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Abstrak :
Latar Belakang : Sindroma Guillain Barre SGB , menyebabkan pasien gagal napas dan memerlukan perawatan dan pengawasan di unit ruang rawat intensif. Beberapa faktor risiko dipikirkan terhadap terjadinya gagal napas pada SGB, berdasarkan gejala klinis yang timbul saat pasien masuk rumah sakit. Metode : Penelitian ini berdesain potong lintang dengan mengambil data sekunder dari pasien SGB yang menjalani perawatan inap di RSUPNCM sejak Januari 2010-Mei 2018. Data dianalisa dan dilakukan penghitungan dengan multivariat regresi logistik. Hasil : Sebanyak 59 pasien memenuhi kriteria inklusi. Insiden terjadinya gagal napas pada pasien SGB sebesar 25. Kelemahan bulbar OR 26,964; IK 95 2,050-354,616 , disotonomia OR 71,646;IK 3,039-1689,312, dan total skor Medical Research Council MRC OR 0,871; IK 95 0,776-0,978 merupakan 3 variabel yang secara independen berisiko tinggi untuk terjadinya gagal napas pada SGB. Faktor risiko yang tidak berhubungan secara bermakna terhadap kejadian gagal napas adalah usia, riwayat antesenden infeksi, durasi awitan hingga admisi, arefleksia, kelemahan fasial, oftalmopegia, dan tipe patologi SGB. Kesimpulan : Kelemahan bulbar, disotonomia dan total skor MRC merupakan faktor risiko untuk terjadinya gagal napas pada pasien SGB dan disarankan agar mendapatkan perawatan di Intensive Care Unit ICU.

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Background Guillain Barre Syndrome GBS may cause respiratory insufficiency and requires care and supervision in the Intensive Care Unit. Several risk factors are thought to be the occurrence of respiratory failure in GBS, based on clinical characteristics at hospital admission. Methods: A cross sectional study was conducted by taking secondary data from GBS patients who were admitted to the Cipto Mangunkusumo hospital from January 2010 to May 2018. Data were analyzed and calculated by multivariate logistic regression. Results: A total of 59 patients met the inclusion criteria. The incidence of respiratory failure in GBS patients was 25 . Bulbar weakness OR 26,964 95 CI 2,050 354,616 , dysotonomia OR 71,646 95 CI 3,039 1689,312 , and total score of Medical Research Council MRC OR 0,871 95 CI 0,776 0,978 are 3 variables that are independently high risk for the occurrence of respiratory failure in GBS. Risk factors that are not significantly associated with respiratory failure are age, antecedent infection history, duration of onset to admission, areflexia, facial weakness, ophthalmopegia, and type of GBS pathology. Conclusions: Bulbar weakness, dysotonomia and total MRC score were risk factors for respiratory failure in GBS patients and were advised to receive treatment in the Intensive Care Unit ICU.

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ABSTRAK
Latar belakang: Nilai normal Kecepatan Hantar Saraf KHS pada saraf perifer, dipengaruhi oleh faktor-faktor fisiologis, antara lain usia, tinggi badan dan indeks massa tubuh, dan faktor non fisiologis seperti teknik pengukuran dan suhu. Referensi nilai normal tiap laboratorium elektrofisiologi berbeda-beda, sehingga dibutuhkan penelitian untuk memperoleh referensi nilai normal KHS yang sesuai dengan populasi di Indonesia, khususnya di RSUPN dr. Cipto Mangukusumo Jakarta..Metode:Penelitian ini merupakan penelitian prospektif. Responden sehat didapatkan sesuai kriteria inklusi dan eksklusi diambil secara concecutive, usia 18-60 tahun sebanyak 210 subyek. Dilakukan penapisan neuropati perifer dengan wawancara dan kuesioner Brief Peripheral Neuropathy Screening Tool BPNS Tool . Subyek yang memenuhi persyaratan dilakukan pemeriksaan Kecepatan Hantar Saraf KHS motorik dan sensorik pada ekstremitas atas dan bawah, meliputi n.medianus, n.ulnaris, n.radialis, n.peroneus, dan n.suralis. Hasil:Didapatkan sebanyak 210 dari 215 subyek yang memenuhi kriteria inklusi. Subyek penelitian terdiri dari 91 sampel ekstremitas laki-laki dan 119 sampel perempuan. Subjek diambil pada usia dewasa rentang 18-60 tahun, dengan nilai tengah 33 tahun. Subyek terbanyak usia 31-40 tahun, sebanyak 68 sampel 32,4 , jenis kelamin wanita sebanyak 119 sampel 56,7 . Usia subyek dengan nilai tengah 33 22,0-53,4 tahun, dengan tinggi badan subyek 1,6 1,49;1,74 m, dan nilai tengah indeks massa tubuh IMT 24.84 18,5- 31,3 kg/m2.Nilai kecepatan hantar saraf KHS digunakan nilai tengah, dengan batas bawah persentil lima dan batas atas persentil sembilan puluh lima. Nilai KHS motorik pada n.medianus 60 50;73,2 m/det, n.ulnaris 66,6 53;80 m/det, pada n.radialis 67 48,1; 81,8 m/det. n.peroneus 55 39,6;69,8 m/det, n.tibialis 59,5 46,5;75 m/det. Hasil pemeriksaan sensorik, didapatkan KHS sensorik pada n.medianus 66,3 49,6;83 m/det, n.ulnaris 52 41,5;70 m/det, n.radialis 46,7 38,4: 59 m/det. n.peroneus superfisialis 62 44;82 m/det, pada n.suralis 62 48;79 m/det. Kesimpulan:Nilai normal kecepatan hantar saraf motorik pada n.medianus ge;50 m/det, n.ulnaris ge;53 m/det, n.radialis ge;48 m/det, n.peroneus ge;40 m/det, n.tibialis ge;46 m/det. Nilai normal kecepatan hantar saraf KHS pada saraf sensorik pada n.medianus ge; 50 m/det, n.ulnaris ge; 41 m/det, n.radialis ge;38 m/det, n.peroneus superfisialis ge;44 m//det, n.suralis ge;48 m/det.

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ABSTRACT<>br> Background The normal value of nerve conduction velocity NCV in peripheral nerves, is influenced by physiological factors, including age, height and body mass index, and non physiological factors such as measurement and temperature techniques. Reference to the normal values of each electrophysiological laboratory is different, so research is needed to obtain references to normal NCV values that are appropriate to the population in Indonesia, especially in dr. Cipto Mangunkusumo Hospital Jakarta. Method This research is a prospective study. Healthy respondents were obtained according to the inclusion and exclusion criteria were taken concecutive, aged 18 60 years as many as 210 subjects.Peripheral neuropathy screening was performed by interview and questionnaire of the Brief Peripheral Neuropathy Screening Tool BPNS Tool . Subjects meeting the requirements were examined for motor and sensory velocity NCV at the upper and lower extremities, including n.medianus, n.ulnaris, n.radialis, n.peroneus, and n.suralis. Result There were 210 out of 215 subjects who met the inclusion criteria. The subjects consisted of 91 samples of male limbs and 119 female samples. Subjects were takenat an adult age range of 18 60 years, with a median of 33 years. Most subjects aged 3140 years, as many as 68 samples 32.4 , gender of women as much as 119 samples 56.7 . Age of subjects with a mean of 33 22.0 53.4 years, with a subjectheight of 1.6 1.49, 1.74 m, and a median body mass index IMT of 24.84 18.5 31.3 kg m2.The value of nerve conduction velocity NCV is used in the middle value, with thelower limit of the fiveth percentile and the upper limit of the ninety five percentile.The value of motor KHS at n.medianus 60 50 73,2 m s, n.ulnaris 66.6 53 80 m s, on n.radialis 67 48,1,81,8 m det. n.peroneus 55 39,6,69,8 m s, n.tibialis 59,5 46,5,75 m s. The results of sensory examination, obtained sensory KHS atn.medianus 66.3 49.6 83 m s, n.ulnaris 52 41,5 70 m s, n.radialis 46,7 38.4 59 m s. n.peroneus superfisialis 62 44 82 m s, on n.suralis 62 48 79 m s. Conclusion The normal value of motor neural conduction velocity in n.medianus ge 50 m s, n.ulnaris ge 53 m s, n.radialis ge 48 m s, n.peroneus ge 40 m s, n.tibialis 46 m s. In the sensory nerves is obtained nerve velocity n.medianus ge 50 .m s, n.ulnaris ge 41 m s, n.radialis ge 38 m s, n.peroneus superfisialis ge 44 m s, n.suralis ge 48 m s.

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Latar Belakang. Epilepsi lobus temporal (ELT) merupakan salah satu sindrom epilepsi yang paling banyak ditemukan dengan proporsi mencapai 20% dari seluruh pasien dengan epilepsi. Sebanyak lebih dari 50% pasien ELT tidak berespon dengan pemberian obat anti bangkitan (OAB) monoterapi pertama kali, sehingga akan memerlukan penggantian bahkan hingga kombinasi dengan 2 atau lebih OAB. Tujuan dari pemberian OAB pada pasien ELT selain untuk mengontrol bangkitan dengan efek samping yang minimal adalah untuk memperbaiki kualitas hidup pada pasien. Berbagai faktor terkait dengan penggunaan OAB dapat berhubungan dengan kualitas hidup pasien dan tujuan dari studi ini adalah untuk menilai lebih lanjut hubungan tersebut. Metode. Studi ini merupakan studi potong lintang yang dilakukan pada April hingga Desember 2023 di RSUPN Cipto Mangunkusumo Jakarta. Kriteria inklusi pada penelitian ini meliputi pasien yang sudah terdiagnosis ELT oleh dokter spesialis neurologi, berusia 18 tahun atau lebih, dan telah menggunakan regimen OAB yang sama selama 1 bulan terakhir. Kriteria eksklusi penelitian ini meliputi pasien dengan epilepsi multifokal serta tidak dapat melengkapi pengisian instrumen penilaian kualitas hidup yaitu Quality of Life in Epilepsy Inventory-31 (QOLIE-31) secara mandiri. Penelitian ini telah mendapatkan ijin etik dari Komite Etik Kedokteran, Fakultas Kedokteran Universitas Indonesia. Hasil. Sebanyak total 100 subjek berpartisipasi pada studi ini dengan sebagian besar berjenis kelamin perempuan (58%) dengan median usia 30 (18-65) tahun. Mayoritas pasien ELT memiliki etiologi sklerosis hipokampus dan frekuensi bangkitan dalam 1 bulan yaitu dengan median 1 (0-34) kali. Sebanyak 70% subjek menggunakan regimen politerapi dengan kombinasi 2 jenis obat menempati proporsi terbanyak (41%). Penggunaan OAB generasi lama lebih banyak dibandingkan dengan generasi baru. Rerata skor kualitas hidup total pada subjek yaitu 61.46 (±1.63). Penggunaan karbamazepin diketahui secara independen berhubungan dengan skor kualitas hidup total yang lebih baik serta utamanya pada domain kekhawatiran akan bangkitan dan fungsi sosial. Penggunaan topiramat didapatkan berhubungan dengan rendahnya skor kualitas hidup pada domain kognitif, efek pengobatan, dan fungsi sosial. Didapatkan pula hubungan yang bermakna pada penggunaan levetirasetam dengan rendahnya skor kualitas hidup pada domain tingkat energi/kelelahan. Kesimpulan. Penggunaan politerapi merupakan praktik yang sering didapatkan pada pasien dengan ELT. Beberapa faktor terkait pemilihan OAB pada pasien diketahui berhubungan dengan kualitas hidup secara keseluruhan maupun pada beberapa domain spesifik. Penting untuk klinisi dapat mempertimbangkan faktor kualitas hidup pasien sebelum menentukan pemberian OAB yang terbaik. ......Background. Temporal lobe epilepsy (TLE) is one of the most common epilepsy syndrome encountered in daily clinical practice with more than 20% proportion out of all epilepsy population. More than 50% of TLE patients do not respond well with the first antiepileptic drug (AED) and required switching or even addition with two or even more drugs. The goal of AED administration should not only be focused on seizure control and minimizing the adverse drug reaction, rather also to consider patients’ quality of life. Multiple factors related to AED administration was known to affect patients’ quality of life, and so the purpose of this study is to assess that relationship in Indonesian ELT population. Methods. This is a cross-sectional study conducted on April to December 2023 in Cipto Mangunkusumo National Referral Hospital. The inclusion criteria for this study were patient diagnosed with TLE by a neurologist, aged 18 or above, and had been using the same AED regimen for at least the last month. The exclusion criteria were multifocal epilepsy as well as patients who could not completed the quality of life questionnaire QOLIE-31 independently. This study had gain ethical approval form Ethical Commission, Faculty of Medicine, Universitas Indonesia Result. A total of 100 subjects were recruited in this study, most of them were female (58%) with the median age of 30 (18-65) years old. The majority of patients had hippocampal sclerosis as the etiology and the seizure frequency during the last month had the median score of 1 (0-34) times. As many as 70% of the subjects were using polytherapy with most of them were using 2 kind of AED. The mean total score for QOLIE-31 was 61.46 (±1.63) out of 100. Several factors related to AED administration were known to be associated with the quality of life. The use of carbamazepine was independently associated with a better total score of QOLIE-31, especially in the seizure worry and social function domain. Topiramate administration was also associated with the lowering of quality of life score in cognitive, medication effect, and social effect domain. There is also a statistically significant association between levetiracetam consumption and the low score in energy domain. Conclusion. The use of polytherapy was vastly encountered in the clinical practice for TLE patients. Several factors of AED selection were associated with the overall quality of life and to some extend in several specific domain. It is crucial for clinical to also consider the quality of life as determining factor for choosing the appropriate AED for every patients.

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Latar belakang : Insomnia merupakan gangguan tidur yang sering dialami pascatrauma kepala, tetapi faktor yang berhubungan dengan insomnia belum banyak diketahui. Penelitian ini bertujuan mengetahui prevalensi insomnia pascatrauma kepala dan faktor yang berhubungan. Metode penelitian: Desain penelitian potong lintang deskriptif menggunakan Pittsburgh Sleep Quality Index (PSQI) versi Bahasa Indonesia pada pasien pascatrauma kepala di Poliklinik Neurologi RSUPN Ciptomangunkusumo, RSUD Pasar Rebo dan RSPAD Gatot Soebroto selama bulan Maret-Mei 2016 dengan onset minimal tiga bulan. Faktor yang dianalisis adalah derajat keparahan trauma kepala, gambaran CT-Scan kepala, derajat nyeri kepala, gangguan depresi dan ansietas. Derajat keparahan trauma kepala dinilai berdasarkan skala koma Glasgow, lamanya pingsan, lamanya amnesia pascatrauma dan CT-Scan kepala. Insomnia ditetapkan jika skor PSQI >8. Nyeri kepala dinilai dengan numeric rating scale, gangguan depresi dan ansietas dinilai dengan Mini Internasional Neuropsychiatric Interview Version ICD-10 (MINI ICD-10). Hasil : Diantara 70 orang subjek pascatrauma kepala, didapatkan prevalensi insomnia sebesar 33%. Subjek cedera kepala berat (31%) memiliki risiko 3,4 kali mengalami insomnia dibandingkan cedera kepala ringan (42%) (IK 95% 1,072-10,806). Subjek dengan nyeri kepala sedang sampai berat (26%) memiliki risiko 5,78 kali mengalami insomnia dibandingkan subjek tanpa nyeri sampai nyeri kepala ringan (74%) (IK 95% 1,730-19,315). Tidak didapatkan hubungan antara gangguan depresi (9%), ansietas (3%) dengan insomnia. Kesimpulan : Insomnia banyak dijumpai pascatrauma kepala. Keluhan nyeri kepala sedang sampai berat, dan cedera kepala berat merupakan faktor yang berhubungan dengan insomnia

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ABSTRACT
Background : Insomnia is very common following traumatic brain injury (TBI), but the related factors with insomnia is less known. This study was aimed to determine the prevalence of insomnia after TBI and related factors. Methods : Cross-sectional descriptive study using Pittsburgh Sleep Quality Index (PSQI) Indonesian version on patients with history of TBI, with a minimum of three months since onset, in Neurology clinic of Cipto Mangunkusumo general hospital, Pasar Rebo general hospital and Gatot Soebroto Army hospital during March-May 2016. The analyzed factors consisted of: severity of TBI, head CT-Scan findings, severity of headache, depression, and anxiety disorders. Severity of TBI was assessed on Glasgow coma scale, duration of loss of consciousness, duration of post traumatic amnesia and head CT-Scan findings. Insomnia was determined if PSQI score > 8. Severity of headache was measured by numeric rating scale, depression and anxiety disorders were assessed based on Mini Internasional Neuropsychiatric Interview Version ICD-10 (MINI ICD-10). Results : Prevalence of insomnia among 70 subjects after TBI was 33%. Severe TBI subjects (31%) had 3.4 times the chance of developing insomnia compared to mild cases (42%) (CI 95% 1.072-10.806). Moderate-severe headache subjects (26%) had 5.78 times the risk of having insomnia compared to no headache-mild headache cases (74%) (CI 95% 1.730-19.315). No significant relation could be established between depression (9%), anxiety disorders (3%) with insomnia. Conclusion : Insomnia is common after TBI. Moderate-severe headache and severe TBI are the related factors of insomnia.

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Latar Belakang: Insidensi hiponatremia pada infeksi intrakranial sebesar 30-66%. Hiponatremia dapat memperburuk manifestasi neurologis infeksi intrakranial itu sendiri serta dikaitkan dengan peningkatan morbiditas dan mortalitas. Metode: Penelitian dengan studi potong lintang retrospektif untuk mengetahui karakteristik hiponatremia dan hubungannya dengan keluaran klinis pasien infeksi intrakranial di RSUPN Dr. Cipto Mangunkusumo (RSCM) pada April 2019 s/d Oktober 2021. Data dasar diambil dari Indonesian Brain Infection Study (IBIS) kemudian dilengkapi dari rekam medis. Subjek ≥18 tahun dengan diagnosis akhir infeksi intrakranial masuk kriteria inklusi, sedangkan data tidak lengkap dan tidak rawat inap masuk kriteria eksklusi. Hasil: Terdapat 296 subjek dengan mayoritas meningoensefalitis tuberkulosis (51,4%). Hiponatremia pada 66,6% subjek, terbagi menjadi derajat ringan (54%), sedang (24%) dan berat (22%). Hiponatremia banyak terjadi pada HIV positif (59,1%), komorbid penyakit paru (44,9%) dengan keluhan terbanyak sakit kepala (58,1%). Kematian terjadi pada (24,2%) subjek hiponatremia, dimana usia >60 tahun, komorbid, penyakit paru atau ginjal, hiponatremia berat dan status hiponatremia tidak terkoreksi berhubungan dengan kematian (p<0,05). Kesimpulan: Pada infeksi intrakranial, koinfeksi HIV berhubungan dengan kejadian hiponatremia. Tidak ditemukan perbedaan bermakna karakteristik hiponatremia terhadap mortalitas, status fungsional maupun durasi perawatan. Faktor yang berhubungan dengan mortalitas adalah usia, derajat hiponatremia, komorbiditas, dan status koreksi hiponatremia. ......ackground: The incidence of hyponatremia in intracranial infection is 30-66%. Hyponatremia can exacerbate the neurological manifestations of the intracranial infection itself and is associated with increased morbidity and mortality. Methods: This study was a retrospective cross-sectional study to determine the characteristics of hyponatremia and its relationship to the clinical outcome of patients with intracranial infections in Dr. Cipto Mangunkusumo (RSCM) from April 2019 to October 2021. Base data were taken from the Indonesian Brain Infection Study (IBIS) and completed from medical records. Subjects 18 years with a final diagnosis of intracranial infection were included in the inclusion criteria, while incomplete data and no hospitalization were included in the exclusion criteria. Results: There were 296 subjects with the majority of meningoencephalitis tuberculosis (51.4%). Hyponatremia in 66.6% of subjects was divided into mild (54%), moderate (24%), and severe (22%). Hyponatremia was common in HIV positive (59.1%), comorbid lung disease (44.9%) with headache as a common complaint (58.1%). Mortality occurred in (24.2%) hyponatremic subjects, where age >60 years, comorbidities, pulmonary or renal disease, severe hyponatremia, and uncorrected hyponatremic status were associated with mortality (p<0.05). Conclusion: In intracranial infection, HIV coinfection is associated with the incidence of hyponatremia. There were no significant differences in the characteristics of hyponatremia on mortality, functional status, and duration of treatment. Factors associated with mortality were age, degree of hyponatremia, comorbidities, and hyponatremia correction status.

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ABSTRAK
Latar belakang: Status epileptikus non konvulsivus SENK merupakan salah satu diagnosis banding pasien dengan penurunan kesadaran termasuk pada ensefalopati metabolik EM . Luaran pasien EM dengan SENK masih belum banyak diteliti.Metode penelitian: Penelitian ini bersifat observasional dengan disain potong lintang terhadap pasien EM dengan gambaran elektroensefalogram EEG SENK berdasarkan kriteria Salzburg yang dirawat di ruang emergensi, ruang rawat intensif, dan ruang rawat inap Rumah Sakit Umum Pusat Nasional Cipto Mangunksumo pada bulan Juli 2016-Juli 2017. Pasien dilakukan pencatatan, pemeriksaan EEG, dan observasi hingga akhir perawatan atau 30 hari perawatan. Luaran dinilai dalam mortalitas dan status fungsional dalam modified Rankin scale mRS yang dibagi menjadi baik mRS 0-2 dan buruk 3-5 . Analisa bivariat dilakukan untuk mencari faktor demografis, klinis, dan elektrografis yang berpotensi mempengaruhi luaran.Hasil: Dari total 32 subjek penelitian, didapatkan mortalitas sebesar 40,6 . Dari 19 subjek hidup, 84,2 memiliki status fungsional buruk. Pada subjek yang meninggal, 84,6 memiliki latar belakang teta, 100 tidak responsif terhadap suara, 92,3 tidak responsif terhadap nyeri, dan 76,9 memiliki gambaran aktivitas delta/teta ritmik dengan frekuensi >0,5Hz. Sepsis dan jumlah etiologi penurunan kesadaran memiliki berpotensi mempengaruhi luaran subjek p0,5Hz. Sepsis dan jumlah etiologi berpotensi mempengaruhi luaran.Kata kunci: luaran; mortalitas; status fungsional; ensefalopati metabolik; status epileptikus non konvulsivus

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ABSTRACT
Background Nonconvulsive status epilepticus NCSE is one of the important differential diagnoses in patients with altered consciousness including metabolic encephalopathy ME . The outcome of ME patients with NCSE has not been studied extensively.Method This is an observational cross sectional study in ME patients with NCSE based on EEG findings that fulfilled the Salzburg criteria treated in the emergency, intensive care, and inpatient units of Cipto Mangunkusumo hospital in July 2016 July 2017. Subjects underwent documentation, EEG recording, and observation until discharge or 30 days of treatment. Outcome was measured in mortality and functional status in modified Rankin scale divided into favorable mRS 0 2 and poor mRS 3 5 . Bivariate analysis was done to find the potential demographic, clinical, and electrographic factors to influence outcome.Result Out of total 32 subjects, the mortality rate was 40.6 . From 19 survivors, 84,2 had poor functional status. In fatal subjects, 84.6 had theta background rhythm, 100 unresponsive to sound, 92.3 unresponsive to pain, and 76.9 had rhythmic delta theta activity 0.5Hz. Sepsis and the number of etiologies causing altered consciousness had the potential to influence outcome p0.5Hz. Sepsis and the number of etiologies had the potential to influence outcome.Keywords mortality functional status metabolic encephalopathy nonconvulsive status epilepticus