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"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. 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. Gangguan memori merupakan konsekuensi epilepsi lobus temporal (ELT) dan salah satu acuan penentuan zona epileptogenik, disesuaikan semiologi kejang, EEG iktal serta neuroimaging. Hal ini diharapkan dapat meningkatkan keberhasilan tatalaksana komprehensif termasuk terapi pembedahan dan meningkatkan kualitas hidup pasien. Tujuan. Mengetahui gambaran gangguan memori penyandang ELT di RSCM. Metode. Desain penelitian berupa studi potong lintang. Subyek adalah penyandang ELT kiri atau kanan, diperoleh secara konsekutif, kemudian dilakukan pemeriksaan Rey Auditory Verbal Learning Test (RAVLT) dan Rey Osterrieth Complex Figure Test (ROCFT) .Hasil. Diperoleh 85 subyek, 63.5% menderita gangguan memori. Dari 24 subyek gangguan memori visual, 29.6% dengan fokus kanan, dan 14.8% dari kiri. Dari 16 subyek gangguan memori auditorik, 25.9% dari fokus kiri dan 3.7% dari kanan. Gangguan memori visual dan auditorik pada 14 orang, dengan fokus kiri 11.1% dan kanan 14.8%. Fokus cetusan kanan berhubungan signifikan dengan gangguan memori visual dan kiri berhubungan signifikan dengan memori auditorik (p=0.001). Penggunaan OAE (p<0.10, OR 2.300,IK 95% 0.874,6.050) mempengaruhi gangguan memori secara umum. Lama menderita epilepsi (p<0.10;OR2.953;IK 95%0.863,10.110), penggunaan OAE (p<0.10;OR9.253;IK 95%1.355,63.168) dan fokus cetusan (p<0.10;OR 19.620; IK 95% 2.012,191,312) mempengaruhi gangguan memori auditorik. Onset bangkitan awal (p<0.10;OR 3.043,IK95%,0.110, 1.136) mempengaruhi gangguan memori visual. Lama menderita epilepsi (p<0.10;OR 2.383; IK95% 0.899,6.318) mempengaruhi gangguan memori visual dan auditorik.Kesimpulan. Sebagian besar penyandang ELT menderita gangguan memori. Gangguan memori visual atau auditorik menunjukkan efek lateralisasi yang signifikan. Penggunaan OAE, lama menderita epilepsi, usia saat bangkitan awal dan fokus cetusan dapat mempengaruhi gangguan memori.

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Background. Memory impairment was a consequence of temporal lobe epilepsy (TLE). Memory impairment with semiology, ictal EEG and neuroimaging were used in determining the epileptogenic zone of TLE, so we could improve the comprehensive management of TLE, and improve patient?s quality of life. Objectives.To determine the proportion of memory impairment in people with TLE in RSCM. Methods A cross-sectional study, subjects were those with left or right TLE. The memory function were assessed using Rey Osterrieth Complex Fugure Test (ROCFT) and Rey Auditory Verbal Learning Test (RAVLT). Results. There were 85 eligible subjects. Memory impairment was found in 63.5% subjects. Visual memory impairment were found in 24 subjects, 29.6% with right focus and 14.8% left focus. Auditory memory impairment were found in 16 subjects, 25.9% with left focus and 3.7% right focus. Visual and auditory memory impairment were 14 people, 11.1% with left focus and 14.8% were right. The right sided focus was associated with visual memory impairment and auditory memory impairment was associated with leftfocus (p = 0.001). The use of Anti Epileptic Drugs (AED) (p <0,10; OR 2.300; 95% CI 0.874; 6.050) affected memory impairment in general. Duration of epilepsy (p <0.10; OR 2.953;95% CI 0.863;10.110) , the use of AED (p <0.10; OR 9.253; 95% CI 1.355;63.168) and focal discharges (p <0.10; OR 19,620; 95% CI 2.012;191,312) affected the auditory memory impairment. Early seizure onset (p <0.10; OR 3.043; 95% CI 0.110; 1136) affected visual memory impairment. Duration of epilepsy (p <0.10; OR 2,383; 95%CI 0.899;6.318) affected visual and auditory memory impairment. Conclusion. Most of subjects were suffering from memory impairment. Subjects with visual or auditory memory impairment showed significantly effects of lateralization. The use of AEDs, duration of epilepsy, early onset of seizure affected memory impairment."

"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."

"[Latar belakang. Epilepsi lobus temporal (ELT) merupakan sindrom epilepsi paling banyak ditemukan pada orang dewasa, dimana sebanyak 2/3 berasal dari lobus temporal mesial. Penyebab umum yang sering ditemukan adalah sklerosis hippokampus (SH) dan kelainan ini seringkali refrakter terhadap pengobatan. Dengan anamnesis semiologi bangkitan epileptik yang baik dapat membantu mengetahui letak lesi dan bermanfaat untuk evaluasi persiapan bedah epilepsi. Tujuan penelitian ini adalah untuk mengetahui hubungan antara semiologi bangkitan epileptik yang diperoleh melalui anamnesis dengan sisi lesi pada pasien ELT mesial-SH.Metode. Desain penelitian adalah potong lintang pada pasien ELT mesial-SH di Poliklinik Epilepsi RSCM. Kriteria inklusi adalah pasien ELT mesial-SH yang menunjukkan lokasi yang sama antara aktivitas epileptiform interiktal pada elektroensefalografi (EEG) dan letak SH pada magnetic resonance imaging (MRI). Dilakukan anamnesis pada pasien dan keluarga, mengenai bentuk bangkitan epileptik, kemudian dinilai kesesuaian antara semiologi dan sisi lesi.Hasil. Didapatkan 45 subjek ELT mesial-SH yang memenuhi kriteria inklusi. Sebanyak 26 (57,8%) subjek dengan sisi lesi kanan dan 19 (42,2%) subjek sisi lesi kiri. Gambaran semiologi secara umum adalah aura sakit kepala (62,2%), automatisme manual (62,2%), automatisme oral (57,8%), perputaran kepala akhir (48,9%), dystonic posture (48,9%), aura epigastrium (42,2%), perputaran kepala awal (33,3%), dan aura rasa takut (26,7%). Terdapat empat gambaran motorik yang sesuai lateralisasi semiologi bangkitan epileptik. Automatisme manual dan perputaran kepala awal menunjukkan ipsilateral sisi lesi, sedangkan perputaran kepala akhir dan dystonic posture menunjukkan kontralateral sisi lesi.Kesimpulan. Terdapat kesesuaian antara semiologi bangkitan epileptik berupa automatisme manual, perputaran kepala awal, perputaran kepala awal, dan dystonic posture dengan sisi lesi. Sehingga penting untuk menanyakan 4 gambaran klinis tersebut pada saat anamnesis bangkitan epileptik.;Background. Temporal lobe epilepsy (TLE) is the most common epilepsy syndrome in adults which 2/3 originates from mesial temporal lobe. The most common etiology is hippocampal sclerosis (HS) and becoming drug resistant. Detail anamnesis on seizure semiology helps to know side of epileptogenic foci and evaluate pre epilepsy surgery. The objective of this study is to determine the concordance between seizure semiology based on anamnesis and side of lesion in mTLE-HS.Methods. This was a cross sectional study involving patients with mTLE-HS in Epilepsy Clinic Cipto Mangunkusumo Hospital. Inclusion criterias were patients with mTLE-HS who have same side of interictal epileptiform activity based on electroencephalography (EEG) and HS based on Magnetic Resonance Imaging (MRI). Anamnesis were taken from patient and family member on seizure semiology. Then, concordance between semiology and side of lesion was analyzed.Results. There were 45 eligible subjects of mTLE-HS patients. There were 26 (57.8%) subjects with left side lesions and 19 (42.2%) subjects were right side lesions. Semiology features commonly found are sefalic aura (62.2%), manual automatism (62.2%), oral automatism (57.8%), late head turning (48.9%), dystonic posture (48.9%), epigastric aura (42.2%), early head turning (33.3%), and fear aura (26.7%). Four clinical motoric features have concordance in seizure semiology lateralization. Manual automatism and early head turning showed ipsilateral with side of lesion, whereas late head turning and dystonic posture showed contralateral side of lesion.Conclusion. We found concordance between seizure semiology features of manual automatism, early head turning, late head turning and dystonic posture with side of lesion. Therefore, it was important to ask these features on anamnesis of seizure semiology., Background. Temporal lobe epilepsy (TLE) is the most common epilepsy syndrome in adults which 2/3 originates from mesial temporal lobe. The most common etiology is hippocampal sclerosis (HS) and becoming drug resistant. Detail anamnesis on seizure semiology helps to know side of epileptogenic foci and evaluate pre epilepsy surgery. The objective of this study is to determine the concordance between seizure semiology based on anamnesis and side of lesion in mTLE-HS.Methods. This was a cross sectional study involving patients with mTLE-HS in Epilepsy Clinic Cipto Mangunkusumo Hospital. Inclusion criterias were patients with mTLE-HS who have same side of interictal epileptiform activity based on electroencephalography (EEG) and HS based on Magnetic Resonance Imaging (MRI). Anamnesis were taken from patient and family member on seizure semiology. Then, concordance between semiology and side of lesion was analyzed.Results. There were 45 eligible subjects of mTLE-HS patients. There were 26 (57.8%) subjects with left side lesions and 19 (42.2%) subjects were right side lesions. Semiology features commonly found are sefalic aura (62.2%), manual automatism (62.2%), oral automatism (57.8%), late head turning (48.9%), dystonic posture (48.9%), epigastric aura (42.2%), early head turning (33.3%), and fear aura (26.7%). Four clinical motoric features have concordance in seizure semiology lateralization. Manual automatism and early head turning showed ipsilateral with side of lesion, whereas late head turning and dystonic posture showed contralateral side of lesion.Conclusion. We found concordance between seizure semiology features of manual automatism, early head turning, late head turning and dystonic posture with side of lesion. Therefore, it was important to ask these features on anamnesis of seizure semiology.]"

"ABSTRAKEpilepsi lobus temporal mesial adalah sindrom epilepsi yang banyak diderita oleh dewasa yang sering mengalami refrakter dalam pengobatan. Atrofi hipokampus yang terlihat melalui MRI kepala dapat ditemukan sebanyak 87% pada pasien epilepsi lobus temporal mesial dan memiliki respon yang baik dengan operasi epilepsi. Salah satu syarat operasi epilepsi adalah EEG monitoring untuk mencari EEG iktal untuk mencari fokus epileptik, walaupun sudah didapatkan adanya gelombang interiktal sebelumnya.Tujuan: Untuk mengetahui hubungan dan kesesuaian antara abnormalitas gelombang EEG dengan sisi atrofi hipokampus dan untuk mengetahui prevalensi atrofi hipokampus pada epilepsi lobus temporal mesial.Metode: Penelitian ini adalah penelitian potong lintang dengan 37 subyek epilepsi lobus temporal mesial, yang terbukti secara klinis dan EEG. Dilakukan pemeriksaan MRI kepala 1,5T untuk melihat ada atau tidaknya atrofi hipokampus secara visual. Kemudian dibandingkan antara abnormalitas gelombang EEG interiktal dengan sisi atrofi hipokampus. Onset usia bangkitan, frekuensi bangkitan, riwayat kejang demam, lama menderita epilepsi dan penggunaan obat entiepilepsi dianalisis sebagai data demografi klinis.Hasil: Prevalensi atrofi hipokampus sebesar 64,8% dengan 64,8% subyek ditemukan gambaran EEG berupa gelombang epileptiform dan 45,8% gelombang lambat. Didapatkan kesesuaian yang kuat antara lateralisasi EEG interiktal, yaitu gelombang epileptiform, dengan MRI (p 0,000; nilai kappa 1,00) dan didapatkan keseuaian yang lemah antara gelombang lambat dengan atrofi hipokampus (p 0,500; nilai kappa 0,689, p 0,008).Simpulan: Pada penelitian ini, didapatkan keseuaian yang kuat antara lateralisasi gelombang epileptiform dengan sisi atrofi hipokampus dan kesesuaian yang lemah antara gelombang lambat dengan sisi atrofi hipokampus.

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ABSTRACT

Mesial temporal lobe epilepsy (mTLE) is the most common epilepsy syndrome in adults and often refractory in medical treatment. The Magnetic resonance imaging (MRI) showed hippocampal atrophy present in 87% patients with mesial temporal lobe epilepsy and have good respons with surgery. EEG monitoring is needed to find ictal EEG although interictal EEG already obtained as one of the requirements of epilepsy surgery for localize the epileptic region.

Objective: To investigate the concordance between abnormalities EEG and side of hippocampal atrophy in patients with mesial temporal lobe epilepsy. To determine prevalance of hippocampal atrophy.

Methods: We reviewed 37 consecutive patients with mesial temporal lobe epilepsy defined by clinical and EEG criteria and had 1,5T MRI visually analyzed by radiologist. We compared the interictal EEG and side of hippocampal atrophy. Age of seizure onset, seizure frequency, history of febrile seizure, antiepileptic drug and duration of epilepsy were analyzed as clinical demographic data.

Results: The prevalence hippocampal atrophy was 64,8%. With 64,8% had epileptiform discharge and 45,8% had slow wave associated with hippocampal atrophy. There was significant concordance between MRI lateralization and interictal EEG (p 0,000, Kappa value 1,00). There was weak concordance between hippocampal atrophy and focal slow wave (p 0,500; Kappa value 0,689, p 0,008).

Conclusions: We found strong concordance between MRI lateralization and interictal EEG in patients with mTLE and weak concordance between hippocampal atrophy and interictal slow wave."

"[ABSTRAKTujuan: Studi ini merupakan studi MRI (Magnetic Resonance Imaging) untuk menilai hubungan asimetrisitas volume, hiperintensitas T2WI FLAIR dan nilai ADC hippokampus hubungannya dengan lateralisasi kejang. Pemeriksaan MRI sekuens rutin ditambah prosedur khusus pemeriksaan hipokampus yaitu sekuens T2WI Inversion Recovery dan T2WI Fluid-attenuated inversion recovery (FLAIR) dapat menilai volume hipokampus. Sekuens DWI (Diffusion Weighted Image) dan ADC (Appearent Difusion Coeffesient) merupakan pemeriksaan kuantitatif.Metode: Penelitian potong lintang menggunakan data sekunder MRI kepala pasien dengan diagnosis epilepsi lobus temporal mesial. Dilakukan pengukuran volume pada potongan koronal sejajar sumbu hippokampus, mulai dari terlihat kepala hippokampus sebanyak 5 irisan. Melihat gambaran hiperintensitas T2WI FLAIR serta mengukur nilai ADC hippokampus dilakukan dengan meletakan ROI pada potongan aksial hippokampus terbesar pada ADC map. Analisis data dilakukan untuk menghitung nilai R Kappa hubungan masing masing variabel dan gabungan variabel.Hasil: Jumlah subyek penelitian 54 orang, terdapat hubungan asosiasi yang cukup kuat (sedang) dan ipsilateral antara hiperintensitas T2WI FLAIR dan asimetrisitas volume dengan lateralisasi kejang dengan R Kappa sama sebesar + 0.52. Hubungan asosiasi yang lemah dan bersifat ipsi lateral dengan R Kappa + 0.37 antara nilai ADC dengan lateralisasi kejang. Hubungan asosiasi antara asimetrisitas volume dan asimetrisitas nilai ADC adalah kontralateral dengan hubungan asosiasi cukup kuat (sedang). Penentuan lateralisasi lesi dengan MRI pada masing masing variabel memiliki sensitivitas dan spesifisitas cukup tinggi. Hubungan asosiasi gabungan 2 dan 3 variabel adalah cukup kuat (sedang) dan bersifat ipsilateral, dengan nilai R Kappa, sensitifitas dan spesifisitanya yang lebih tinggi dibandingkan dengan hubungan masing masing variabel.Kesimpulan: MRI memiliki peranan penting menentukan lateralisasi kejang. Menilai hubungan dari gabungan 2 dan 3 variabel didapatkan secara statistik lebih besar hubungannya dengan lateralisasi kejang dibandingkan dengan menghubungkan masing masing variabel secara terpisah, sehingga penilaian MRI yang dilakukan untuk ke 3 variabel ini akan lebih menguatkan diagnosis sisi hipokampus yang mengalami kelainan.

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ABSTRACTObjective: This study is MRI ( Magnetic Resonance Imaging ) to assess the relationship asymmetry volume, T2WI FLAIR hyperintensity and hippocampal ADC values its relationship with the lateralization of seizures. Routine MRI examination sequences plus a special procedure that hippocampal examination Inversion Recovery sequence T2WI and T2WI Fluid-attenuated inversion recovery ( FLAIR ) can assess hippocampal volume. Sequences DWI ( Diffusion Weighted Image ) and ADC ( Appearent Diffusion Coeffesient ) is a quantitative examination.Methods: A cross-sectional study using secondary data MRI diagnosis of the patient's head with mesial temporal lobe epilepsy. Volume measurements performed on coronal slice axis parallel to the hippocampus, ranging from the visible head of the hippocampus as much as 5 slices. See picture T2WI FLAIR hyperintensity and measuring the ADC value hippocampus done by placing the ROI on axial cuts at the largest hippocampal ADC map. Data analysis was performed to calculate the value of R Kappa relationship each and combined variable.Results: There is a fairly strong association relationship (medium) and ipsilateral between T2WI FLAIR hyperintensity volume and asymmetry with lateralization of seizures with R Kappa equal to + 0.52. A weak association relationship and are IPSI lateral with R Kappa + 0.37 between the ADC values with lateralization of seizures. Association relationship between volume and asymmetry value asymmetry ADC is contralateral to the association relationship is strong enough (medium). Determination of lateralization of lesions by MRI in each variable has a fairly high sensitivity and specificity. The combined association relationship 2 and 3 variables are strong enough (medium) and ipsilateral, with a value of R Kappa, sensitivity and spesifisitanya higher than the correlation of each variable.Conclusion: MRI has an important role determining the lateralization of seizures. Assess the relationship of the combined second and third variables are statistically bigger obtained conjunction with lateralization of seizures compared to connecting each variable separately, so the MRI assessment carried out for 3 to this variable will further strengthen the diagnosis of hippocampal abnormalities., Objective: This study is MRI ( Magnetic Resonance Imaging ) to assess the relationship asymmetry volume, T2WI FLAIR hyperintensity and hippocampal ADC values its relationship with the lateralization of seizures. Routine MRI examination sequences plus a special procedure that hippocampal examination Inversion Recovery sequence T2WI and T2WI Fluid-attenuated inversion recovery ( FLAIR ) can assess hippocampal volume. Sequences DWI ( Diffusion Weighted Image ) and ADC ( Appearent Diffusion Coeffesient ) is a quantitative examination.Methods: A cross-sectional study using secondary data MRI diagnosis of the patient's head with mesial temporal lobe epilepsy. Volume measurements performed on coronal slice axis parallel to the hippocampus, ranging from the visible head of the hippocampus as much as 5 slices. See picture T2WI FLAIR hyperintensity and measuring the ADC value hippocampus done by placing the ROI on axial cuts at the largest hippocampal ADC map. Data analysis was performed to calculate the value of R Kappa relationship each and combined variable.Results: There is a fairly strong association relationship (medium) and ipsilateral between T2WI FLAIR hyperintensity volume and asymmetry with lateralization of seizures with R Kappa equal to + 0.52. A weak association relationship and are IPSI lateral with R Kappa + 0.37 between the ADC values with lateralization of seizures. Association relationship between volume and asymmetry value asymmetry ADC is contralateral to the association relationship is strong enough (medium). Determination of lateralization of lesions by MRI in each variable has a fairly high sensitivity and specificity. The combined association relationship 2 and 3 variables are strong enough (medium) and ipsilateral, with a value of R Kappa, sensitivity and spesifisitanya higher than the correlation of each variable.Conclusion: MRI has an important role determining the lateralization of seizures. Assess the relationship of the combined second and third variables are statistically bigger obtained conjunction with lateralization of seizures compared to connecting each variable separately, so the MRI assessment carried out for 3 to this variable will further strengthen the diagnosis of hippocampal abnormalities.]"

"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. "

"Kanker kolorektal adalah kanker yang berlokasi dibagian kolon atau rektum dengan indikasi awal adalah keberadaan polip non-kanker. Kanker kolorektal menempati urutan ketiga sebagai kanker ganas dan urutan kedua dengan tingkat mortalitas tertinggi di tingkat dunia. Peningkatan morbiditas kanker kolorektal tercatat pada orang dewasa berusia 30-40 tahun. Prevalensi dan urgensi deteksi dini kanker kolorektal diperlukan untuk mendapatkan hasil diagnosis kanker sebagai solusi pengobatan kanker. Gen MDR1 sebagai gen penghabisan obat membentuk resistensi terhadap pengobatan yang menyebabkan kegagalan dalam kemoterapi. Penelitian ini bertujuan untuk mengetahui ekspresi gen MDR1 pada kanker kolorektal. Penelitian ini menggunakan metode qPCR yang bersifat spesifik dan sensitif pada satu target. Berdasarkan hasil qPCR diperoleh di antara 10 penderita kanker kolorektal terdapat 6 penderita yang positif terdeteksi gen MDR1 dan 4 penderita tidak mengekspresikan gen MDR1. Khususnya, ekspresi mRNA tertinggi diamati pada penderita yang telah mengalami metastasis terutama menuju hepar. Secara statistik, pengujian menggunakan Shapiro-Wilk (0,049 < 0,05) menyatakan data tidak terdistribusi normal antara kelompok jaringan normal dan kanker kolorektal. Sedangkan, pada uji Mann Whitney U (0,065 > 0,05) tidak terdapat perbedaan signifikan antara jaringan normal dan jaringan kanker kolorektal. Rekomendasi selanjutnya adalah dengan menggunakan sampel lebih banyak untuk melihat pola ekspresi gen.

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Colorectal cancer is cancer located in the colon or rectum with the initial indication is the presence of non-cancerous polyps. Colorectal cancer ranks third as a malignant cancer and ranks second with the highest mortality rate in the world. The increase in colorectal cancer recorded in adults aged 30-40 years. The prevalence and urgency of early detection of colorectal cancer is obtained to get the results of a cancer diagnosis as a cancer treatment solution. The MDR1 gene as a drug efflux forms resistance to treatment causes failure in chemotherapy. This study aims to determine the expression of the MDR1 gene in colorectal cancer. This study uses the qPCR method which is specific and sensitive to one target. Based on the qPCR results, it was found that among 10 patients with colorectal cancer, there were 6 patients who were positive for the MDR1 gene and 4 patients were negative the MDR1 gene. In particular, the highest mRNA expression was observed in patients who had metastasized mainly to the liver. Statistically, the Shapiro-Wilk test (0.049 < 0.05) stated that the data were not normally distributed between the normal tissue groups and colorectal cancer. Meanwhile, the Mann Whitney U test (0.065 > 0.05) means that there is no significant difference between normal tissue and colorectal cancer tissue. The next recommendation is to use more samples to see the pattern of gene expression."

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Proprotein konvertase subtilisin kexin 9 adalah protein regulator low density lipoprotein yang dapat menyebabkan beberapa penyakit kardiovaskular. Pengobatan yang mampu menghambat protein tersebut baru tersedia dalam bentuk injeksi. Pada usus halus peran dari protein tersebut juga belum diketahui secara pasti sehingga membutuhkan penelitian lebih lanjut. Metode in vivo yang telah digunakan dalam studi terkait pengembangan inhibitor protein tersebut dalam bentuk oral belum menggunakan hewan uji yang tersedia di Indonesia. Pada penelitian ini dikembangkan model hewan tinggi proprotein konvertase subtilisin kexin 9 yang tersedia di Indonesia. Tikus Wistar jantan wild diinduksi diet tinggi fruktosa (3mL/200gram berat badan) selama 3, 4, dan 5 minggu sebelum protein tersebut diukur pada plasma darah dan jaringan usus halus menggunakan uji ELISA dan western blot. Tikus yang diinduksi fruktosa memiliki kadar yang meningkat secara signifikan (p<0.05) pada plasma dan usus halus dibandingkan kontrol pada durasi 3 dan 4 minggu. Tetapi pada durasi induksi 5 minggu, tidak dihasilkan perbedaan yang signifikan antara kelompok induksi dan kontrol (p>0.05). Hasil western blot tidak dapat dikuantifikasi karena pengikatan non-spesifik yang berlebih. Maka, metode yang diterapkan pada penelitian ini mampu menciptakan tikus tinggi proprotein konvertase subtilisin kexin 9. Namun, diperlukan optimasi lebih lanjut dalam pengukuran kadarnya di usus halus.

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Proprotein convertase subtilisin kexin 9 (PCSK9) regulates low-density lipoprotein in circulation and could cause various cardiovascular diseases, but inhibitor of said protein only exists in injection form. Its role in small intestines have yet to be known and requires further studies. An in vivo method that could help develop an oral drug is required as earlier studies have yet to utilize animals available in Indonesia. This study is performed to acquire an animal model high in said protein using Male Wistar wild rats administered with high-fructose diet (3mL/200gram body weight). Using ELISA kit and western blot, levels in blood plasma and small intestinal tissues are measured after 3, 4, and 5 weeks of administration. The levels in both blood plasma and small intestines are significantly greater (p<0.05) in fructose-treated rats compared to the control after 3 and 4 weeks. There is no significant difference found between treatment group and control group in rat’s blood plasma treated for 5 weeks. Western blot result is unable to be determined due to high background. As such, the method in this study created a rat model high in proprotein convertase subtilisin kexin 9. Further optimization of its level measurements in small intestines is necessary.

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