Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
ABSTRAK
Latar belakang : Sindrom Down merupakan penyakit genetik yang dapat menyebabkan keterlambatan perkembangan motorik, bahasa, kognitif, dan psikososial. Periode perkembangan anak dalam tiga tahun pertama kehidupan sangat penting, karena merupakan dasar untuk hasil perkembangan selanjutnya. Sampai saat ini belum dilakukan penelitian yang menghubungkan kemampuan motorik pasien sindrom Down dengan faktor-faktor yang memengaruhinya. Mengingat prevalensi anak sindrom Down yang cukup banyak di Indonesia, dan belum didapatkan data tersebut maka penelitian dilakukan pada anaksindrom Down sehingga anaksindrom Down mendapatkan hasil optimal dari program intervensi yang dijalankan Tujuan : Mengetahui karakteristik pertumbuhan dan perkembangan motorik anak sindrom Down serta faktor yang memengaruhi tingkat perkembangan motorik kasar untuk menentukan kemampuan anak, kebutuhan terapi dan meningkatkan kualitas pelayanan. Metode: Studi potong lintang deskriptif dan analitik selama Agustus sampai September 2015 pada 103 anak sindrom Down usia 6 bulan - 3 tahun di Poli Anak dan Poli Rehabilitasi medic Rumah Sakit Cipto Mangunkusumo (RSCM). Data orang tua didapat dari autoanamnesis dan pencarian rekam medis, data antropometrik berupa beratbadan, tinggi badan dan lingkar kepala diplot pada kurva pertumbuhan khusus anak sindromDown, perkembangan motorik kasar dinilai berdasarkan milestone khusus anak sindrom Down. Hasil penelitian : Sejumlah 103 subjek (56 laki-laki, 47 perempuan) memenuhi kriteria inklusi. Median subjek adalah 12 bulan. Jumlah subjek yang mengalami gizi baik dan gizi kurang hampir sama. Mikrosefali dialami oleh sebagian kecil subjek 10 (9,6%). Anak sindrom Down dengan tipe klasik ditemukan pada sebagian besar pasien sebanyak 99 (96%) dan tipe translokasi sebanyak 4 (3,9%). Keterlambatan motorik ringan dialami oleh 69,2% subjek, keterlambatan motorik sedang 16,3%, dan keterlambatan motorik ringan 13,5%. Hasil analisis multivariate memperlihatkan faktor risiko yang berhubungan dengan keterlambatan motorik adalah lingkar kepala (p=0,011; OR 6,852; IK95% 1,565-30,038), riwayat asfiksia (p=0,009; OR 4,033; IK95% 1,427-11,4), dan frekuensi program stimulasi (p=0,006; OR 3,845; IK95% 1,460-10,125). Kesimpulan : Lingkar kepala, riwayat asfiksia, dan frekuensi program stimulasi merupakan faktor risiko keterlambatan perkembangan motorik anak sindromDown.ABSTRACT
Background : Down Syndrome is one of genetics disease that could cause delayed motoric, language, cognitive, and psycho-social development. Development of the first three years of life is crucial, because it is a basic for further development. Until recently, there are not study which conducted to correlates motoric capabilities Down Syndromes patients to factors that interfere its. In Indonesia, prevalence of child with Down Syndromes is quite high, there are no data depicted that correlation;hence, this study was conducted in child with Down Syndromes so that they obtained optimal outcome from intervention program conducted. Aim: To know characteristics of motoric growth and development in children with Down Syndromes and factors interfere degree of gross motoric development which to determine children?s capability, needs therapy, and improves quality of service. Methods : A descriptive cross-sectional study was conducted to 103 children with Down Syndromes aged 6 months ? 3 years old in Pediatrics Outpatient Clinics and Medical Rehabilitation Outpatient Clinics of Rumah Sakit Cipto Mangunkusumo (RSCM) during August to September 2015. Data were obtained by their parents (auto-anamnesis) and medical records, anthropometric data comprised body weight, body height, and head circumference which were plotted to special growth curve of children with Down Syndromes, gross motoric developments were assessed by special milestone of children with Down Syndromes. Results : One hundred and three subjects were fulfilled as inclusion criterions. Median subject was twelve months. Amount of subjects with good nutrition and malnutrition were equal. Subjects with microcephaly were 10 (9.6%). Children with classical type of Down Syndromes were 99(96%) and translocation type were 4(3.9%). Children with mild motoric development were 69.2%, intermediate motoric development were 16.3%, and severe motoric development were 13.5%. Multivariate analysis showed risk factors correlates to motoric development were head circumference (p=0,011; OR 6,852; CI 95% 1,565-30,038), history of asphyxia (p=0,009; OR 4,033; CI 95% 1,427-11,4), and frequency of stimulation programs (p=0,006; OR 3,845; CI95% 1,460-10,125). Conclusion : Head circumference, history of asphyxia, and frequency of stimulation programs were risk factors of motoric development in children with Down Syndromes. ;Background : Down Syndrome is one of genetics disease that could cause delayed motoric, language, cognitive, and psycho-social development. Development of the first three years of life is crucial, because it is a basic for further development. Until recently, there are not study which conducted to correlates motoric capabilities Down Syndromes patients to factors that interfere its. In Indonesia, prevalence of child with Down Syndromes is quite high, there are no data depicted that correlation;hence, this study was conducted in child with Down Syndromes so that they obtained optimal outcome from intervention program conducted. Aim: To know characteristics of motoric growth and development in children with Down Syndromes and factors interfere degree of gross motoric development which to determine children?s capability, needs therapy, and improves quality of service. Methods : A descriptive cross-sectional study was conducted to 103 children with Down Syndromes aged 6 months ? 3 years old in Pediatrics Outpatient Clinics and Medical Rehabilitation Outpatient Clinics of Rumah Sakit Cipto Mangunkusumo (RSCM) during August to September 2015. Data were obtained by their parents (auto-anamnesis) and medical records, anthropometric data comprised body weight, body height, and head circumference which were plotted to special growth curve of children with Down Syndromes, gross motoric developments were assessed by special milestone of children with Down Syndromes. Results : One hundred and three subjects were fulfilled as inclusion criterions. Median subject was twelve months. Amount of subjects with good nutrition and malnutrition were equal. Subjects with microcephaly were 10 (9.6%). Children with classical type of Down Syndromes were 99(96%) and translocation type were 4(3.9%). Children with mild motoric development were 69.2%, intermediate motoric development were 16.3%, and severe motoric development were 13.5%. Multivariate analysis showed risk factors correlates to motoric development were head circumference (p=0,011; OR 6,852; CI 95% 1,565-30,038), history of asphyxia (p=0,009; OR 4,033; CI 95% 1,427-11,4), and frequency of stimulation programs (p=0,006; OR 3,845; CI95% 1,460-10,125). Conclusion : Head circumference, history of asphyxia, and frequency of stimulation programs were risk factors of motoric development in children with Down Syndromes. ;Background : Down Syndrome is one of genetics disease that could cause delayed motoric, language, cognitive, and psycho-social development. Development of the first three years of life is crucial, because it is a basic for further development. Until recently, there are not study which conducted to correlates motoric capabilities Down Syndromes patients to factors that interfere its. In Indonesia, prevalence of child with Down Syndromes is quite high, there are no data depicted that correlation;hence, this study was conducted in child with Down Syndromes so that they obtained optimal outcome from intervention program conducted. Aim: To know characteristics of motoric growth and development in children with Down Syndromes and factors interfere degree of gross motoric development which to determine children?s capability, needs therapy, and improves quality of service. Methods : A descriptive cross-sectional study was conducted to 103 children with Down Syndromes aged 6 months ? 3 years old in Pediatrics Outpatient Clinics and Medical Rehabilitation Outpatient Clinics of Rumah Sakit Cipto Mangunkusumo (RSCM) during August to September 2015. Data were obtained by their parents (auto-anamnesis) and medical records, anthropometric data comprised body weight, body height, and head circumference which were plotted to special growth curve of children with Down Syndromes, gross motoric developments were assessed by special milestone of children with Down Syndromes. Results : One hundred and three subjects were fulfilled as inclusion criterions. Median subject was twelve months. Amount of subjects with good nutrition and malnutrition were equal. Subjects with microcephaly were 10 (9.6%). Children with classical type of Down Syndromes were 99(96%) and translocation type were 4(3.9%). Children with mild motoric development were 69.2%, intermediate motoric development were 16.3%, and severe motoric development were 13.5%. Multivariate analysis showed risk factors correlates to motoric development were head circumference (p=0,011; OR 6,852; CI 95% 1,565-30,038), history of asphyxia (p=0,009; OR 4,033; CI 95% 1,427-11,4), and frequency of stimulation programs (p=0,006; OR 3,845; CI95% 1,460-10,125). Conclusion : Head circumference, history of asphyxia, and frequency of stimulation programs were risk factors of motoric development in children with Down Syndromes. ;Background : Down Syndrome is one of genetics disease that could cause delayed motoric, language, cognitive, and psycho-social development. Development of the first three years of life is crucial, because it is a basic for further development. Until recently, there are not study which conducted to correlates motoric capabilities Down Syndromes patients to factors that interfere its. In Indonesia, prevalence of child with Down Syndromes is quite high, there are no data depicted that correlation;hence, this study was conducted in child with Down Syndromes so that they obtained optimal outcome from intervention program conducted. Aim: To know characteristics of motoric growth and development in children with Down Syndromes and factors interfere degree of gross motoric development which to determine children?s capability, needs therapy, and improves quality of service. Methods : A descriptive cross-sectional study was conducted to 103 children with Down Syndromes aged 6 months ? 3 years old in Pediatrics Outpatient Clinics and Medical Rehabilitation Outpatient Clinics of Rumah Sakit Cipto Mangunkusumo (RSCM) during August to September 2015. Data were obtained by their parents (auto-anamnesis) and medical records, anthropometric data comprised body weight, body height, and head circumference which were plotted to special growth curve of children with Down Syndromes, gross motoric developments were assessed by special milestone of children with Down Syndromes. Results : One hundred and three subjects were fulfilled as inclusion criterions. Median subject was twelve months. Amount of subjects with good nutrition and malnutrition were equal. Subjects with microcephaly were 10 (9.6%). Children with classical type of Down Syndromes were 99(96%) and translocation type were 4(3.9%). Children with mild motoric development were 69.2%, intermediate motoric development were 16.3%, and severe motoric development were 13.5%. Multivariate analysis showed risk factors correlates to motoric development were head circumference (p=0,011; OR 6,852; CI 95% 1,565-30,038), history of asphyxia (p=0,009; OR 4,033; CI 95% 1,427-11,4), and frequency of stimulation programs (p=0,006; OR 3,845; CI95% 1,460-10,125). Conclusion : Head circumference, history of asphyxia, and frequency of stimulation programs were risk factors of motoric development in children with Down Syndromes. ;Background : Down Syndrome is one of genetics disease that could cause delayed motoric, language, cognitive, and psycho-social development. Development of the first three years of life is crucial, because it is a basic for further development. Until recently, there are not study which conducted to correlates motoric capabilities Down Syndromes patients to factors that interfere its. In Indonesia, prevalence of child with Down Syndromes is quite high, there are no data depicted that correlation;hence, this study was conducted in child with Down Syndromes so that they obtained optimal outcome from intervention program conducted. Aim: To know characteristics of motoric growth and development in children with Down Syndromes and factors interfere degree of gross motoric development which to determine children?s capability, needs therapy, and improves quality of service. Methods : A descriptive cross-sectional study was conducted to 103 children with Down Syndromes aged 6 months ? 3 years old in Pediatrics Outpatient Clinics and Medical Rehabilitation Outpatient Clinics of Rumah Sakit Cipto Mangunkusumo (RSCM) during August to September 2015. Data were obtained by their parents (auto-anamnesis) and medical records, anthropometric data comprised body weight, body height, and head circumference which were plotted to special growth curve of children with Down Syndromes, gross motoric developments were assessed by special milestone of children with Down Syndromes. Results : One hundred and three subjects were fulfilled as inclusion criterions. Median subject was twelve months. Amount of subjects with good nutrition and malnutrition were equal. Subjects with microcephaly were 10 (9.6%). Children with classical type of Down Syndromes were 99(96%) and translocation type were 4(3.9%). Children with mild motoric development were 69.2%, intermediate motoric development were 16.3%, and severe motoric development were 13.5%. Multivariate analysis showed risk factors correlates to motoric development were head circumference (p=0,011; OR 6,852; CI 95% 1,565-30,038), history of asphyxia (p=0,009; OR 4,033; CI 95% 1,427-11,4), and frequency of stimulation programs (p=0,006; OR 3,845; CI95% 1,460-10,125). Conclusion : Head circumference, history of asphyxia, and frequency of stimulation programs were risk factors of motoric development in children with Down Syndromes.

Abstrak :
ABSTRAK
Perkembangan anak merupakan sesuatu yang bersifat multi dimensi dan terdiri atas area kognitif, bahasa, fungsi gerak, sosial emosional dan perilaku adaptif, masing-masing memiliki nilai tersendiri namun saling berintegrasi. Dua metode stimulasi (Glenn Doman (GD) dan Kemenkes (K)) dinilai kualitasnya dalam penelitian ini. Tujuan.Mengetahui pengaruh perbedaan stimulasi metode GD dan K terhadap skor perkembangan bayi usia 6-12 bulan. Metode.Penelitian kohort prospektif pada bayi normal.Skrining perkembangan awal dilakukan menggunakan alat ukur Denver.Pasca 3 bulan intervensi, perkembangan bayi dinilai menggunakan BSID edisi-III yang terlebih dahulu dilakukan uji validitas dan reliabilitas.Kualitas stimulasi rumah di nilai menggunakan alat ukur HOME. Hasil.Skor validitas dari BSID edisi-III adalah 0,964 (kognitif), 0,934 (bahasa), 0,822 (gerak) dengan Cronbach Alpha sebesar 0,918 serta reliabilitas test-retest 0,846. Subjek yang memenuhi kriteria sebanyak 88 orang, dengan jenis kelamin laki-laki (61,4%), usia 9-12 bulan (68,2%), status gizi baik (75%). Perbedaan bermakna terdapat pada skor HOME dan semua aspek penilaian perkembangan BSID di kedua grup setelah masa intervensi 3 bulan (p<0,001). Skor grup GD lebih unggul 1 angka dibandingkan K pada skor HOME (p=0,024) and 32 angka lebih unggul pada skor BSID (p=0,002). Faktor jumlah anak bermakna secara statistik memengaruhi perkembangan dengan risiko relative 3.13 (IK 95% 1.18- 8.33, p=0,022). Simpulan.Instrumen BSID edisi-III versi Bahasa Indonesia merupakan alat ukur yang sahih dan andal untuk digunakan pada penelitian ini. Secara umum tidak terdapat perbedaan skor perkembangan bayi usia 6-12 bulan yang mendapat stimulasi metode GD dan K kecuali perkembangan perilaku adaptif.

---

ABSTRACT
Child development is multi-dimensional and encompasses cognitive, language, sensory-motor, social-emotional, adaptive behavior domains, all of which are interdependent. Two stimulation interventions (Glenn Doman (GD) and Kemenkes (K) methods) were conducted in this study. Aims.To investigate the difference in developmental aspects after intervention with GD and K methods in infants age 6-12 months. Methods. This was a prospective cohort study in normal developmental infants. Developmental screening at enrollment used Denver instrument. Three months post intervention, the development was assessed with BSID III, in which validation and reliability test were undertaken as first step. A modified version of HOME inventory was used as edition to assess home environment. Results.The validity score of BSID-III was 0.964 (cognitive), 0.934 (language), 0.822 (motor) with Cronbach alpha of 0.918 and a reliability test-retest of 0.846. There were 88 subjects fulfilled the criteria. Subject mostly were male (61.4%) 9- 12 months old (68.2%), normal anthropometric status (75%). The results revealed significant differences in HOME score and all aspects of Bayley score in GD and K group after 3 months intervention period (p<0.001). The GD benefited 1 point compared with K group in HOME score (p=0.024) and 32 points in Bayley score (p=0.002). Number of children was the most influential factor in infants’ development with a relative risk of 3.13 (CI95% 1.18-8.33, p=0.022). Conclusions.The Bahasa Indonesia version of BSID-III was a reliable and valid tool for the assessment of this study. There was no difference in developmental score at age 6-12 months who had GD and K stimulation methods except for adaptive behavior scale.

Abstrak :
Hidrosefalus adalah kelainan susunan saraf pusat yang ditandai dengan pelebaran sistem ventrikel. Diperlukan data mengenai ukuran ventrikel serebral normal sebagai batas ambang untuk mendiagnosis pelebaran ventrikel serebral awal. Tujuan penelitian ini untuk mengetahui ukuran ventrikel serebral neonatus aterm normal dan melihat gambaran korelasi parameter pengukuran ventrikel serebral. Penelitian dilakukan terhadap 55 neonatus aterm normal menggunakan modalitas ultrasonografi untuk mendapatkan ukuran ventrikel serebral. Data kuantitatif yang diperoleh dihitung nilai rerata dan digunakan analisis bivariat Pearson/ Spearman untuk melihat gambaran korelasi parameter ukuran ventrikel serebral. Didapatkan rerata ukuran lebar kornu anterior ventrikel lateralis, indeks ventrikel, lebar ventrikel III, jarak talamo-oksipital dan ukuran ventrikel IV. Terdapat korelasi bermakna (p<0,05) antara: lebar kornu anterior kanan dengan indeks ventrikel kanan dengan arah korelasi positif dan kekuatan korelasi sedang (r= 0,506) dan lebar kornu anterior kiri dengan indeks ventrikel kiri dengan arah korelasi positif dan kekuatan korelasi sedang (r=0,488). Tidak terdapat korelasi bermakna (p>0,05) antara : lebar kornu anterior ventrikel lateralis kanan dengan jarak talamo-oksipital kanan dan dari lebar kornu anterior ventrikel lateralis kiri dengan jarak talamo-oksipital kiri. Rerata ukuran ventrikel serebral neonatus aterm normal: lebar kornu anterior ventrikel lateralis 1,50 mm (0,8-3,00 mm); indeks ventrikel 6,52 mm (3,39-12,10 mm); lebar ventrikel III 1,87 mm (0,93-3,80 mm); jarak talamo oksipital 14,82 ±1,69 mm dan ukuran ventrikel IV 4,06 ± 0,53 mm. Ukuran kornu anterior ventrikel lateralis yang besar biasanya disertai indeks ventrikel yang besar pula. Tidak terdapat korelasi antara lebar kornu anterior ventrikel lateralis dengan jarak talamo-oksipital. ...... Cerebral ventricular dilation is a sign of hydrocephalus. Late diagnosis and late treatment of hydrocephalus can cause parenchymal damage and even death. To diagnose early dilation of cerebral ventricles in neonates required data of the size of the cerebral ventricles as the normal threshold. The purpose of this study was to determine the size of the cerebral ventricles of normal full-term neonates and the correlation parameter ventricular measurement. Study of 55 normal full-term neonates by ultrasonography to establish measurement of parameters ventricular. Quantitative data were obtained calculated mean values and to determinate the correlation parameter cerebral ventricle measurements used bivariate analysis Pearson/ Spearman. Data obtained cerebral ventricular size parameters consisting of the anterior horn width lateral ventricle, ventricular index, the width of the third ventricle, talamo-occipital distance and the size of the fourth ventricle in healthy full-term neonates. There was significant (p <0.05) positive and moderate correlation between: right anterior horn width lateral ventricle with right ventricular index (r = 0.506) as well as left anterior horn width lateral ventricle with left ventricular index (r = 0.488). There were no significant correlation (p> 0.05) between: right anterior horn width lateral ventricle with right talamo-occipital distance and left anterior horn width lateral ventricle with left talamo-occipital distance. The mean size of the cerebral ventricles of healthy full-term neonates are: anterior horn width of the lateral ventricle 1.50 mm(0.8 to 3.00 mm); ventricular index 6.52 mm (3.39 to 12.10 mm); third ventricular width 1.87 mm (0.93 to 3.80 mm); Talamo-occipital distance 14.82 ± 1.69 mm and 4.06 ± fourth ventricle size of 0.53 mm. The greater width of the anterior horn of the lateral ventricle is usually accompanied by greater the ventricular index. There is no correlation between anterior horn width lateral ventricle with the talamo-occipital distance.

Abstrak :
[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.]

Abstrak :
ABSTRAK
Latar belakang: Thalassemia merupakan kelainan genetik terbanyak di dunia, termasuk Indonesia. Pasien thalassemia mayor berisiko mengalami gangguan fungsi neurokognitif akibat anemia kronik dan penumpukan besi. Tujuan: mengetahui prevalens abnormalitas hasil EEG dan tes IQ, menganalisis faktor-faktor yang diduga berhubungan dengan gangguan fungsi neurokognitif pada anak dengan thalassemia mayor usia saat diagnosis, lama transfusi, pendidikan pasien, rerata Hb pra-transfusi, kadar feritin serum, saturasi transferin, dan komplians terhadap obat kelasi besi , serta untuk mengetahui apakah gangguan neurokognitif dapat memengaruhi fungsi sekolah. Metode: Penelitian potong lintang deskriptif analitik antara April 2016-April 2017. Pengukuran tes IQ menggunakan WISC-III. Hasil: Total subyek adalah 70 anak thalassemia mayor berusia antara 9 hingga 15,5 tahun. Prevalens hasil EEG abnormal adalah 60 dan prevalens skor IQ abnormal

---

ABSTRACT
Background Thalassemia is the most common hereditary disorders worldwide, including Indonesia. Chronic anemia and iron overload in thalassemia major lead to several risk factors including neurocognitive problems. Aim To investigate the prevalence of abnormal EEG and IQ test, to identify the factors related to neurocognitive function in children with thalassemia major age at diagnosis, years of transfusion, patients education, pre transfusion haemoglobin level, ferritin, transferrin saturation, and compliance to chelation , and to identify whether neurocognitive dysfunction affects child rsquo s school performance. Methods A cross sectional descriptive analitic study. Subjects were recruited from April 2016 April 2017. Cognitive function assessed by the WISC III. Results A total 70 children aged from 9 to 15.5 years old were recruited. The prevalence of abnormal EEG and abnormal IQ score

Abstrak :
ABSTRAK
Latar Belakang. Anak epilepsi dengan usia awitan di atas lima tahun merupakan kelompok dengan karakteristik epidemiologis dan klinis khas yang mungkin memiliki faktor risiko resistensi terhadap obat anti epilepsi OAE spesifik. Penelitian mengenai resistensi obat pada kelompok usia ini masih sedikit. Tujuan. Mengidentifikasi faktor risiko resistensi OAE pada anak epilepsi dengan usia awitan di atas lima tahun. Metode. Dilakukan penelitian kasus kontrol terhadap anak epilepsi dengan usia awitan di atas lima tahun yang berobat di poliklinik RS Cipto Mangunkusumo dan Mohammad Hoesin bulan Agustus-September 2016. Kelompok kasus adalah anak yang resisten OAE sedangkan kelompok kontrol adalah anak responsif OAE berdasarkan klasifikasi ILAE 2010. Faktor risiko yang diteliti yaitu awitan, jumlah kejang dan lama sakit sebelum berobat, etiologi, jenis kejang, status epileptikus, gambaran EEG awal, evolusi EEG, pencitraan otak dan respon awal terapi. Hasil. Sebanyak 32 pasang anak ikut dalam penelitian. Setelah analisis regresi logistik, faktor yang ditemukan berhubungan dengan resistensi OAE adalah etiologi simtomatik adjusted OR 84,71; IK 95 5,18-1359,15 dan respon awal pengobatan tidak baik adjusted OR 72,55; IK 95 7,08-743,85 . Simpulan. Etiologi simtomatik dan respon awal pengobatan tidak baik merupakan faktor risiko resistensi terhadap OAE pada anak epilepsi dengan usia awitan di atas lima tahun yang bersifat independen.

---

Background. Epileptic children with onset above five years encompass distinct epidemiological and clinical characteristics that may have specific risk factors for resistance to anti epileptic drugs AED . Studies on this age group are limited. Objective. To identify risk factors for drug resistance in epileptic children with age of onset above five years. Methods. A case control study was conducted on epileptic children with onset above five years visiting Pediatric Neurology clinic of Cipto Mangunkusumo and Mohammad Hoesin Hospital between August and September 2016. Cases consisted of drug resistant children while control consisted of drug responsive children according to 2010 ILAE classification. Risk factors studied include onset, number of seizures and illness duration before treatment, cause, seizure type, status epilepticus, initial EEG and evolution of EEG, brain imaging, and initial treatment response. Results. Thirty two pairs of children were included in the study. After logistic regression analysis, symptomatic etiology and failure to achieve early response to treatment were found to be associated with drug resistance with adjusted OR 84.71 95 CI 5.18 1359.15 and 72.55 95 CI 7.08 743.85 respectively. Conclusion. Poor initial response to AED and symptomatic etiology are independent risk factors for drug resistance in epileptic children with age of onset above five years.

Abstrak :
Kemampuan makan dan menelan pada anak bersifat dinamis sejalan dengan proses tumbuh kembang anak. Struktur anatomi mengalami pertumbuhan yang selanjutnya berdampak pada kematangan fungsi menelan. Gangguan pada proses menelan menyebabkan disfagia. Tesis ini membahas mengenai gambaran proses menelan pada anak dengan kecurigaan disfagia, dengan menggunakan pemeriksaan menelan dengan endoskopi serat optik lentur, serta menilai karakteristik percontoh berdasarkan usia, masa kehamilan, pengasuh, gejala, komplikasi serta kelainan medis. Penelitian ini adalah penelitian potong lintang dengan desain deskriptif pada 54 subyek yang diambil secara berurutan. Hasil dari penelitian ini didapatkan prevalensi disfagia pada anak dengan kecurigaan kesulitan makan sebesar 63 . Gejala disfagia pada anak le; 6 bulan yang paling sering adalah apnea saat menyusu 7/34 . Sedangkan pada anak > 6 bulan adalah postur tubuh terganggu 10/34 , mengeces berlebih 6/34 , dan batuk saat makan 8/34 . Kelainan medis yang mendasari adalah kelainan struktural 25/34 , kelainan jantung / paru / laring 24/34 , dan kelainan neurologis 23/34 . Komplikasi yang terjadi adalah PRGE 12/34 , gagal tumbuh 10/34 , dan pneumonia aspirasi 3/34 . Pada pemeriksaan FEES didapatkan standing secretion 22/34 dan pergerakan lidah terganggu 20/34 adalah tanda yang sering ditemukan pada anak disfagia; dan residu sering terjadi pada konsistensi tim kasar 44,7 , penetrasi pada konsistensi air 44,2 , serta aspirasi pada konsistensi susu 34,8 .Kata kunci: aspirasi, disfagia, pemeriksaan menelan dengan endoskopi serat optik lentur, penetrasi, residu, sekret yang terkumpul di hipofaring.

---

Eating and swallowing ability in Children had dynamic characteristic and closely related with growth process in themselves. The anatomical structure underwent growth process, therefore had impact in the maturity of swallowing ability. Disruption of swallowing process may caused dysphagia. This study use Flexible Endoscopic Evaluation of Swallowing FEES and also assessed the characteristics of the subjects based on age, gestation age, caregivers, symptom, complication, and medical disorder. This study is a descriptive cross sectional design involving 54 subjects with consecutive sampling. The result of this study are prevalence of dysphagia is 63 in children with dysphagia suspicion. Dysphagia symptom in children 6 months, apnea while bottle breast feeding 7 34 . Meanwhile, in children 6 months, postural impairment 10 34 , drooling 6 34 , and cough while eating 8 34 . Underlying disease are structural anomaly 5 34 , cardiopulmonary larynx disorder 24 34 and neurological disorder 23 43 . The complication are GERD 12 34 , failure to thrive 10 34 , and aspiration pneumonia 3 34 . In FESS examination, standing secretion 22 34 and impaired tongue movement 20 34 are sign for dysphagia, and residue is more common in gastric rice consistency 44,7 while penetration in thin liquid 44,2 and aspirations is more common in thick liquid 34,8.

Abstrak :
ABSTRAK
Pemakaian obat anestetika inhalasi sevofluran terbukti meningkatkan angka kejadian delirium emergens terutama pada anak. Delirium emergens yang terjadi pascapajanan dengan anestesia inhalasi merupakan kejadian tidak diharapkan yang dapat membahayakan keselamatan pasien dan pada akhirnya meningkatkan biaya perawatan. Mekanisme kerja sevofluran pada sel saraf menyebabkan kadar kalsium intrasel meningkat. Penelitian ini adalah penelitian invitro yang meneliti kejadian delirium emergens pada hewan coba dan invivo dengan mengkaji fisiologi kelistrikan sel, konsentrasi kalsium intrasel dan peran magnesium.Setelah mendapat persetujuan dari Komite Etik Penelitian FKUI, anak tikus Sprague-Dawley berusia 2 ndash;5 minggu yang memenuhi kriteria penerimaan diberikan pajanan dengan obat anestetika sevofluran. Satu kelompok mendapatkan suntikan magnesium sulfat intraperitoneal setelah induksi anestesia. Setelah pajanan anestesia dihentikan diamati kejadian hipereksitasi yang terjadi, kemudian tikus didekapitasi dan dibuat sediaan irisan jaringan otak tikus untuk diperiksa menggunakan patch clamp dengan metode cell-attached current clamp dan voltage clamp. Sebagian irisan jaringan otak tikus juga diberikan pewarna sensitif kalsium Fura-Red AM, yang memiliki sifat rasiometri sehingga memungkinkan untuk dilakukan pengukuran kadar kalsium intrasel secara kuantitatif. Sisa jaringan otak tikus diproses menjadi homogenat untuk pemeriksaan reaksi inflamasi NF?B dan stress oksidatif Malondialdehyde.Angka kejadian perilaku eksitasi pascapajanan sevofluran pada hewan coba sebesar 9 dari 15 ekor tikus dan tidak terdapat perilaku eksitasi pada kelompok yang mendapatkan magnesium sulfat. Hasil pemeriksaan reaksi inflamasi dan stres oksidatif menunjukkan nilai rerata normal. Hewan coba yang mengalami delirium emergens memiliki kadar kalsium sitosol yang lebih tinggi dibandingkan kelompok yang tidak mengalami delirium emergens dan kelompok yang mendapat magnesium sulfat, namun perbedaannya tidak memiliki kemaknaan statistik. Hasil perekaman dengan menggunakan patch clamp metode cell attached current clamp dan voltage clamp memperlihatkan angka yang lebih tinggi pada kelompok yang mengalami delirium emergens, walaupun masih dalam rentang normal.Terdapat peningkatan konsentrasi Ca2 sitosol sel neuron neokortikal anak tikus Sprague-Dawley dengan potensial membran istirahat yang lebih tinggi pada saat pajanan dengan gas anestetika sevofluran dihentikan dan mengalami delirium emergens. Pemberian magnesium sulfat terbukti mencegah terjadinya delirium emergens pada hewan coba.

---

Sevoflurane has been proven to increase the event of emergence delirium. The increase in cytosol calcium level post sevoflurane anaesthesia may play role in emergence delirium. This study reviews the level of intracellular calcium in rats experiencing hyperexcitatory behaviour after being exposed to sevoflurane; also the role of magnesium in preventing hyperexcitatory behaviour after sevoflurane exposure in rats.After ethical approval, 2 ndash;5 week old Sprague-Dawley mice were insufflated with sevoflurane in a modified anaesthesia chamber. A group of rats were randomnly chosen to receive MgSO4 administration intraperitoneally. After the exposure to sevoflurane was stopped, we observe the event of hyperexcitation. Preparations from the rats rsquo; brain tissue were done for measurement of its cell membrane electricity using patch clamp method, intracellular calcium level quantitatively using Fura Red AM, and the presence of inflammation or oxidative stress reaction using NF?B and MDA.The incidence of hyperexcitatory behaviour post sevoflurane exposure was 52.6 in the observation group and none in the group receiving MgSO4. The assay for inflammation and oxidative stress were averaging normal. Rats showing hyperexcitation showed a statistically significant higher level of cytosol calcium concentration compared to other groups. The recording for cell attached patch clamp method showed a higher resting membrane potential in group with hyperexcitatory behaviour, though still within normal range.There is an increase in neurocortical neurons calcium concentration with a higher resting membrane potential in Sprague-Dawley rats experiencing hyperexcitatory behaviour after being exposed to sevoflurane. The administration of MgSO4 can prevent the event of hyperexcitation in experimental animals.