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"[Latar Belakang. Tatalaksana epilepsi bertujuan untuk mencapai keadaan bebas bangkitan tanpa efek samping obat, sehingga tercapai kualitas hidup optimal untuk penderita epilepsi. Saat ini tatalaksana farmakologis masih menjadi pilihan terapi yang banyak digunakan namun diduga sekitar 30% pasien akan resisten terhadap pengobatan. Epilepsi lobus temporal (ELT) merupakan epilepsi fokal yang paling sering resisten terhadap pengobatan. Kegagalan dalam merespons obat antiepilepsi (OAE) merupakan suatu masalah klinis penting. Tujuan penelitian ini adalah untuk mengetahui faktor-faktor yang mempengaruhi epilepsi lobus temporal potensial resisten obat.Metode. Desain penelitian adalah potong lintang pada pasien ELT di Poliklinik Epilepsi RSCM. Subjek dikelompokkan menjadi potensial resisten obat dan tidak potensial resisten obat. Dilakukan wawancara dan pencatatan rekam medis mencakup usia saat onset epilepsi, frekuensi bangkitan awal, respons terhadap pengobatan pertama, etiologi epilepsi, riwayat status epileptikus, riwayat kejang demam, riwayat keluarga dengan epilepsi, gambaran CT-Scan/MRI Kepala, dan gambaran EEG.Hasil. Didapatkan 71 subjek yang memenuhi kriteria inklusi. Sebanyak 60 (84,51%) subjek potensial resisten obat. Pada analisis bivariat didapatkan hubungan bermakna antara frekuensi bangkitan awal ≥ 1x/bulan dan tidak respons terhadap pengobatan pertama dengan ELT potensial resisten obat. Pada analisis multivariat adanya riwayat status epileptikus dan tidak respons terhadap pengobatan pertama merupakan faktor yang berpengaruh secara independen terhadap ELT potensial resisten obat, sedangkan usia saat onset < 15 tahun, frekuensi bangkitan awal ≥ 1x/bulan, dan adanya riwayat kejang demam tidak secara independen berpengaruh terhadap ELT potensial resisten obat.Simpulan. Faktor yang mempengaruhi ELT potensial resisten obat adalah riwayat status epileptikus dan tidak respons terhadap pengobatan pertama sehingga perlu dievaluasi pada semua pasien ELT.;Background. The goal of management patients with epilepsy is to achieve seizure-free without medication side effects, in order to reach optimal quality of life for people with epilepsy. Currently antiepileptic drugs (AEDs) are widely used as a therapeutic option, nevertheless approximately 30% of patients are thought to be resistant to drug treatment. Temporal lobe epilepsy (TLE) is the most common type of epilepsy which is prone to be drug resistant. Failure to respond to AEDs is a problematic clinical issue. The objective of this study is to determine the factors influencing potential drug resistant temporal lobe epilepsy.Method. This was a cross sectional study involving patients with TLE in Epilepsy Clinic Cipto Mangunkusumo Hospital. Subjects were grouped into potential drug resistant and non potential drug resistant. Data obtained from interviews and medical records were age of onset, initial seizure frequency, response to the first AED, etiology of epilepsy, history of status epilepticus, history of febrile seizures, family history of epilepsy, head CT Scan/MRI features, and EEG features.Result. There were 71 eligible subjects. Potential drug resistant was found in 60 subjects (84,51%). In bivariate analysis there was a significant association between initial seizure frequency of ≥ 1x/month and no response to first AED with potential drug resistant TLE. In multivariate analysis, history of status epilepticus and no response to first AED are independent factors influencing potential drug resistant TLE, while age at onset < 15 years, initial seizure frequency ≥ 1x/month, and history of febrile seizures did not independently influence potential drug resistant TLE.Conclusion. Factors influencing potential drug resistant TLE are history of status epilepticus and no response to first AED and need to be evaluated in TLE patients., Background. The goal of management patients with epilepsy is to achieve seizure-free without medication side effects, in order to reach optimal quality of life for people with epilepsy. Currently antiepileptic drugs (AEDs) are widely used as a therapeutic option, nevertheless approximately 30% of patients are thought to be resistant to drug treatment. Temporal lobe epilepsy (TLE) is the most common type of epilepsy which is prone to be drug resistant. Failure to respond to AEDs is a problematic clinical issue. The objective of this study is to determine the factors influencing potential drug resistant temporal lobe epilepsy.Method. This was a cross sectional study involving patients with TLE in Epilepsy Clinic Cipto Mangunkusumo Hospital. Subjects were grouped into potential drug resistant and non potential drug resistant. Data obtained from interviews and medical records were age of onset, initial seizure frequency, response to the first AED, etiology of epilepsy, history of status epilepticus, history of febrile seizures, family history of epilepsy, head CT Scan/MRI features, and EEG features.Result. There were 71 eligible subjects. Potential drug resistant was found in 60 subjects (84,51%). In bivariate analysis there was a significant association between initial seizure frequency of ≥ 1x/month and no response to first AED with potential drug resistant TLE. In multivariate analysis, history of status epilepticus and no response to first AED are independent factors influencing potential drug resistant TLE, while age at onset < 15 years, initial seizure frequency ≥ 1x/month, and history of febrile seizures did not independently influence potential drug resistant TLE.Conclusion. Factors influencing potential drug resistant TLE are history of status epilepticus and no response to first AED and need to be evaluated in TLE patients.]"

"Latar belakang. Epilepsi merupakan satu dari penyakit neurologi yang sering menyebabkan disabilitas dan kematian. Prediktor terbaik menentukan remisi epilepsi adalah respons awal terhadap OAE. Terdapat beberapa faktor yang memengaruhi respons awal terapi diantaranya etiologi epilepsi, jumlah kejang sebelum pengobatan, bentuk bangkitan kejang, status neurologi, usia awitan dan gambaran elektroensefalografi.Tujuan. Mengetahui respons awal dan faktor-faktor yang mempengaruhi respons awal OAE monoterapi pada pasien epilepsi baru pertama kali di RSCM Metode penelitian. Penelitian merupakan penelitian kohort prospektif pada 92 anak berusia < 17 tahun dengan melihat respons awal OAE monoterapi pada anak penderita epilepsi baru selama 3 bulan yang berobat ke poliklinik rawat jalan RSUP dr Cipto Mangunkusumo sejak Januari 2017 sampai Agustus 2017. Faktor-faktor risiko etiologi epilepsi, jumlah kejang sebelum pengobatan, bentuk bangkitan kejang, status neurologi, usia awitan dan gambaran elektroensefalografi dianalisis secara bivariat dan multivariat. Hasil penelitian. Terdapat 92 pasien epilepsi baru yang memenuhi kriteria penelitian. Insidens epilepsi baru pada penelitian ini adalah 21,9 . Pasien epilepsi baru yang mendapat OAE monoterapi sebagian besar berumur ge; 1 tahun, awitan kejang ge; 1 tahun, etiologi struktural, jumlah kejang sebelum pengobatan ge; 10 kali, mempunyai kelainan neurologi, bangkitan kejang umum dan gambaran normal pada pemeriksaan EEG. Respons awal yang baik pada penderita epilepsi baru terhadap OAE monoterapi adalah sebesar 77,2 dalam 3 bulan pengobatan. Faktor yang memengaruhi respons awal baik dalam 3 bulan OAE monoterapi setelah analisis multivariat jumlah kejang dan gambaran EEG. Simpulan. Sebagian besar pasien epilepsi menunjukkan respons awal baik terhadap obat antiepilepsi monoterapi. Faktor yang berperan terhadap respons awal terapi OAE monoterapi adalah jumlah kejang dan gambaran EEG

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Background. Epilepsy is one of neurological disorder that cause disability and death. Initial response to antiepileptic drugs AEDs is the best predictive indicator to determine remission of epilepsy. Factors that influence the initial response are the etiology of epilepsy, pre treatment frequency of seizures, type of seizures, neurological deficits, age of onset, and electroencephalography EEG findings. Objectives. To investigate the initial response and influence factors of the initial response in monotherapy antiepileptic drug in patients with newly diagnosed epilepsy Method. Cohort prospective study was conducted in neurology outpatient clinic Cipto Mangunkusumo hospitals RSCM between January to August 2017 on newly diagnosed pediatric epilepsy. Response of AED monotherapy was observed after three months of treatment. The risk factors were analyzed by bivariate and multivariate statistical analysis. Results. There were 92 subjects that fulfilled the criteria. The incidence of newly diagnosed epilepsy children at RSCM was 21.9 . The age of subjects who take monotherapy AED were commonly ge 1 year old, onset of the first seizure ge 1 year, with structural as the etiology, already have more than 10 times seizure before initial treatment begin, neurological deficit and normal EEG findings. Of 77.2 subjects have a good initial response to monotherapy AED. Multivariate analysis showed that frequency of seizures and electroencephalography EEG findings were the risk factors of the initial response to monotherapy AED in newly diagnosed epilepsy patient. Conclusion. Most of the subject have a good initial response to monotherapy AED. The influence factors of the initial response are frequency of seizures and EEG findings."

"ABSTRAKLatar belakang: Pada semua sindrom epilepsi, epilepsi lobus temporal ELT memiliki kemungkinan paling besar untuk menjadi resisten terhadap obat.Polimorfisme gen multidrug resistant-1 MDR1 C3435T dicurigai sebagai salahsatu penyebabnya. Di RS Cipto Mangunkusumo RSCM , sebagai pusat rujukannasional, prevalensi ELT potensial resisten obat adalah 84.51 dan duapertiganya dalam terapi karbamazepin KBZ .Tujuan: Mengetahui polimorfisme dan ekspresi gen MDR1 C3435T serta kadarplasma KBZ pada penderita epilepsi yang responsif dan resisten terhadap obat.Metode: Penelitian potong lintang komparatif dilakukan di RSCM dari Juni 2015sampai Desember 2016. Penderita ELT dipilih secara konsekutif. Kelompokkontrol terdiri dari subjek sehat tanpa riwayat epilepsi. Identifikasi genotipemenggunakan teknik restriction Fragment Length Polymorphism PCR denganenzim restriksi Mbo1. Pemeriksaan kadar plasma KBZ menggunakan HighPerformance Liquid Chromatography. Ekspresi mRNA dengan metodesequencing and real time quantitative PCR.Hasil: Didapatkan 61 subjek dan 25 kontrol. Sebaran genotipe TT 71,43 danalel T genotipe CT dan TT lebih tinggi pada grup resisten x= 10,41; p =0,001 . Terdapat korelasi sangat kuat antara dosis dan kadar plasma KBZ padagrup responsif r = 0,75; p = 0,000 dengan rerata dosis 405,21 226,50mg dankadar plasma 7,59 2,32mcg/mL. Ekspresi kuantitatif relatif Rq mRNA palingtinggi pada grup kontrol diikuti resisten dan responsif. Genotipe TT menunjukkanRq yang berbeda pada tiap grup. Terdapat perbedaan bermakna antara dosis dankadar plasma KBZ pada masing-masing genotipe tiap grup, terutama antaragenotipe CT reponsif dengan semua genotipe grup resisten.Kesimpulan: Genotipe TT dan alel T MDR1 C3435T secara statistik berhubungandengan dosis dan kadar plasma KBZ yang lebih tinggi pada ELT resisten obat.

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ABSTRACTBackground Among epilepsy syndrome, temporal lobe epilepsy TLE has thehighest probability to become drug resistant. Multidrug resistant 1 MDR1 C3435T polymorphism was suspected to be one of the caused. In CiptoMangunkusumo hospital RSCM , as the national reference hospital, potentialdrug resistant epilepsy prevalence was 84.51 and carbamazepine CBZ usagein two third of the patients.Objective This study was performed to learn about MDR1 C3435T polymorphismand expressions, and CBZ plasma concentration in drug responsive and resistanttemporal lobe epilepsy patients.Methods A comparative cross sectional study was performed in RSCM. TLEpatients were selected consecutively. Healthy people were also selected as thecontrol group. Restriction Fragment Length Polymorphism PCR technique withMbo1 restriction enzyme was used to identify the genes. High Performance LiquidChromatography method was used to determine CBZ concentration in plasma.mRNA expressions identification were using sequencing and real timequantitative PCR methods.Result There were 61 subjects in study group and 25 in control group. Frequencyof TT genotype 71.43 and T allele CT and TT genotype were higher inresistant one x2 10.41, p 0.001 . There was a very strong correlationsbetween CBZ plasma concentration in drug responsive epilepsy r 0.75, p 0.000 in mean dosage of 405,21 226,50mg and plasma concentration of 7,59 2,32mcg mL. mRNA expressions were highest in control group followed byresistant and responsive ones. TT genotype expression was relatively different ineach group. There were signifant differences between genotype in each groupwith CBZ dosage and plasma concentration, especially in CT responsivecompare to all genotypes in resistant group.Conclusion TT genotype and T allele of MDR1 C3435T statistically associatedwith higher CBZ dosage and plasma concentration in drug resistant TLE patients."

"Latar Belakang: Epilepsi di negara berkembang dua kali lebih tinggi dibandingkan negara maju. Sekitar 60-70% pasien bebas kejang dengan obat antiepilepsi (OAE) generasi satu, jika tidak respons dan kejang menetap maka dipertimbangkan OAE generasi dua. Keberhasilan pengobatan epilepsi dipengaruhi oleh pelbagai faktor serta bergantung terhadap plastisitas dan maturitas otak hingga usia tiga tahun. Belum ada penelitian yang menilai faktor-faktor keberhasilan terapi OAE generasi dua.Tujuan: Mengetahui faktor risiko keberhasilan keberhasilan terapi OAE generasi 2 pada pasien epilepsi anak usia di bawah tiga tahun.Metode: Studi kasus kontrol dengan data sekunder berupa rekam medis. Sampel penelitian adalah anak epilepsi berusia di bawah tiga tahun yang mendapatkan minimal salah satu OAE generasi 2 berupa topiramat/levetiracetam/lamotrigin. Subyek terbagi kelompok kontrol (dilakukan matching usia) yang kejangnya tidak terkontrol dan kelompok kasus yang kejangnya terkontrol minimal enam bulan. Faktor risiko yang diteliti adalah tipe kejang, status perkembangan, status neurologis awal, gambaran elektroensefalografi (EEG) awal, evolusi klinis dan evolusi EEG.Hasil: Didapatkan 60 subyek pada masing-masing kelompok; pada kelompok kasus paling banyak dijumpai 66,7% laki-laki, 31,7% rentang usia 6-12 bulan, 83,3% usia awitan kejang <12 bulan, dan 93,3% tipe kejang umum. Dari 6 faktor risiko yang diteliti, hanya evolusi EEG berperan independen dalam memengaruhi keberhasilan terapi, nilai p<0,001; aOR 9,53; IK95% 3,39-26,77.Kesimpulan: Pasien dengan evolusi EEG baik memiliki kemungkinan sebesar 9,53 kali lipat lebih besar untuk kerjangnya terkontrol dengan OAE generasi 2, dibandingkan pasien dengan evolusi EEG buruk.

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Background: Epilepsy in developing countries is twice compared developed countries. About 60-70% epilepsy patients had seizure-free with first generation antiepileptic drugs (AED), if there is no response and persistent seizures, second generation AED is considered. The success of epilepsy treatment is influenced by various factors and depends on the plasticity and maturity of the brain until the first 3 years. There are no studies that assess the success factors of second generation OAE therapy.Purpose: To assess the risk factors that affecting the success of second generation therapy in children under 3 years old with epilepsy.Methods: A case control study with secondary data from medical records. The study sample was children under 3 years old with epilepsy who received at least one of second generation AED (topiramate/levetiracetam/lamotrigine). Subjects were divide into 2 groups, control groups (age matching) whose seizure were not controlled and case groups whose seizure were controlled for at least six months. The risk factors studied were seizure type, developmental status, initial neurological status, initial electroencephalography (EEG), clinical evolution and EEG evolution,Results: There were 60 subjects in each group; the most proportion in case group were 66,7% males, 31,7% of the age range of 6-12 months, 83,3% onset of seizures <12 months, and 93,3% general seizures. Of the 6 risk factors studied, only the EEG evolution significantly and independently affecting the success of therapy, with p value <0,001; aOR 9.53; 95%CI 3.39-26.77.Conclusion: Patients with good EEG evolution were 9.53 times more likely to have controlled seizure with second generation AED, compared to patients with poor EEG evolution."

"Proporsi pasien Tuberkulosis Resistan Obat (TB RO) yang memiliki hasil akhir pengobatan meninggal meningkat di tahun 2021 menjadi 19%. Tujuan penelitian ini adalah mengetahui faktor risiko kematian pasien TB RO selama masa pengobatan di Indonesia. Desain penelitian ini adalah kohort retrospektif dengan menggunakan data kasus TB RO yang memulai pengobatan tahun 2020-2021 dan telah memiliki hasil akhir pengobatan hingga Mei 2023 dan tercatat pada Sistem Informasi Tuberkulosis. Analisis yang digunakan pada penelitian ini adalah analisis deskriptif, survival dengan menggunakan Kaplan Meier, dan multivariat dengan menggunakan cox regression. Jumlah sampel penelitian adalah 7.515. Hasil penelitian ini menunjukkan sebanyak 19,39% pasien meninggal dengan laju kejadian keseluruhan adalah 6 per 10.000 orang hari dan probabilitas kumulatif survival sebesar 73%. Analisis multivariat menunjukkan Faktor-faktor yang mempengaruhi kematian pasien TB RO selama masa pengobatan di Indonesia adalah kelompok umur 45-65 (HR 1,519; 95% CI 1,275-1,809) tahun dan 65+ (HR 3,170; 95% CI 2,512-4,001), wilayah fasyankes Jawa-Bali (HR 1,474; 95% CI 1,267-1,714), koinfeksi HIV (HR 3,493; 95% CI 2,785-4,379), tidak mengetahui status HIV (HR 1,655; 95% CI 1,474-1,858) memiliki riwayat pengobatan (HR 1,244; 95% CI 1,117-1,385), tidak konversi ≤3 bulan (HR 4,435; 95% CI 3,920-5,017), paduan pengobatan LTR (1,759; 95% CI 1,559-1,985), kepatuhan pengobatan pada kelompok tidak minum obat 1-30 hari (HR 0,844; 95% CI 0,748-0,953) dan kepatuhan pengobatan pada kelompok tidak minum obat >30 hari (HR 0,318; 95% CI 0,273-0,370). 

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The proportion of drug-resistant tuberculosis (RO-TB) patients who have the final outcome of treatment will die in 2021 to 19%. The purpose of this study was to determine the risk factors for death of TB RO patients during the treatment period in Indonesia. The design of this study was a retrospective cohort using data on TB RO cases that started treatment in 2020-2021 and had final treatment results until May 2023 and were recorded in the Tuberculosis Information System. The analysis used in this study is descriptive analysis, survival using Kaplan Meier, and multivariate using cox regression. The number of research samples is 7,515. The results of this study showed that 19.39% of patients died with an overall incidence rate of 6 per 10,000 person days and a cumulative probability of survival of 73%. Multivariate analysis shows that the factors that influence the death of TB RO patients during the period of treatment in Indonesia are the age group 45-65 (HR 1.519; 95% CI 1.275-1.809) years and 65+ (HR 3.170; 95% CI 2.512-4.001), health facilities area Java-Bali (HR 1.474; 95% CI 1.267-1.714), HIV coinfection (HR 3.493; 95% CI 2.785-4.379), do not know HIV status (HR 1.655; 95% CI 1.474-1.858) have a history of treatment ( HR 1.244; 95% CI 1.117-1.385), no conversion ≤3 months (HR 4.435; 95% CI 3.920-5.017), mixed treatment LTR (1.759; 95% CI 1.559-1.985), treatment adherence in non-medication group 1 -30 days (HR 0.844; 95% CI 0.748-0.953) and medication adherence in the non-medication group >30 days (HR 0.318; 95% CI 0.273-0.370)."

"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.

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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."

"Epilepsi merupakan penyakit neurologis kronis dengan prevalensi tingkat 0,5-1% pada populasi anak dan terjadi puncaknya pada tahun-tahun awal kehidupan. Obat Antiepilepsi (OAE) masih merupakan obat utama dalam pengobatan pasien epilepsi. Hingga saat ini, sebanyak 30 (tiga puluh) Obat Antiepilepsi (OAE) generasi pertama-ketiga digunakan dalam pengobatan penyakit epilepsi. Pilihan monoterapi yang tepat untuk pasien merupakan tantangan klinis yang harus mempertimbangkan mekanisme kerja, spektrum efikasi, efek samping hingga potensi interaksi masing-masing obat. Tantangan tersebut semakin penting apabila diterapkan dalam pengobatan epilepsi pada pasien anak-anak dengan interval waktu pemberian yang tepat terutama jika pasien anak-anak mendapatkan terapi kombinasi 2 atau lebih Obat Antiepilepsi (OAE). Interval waktu pemberian pada terapi kombinasi Obat Antiepilepsi (OAE) dalam mencapai kadar terapeutiknya dipengaruhi oleh profil farmakokinetik masing-masing obat. Obat Antiepilepsi (OAE) perlu dipantau terutama karena variabilitas antar pasien yang tinggi akibat adanya farmakokinetik non-linear serta lingkup terapeutik yang sempit. Melalui tugas khusus ini dapat diketahui bahwa dari 6 Obat Antiepilepsi (OAE) yang digunakan pada pasien pediatrik, Carbamazepine memiliki potensi terdistribusi lebih banyak dalam plasma darah maupun jaringan plasma yaitu dengan nilai Vd sebesar 0,8-2 L/Kg serta Levetiracetam memiliki nilai Tmaks dan T1/2 paling kecil, yaitu Tmaks sebesar 1,3 jam dan T1/2 sebesar 6 jam sehingga Levetiracetam dapat mencapai kadar maksimum dalam darah (Cpmaks) maupun tereliminasi dari tubuh lebih cepat dibandingkan ke 5 (lima) obat lainnya.

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Epilepsy is a chronic neurological disease with a prevalence rate of 0.5-1% in the pediatric population and peaks in the early years of life. Antiepileptic drugs (OAE) are still the main drugs in the treatment of epilepsy patients. Until now, as many as 30 (thirty) first-third generation Antiepileptic Drugs (OAE) are used in the treatment of epilepsy. The choice of the right monotherapy for a patient is a clinical challenge that must consider the mechanism of action, spectrum of efficacy, side effects to the potential interactions of each drug. This challenge is even more important when applied in the treatment of epilepsy in pediatric patients at the right time interval, especially if the pediatric patient is receiving combination therapy of 2 or more Antiepileptic Drugs (OAE). The time interval for administration of antiepileptic drug combination therapy (OAE) in achieving therapeutic levels is influenced by the pharmacokinetic profile of each drug. Antiepileptic drugs (OAE) need to be monitored, especially because of high inter-patient variability due to non- linear pharmacokinetics and a narrow therapeutic scope. Through this special assignment it can be seen that of the 6 Antiepileptic Drugs (OAE) used in pediatric patients, Carbamazepine has the potential to be distributed more in blood plasma and plasma tissue with a Vd value of 0.8-2 L/Kg and Levetiracetam has a Tmax value and the lowest T1/2, namely Tmax of 1.3 hours and T1/2 of 6 hours so that Levetiracetam can reach maximum levels in the blood (Cpmax) and be eliminated from the body faster than the other 5 (five) drugs."

"Latar Belakang: Cutaneous Adverse Drug Reaction (CADR) dapat memengaruhi tatalaksana infeksi TB. Hal ini berdampak pada bukan hanya morbiditas dan mortalitas tapi juga resistensi kuman. Untuk itu, proporsi CADR dan faktor-faktor yang berhubungan pada penggunaan Obat Anti Tuberkulosis (OAT) perlu ditentukan demi tatalaksana pasien yang komprehensif.Tujuan: Mengetahui gambaran kejadian CADR terkait pemberian OAT dalam bentuk proporsi, analisis peran faktor pejamu yang berkaitan dengan kejadian tersebut, dan OAT yang paling sering menimbulkan CADR. Metode: Desain penelitian ini adalah kohort retrospektif dengan menggunakan rekam medik pasien Rumah Sakit Cipto Mangunkusumo selama 1 Januari 2014hingga 30 Juni 2015. Sampel diperoleh dengan metode konsekutif yang diseleksi berdasarkan kriteria penelitian. Data kemudian dianalisis untuk menilai hubungan antara CADR dengan usia, jenis kelamin, status HIV, status gizi, dan riwayatmlkojuujhjh Adverse Drug Reaction (ADR). Hasil: Proporsi CADR pada pemberian OAT mencapai angka 5,5%. Dari kelima variabel independen, variabel usia (RR=6,510; IK95% 2,036-20,819 p=0,008) dan riwayat ADR (RR=5,174; IK95% 1,500-17,838; p=0,009) berpengaruh terhadap kejadian CADR. OAT yang paling sering menyebabkan kejadian CADR adalahrifampisin. Analisis Cochran Mantel-Haenszel menunjukkan bahwa risiko relatif terjadinya CADR untuk faktor usia adalah 7,267 (IK95% 2,093-25,235 p <0,001) dan risiko relatif terjadinya CADR untuk faktor riwayat ADR adalah 5,880 (IK95% 1,552-22,273 p=0,003). Simpulan: Proporsi kejadian CADR setelah pemberian OAT adalah 5,5%. Variabel usia dan riwayat ADR bermakna secara statistik dan klinis terhadap kejadian CADR. Rifampisin adalah OAT tersering yang menimbulkan CADR.

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Background: Cutaneous Adverse Drug Reaction (CADR) affected the therapy of TB, which impacted not only its morbidity and mortality but also its resistance. Therefore, the incidence of CADR and the factors associated during the

administration of Anti Tuberculosis Drugs (ATDs) needed to be determined in order to achieve comprehensive treatment.

Objective: To know CADR events on ATD administration by finding the incidence, analyzing the host factors associated with those events, and searching the most common ATD that caused CADR. Methods: This study used retrospective cohort by accessing medical record registered in Cipto Mangunkusumo Hospital from January 1st 2014 until June 30th 2015. Samples were collected consecutively, selected by certain criteria. The data were then analyzed to determine the association between CADR and age, sex, HIV infection, nutritional status, and history of Adverse Drug Reaction (ADR). Results: The incidence of CADR after the administration of ATD was 5.5%. Among the five variables, age (RR=6.510; 95%CI 2.036-20.819, p=0.008) and past history of ADR (RR=5.174; 95%CI 1.500-17.838; p=0.009) were statistically and clinically correlated to CADR. The most frequent drug that triggered CADR was rifampicin. Cochran Mantel-Haenszel showed that the relative risk of CADR according to age was 7,267 (IK95% 2,093-25,235 p <0,001), while the relative

risk according to the past history of ADR was 5,880 (IK95% 1,552-22,273 p=0,003). Conclusions: The incidence of CADR after ATDs administration was 5.5%. Age and past history of ADR were significantly associated with CADR. The most common ATD causing CADR was rifampicin."

"Penggunaan Obat Anti-Epilepsi (OAE) jangka panjang merupakan strategi terapi yang optimal setelah diagnosis epilepsi. Kepatuhan terhadap pengobatan merupakan salah satu masalah utama dalam keberhasilan terapi jangka panjang pada pasien epilepsi. Salah satu faktor yang berpotensi kuat mempengaruhi kepatuhan adalah adanya Reaksi Obat yang Tidak Dikehendaki (ROTD). Epilepsi Lobus Temporal (ELT) merupakan tipe epilepsi fokal yang paling banyak; lebih dari 80% pasien ELT berpotensi resisten obat. Penelitian ini bertujuan untuk melihat ROTD OAE pada pasien ELT dan hubungannya dengan kepatuhan pengobatan. Metode penelitian yang digunakan adalah cross sectional study yang membandingkan ada/tidaknya ROTD menggunakan kuisioner Liverpool Advesre Event Profile (LAEP) dengan tingkat kepatuhan menggunakan kuisioner Morisky Adherence Questionaire (MAQ). Subyek penelitian adalah pasien ELT di Unit Rawat Jalan Departemen Neurologi RSUPN Dr. Cipto Mangunkusumo periode Agustus-Oktober 2019. Hasil penelitian menunjukkan dari 88 pasien, 78.40% mengalami kejadian ROTD dan sebanyak 47.73% pasien memiliki tingkat kepatuhan sedang-rendah. Terdapat hubungan yang signifikan antara kejadian ROTD dan tingkat kepatuhan (p=0.039;OR 4.313). Hasil ini menunjukan pasien ELT yang mengalami kejadian ROTD memiliki kecenderungan untuk tidak patuh terhadap pengobatannya. Faktor lain yang berpengaruh secara signifikan terhadap kepatuhan pengobatan pasien yaitu jenis OAE (p=0,011; OR 0,249)). Jenis OAE yang memperlihatkan hubungan yang signifikan terhadap tingkat kepatuhan pengobatan adalah jenis OAE kombinasi (generasi lama dan generasi baru). Perlu dilakukan intervensi konseling secara berkala oleh farmasis untuk meningkatkan pemahaman mengenai ROTD yang terjadi selama penggunaan OAE dan edukasi terkait pentingnya kepatuhan pengobatan pasien.

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The long-term use of Anti-Epileptic Drugs (AED) is an optimal therapeutic strategy after the diagnosis of epilepsy. Adherence to treatment is one of the main problems in the long-term success of therapy in epilepsy patients. One factor that has the potential to strongly influence adherence is the presence of Adverse Drug Reaction (ADR). Temporal Lobe Epilepsy (TLE) is the most common type of focal epilepsy; more than 80% of TLE patients are potentially drug resistant. This study aimed to explore the ADR of AED in TLE patients and its correlation with medication adherence. The research method used was a cross sectional study comparing the presence of ADR using the Liverpool Adverse Event Profile (LAEP) questionnaire with the level of compliance using the Morisky Adherence Questionaire (MAQ). The research subjects were TLE patients in the Outpatient Unit of the Department of Neurology, Dr. Cipto Mangunkusumo Hospital, August-October 2019.

The results showed that of 88 patients, 78.40% experienced ADR and 47.73% of patients had moderate-low adherence. There is a significant correlation between the incidence of ADR and the level of compliance (p = 0.031;OR = 4.35). Another factor that significantly affected patient adherence was type of AED (p = 0.011; OR 0.249). The type of AED that shows a significant relationship to the level of medication adherence is combination of old and new generation AED. These findings indicate that patients who experience ADR have a tendency to disobey their treatment. Interventions programmed by pharmacists need to be done to increase the understanding of ADR that occurs during AED use and education related to the importance of medication adherence. "

"[ABSTRAKStaphylococcus spp. peragi manitol merupakan flora normal kulit terbanyak dan sering bersifat multiresisten, serta dapat menjadi salah satu penyebab healthcare associated infection (HAI). Di Indonesia, data mengenai Staphylococcus spp. peragi manitol yang resisten metisilin belum tersedia. Penelitian ini bersifat retrospektif untuk mengetahui pola kepekaan dan karakteristik genotipik (mecA dan tipe SCCmec I-V) flora normal Staphylococcus spp peragi manitol yang diisolasi dari pasien ICU Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPNCM) tahun 2011, 2013 dan 2014. Dari 187 isolat, 15% di antaranya merupakan methicillin resistant Staphylococcus aureus (MRSA) yang sebagian besar resisten terhadap gentamisin (64,3%), klindamisin (50%), golongan fluorokuinolon (64,3-71,4%) dan tetrasiklin (57,1%). Sedangkan 55,6% merupakan Staphylococcus koagulase negatif resisten metisilin (MR-CoNS) yang sebagian besar resisten terhadap gentamisin (55%), fluorokuinolon (62,5-88,5%), eritromisin (91,3%), klindamisin (75%) dan rifampisin (82,7%). Resisten metisilin pada MRSA hampir semuanya disebabkan oleh gen mecA (96,4%), sedangkan pada MR-CoNS, gen mecA ditemukan pada 76,9% isolat. Tipe SCCmec yang paling banyak ditemukan pada kedua kelompok yaitu SCCmec tipe I. Dapat disimpulkan bahwa sebagian besar Staphylococcus spp. peragi manitol yang merupakan flora normal pasien yang dirawat di ICU RSUPNCM, merupakan pembawa gen mecA. Surveilens berkelanjutan dibutuhkan untuk mengetahui kecenderungan perubahan pola kepekaan dan pencegahan transmisi di fasilitas kesehatan.

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ABSTRACTStaphylococcus spp. mannitol fermenters are the most abundant skin normal flora. It is frequently resistant to many drugs and could become one of the causes of the healthcare associated infection (HAI). There is no data about Methicillin Resistant Staphylococcus spp. mannitol fermenters in Indonesia yet. In this restrospective study we aim to identify the susceptibility patterns and genotypic characteristics (mecA gene and SCCmec type I-V) of normal flora Staphylococcus spp. mannitol fermenters isolated from Intensive Care Unit patients of Cipto Mangunkusumo Hospital during 2011, 2013 and 2014. This study found that 15% of 187 isolates were methicillin resistant Staphylococcus aureus (MRSA) and mostly resistant to gentamycin (64,3%), clindamycin (50%), fluoroquinolone (64,3-71,4%) and tetracycline (57,1%). While 55,6% of the isolates were methicillin resistant coagulase negative Staphylococcus (MR-CoNS) and mostly resistant to gentamycin (55%), fluoroquinolone (62,5-88,5%), erithromycin (91,3%), clindamycin (75%) and rifampicin (82,7%). Methicillin-resistant on almost MRSA, carried mecA gene (96.4%), while in the MR-CoNS, mecA gene was found in 76.9% of all isolates. The most common SCCmec type found was SCCmec type I. Thus, mecA gene carrier Staphylococcus spp. mannitol fermenters were found as normal flora in intensive care patients of Cipto Mangunkusumo Hospital. Continuous surveillance is however, necessary to determine the tendency of changing susceptibility patterns and transmission prevention in health facilities.;Staphylococcus spp. mannitol fermenters are the most abundant skin normal flora. It is frequently resistant to many drugs and could become one of the causes of the healthcare associated infection (HAI). There is no data about Methicillin Resistant Staphylococcus spp. mannitol fermenters in Indonesia yet. In this restrospective study we aim to identify the susceptibility patterns and genotypic characteristics (mecA gene and SCCmec type I-V) of normal flora Staphylococcus spp. mannitol fermenters isolated from Intensive Care Unit patients of Cipto Mangunkusumo Hospital during 2011, 2013 and 2014. This study found that 15% of 187 isolates were methicillin resistant Staphylococcus aureus (MRSA) and mostly resistant to gentamycin (64,3%), clindamycin (50%), fluoroquinolone (64,3-71,4%) and tetracycline (57,1%). While 55,6% of the isolates were methicillin resistant coagulase negative Staphylococcus (MR-CoNS) and mostly resistant to gentamycin (55%), fluoroquinolone (62,5-88,5%), erithromycin (91,3%), clindamycin (75%) and rifampicin (82,7%). Methicillin-resistant on almost MRSA, carried mecA gene (96.4%), while in the MR-CoNS, mecA gene was found in 76.9% of all isolates. The most common SCCmec type found was SCCmec type I. Thus, mecA gene carrier Staphylococcus spp. mannitol fermenters were found as normal flora in intensive care patients of Cipto Mangunkusumo Hospital. Continuous surveillance is however, necessary to determine the tendency of changing susceptibility patterns and transmission prevention in health facilities.;Staphylococcus spp. mannitol fermenters are the most abundant skin normal flora. It is frequently resistant to many drugs and could become one of the causes of the healthcare associated infection (HAI). There is no data about Methicillin Resistant Staphylococcus spp. mannitol fermenters in Indonesia yet. In this restrospective study we aim to identify the susceptibility patterns and genotypic characteristics (mecA gene and SCCmec type I-V) of normal flora Staphylococcus spp. mannitol fermenters isolated from Intensive Care Unit patients of Cipto Mangunkusumo Hospital during 2011, 2013 and 2014. This study found that 15% of 187 isolates were methicillin resistant Staphylococcus aureus (MRSA) and mostly resistant to gentamycin (64,3%), clindamycin (50%), fluoroquinolone (64,3-71,4%) and tetracycline (57,1%). While 55,6% of the isolates were methicillin resistant coagulase negative Staphylococcus (MR-CoNS) and mostly resistant to gentamycin (55%), fluoroquinolone (62,5-88,5%), erithromycin (91,3%), clindamycin (75%) and rifampicin (82,7%). Methicillin-resistant on almost MRSA, carried mecA gene (96.4%), while in the MR-CoNS, mecA gene was found in 76.9% of all isolates. The most common SCCmec type found was SCCmec type I. Thus, mecA gene carrier Staphylococcus spp. mannitol fermenters were found as normal flora in intensive care patients of Cipto Mangunkusumo Hospital. Continuous surveillance is however, necessary to determine the tendency of changing susceptibility patterns and transmission prevention in health facilities., Staphylococcus spp. mannitol fermenters are the most abundant skin normal flora. It is frequently resistant to many drugs and could become one of the causes of the healthcare associated infection (HAI). There is no data about Methicillin Resistant Staphylococcus spp. mannitol fermenters in Indonesia yet. In this restrospective study we aim to identify the susceptibility patterns and genotypic characteristics (mecA gene and SCCmec type I-V) of normal flora Staphylococcus spp. mannitol fermenters isolated from Intensive Care Unit patients of Cipto Mangunkusumo Hospital during 2011, 2013 and 2014. This study found that 15% of 187 isolates were methicillin resistant Staphylococcus aureus (MRSA) and mostly resistant to gentamycin (64,3%), clindamycin (50%), fluoroquinolone (64,3-71,4%) and tetracycline (57,1%). While 55,6% of the isolates were methicillin resistant coagulase negative Staphylococcus (MR-CoNS) and mostly resistant to gentamycin (55%), fluoroquinolone (62,5-88,5%), erithromycin (91,3%), clindamycin (75%) and rifampicin (82,7%). Methicillin-resistant on almost MRSA, carried mecA gene (96.4%), while in the MR-CoNS, mecA gene was found in 76.9% of all isolates. The most common SCCmec type found was SCCmec type I. Thus, mecA gene carrier Staphylococcus spp. mannitol fermenters were found as normal flora in intensive care patients of Cipto Mangunkusumo Hospital. Continuous surveillance is however, necessary to determine the tendency of changing susceptibility patterns and transmission prevention in health facilities.]"