dan kejang saat persalinan.

Kesimpulan: Gangguan fungsi reproduksi pada WDE didapatkan pada 41,2% subjek, dengan jenis gangguan terbanyak adalah gangguan siklus menstruasi dan gangguan fertilitas.

Kata Kunci: gangguan fertilitas, gangguan fungsi reproduksi, gangguan menstruasi, wanita dengan epilepsi.

 

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Background: Women with epilepsy (WWE) in reproductive age prevalence at Cipto  Mangunkusumo Nasional Hospital (RSCM) is 61,7% in 2019. Seizure frequencies in WWE could be influenced by hormonal changes. Reproductive function of WWE in RSCM has not been exactly known until now. The purpose of this study is to know the characteristic of reproductive system disorder in WWE at RSCM.

Methods: A cross-sectional study using primary and secondary data. Inclusion criteria are WWE older than 18 years old and has been diagnosed with epilepsy by the doctors at RSCM from September 2020 until November 2021. Reproductive system disorder consist of menstrual cycle disorder, infertility, pregnancy problems or delivery problems.

Results: There were 136 subjects, 41,2% have reproductive system disorder. Menstrual cycle disorder found in 31,6% subjects. There were 34,6% married subjects, and 77,3% of them have pregnancy experience, while infertility found in 45,5% subjects. Eight (47,1%) subjects were having problem during their pregnancy. Spontaneous abortion found in 23,5%. Seizure frequency increased in 23,5% subjects, decreased in 23,5% subjects and 47,1% subjects. Seizure free during their pregnancy. Fifteen (68,2%) subjects have delivery experiences and 66,7% subjects were using C-section methods. Two subjects were having problem during their delivery. One subject has premature delivery while the other one was having seizure during delivery.

Conclusion: Reproductive system disorder found in 41,2% subjects. Menstrual cycle disorder and infertility are the greatest disorder found in this study.

Keyword: infertility, menstrual cycle disorder, reproductive system disorder, women with epilepsy

 

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"Latar Belakang: Status epileptikus (SE) merupakan salah satu kedaruratan neurologis dengan mortalitas yang tinggi. SE dengan gejala motorik yang menonjol dan gangguan kesadaran disebut sebagai status epileptikus konvulsivus (SEK). Tujuan tatalaksana SEK adalah menghentikan bangkitan secara cepat dan efektif karena pada SEK yang berkepanjangan akan menyebabkan kerusakan neuron dan gangguan sistemik yang luas. Tujuan penelitian ini adalah mengetahui gambaran tatalaksana farmakologis dan faktor-faktor yang mempengaruhi waktu terminasi SEK di RSUPN dr. Cipto Mangunkusumo (RSCM).Metode: Desain penelitian dengan potong lintang pada 22 pasien SEK secara retrospektif. Data yang didapatkan merupakan data dari penelurusan rekam medik. Dilakukan pencatatan usia, jenis kelamin, komorbid, riwayat epilepsi, etiologi, bentuk kejang, kelainan metabolik, onset kejang, jenis, lini, dosis, dan jumlah obat anti kejang yang didapat. Kemudian dilakukan pencatatan waktu dari tatalaksana SEK hingga terminasi SEK.Hasil: Dari 22 subjek, 16 subjek dapat diterminasi <60 menit (72,7%). Kelompok terminasi <60 menit memiliki rerata usia lebih muda, memiliki riwayat epilepsi, dan sebagian besar tidak memiliki komorbid. Pada kedua kelompok terminasi etiologi tersering adalah etiologi akut. Seluruh subjek dengan semiologi SEK kejang konvulsif umum tonik klonik dan kejang umum tonik termasuk dalam kelompok terminasi <60 menit. Sedangkan bentuk kejang lainnya terdapat sebagian kecil subjek termasuk dalam kelompok terminasi >60 menit. Median onset kejang pada penelitian ini didapat lebih lama pada kelompok terminasi <60 menit. Kelainan metabolik hipoalbumin dan gangguan hepar didapatkan sedikit lebih banyak pada kelompok terminasi <60 menit. Sedangkan subjek dengan kelainan ginjal didapat persentase yang sama. Sebagian besar subjek cukup mendapat lini I, diazepam IV, dan 1 jumlah obat anti kejang dalam terminasi SEK. Pada subjek kelompok terminasi >60 menit mendapat dosis diazepam IV dan fenitoin IV lebih besar. Pada subjek yang mendapat levetiracetam oral dan midazolam IV seluruhnya terdapat dalam kelompok terminasi >60 menit.Kesimpulan: Tatalaksana farmakologis SEK di RSCM sesuai dengan alogaritme SE dan sebagian besar dapat diterminasi <60 menit. Distribusi demografis dan klinis subjek penelitian seperti usia muda, riwayat epilepsi, dan tidak adanya komorbid serta kelainan metabolik hipoalbumin dan kelainan hepar distribusinya lebih banyak pada kelompok terminasi <60 menit.

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Background: Status epilepticus (SE) is one of the neurological emergencies with high mortality. SE with prominent motor symptoms and impaired consciousness is called a convulsive status epilepticus (CSE). The goal of treatment for CSE is to stop seizures quickly and effectively because prolonged CSE will cause extensive neuronal damage and systemic disturbances. The purpose of this study was to determine the description of pharmacological management and the factors that influence the termination of CSE in Cipto Mangunkusumo Hospital.

Method: It was a retrospective cross-sectional study design in 22 CSE patients. The data was retrieved from medical records including age, sex, comorbid, history of epilepsy, etiology, form and onset of seizures, metabolic disorders, type, line, dose and amount of anti-seizure drugs were carried out. The duration from time-point of CSE management up to the CSE termination was recorded.

Result: Among 22 subjects, there were 16 subjects who had CSE termination <60 minutes (72.7%). The <60 minutes termination group had a younger age, had a history of epilepsy and most of them had no comorbidities. All three subjects with a history of epilepsy were also included in the <60 minutes termination group. In both groups the most common etiology of termination was acute. All subjects with the semiology convulsive generalized tonic-clonic seizures and generalized tonic seizures were included in the <60 minutes termination group. While other forms of semiology, a small proportion of subjects were included in the group termination >60 minutes. Median seizure onset in this study was longer in the termination group <60 minutes. Hypoalbumin metabolic and hepatic disorders were slightly more in the <60 minutes termination group. Among <60 minutes termination group, the most common anti-convulsant was first line drug which was Diazepam IV, wherease the most common one in >60 minutes termination group was second line drug which was Phenytoin IV. Subjects in the group terminated> 60 minutes received larger doses of IV diazepam and IV phenytoin. Subjects receiving oral levetiracetam and IV midazolam were all in the> 60 minutes termination group.

Conclusion: CSE management in Cipto Mangunkusumo Hospital was already in accordance with the SE management algorithm. Demographic and clinical distribution of study subjects such as younger age, history of epilepsy, absence of co-morbids and metabolic disorders of hypoalbumin and liver disorders were common in the <60 minutes termination group."

"Latar belakang: Status Epilepticus Severity Score (STESS) merupakan instrumen untuk memprediksi luaran pasien status epileptikus (SE) sebelum dilakukan tata laksana. Status Epilepticus Severity Score sudah divalidasi sebelumnya di Swiss dengan nilai cut-off > 4. Instrumen ini adalah instrumen sederhana, dan dapat digunakan dengan cepat, pada pasien di Instalasi Gawat Darurat (IGD) dan ruang perawatan intensif. Tujuan utama penelitian ini untuk menilai validitas dan reliabilitas STESS yang telah diterjemahkan ke dalam Bahasa Indonesia. Tujuan tambahan adalah untuk melihat hubungan antara nilai STESS dengan luaran pada 24 jam, 48 jam, hari ke 7, hari ke 30, dan akhir perawatan pasca-SE ditegakan. Metode penelitian: Penelitian ini dilakukan di RS Cipto Mangunkusumo Jakarta pada bulan Juni 2020 hingga November 2020. Penelitian ini menggunakan disain potong-lintang prospektif dan dilakukan penilaian secara serial untuk melihat luaran pada 24 dan 48 jam pertama, hari ke-7, 30 dan akhir perawatan. Luaran yang dinilai adalah hidup dan mati. Kriteria inklusi adalah pasien SE konvulsivus yang belum mendapatkan tata laksana kejang. Kuesioner STESS telah diterjemahkan ke dalam Bahasa Indonesia. Dilakukan uji validitas dan reliabilitas STESS Bahasa Indonesia (STESS-INA). Selanjutnya ditentukan nilai titik potong STESS dengan menggunakan kurva Receiver Operating Characteristic (ROC) dan menilai Area Under Curve (AUC) terhadap titik potong yang ditentukan. Setelah itu dilakukan analisa statistik berdasarkan titik potong tersebut terhadap luaran pasien pada 24 dan 48 jam, hari ke-7 dan 30, serta akhir perawatan. Luaran yang dinilai dalam bentuk pasien hidup atau meninggal.Hasil: Didapatkan 17 subyek penelitian yang memenuhi kriteria inklusi. Hasil uji validitas interna STESS-INA untuk tiap item didapatkan koefisien korelasi 0,484 hingga 0,702 dengan nilai Cronbach’s Alpha 0,71. Pada studi ini didapatkan mortalitas adalah sebesar 23%. Berdasarkan kurva ROC, didapatkan nilai titik potong 4. Nilai AUC STESS-INA pada akhir perawatan 96,2% dengan menggunakan nilai titik potong STESS > 4. Nilai STESS-INA > 4 berhubungan bermakna dengan luaran kematian pada akhir perawatan (p=0,006).Kesimpulan: STESS-INA merupakan instrumen valid dan reliabel. Nilai STESS-INA > 4 berhubungan bermakna terhadap luaran kematian pada akhir perawatan.

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Background: STESS in an instrument to predict the outcome of a status epilepticus (SE) patient before being managed. STESS has been validated before in Swiss with a cut-off point of ≥4. This simple instrument can be used quickly for patients in the ER and ICU. The goal of this research is to assess the validity, reliability of STESS Indonesia version (STESS-INA) and to evaluate the association of score of STESS-INA and outcome on 24 hours, 48 hours, 7th day, 30th day, and at the last day of hospitalization.

Method: Research was being done at RSUPN Cipto Mangunkusumo on June 2020 to November 2020. STESS was translated to Indonesia version (STESS-INA) followed by validity and reliability evaluation. STESS-INA was assessed when patient is being diagnosed with SE before being managed, then being observed on the first 24 hours, 48 hours, 7th day, 30th day and the last day of hospitalization. Predictive value of STESS-INA was being assessed by Receiver Operating Character (ROC) with the cut-off point at the most optimal sensitivity and specificity followed by assess the correlation between STESS-INA cut-off point and the outcome on 24 hours, 48 hours, 7th day, 30th day, and at the last day of hospitalization. The outcome was live/deceased.

Result: There were 17 patients in this study. The results of the internal validity test obtained a correlation coefficient of STESS-INA was 0.484 to 0.702. Internal consistency reliability test with Cronbach’s Alpha was 0.71. The mortality rate of these study was 23%. The AUC value of STESS-INA at the end of hospitalization was 96.2 with cut-off point >4. In this study, STESS-INA with cut-off point 4 has significantly associated with outcome at the last day of hospitalization (p = 0.006).

Conclusion: STESS-INA is a valid and reliable instrument in predicting outcome at the end of hospitalazation. STESS with a cut-off >4 was associated with mortality at the last day of hospitalization."

"Pendahuluan: Jumlah penyandang epilepsi semakin meningkat, namun tidak disertai dengan edukasi sehingga masih terdapat stigma dan diskriminasi yang dapat menurunkan kualitas hidup orang dengan epilepsi (ODE). Dengan demikian perlu dilakukan penelitian sikap mahasiswa kedokteran preinternship, peserta program pendidikan dokter spesialis (PPDS) dan perawat karena mereka merupakan sumber penting pengetahuan tentang epilepsi dan dapat memberikan contoh bagi masyarakat. Metode: Penelitian ini menggunakan desain potong lintang dari Juni 2020 hingga Januari 2021. Sampel penelitian yaitu mahasiswa kedokteran preintership, peserta PPDS dan perawat di RSUPN Dr. Cipto Mangunkusumo. Penelitian ini menggunakan kuesioner Public Attitude Toward Epilepsy (PATE) versi Bahasa Indonesia yang telah divalidasi. Hasil: Mahasiswa kedokteran preinternship, peserta PPDS dan perawat memberikan sikap positif pada pertanyaan yang bersifat umum, namun hal sebaliknya didapatkan sikap negatif pada pertanyaan yang bersifat pribadi yakni berkencan, menikah ataupun memberikan saran kepada keluarga untuk menikah dengan ODE. Faktor sosiodemografi tidak mempengaruhi sikap terhadap epilepsi. Kesimpulan: Mahasiswa kedokteran preinternship, peserta PPDS dan perawat memberikan sikap yang negatif dalam hal berkencan maupun menikah dengan ODE.

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Background: The number of people with epilepsy is increasing, but this not followed by education so that there is still stigma and discrimination that can reduce the quality of life of people with epilepsy (PWE). Thus, it is necessary to conduct research on the attitudes of preintership medical students, residents and nurses because they are an important source of knowledge about epilepsy and can provide an example for the community.

Method: This study used a cross sectional design from June 2020 until Januari 2021. The research sample were preintership medical students, residents and nurses at Cipto Mangunkusumo Hospital. The study was conducted using a validated Indonesian version of the PATE questionnaire.

Results: Preintership medical students, residents and nurses gave a positive attitude to general questions, but on the contrary, a negative attitude was found on questions related to personalities, namely dating, getting married or giving advice to families to marry people with epilepsy. Sociodemographic factors did not influence attitude towards epilepsy.

Conclusion: Preintership medical students, residents and nurses give negative attitudes in dating and marrying PWE."