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"Latar belakang: Saat ini, diet ketogenik menjadi salah satu penanganan epilepsi yang sulit terkontrol dengan obat anti-epilepsi (intraktabel) pada anak dan sudah mulai diterapkan di seluruh dunia.Diet ketogenik Modified Atkins Diet (MAD) adalah jenis diet ketogenik yang lebih tidak restriktif dengan prinsip yang sama dengan diet ketogenik yang klasik.Penelitian mengenai penggunaan diet ketogenik MAD pada anak dengan epilepsi intraktabel juga masih belum ada di Indonesia. Penelitian ini bertujuan untuk menilai pengaruh, efek samping, toleransi, tingkat kepatuhan, menu makanan diet ketogenik MAD yang mudah diterapkan pada anak dengan epilepsi intraktabel yang dipantau dalam waktu 6 bulan. Metode: Penelitian ini merupakan penelitian awal dengan uji klinis pre dan post treatment pada populasi anak dengan epilepsi intraktabel yang berobat ke Poliklinik Neurologi dan Nutrisi Penyakit Metabolik Anak Rumah Sakit Umum Pusat Nasional dr.Cipto Mangunkusumo Jakarta pada bulan November 2021 hingga Juni 2022. Hasil penelitian: Sebanyak 31 subyek penelitian memenuhi kriteria inklusi. Subyek yang menjalani diet ketogenik MAD pada bulan pertama 31 subyek (100%), bulan ke-3 13 subyek (41,9%), dan bulan ke-6 adalah 9 subyek (29%). Pengaruh diet ketogenik MAD terhadap median pengurangan frekuensi kejang pada bulan pertama 50%, p=0,144; bulan ketiga 62%, p=0,221; dan bulan keenam 83,3%, p=0,028. Efek samping diet ketogenik MAD yang paling sering adalah muntah dan diare. Tingkat ketidakpatuhan diet ketogenik MAD ditemukan pada 18 subyek (58,1%). Buku contoh menu diet ketogenik MAD untuk anak epilepsi intraktabel di Indonesia dibuat untuk memudahkan orangtua dalam menjalankan diet ketogenik. Simpulan: Pengaruh diet ketogenik MAD pada anak dengan epilepsi intraktabel yang ditunjukkan dengan penurunan frekuensi kejang (median) secara klinis pada bulan ke-1,3,6 dan bermakna secara statistik pada bulan ke-6. Penelitian dengan metode uji acak ganda tersamar dan jumlah sampel penelitian yang lebih besar, multisenter, waktu lebih lama serta menu diet ketogenik MAD khas Indonesia yang mudah diterapkan dan murah diperlukan untuk mendapatkan hasil penelitian yang lebih baik. Kata kunci: epilepsi, diet, ketogenik, modified atkins

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Background: At present, ketogenic diet has been explored as a potential treatment approach for intractable epilepsy (difficult to control with anti-epileptic drugs) in children, and is applied in various parts of the world. The Modified Atkins Diet (MAD) is a less restrictive type of ketogenic diet, while still maintaining the same principles as the classic ketogenic diet. However, no existing studies have been performed to evaluate the use of the MAD ketogenic diet in children with intractable epilepsy in Indonesia. This study aims to assess the influence, side effects, tolerance, degree of adherence, and menu of MAD ketogenic diet food that can be easily applied to children with intractable epilepsy during a 6-months monitoring period. Methods: This is a pilot pre- and post-treatment clinical trial involving children with intractable epilepsy treated at the Pediatric Neurology and Nutrition & Metabolic Diseases Outpatient Clinics at the Dr. Cipto Mangunkusumo General Hospital Jakarta treated between November 2021 and June 2022. Results: A total of 31 subjects met the inclusion criteria. There were 31 subjects receiving the MAD ketogenic diet in the first month (100%), followed by 13 subjects in the third month (41.9%), and 9 subjects in the sixth month (29%). The effect of ketogenic diet in reducing the frequency of seizures was 50% in the first month (p=0.144), 62% in the third month (p=0.221), and 83.3% in the sixth month 83.3% (p=0.028). The most frequent side effects of the MAD ketogenic diet were vomiting and diarrhea. Non-compliance to the MAD ketogenic diet was observed in 18 (58.1%) of subjects. A sample book of food menu complying to the MAD ketogenic diet for intractable epilepsy based on Indonesian delicacies was also created to ease parents to comply to the diet. Conclusions: Effect of the MAD ketogenic diet in children with intractable epilepsy was clinically observed as a decrease in the median frequency of seizures in the first, third, sixth month of the diet and statistically significant in the sixth month. Further multicenter double-randomized trials with larger sample size, longer observation period and the MAD ketogenic diet with indonesian menu (cheap and applicable) are also warranted to obtain more rigorous research results. Keywords: epilepsy, diet, ketogenic, modified atkins"

"Latar belakang. Epilepsi fokal merupakan jenis epilepsi terbanyak pada anak. Kemungkinan untuk terjadinya epilepsi intraktabel pada epilepsi fokal lebih besar dibandingkan dengan epilepsi umum. Data mengenai faktor risiko epilepsi fokal intraktabel masih sangat sedikit. Perlu dilakukan penelitian lebih lanjut untuk mengetahui strategi pengobatan dan konseling bagi pasien dan keluarga. Tujuan. (1) mendapatkan frekuensi terjadinya epilepsi intraktabel pada anak dengan epilepsi fokal. (2) mengetahui karakteristik pasien epilepsi fokal yang kontrol ke poliklinik Neurologi Anak. (3) mengetahui apakah usia awitan, etiologi epilepsi, frekuensi awal serangan, status perkembangan motor kasar awal, respon terapi awal, gambaran EEG awal, dan gambaran CT-Scan/MRI kepala dapat memprediksi kemungkinan terjadinya epilepsi intraktabel pada pasien anak dengan epilepsi fokal. (4) mengetahui apakah evolusi status perkembangan motor kasar, dan evolusi EEG epileptiform dapat memprediksi terjadinya epilepsi intraktabel. Metode penelitian. Desain penelitian adalah kohort retrospektif dan dilakukan poliklinik rawat jalan Neurologi Anak di RSCM sejak November 2013 sampai dengan Februari 2014 terhadap anak epilepsi fokal hingga usia 18 tahun, dengan lama pengobatan minimal 6 bulan. Faktor risiko dianalisis bivariat dan multivariat. Hasil penelitian. Angka kejadian epilepsi fokal intraktabel adalah 35 (39%).Usia subjek terbanyak adalah usia>3 tahun sebanyak 81(90%) subjek. Pada analisis bivariat didapat faktor risiko bermakna adalah etiologi kejang simtomatik (OR 6,12 IK95% 2,08-18,04), frekuensi kejang>5x/hari (OR 3,91 IK95% 1,43-10,75), respon awal terapi buruk (OR 233,14 IK95% 27,40-1983,27), EEG awal abnormal (OR 4,51 IK95% 1,82-11,17), MRI abnormal (OR 10,38 IK95% 2,91-37,06), evolusi status perkembangan motor kasar buruk (OR 21,62 IK95% 2,62-178,1), dan evolusi EEG epileptiform buruk (OR 25 IK95% 7,71-81,03). Pada analisis multivariat didapatkan respon awal terapi buruk dengan nilai OR136,00 (IK95% 14,79 sampai 1250,08), dan evolusi EEG epileptiform buruk dengan nilai OR 10,00 (1,68 sampai 59,35) merupakan faktor risiko yang berperan untuk menjadi epilepsi fokal intraktabel. Simpulan. Angka kejadian epilepsi fokal intraktabel sebanyak 39%. Faktor risiko yang berperan adalah respon terapi awal buruk, dan evolusi EEG epileptiform buruk.

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Background. Epilepsy focal is the most common type epilepsy in children. The chance to be intractable epilepsy is higher than general epilepsy. Therefore, study of the risk factors to predict intractable epilepsy is the utmost importance to conduct the treatment strategy and consult the patients and family.

Objective. (1) to determine the characteristic focal epilepsy in children (2) to determine the frequency of intractable focal epilepsy (3) to identify and analyze the association of early risk factors including the onset of seizure, frequency of seizure, etiology of epilepsy, gross motor developmental status, the response of antiepileptic drugs, the electroencephalogram (EEG), and magnetic resonance imaging (MRI) / computed tomography (CT) Scan findings with intractable focal epilepsy, (4) to identify and analyze the relationship between the evolution factors including the evolution of EEG epileptiform, and the evolution of gross motor development with intractable focal epilepsy.

Methods. Retrospective cohort study was conducted in child neurology outpatient clinics in Cipto Mangunkusumo Hospital Jakarta on November 2013 to February 2014. Inclusion criteria was children with epilepsy focal who was treated with antiepileptic drugs at least 6 month therapy until 18 years old age. Patients with febrile convulsions; central nervous system infections; neurodegenerative, neurometabolic diseases; and catastrophic epileptic syndromes with poor prognosis were excluded from the study. Data were analyzed using the IBM SPSS for Windowsv.17 software (IBM, New York, USA).

Results. The proportion of intractable focal epilepsy is 35 (39%). The most of children is >3 years old 81 (90%). Bivariate analysis showed that significantly early risk factors are symptomatic epileptic (OR = 6.12; 95%CI 2.08-18.04), frequency of seizure >5x/day (OR = 3.91; 95%CI 1.43-10,75), gross motor developmental delay (OR = 233.14; 95%CI 27.40-1983.27), early abnormal EEG wave (OR = 4.51; 95%CI 1.82-11.17), abnormal MRI (OR = 10.38; 95%CI 2.91-37.06), poor gross motor developmental evolution (OR = 21.62; 95%CI 2.62-178.1), and poor the EEG epileptiform evolution (OR = 25; 95%CI 7.71-81.03). Multivariate logistic regression analysis revealed that an initial non response to antiepileptic drugs (OR = 136.00; 95%CI 14.79-1250.08), and the poor evolution of EEG epileptiform (OR =10.00; 95%CI 1.68-59.35) were all found to be significant and independent risk factors for intractable focal epilepsy.

Conclusion. The present study reveals that the early non response to antiepileptic drugs, and poor of EEG epileptiform evolution are strongly associated with intractable focal epilepsy."

"[ABSTRAKLatar belakang: Epilepsi umum merupakan jenis epilepsi yang sering dijumpai pada anak. Data mengenai faktor risiko epilepsi intraktabel pada anak dengan epilepsi umum masih sangat terbatas. Perlu dilakukan penelitian lebih lanjut untuk mengetahui faktor risiko yang berperan dalam kejadian epilepsi intraktabel sehingga dapat menjadi dasar dalam tata laksana serta edukasi pasien dan orangtua.Tujuan: (1) Mengetahui karakteristik pasien epilepsi umum dan frekuensi terjadinya epilepsi intraktabel pada anak dengan epilepsi umum . (2) Mengetahui apakah usia awitan, tipe kejang, frekuensi awal serangan, status perkembangan motor kasar awal, respon terapi awal, gambaran EEG awal, dan gambaran MRI/CT Scan kepala dapat menjadi faktor risiko terjadinya epilepsi intraktabel pada anak dengan epilepsi umum. (3) Mengetahui apakah evolusi status perkembangan motor kasar, dan evolusi EEG epileptiform dapat menjadi faktor risiko terjadinya epilepsi intraktabel pada anak dengan epilepsi umumMetode: Penelitian kohort retrospektif berdasarkan rekam medis dilakukan di poliklinik rawat jalan neurologi anak Departemen Ilmu Kesehatan Anak FKUI-RSCM dan poliklinik anak swasta RSCM antara bulan September sampai dengan Desember 2014 terhadap anak epilepsi umum usia koreksi 1 bulan hingga 18 tahun, dengan lama pengobatan minimal 6 bulan. Faktor risiko dianalisis bivariat dan multivariat.Hasil: Angka kejadian epilepsi umum intraktabel adalah 21 (21%). Usia subjek terbanyak adalah usia >3 tahun sebanyak 85(83%) subjek. Pada analisis bivariat didapatkan faktor risiko yang bermakna adalah usia awitan kejang <1 tahun (OR 11,4 IK 95% 3,45-37,62), frekuensi awal serangan ≥5 kali/hari (OR 8,5 IK95% 2,90-24,80), respon awal terapi buruk (OR 160 IK 95% 19,12-1339,06), evolusi status perkembangan motor kasar buruk (OR 4,9 IK95% 1,79-13,67) dan evolusi EEG epileptiform buruk (OR 10 IK95%3,25-30,92). Pada analisis multivariat didapatkan respon awal terapi buruk dengan nilai OR 144,3 (IK95% 15,47-1345,59) dan usia awitan kejang < 1 tahun dengan nilai OR 9,6 (IK95% 1,78-51,92) merupakan faktor risiko yang berpern untuk menjadi epilepsi umum intraktabel.Simpulan : Angka kejadian epilepsi umum intraktabel sebanyak 21%. Faktor risiko yang sangat berperan adalah respon terapi awal buruk dan usia awitan kejang <1 tahun.

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ABSTRACTBackground: Generalized epilepsy is the most common type of epilepsy in children. Limited datas of intractable epilepsy risk factors are available at present. Therefore, more studies are needed to investigate the risk factors of intractable epilepsy in order to manage and educate both patients and parents.Objective: (1) to describe characteristic and frequency of intractable epilepsy in children with generalized epilepsy, (2) to investigate the role of age onset of seizure, initial seizure frequency, type of seizure, early gross motor developmental status, early therapeutic response, early EEG description and cerebral MRI/CT scan as risk factors of intractable epilepsy in children with generalized epilepsy, (3) to investigate the role of gross motor developmental status evolution and epileptiform EEG evolution as risk factors of intractable epilepsy.Methods: Retrospective cohort study was conducted at neurology outpatient pediatric RSCM and private outpatient clinic between September to December 2014. The inclusion criteria was generalized epilepsy children age 1 month of corrected age to 18 years old which has been treated with antiepileptic drugs for at least 6 months. Risk factors were analyze with bivariate and multivariate analysis.Results: Prevalence of intractable generalized epilepsy is 21%. Most subject are >3 years old 85(83%) subject. Bivariate analysis showed that age onset of seizure (OR 11,4 CI95% 3,45-37,62), initial seizure frequency ≥5 times/day (OR 8,5 CI 95% 2,90-24,80), non-responder of early treatment (OR 160 CI 95% 19,12-1339,06), unfavorable gross motor development evolution (OR 4,9 CI 95% 1,79-13,67) and unfavorable epileptiform EEG evolution (OR 10 CI 3,25-30,92) are significantly associated with intractable epilepsy. The most important among those risk factors based on multivariate analysis are non-responder of early treatment with OR 144,3 (CI95% 15,47-1345,59) and age onset < 1 year old with OR 9,6 (CI 1,78-51,92).Conclusions: Prevalence of intractable generalized epilepsy is 21%. Non-responder early treatment and age onset of seizure < 1 year old are strongly associated with intractable generalized epilepsy.;Background: Generalized epilepsy is the most common type of epilepsy inchildren. Limited datas of intractable epilepsy risk factors are available at present.Therefore, more studies are needed to investigate the risk factors of intractableepilepsy in order to manage and educate both patients and parents. Objective: (1) to describe characteristic and frequency of intractable epilepsy inchildren with generalized epilepsy, (2) to investigate the role of age onset ofseizure, initial seizure frequency, type of seizure, early gross motor developmentalstatus, early therapeutic response, early EEG description and cerebral MRI/CTscan as risk factors of intractable epilepsy in children with generalized epilepsy,(3) to investigate the role of gross motor developmental status evolution andepileptiform EEG evolution as risk factors of intractable epilepsy. Methods: Retrospective cohort study was conducted at neurology outpatientpediatric RSCM and private outpatient clinic between September to December2014. The inclusion criteria was generalized epilepsy children age 1 month ofcorrected age to 18 years old which has been treated with antiepileptic drugs for atleast 6 months. Risk factors were analyze with bivariate and multivariate analysis. Results: Prevalence of intractable generalized epilepsy is 21%. Most subject are>3 years old 85(83%) subject. Bivariate analysis showed that age onset of seizure(OR 11,4 CI95% 3,45-37,62), initial seizure frequency ≥5 times/day (OR 8,5 CI95% 2,90-24,80), non-responder of early treatment (OR 160 CI 95% 19,121339,06),unfavorablegrossmotordevelopmentevolution(OR4,9CI95%1,7913,67)and unfavorable epileptiform EEG evolution (OR 10 CI 3,25-30,92) aresignificantly associated with intractable epilepsy. The most important amongthose risk factors based on multivariate analysis are non-responder of earlytreatment with OR 144,3 (CI95% 15,47-1345,59) and age onset < 1 year old withOR 9,6 (CI 1,78-51,92). Conclusions: Prevalence of intractable generalized epilepsy is 21%. Nonresponder early treatment and age onset of seizure < 1 year old are strongly associated with intractable generalized epilepsy.;Background: Generalized epilepsy is the most common type of epilepsy inchildren. Limited datas of intractable epilepsy risk factors are available at present.Therefore, more studies are needed to investigate the risk factors of intractableepilepsy in order to manage and educate both patients and parents. Objective: (1) to describe characteristic and frequency of intractable epilepsy inchildren with generalized epilepsy, (2) to investigate the role of age onset ofseizure, initial seizure frequency, type of seizure, early gross motor developmentalstatus, early therapeutic response, early EEG description and cerebral MRI/CTscan as risk factors of intractable epilepsy in children with generalized epilepsy,(3) to investigate the role of gross motor developmental status evolution andepileptiform EEG evolution as risk factors of intractable epilepsy. Methods: Retrospective cohort study was conducted at neurology outpatientpediatric RSCM and private outpatient clinic between September to December2014. The inclusion criteria was generalized epilepsy children age 1 month ofcorrected age to 18 years old which has been treated with antiepileptic drugs for atleast 6 months. Risk factors were analyze with bivariate and multivariate analysis. Results: Prevalence of intractable generalized epilepsy is 21%. Most subject are>3 years old 85(83%) subject. Bivariate analysis showed that age onset of seizure(OR 11,4 CI95% 3,45-37,62), initial seizure frequency ≥5 times/day (OR 8,5 CI95% 2,90-24,80), non-responder of early treatment (OR 160 CI 95% 19,121339,06),unfavorablegrossmotordevelopmentevolution(OR4,9CI95%1,7913,67)and unfavorable epileptiform EEG evolution (OR 10 CI 3,25-30,92) aresignificantly associated with intractable epilepsy. The most important amongthose risk factors based on multivariate analysis are non-responder of earlytreatment with OR 144,3 (CI95% 15,47-1345,59) and age onset < 1 year old withOR 9,6 (CI 1,78-51,92). Conclusions: Prevalence of intractable generalized epilepsy is 21%. Nonresponder early treatment and age onset of seizure < 1 year old are strongly associated with intractable generalized epilepsy., Background: Generalized epilepsy is the most common type of epilepsy inchildren. Limited datas of intractable epilepsy risk factors are available at present.Therefore, more studies are needed to investigate the risk factors of intractableepilepsy in order to manage and educate both patients and parents. Objective: (1) to describe characteristic and frequency of intractable epilepsy inchildren with generalized epilepsy, (2) to investigate the role of age onset ofseizure, initial seizure frequency, type of seizure, early gross motor developmentalstatus, early therapeutic response, early EEG description and cerebral MRI/CTscan as risk factors of intractable epilepsy in children with generalized epilepsy,(3) to investigate the role of gross motor developmental status evolution andepileptiform EEG evolution as risk factors of intractable epilepsy. Methods: Retrospective cohort study was conducted at neurology outpatientpediatric RSCM and private outpatient clinic between September to December2014. The inclusion criteria was generalized epilepsy children age 1 month ofcorrected age to 18 years old which has been treated with antiepileptic drugs for atleast 6 months. Risk factors were analyze with bivariate and multivariate analysis. Results: Prevalence of intractable generalized epilepsy is 21%. Most subject are>3 years old 85(83%) subject. Bivariate analysis showed that age onset of seizure(OR 11,4 CI95% 3,45-37,62), initial seizure frequency ≥5 times/day (OR 8,5 CI95% 2,90-24,80), non-responder of early treatment (OR 160 CI 95% 19,121339,06),unfavorablegrossmotordevelopmentevolution(OR4,9CI95%1,7913,67)and unfavorable epileptiform EEG evolution (OR 10 CI 3,25-30,92) aresignificantly associated with intractable epilepsy. The most important amongthose risk factors based on multivariate analysis are non-responder of earlytreatment with OR 144,3 (CI95% 15,47-1345,59) and age onset < 1 year old withOR 9,6 (CI 1,78-51,92). Conclusions: Prevalence of intractable generalized epilepsy is 21%. Nonresponder early treatment and age onset of seizure < 1 year old are strongly associated with intractable generalized epilepsy.]"

"Nutrisi merupakan salah satu faktor lingkungan hidup sebagai kebutuhan dasar yang sangat panting untuk anak. Nutrisi dibutuhkan setiap hari tanpa dapat ditangguhkan ke hari esok untuk kelangsungan hidup maupun tumbuh kembang anak.Selama ini pengetahuan tentang nutrisi sebagian besar membicarakan komponen diet, penyakit yang berhubungan dengan kekurangan gizi dan jumlah yang diperlukan untuk mencegahnya. Pada dekade terakhir timbul pemikiran bahwa nutrisi dapat berlaku sebagai "pengobatan". Diet tertentu bukan hanya merupakan obat bagi beberapa kelainan inborn error of metabolism seperti fenilketonuria, homosistinuria, dan galaktosemia, tetapi juga sebagai terapi penyakit lain. Salah satunya adalah diet ketogenik sebagai terapi epilepsi intraktabel.Angka kejadian epilepsi pada anak dan remaja berkisar antara 50 - 100 per 100.000 penduduk pertahun. Di Inggris, 20 - 70 kasus per 100.000 populasi pertahun dengan prevalensi 4 - 10 kasus per 1000 populasi. Di Bagian Ilmu Kesehatan Anak FKUI - RSCM. terjadi peningkatan cukup berarti, darn 65 kasus barn dan 343 kasus epilepsi lama pada tahun 2000 menjadi 116 kasus epilepsi baru dan 356 kasus epilepsi lama pada tahun 2001.Obat anti epilepsi (OAF) merupakan pilihan terapi pertama dan berhasil bank pada sebagian besar penderita anak, tempi lebih darn 25% diantaranya menderita epilepsi intraktabel atau kejang tidak terkontrol. Di Indonesia angka kejadian epilepsi intraktabel belum tercatat, diperkirakan tidak berbeda jauh dengan penelitian di luar negeri. Diet ketogenik dapat menjadi alternatif terapi epilepsi intraktabel. Variabel lama diet ketogenik adalah rasio ketogen dan non ketogen, yaitu rasio lemak dengan protein ditambah karbohidrat."

"Epilepsi masih menjadi masalah neurologis pada anak, dengan pertambahan kasus sebesar 75%-80% setiap tahunnya di negara-negara berkembang. Sudah terdapat banyak pilihan Obat Anti Epilepsi (OAE) yang tersedia. Sayangnya, mencapai 30% pasien anak yang menjalani pengobatan tidak mencapai bebas kejang, dan berkembang menjadi epilepsi dengan kejang tidak terkontrol, atau disebut dengan epilepsi intraktabel. Perjalanan pengobatan sangat penting pada keadaan epilepsi anak usia di bawah tiga tahun, yang masih dalam masa perkembangan otak, namun belum banyak penelitian yang melihat evolusi faktor risiko dalam memprediksi kejadian epilepsi intraktabel. Penelitian ini melihat perubahan atau evolusi faktor risiko pasien epilepsi anak usia di bawah tiga tahun pada 3 lokasi penelitian di Jakarta, dengan melakukan studi kasus-kontrol.Tujuan penelitian ini yaitu untuk mengidentifikasi peran evolusi faktor risiko untuk memprediksi epilepsi intraktabel anak usia di bawah tiga tahun. Penelitian dilakukan secara retrospektif, menggunakan data sekunder, dengan melihat rekam medis pasien epilepsi anak usia di bawah tiga tahun yang diperoleh dari RSUPN Cipto Mangunkusumo, Jakarta Pusat, RS Puri Cinere Depok, dan Klinik Anakku Pondok Pinang Center, Jakarta Selatan. Total subjek sebanyak 102 rekam medis pasien, dengan perbandingan kasus:kontrol yaitu 1:1. Hasil analisis pearson chi-square memperoleh 3 evolusi faktor risiko yang signifikan terhadap kejadian epilepsi intraktabel, yaitu: evolusi kelumpuhan motorik kasar (p<0,001; OR 7,86; IK95% 3,142-19,659); evolusi status neurologis (p<0,001; OR 9,84; IK95% 3,934-24,614); dan evolusi gelombang epileptiform EEG (p<0,001; OR 23,25; IK95% 7,657-70,599). Evolusi tipe kejang menunjukkan hasil tidak bermakna terhadap kejadian epilepsi intraktabel anak. Hasil analisis multivariat kemudian menunjukkan bahwa evolusi gelombang epileptiform EEG baik/buruk memiliki peran paling kuat dalam memprediksi kejadian epilepsi intraktabel (p<0,001; OR 0,075; IK95% 0,022-0,253). Evolusi gelombang epileptiform EEG buruk merupakan faktor prediktor epilepsi intraktabel anak usia di bawah tiga tahun yang paling berpengaruh.

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Epilepsy is still a neurological problem among children, with an increase in cases of 75% -80% annually in developing countries. There are already many choices of Anti-Epileptic Drugs (AED) available. Unfortunately, up to 30% of pediatric patients who undergo treatment do not achieve seizure-free, and develop epilepsy with uncontrolled seizures, also known as intractable epilepsy. The course of treatment is very important in the epilepsy of children under three years of age, who are still in the process of brain development, but not many studies have looked at the evolution of risk factors in predicting the incidence of intractable epilepsy. This study looked at changes or evolution of risk factors for epilepsy patients under three years of age in 3 study locations in Jakarta, by conducting a case-control study. The objective of this research is to Identified the evolution of risk factors role in predicting intractable epilepsy in children under three years of age. The study was conducted retrospectively, using secondary data, by looking at the medical records of epilepsy children under three years of age obtained from RSUPN Cipto Mangunkusumo, Central Jakarta, Puri Cinere Hospital Depok, and Klinik Anakku Pondok Pinang Center, South Jakarta. The total subjects were 102 patient medical records, with a case: control ratio of 1: 1. The results of the Pearson chi-square analysis obtained three significant evolution of risk factors for the incidence of intractable epilepsy, namely: the evolution of gross motor paralysis (p<0.001; OR 7.86; 95% CI 3.142-19.659); evolution of neurological status (p<0.001; OR 9.84; CI95% 3,934-24.614); and EEG epileptiform wave evolution (p<0.001; OR 23.25; IK95% 7,657-70,599). The evolution of seizure types showed no significant effect on the incidence of intractable epilepsy in children. The results of multivariate analysis then showed that the evolution of epileptiform EEG waves good/bad had the strongest role in predicting the incidence of intractable epilepsy (p<0.001; OR 0.075; CI95% 0.022-0.253). The bad evolution of EEG epileptiform waves was the most influential predictor of intractable epilepsy among children under three years of age."

"Latar belakang: Elektroensefalografi EEG adalah suatu prosedur untuk mendukung diagnosis dan evaluasi pengobatan pada penyakit epilepsi. Perekaman EEG ideal dapat dicapai bila anak mengalami tidur alamiah, yang sampai saat ini masih sulit untuk dilakukan. Melatonin, merupakan hormon tidur alami yang dihasilkan oleh kelenjar pineal, mulai dikembangkan sebagai premedikasi EEG yang diharapkan memiliki efek samping lebih kecil dibanding prosedur deprivasi tidur parsial DTP dan obat sedasi.Tujuan: 1 mengetahui perbandingan awitan tidur, makrostruktur tidur, dan lama tidur pada anak epilepsi yang diberikan melatonin oral dengan yang dilakukan prosedur DTP, 2 mengetahui perbedaan efek samping pemberian premedikasi melatonin dibandingkan prosedur DTP pada anak epilepsi yang direncanakan EEGMetode: Penelitian uji klinik acak tersamar tunggal secara paralel dilakukan pada 76 subyek berusia 1-18 tahun yang melakukan pemeriksaan EEG di Laboratorium Elektrodiagnostik IKA-RSCM selama periode November 2016 ndash; Januari 2017. Seluruh subyek tersebut dibagi menjadi 2 kelompok, satu kelompok diberikan premedikasi melatonin per oral, sedangkan kelompok lainnya dilakukan prosedur DTP.Hasil: Rerata awitan tidur kelompok DTP adalah 42,39 menit sedangkan kelompok melatonin 33,97 menit p le;0,01 . Rerata lama tidur kelompok DTP adalah 22,58 menit, sedangkan kelompok melatonin 25,09 menit p=0,144 . Gambaran makrostruktur tidur p>0,05 dan efek samping prosedur p>0,05 pada kedua kelompok subyek tidak berbeda bermakna.Simpulan: Awitan tidur pada kelompok melatonin lebih cepat dibandingkan kelompok DTP, dengan durasi tidur yang serupa antar 2 kelompok. Makrostruktur tidur kedua kelompok mirip dengan tidur alamiah. Tidak didapatkan perbedaan efek samping antara kelompok DTP dan kelompok melatonin. Melatonin dapat digunakan sebagai premedikasi EEG pada anak untuk praktik sehari-hari.

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Background Electroencephalography EEG is a procedure to support and evaluate therapy in children with epilepsy. Ideally, EEG result can be achieved if the child fell on a natural sleep, but this phase was difficult to gain. Melatonin, a natural sleep hormone that is produced by the pineal gland, was started to developed as a premedication following EEG procedure to produce natural sleep with minimal side effects compared to partial sleep deprivation PSD and other sedative agents.Aim 1 to discover sleep onset, sleep duration, and sleep macrostructure in children with the oral administration of melatonin compared to partial sleep deprivation, 2 to discover side effects of oral melatonin EEG premedication in epilepsy childrenMethod In a parallel single blinded randomized clinical trial, 76 children who were referred to EEG Unit of Cipto Mangunkusumo Hospital from November 2016 to January 2017 were evaluated. The children were randomly assigned into two groups to receive PSD procedure control group and oral melatonin treatment group.Results Mean sleep onset in PSD group was 42.39 minutes, while in melatonin group was 33.97 minutes p le 0,01 . Mean sleep duration in PSD group was 22.58 minutes, while in melatonin group was 25.09 minutes p 0,05 . There were no significant differences in both sleep macrostructure p 0,05 and procedure rsquo s side effects p 0,05 in both groups.Conclusions Sleep onset was more prompt in melatonin group compares to PDS group, while sleep duration was similar between each groups. Both of sleep macrostructures were similar to natural sleep process. There were no significant differences of side effects in both groups. Melatonin can be use as premedication for EEG examination in epilepsy children."

"Menurut World Health Ranking 2020, kematian epilepsi di Indonesia mencapai 706 orang dari total kematian dan menempatkan Indonesia pada peringkat 183 di dunia. Kualitas hidup pasien epilepsi dipengaruhi oleh beberapa faktor. Penelitian ini bertujuan mengidentifikasi faktor-faktor yang berhubungan dengan kualitas hidup anak epilepsi. Menggunakan metode cross sectional dengan accidental sampling dan didapatkan 94 responden, yaitu orang tua anak epilepsi berumur 4-18 tahun. Uji yang digunakan adalah Chi Square dengan Quality of Life in Childhood Epilepsy Questionner (QOLCE-16). Hasil penelitian menunjukan rata-rata nilai QOLCE-16 anak epilepsi adalah 42.25 dimana 52.1% anak memiliki kualitas hidup buruk. Faktor yang berhubungan dengan kualitas hidup anak epilepsi, yaitu usia orang tua, tingkat pendidikan orang tua, status pendidikan anak, lama pengobatan, frekuensi kejang, jenis OAE, dan durasi epilepsi. Hasil penelitian ini dapat dijadikan rujukan dalam pengembangan pengkajian keperawatan pada pasien epilepsi terkait kualitas hidup.

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According to the 2020 World Health Ranking, Indonesia ranked 183rd with 706 epilepsy-related fatalities out of total deaths. Various factors impact the life quality experienced by those with epilepsy. Finding the variables affecting children with epilepsy's life quality is the goal of this study. 94 parents of children with epilepsy between the ages of 4 and 18 were selected from the population using an unintentional sampling technique. Chi Square with Life quality in Childhood Epilepsy Questionner (QOLCE-16) was the test utilized. The study finds 52.1% of children with epilepsy reported a low life quality, with an average QOLCE-16 score of 42.25. AED type, length of therapy, frequency of seizures, length of parental education, and length of epilepsy are all factors that affect the life quality for children with epilepsy. These findings can be referenced when creating life quality nursing assessments for patients with epilepsy."

"Obesitas di usia dini dapat merugikan kesehatan anak sepanjang hidupnya secara permanen. Dewasa ini, asam lemak omega-3 diperkenalkan sebagai alternatif solusi obesitas. Penelitian ini bertujuan untuk menginvestigasi pengaruh dari konseling asam lemak omega-3 selama 10 minggu terhadap pengetahuan, sikap, asupan, dan IMT/U. Penelitian ini membagi acak subjek; grup yang mendapat konseling dengan optimalisasi asam lemak omega-3 disertai rekomendasi menu harian yang spesifik (Grup intervensi, n=18); dan yang mendapat konseling dan menu standar (Grup kontrol, n=20). Hasil menunjukkan tingkat pengetahuan pada grup intervensi meningkat signifikan (p<.001). Dibutuhkan investigasi lebih lanjut untuk mengetahui pengaruh intervensi ini terhadap keluaran lain yang diharapkan.

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Obesity in early life could result in permanent heath consequences. Omega-3 fatty acids (FAs) are beneficial in obesity management, but food-based nutrition education enhancing omega-3 FAs especially in children was lacking. We investigated the effect of 10-week enhanced counseling on caregivers knowledge, attitude, as well as children's intakes and body mass index-for-age (BAZ). Children were randomly assigned to receive; enhanced counseling with specific daily menu (intervention group, n=18), or standard counseling with general menu (control group, n=20). Intervention group significantly improved knowledge (p<.001). However, its effect on other outcomes may need further investigation."

"Latar belakang : Tidur berguna untuk kesehatan mental, emosi, fisik, dan sistemimunitas tubuh. Gangguan tidur pada anak semakin menjadi masalah karena akanberdampak pada mood, perilaku dan intelektual anak. Dilaporkan, insidensigangguan tidur pada anak lebih tinggi pada kasus epilepsi.Tujuan : Mengetahui prevalensi gangguan tidur pada anak dengan epilepsi, sertamenilai hubungan antara faktor-faktor risiko yang memengaruhinya kejadiangangguan tidur pada anak dengan epilepsi.Metode : Studi potong lintang yang dilakukan di Poliklinik Anak Kiara RS CiptoMangunkusumo Jakarta dengan populasi anak epilepsi usia 4-18 tahun. Penilainvariabel gangguan tidur menggunakan kuesioner sleep disturbance scale forchildren (SDSC) terdiri dari 26 pertanyaan yang telah tervalidasi sebelumnya.Kuesioner akan diisi oleh orang tua mengenai pola tidur anak dalam 6 bulanterakhir. Pasien yang sebelumnya memiliki gangguan tidur primer sepertiobstructive sleep apnea (OSA), sindrom epilepsi, disabilitas intelektual, attentiondeficit hyperactivity disorder (ADHD) akan dieksklusi.Hasil : Didapatkan 99 subyek dengan karakteristik 22,2% menderita epilepsiintraktabel, 28,2% serebral palsi dan 64,6% tipe kejang umum. Dari hasilkuisioner SDSC didapatkan 71,7% anak dengan epilepsi mengalami gangguantidur, jenis terbanyak 62% gangguan memulai dan mempertahankan tidur. Faktorrisiko yang terbukti memengaruhi secara independen kejadian gangguan tidurpada pasien epilepsi adalah tipe kejang umum, serebral palsi, epilepsi intraktabel,elektroensefalografi (EEG) abnormal, dan obat antiepilepsi (OAE) jenis nonbenzodiazepin.Kesimpulan : Tipe kejang umum, serebral palsi, epilepsi intraktabel,abnormalitas EEG, dan OAE jenis non-benzodiazepin bermakna secara statistikindependen memengaruhi kejadian gangguan tidur pada epilepsi.

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Background : Sleep is affecting mental health, emotional, physical, and immunesystem. Sleep disorder in children was increased and became a burden because itwill affect the mood, behaviour and intellectual. Reportedly, the incidence ofsleep disorder is higher in children with epilepsy.Objective : Knowing the prevalence of sleep disorder in children with epilepsy,and to assess the risk factors which affecting it.Methods : A cross-sectional study was conducted at children polyclinic CiptoMangunkusumo Hospital in Jakarta with populations of epilepsy children aged 4-18 years old. The assessment of sleep disorder using the sleep disturbance scalefor children (SDSC), which consist of 26 questions that had been previouslyvalidated. The questionnaire will be filled out by parents regarding the childssleep pattern in the past 6 months. Patients who had primary sleep disorders suchas obstructive sleep apnea (OSA), epilepsy syndrome, intellectual disabilities,attention deficit hyperactivity disorder (ADHD) will be excluded.Results : There were 99 subjects, with characteristics are 22.2% had intractableepilepsy, 28.2% had cerebral palsy and 64.6% generalized seizures. Theprevalence of sleep disorder in child with epilepsy in this study was 71.7%, themost frequent type was disorder of starting and maintaining sleep. Risk factorsthat have been shown to independently affecting the incidence of sleep disorder inepilepsy patients are generalized seizures, cerebral palsy, intractable epilepsy,electroencephalography (EEG) abnormality, and non-benzodiazepine typeantiepileptic drugs (AED).Conclusion : Generalized seizure, cerebral palsy, intractable epilepsy, EEGabnormality, and non-benzodiazepine type of AED are statistically significantaffecting the incidence of sleep disturbance in epilepsy independently."