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Abstrak :
Pendahuluan: Prevalensi psikosis pada epilepsi (PPE) 15 kali lebih tinggi dibandingkan psikosis pada populasi umum. Gambaran klinis PPE berupa halusinasi dan waham yang dominan dengan hendaya. Faktor risiko PPE antara lain onset dini epilepsi, epilepsi yang tidak terkontrol, riwayat status epileptikus, fokus epileptogenik di temporal kiri, sklerosis hipokampus, dan riwayat psikosis dalam keluarga. PPE sendiri sering dihubungkan dengan gangguan fungsi psikososial dan kesejahteraan pasien. Penelitian ini bertujuan untuk mengetahui angka kejadian PPE pada epilepsi fokal, gambaran klinis serta faktor-faktor yang berkaitan. Metode: Studi ini bersifat deskriptif dengan metode potong lintang pada pasien epilepsi fokal di Poliklinik Neurologi RSCM. Subjek yang bersedia ikut serta dalam penelitian kemudian dilakukan wawancara menggunakan MINI-ICD 10 bagian psikotik untuk menapis gejala psikotik dan dilakukan konfirmasi hasil dengan dokter spesialis kesehatan jiwa untuk mendiagnosis PPE. Hasil: Jumlah subjek yang didapatkan sebanyak 34 subjek. Dari MINI ICD-10 bagian psikotik, terdapat 10 subjek mengalami gejala psikotik dan hendaya dialami 2 subjek. Angka kejadian PPE didapatkan sebesar 5,9%. Gambaran klinis psikosis berupa halusinasi (auditori dan visual), waham (paranoid dan bizzare), dan hendaya. Kedua subjek PPE memiliki jenis kelamin perempuan, awitan epilepsi usia muda, durasi epilepsi ke psikosis selama 6 dan 23 tahun, frekuensi kejang yang belum terkontrol, riwayat status epileptikus, memiliki sindrom epilepsi lobus temporal dan sklerosis hipokampus dengan lateralisasi fokus bilateral dan kiri serta keduanya menggunakan politerapi. Kesimpulan: Angka kejadian PPE pada epilepsi fokal sebesar 5,9% dengan waham yang muncul berupa waham paranoid dan bizzare. Halusinasi yang muncul adalah halusinasi visual dan auditorik. Penelitian ini tidak dapat mencari faktor resiko yang berhubungan dengan PPE. ......Background: The prevalence of psychosis in epilepsy (PPE) is 15 times higher than general population. The clinical features of PPE are hallucinations and dominant delusions with disability. Risk factors for PPE include early onset of epilepsy, uncontrolled epilepsy, history of status epilepticus, left temporal epileptogenic focus, hippocampal sclerosis, and family history of psychosis. PPE often associated with impaired psychosocial functioning and patient well-being. This study aims to determine the incidence clinical features and related factors of PPE in focal epilepsy. Method: This study is a descriptive cross-sectional in patients with focal epilepsy at the RSCM Neurology outpatient clinic. Subjects are focal epilepsy patient who willing to participate then interviewed using the MINI-ICD 10 psychotic section to screen for psychotic symptoms. Results are confirmed by psychiatrist to diagnose PPE. Results: The number of subjects obtained was 34 subjects. From the psychotic section of the MINI ICD-10, there were 10 people who experienced psychotic symptoms and 2 subjects experienced disability. The prevalence of PPE was 5.9%, with clinical features of psychosis are hallucinations (auditory and visual) and delusions (paranoid and bizzare). Both PPE subjects had female gender, young onset of epilepsy, duration of epilepsy to psychosis for 6 and 23 years, uncontrolled seizure frequency, history of status epilepticus, temporal lobe epilepsy syndrome and hippocampal sclerosis with focal lateralization to bilateral and left as well as use of polytherapy. Conclusion: The incidence of PPE was 5.9% with delusions in the form of paranoid and bizzare. The hallucinations that manifest are visual and auditory hallucinations. This study was unable to look for risk factors associated with PPE.

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ABSTRAK
Latar Belakang. Gangguan cemas menyeluruh (GCM) merupakan salah satu bentuk gangguan ansietas tersering pada populasi epilepsi yang dapat menurunkan kualitas hidup, sehingga deteksi dini sangatlah penting. Generalized Anxiety Disorder-7 (GAD-7) merupakan instrumen penapis GCM satu-satunya yang pernah divalidasi pada pasien epilepsi, yaitu di Korea dengan titik potong ≥7. Instrumen GAD-7 dapat dikerjakan pasien sendiri kurang dari 3 menit, sehingga cocok digunakan di poliklinik neurologi. Penelitian ini bertujuan untuk mendapatkan kuesioner GAD-7 versi bahasa Indonesia yang valid, reliabel dan akurat untuk menapis GCM pada pasien epilepsi dewasa. Metode Penelitian. Penelitian dibagi menjadi 2 tahap. Tahap pertama meliputi adaptasi lintas budaya berdasarkan ketentuan World Health Organization (WHO), uji validitas isi berdasarkan penilaian pakar mengenai relevansi butir pertanyaan GAD-7 hasil adaptasi, dilanjutkan uji validitas interna, reliabilitas interna dan reliabilitas test-retest pada 30 pasien epilepsi yang memenuhi kriteria inklusi. Tahap kedua adalah uji diagnostik. Hasil GAD-7 dengan titik potong ≥7 dibandingkan dengan wawancara Mini International Neuropsychiatric Interview International Classification of Diseases-10 (MINI ICD-10) sebagai baku emas. Hasil. Koefisien validitas isi berdasarkan metode Martuzua dari GAD-7 hasil adaptasi bahasa Indonesia adalah 0,847. Hasil uji validitas interna dengan korelasi Spearman didapatkan koefisien korelasi 0,648 hingga 0,800 (p<0,01). Uji reliabilitas konsistensi interna dengan Cronbach?s Alpha 0,867. Perbedaan nilai koefisien korelasi dan Cronbach?s Alpha antara pemeriksaan pertama dan retest menunjukkan reliabilitas test-retest yang baik. Dari 146 subyek uji diagnostik, prevalensi GCM hasil pemeriksaan MINI ICD-10 sebesar 16,4%. Dengan titik potong ≥7, GAD-7 memiliki sensitivitas 100% dan spesifisitas 84,4%. Kesimpulan. Kuesioner GAD-7 versi Indonesia terbukti valid dan reliabel sehingga dapat digunakan untuk menapis GCM. Dengan titik potong ≥7, GAD-7 memiliki nilai akurasi yang tinggi untuk menapis GCM pada pasien epilepsi dewasa.ABSTRACT
Background. Generalized anxiety disorder (GAD) is one of the most common type among anxiety disorders in epilepsy population that can impaired patients quality of life. The Generalized Anxiety Disorder-7 (GAD-7) is a screening tool for detecting GAD that has been validated in epilepsy patients in Korea with cut-off point ≥7. The GAD-7 could be filled by the patients themselves in less than three minutes; hence, it is appropriate to be used in the neurology outpatient setting. The objective of this study is to obtain a valid, reliable, and accurate GAD-7 in Indonesian language as a screening tool of GAD in adult epilepsy patients. Method. The study was conducted in two phases. The first phase included transcultural adaptation based on World Health Organization standards, content validity test based on expert consideration regarding the relevance of GAD-7 question items, followed by internal validity test, internal reliability test and test-retest in 30 epilepsy patients. The second phase was diagnostic test, in which, the GAD-7 with cut off point ≥7 will be compared with Mini International Neuropsychiatric Interview International Classification of Diseases-10 (MINI ICD-10) as the gold standard examination for diagnosing GAD. Results. Content validity coefficient of GAD-7 adapted version based on Martuzua method was 0.847. Internal validity test with Spearman correlation obtained the correlation coefficient 0.648 to 0.800 (p< 0.01). Internal consistency reliability test with Cronbach?s Alpha was 0.867. The difference of correlation coefficient and Cronbach?s Alpha between the first and the retest showed good test-retest reliability. Out of 146 subjects of diagnostic test, the prevalence of GAD using MINI ICD-10 was 16.4%. With cut off point >7, GAD-7 had sensitivity 100% and specificity 84.4%. Conclusion. The Indonesian version of the the GAD-7 was proven to be valid and reliable, also was found to be accurate as a screening tool for GAD in adult epilepsy patient with cut off point ≥7.;Background. Generalized anxiety disorder (GAD) is one of the most common type among anxiety disorders in epilepsy population that can impaired patients quality of life. The Generalized Anxiety Disorder-7 (GAD-7) is a screening tool for detecting GAD that has been validated in epilepsy patients in Korea with cut-off point ≥7. The GAD-7 could be filled by the patients themselves in less than three minutes; hence, it is appropriate to be used in the neurology outpatient setting. The objective of this study is to obtain a valid, reliable, and accurate GAD-7 in Indonesian language as a screening tool of GAD in adult epilepsy patients. Method. The study was conducted in two phases. The first phase included transcultural adaptation based on World Health Organization standards, content validity test based on expert consideration regarding the relevance of GAD-7 question items, followed by internal validity test, internal reliability test and test-retest in 30 epilepsy patients. The second phase was diagnostic test, in which, the GAD-7 with cut off point ≥7 will be compared with Mini International Neuropsychiatric Interview International Classification of Diseases-10 (MINI ICD-10) as the gold standard examination for diagnosing GAD. Results. Content validity coefficient of GAD-7 adapted version based on Martuzua method was 0.847. Internal validity test with Spearman correlation obtained the correlation coefficient 0.648 to 0.800 (p< 0.01). Internal consistency reliability test with Cronbach?s Alpha was 0.867. The difference of correlation coefficient and Cronbach?s Alpha between the first and the retest showed good test-retest reliability. Out of 146 subjects of diagnostic test, the prevalence of GAD using MINI ICD-10 was 16.4%. With cut off point >7, GAD-7 had sensitivity 100% and specificity 84.4%. Conclusion. The Indonesian version of the the GAD-7 was proven to be valid and reliable, also was found to be accurate as a screening tool for GAD in adult epilepsy patient with cut off point ≥7.;Background. Generalized anxiety disorder (GAD) is one of the most common type among anxiety disorders in epilepsy population that can impaired patients quality of life. The Generalized Anxiety Disorder-7 (GAD-7) is a screening tool for detecting GAD that has been validated in epilepsy patients in Korea with cut-off point ≥7. The GAD-7 could be filled by the patients themselves in less than three minutes; hence, it is appropriate to be used in the neurology outpatient setting. The objective of this study is to obtain a valid, reliable, and accurate GAD-7 in Indonesian language as a screening tool of GAD in adult epilepsy patients. Method. The study was conducted in two phases. The first phase included transcultural adaptation based on World Health Organization standards, content validity test based on expert consideration regarding the relevance of GAD-7 question items, followed by internal validity test, internal reliability test and test-retest in 30 epilepsy patients. The second phase was diagnostic test, in which, the GAD-7 with cut off point ≥7 will be compared with Mini International Neuropsychiatric Interview International Classification of Diseases-10 (MINI ICD-10) as the gold standard examination for diagnosing GAD. Results. Content validity coefficient of GAD-7 adapted version based on Martuzua method was 0.847. Internal validity test with Spearman correlation obtained the correlation coefficient 0.648 to 0.800 (p< 0.01). Internal consistency reliability test with Cronbach?s Alpha was 0.867. The difference of correlation coefficient and Cronbach?s Alpha between the first and the retest showed good test-retest reliability. Out of 146 subjects of diagnostic test, the prevalence of GAD using MINI ICD-10 was 16.4%. With cut off point >7, GAD-7 had sensitivity 100% and specificity 84.4%. Conclusion. The Indonesian version of the the GAD-7 was proven to be valid and reliable, also was found to be accurate as a screening tool for GAD in adult epilepsy patient with cut off point ≥7.;Background. Generalized anxiety disorder (GAD) is one of the most common type among anxiety disorders in epilepsy population that can impaired patients quality of life. The Generalized Anxiety Disorder-7 (GAD-7) is a screening tool for detecting GAD that has been validated in epilepsy patients in Korea with cut-off point ≥7. The GAD-7 could be filled by the patients themselves in less than three minutes; hence, it is appropriate to be used in the neurology outpatient setting. The objective of this study is to obtain a valid, reliable, and accurate GAD-7 in Indonesian language as a screening tool of GAD in adult epilepsy patients. Method. The study was conducted in two phases. The first phase included transcultural adaptation based on World Health Organization standards, content validity test based on expert consideration regarding the relevance of GAD-7 question items, followed by internal validity test, internal reliability test and test-retest in 30 epilepsy patients. The second phase was diagnostic test, in which, the GAD-7 with cut off point ≥7 will be compared with Mini International Neuropsychiatric Interview International Classification of Diseases-10 (MINI ICD-10) as the gold standard examination for diagnosing GAD. Results. Content validity coefficient of GAD-7 adapted version based on Martuzua method was 0.847. Internal validity test with Spearman correlation obtained the correlation coefficient 0.648 to 0.800 (p< 0.01). Internal consistency reliability test with Cronbach?s Alpha was 0.867. The difference of correlation coefficient and Cronbach?s Alpha between the first and the retest showed good test-retest reliability. Out of 146 subjects of diagnostic test, the prevalence of GAD using MINI ICD-10 was 16.4%. With cut off point >7, GAD-7 had sensitivity 100% and specificity 84.4%. Conclusion. The Indonesian version of the the GAD-7 was proven to be valid and reliable, also was found to be accurate as a screening tool for GAD in adult epilepsy patient with cut off point ≥7.

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ABSTRAK
Tujuan: Menentukan prevalensi excessive daytime sleepiness (EDS) pada pasien dengan epilepsi dan faktor-faktor yang berhubungan di Rumah Sakit Cipto Mangunkusumo (RSCM). Metode: Studi potong lintang deskriptif ini menggunakan kuesioner Epworth Sleepiness Scale (ESS) pada pasien epilepsi yang diambil secara konsekutif di poliklinik neurologi RSCM, pada bulan Oktober-November 2015. Faktor-faktor yang dianalisis meliputi usia, jenis kelamin, jenis bangkitan, sindrom epilepsi, etiologi epilepsi, frekuensi bangkitan, bangkitan nokturnal, risiko Obstructive Sleep Apnea (OSA), depresi mayor, gangguan cemas menyeluruh, obat anti epilepsi, dan potensial resistensi obat. EDS ditentukan jika skor ESS > 10. Risiko OSA ditetapkan dengan kuesioner STOP-Bang; depresi mayor ditentukan dengan kuesioner Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) versi Indonesia; gangguan cemas menyeluruh ditentukan dengan kuesioner Mini International Neuropsychiatric Interview for International Classification of Diseases-10 (MINI ICD-10). Hasil: Diantara 93 pasien epilepsi, prevalensi EDS adalah sebanyak 32.3%; wanita lebih banyak dari pria. Faktor-faktor yang berhubungan secara signifikan dengan EDS adalah usia kurang dari 35 tahun, frekuensi bangkitan dalam 1 tahun lebih dari sama dengan 8 kali, depresi mayor, dan potensial resisten obat. Dari analisis multivariat, terdapat 2 faktor independen yang berhubungan dengan EDS yaitu depresi mayor dan potensial resisten obat. Kesimpulan: EDS umum dijumpai pada pasien epilepsi dengan prevalensi 32.3%. Depresi mayor dan potensial resistensi obat merupakan faktor yang berhubungan dengan EDS pada pasien epilepsi ABSTRACT
Purpose: To determine the prevalence of excessive daytime sleepiness (EDS) in epilepsy patients and its related factors at Cipto Mangunkusumo Hospital Jakarta, Indonesia. Materials and Method: This cross-sectional descriptive study using Epworth Sleepiness Scale (ESS) questionnaire to identify EDS in epilepsy patients visited our neurology clinic during October-November 2015 consecutively. Related factors that had been analyzed were age, sex, seizure type, epilepsy syndrome, etiology, seizure frequency, nocturnal seizures, risk of Obstructive Sleep Apnea (OSA), major depression, general anxiety disorder, anti epileptic drug, and potentially drug resistant epilepsy (DRE). EDS was determined if ESS score > 10. Risk of OSA was assessed by STOP-Bang questionnaire; major depression was assessed by Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) Indonesian version; general anxiety disorder was assessed by Mini International Neuropsychiatric Interview for International Classification of Diseases-10 (MINI ICD-10). Data analysis was done using SPSS 17.0. Results: Among 93 subjects, prevalence of EDS was 32.3%; female was more common than male. Related factors that significantly influenced to EDS were age < 35 years old, seizure frequency within 1 year >8 times, major depression and potentially DRE. From multivariate analysis, there were 2 independent factors that related to EDS that were major depression and potentially DRE. Conclusions: EDS is common in epilepsy patients (32.3%). Major depression and potentially DRE were related factors of EDS in epilepsy patients. ;Purpose: To determine the prevalence of excessive daytime sleepiness (EDS) in epilepsy patients and its related factors at Cipto Mangunkusumo Hospital Jakarta, Indonesia. Materials and Method: This cross-sectional descriptive study using Epworth Sleepiness Scale (ESS) questionnaire to identify EDS in epilepsy patients visited our neurology clinic during October-November 2015 consecutively. Related factors that had been analyzed were age, sex, seizure type, epilepsy syndrome, etiology, seizure frequency, nocturnal seizures, risk of Obstructive Sleep Apnea (OSA), major depression, general anxiety disorder, anti epileptic drug, and potentially drug resistant epilepsy (DRE). EDS was determined if ESS score > 10. Risk of OSA was assessed by STOP-Bang questionnaire; major depression was assessed by Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) Indonesian version; general anxiety disorder was assessed by Mini International Neuropsychiatric Interview for International Classification of Diseases-10 (MINI ICD-10). Data analysis was done using SPSS 17.0. Results: Among 93 subjects, prevalence of EDS was 32.3%; female was more common than male. Related factors that significantly influenced to EDS were age < 35 years old, seizure frequency within 1 year >8 times, major depression and potentially DRE. From multivariate analysis, there were 2 independent factors that related to EDS that were major depression and potentially DRE. Conclusions: EDS is common in epilepsy patients (32.3%). Major depression and potentially DRE were related factors of EDS in epilepsy patients.

Abstrak :
Asam valproat merupakan salah satu obat antiepilepsi yang sering digunakan yang memiliki banyak efek samping sehingga perlu dilakukan pengukuran kadarnya dalam plasma. Penelitian ini bertujuan untuk mengembangkan metode analisis asam valproat tanpa derivatisasi dalam plasma mulai dari kondisi kromatografi optimum, metode preparasi plasma optimum, validasi metode analisis, hingga aplikasi metode analisis tervalidasi. Kondisi kromatografi optimum adalah kolom C-8 Symmetry® (5 µm; 150 x 3,9 mm), suhu kolom 45oC; fase gerak dapar natrium dihidrogen fosfat 40 mM pH 3,5 – asetonitril (56 : 44 %v/v); laju alir 1,00 mL/menit; detektor photodiode array pada panjang gelombang 210 nm; dan asam nonanoat sebagai baku dalam. Metode preparasi optimum adalah metode ekstraksi cair-cair menggunakan asam fosfat dan n-heksana diekstraksi dengan 150 µL trietilamin 0,5%; pengocokan dengan vorteks selama 2 menit; dan pemutaran dengan sentrifugasi selama 10 menit. Hasil validasi terhadap metode analisis asam valproat yang dilakukan memenuhi persyaratan validasi berdasarkan EMEA Bioanalytical Guideline tahun 2011. Metode yang diperoleh linear pada rentang konsentrasi 2,0 – 200,0 µg/mL dengan r > 0,9992. Metode analisis yang valid ini berhasil diaplikasikan terhadap satu orang subjek sehat yang diberikan sediaan kaplet lepas lambat yang mengandung 500 mg asam valproat. ...... Valproic acid is one of mostly used antiepileptic drug which has many side effects, therefore it is highly recommended to determine its plasma concentration. The aim of the research was to develop an analytical method of valproic acid without derivatization in human plasma from optimal chromatographic condition, optimal sample preparation, analytical method validation, until its application. The optimal chromatographic condition was obtained using : C-8 Symmetry® column (5 µm; 150 x 3,9 mm), temperature 45oC; the mobile phase contains buffer sodium dihydrogen phosphate 40 mM pH 3.5 – acetonitrile (56 : 44 %v/v); flow rate was 1.00 mL/min; which was detected by photodiode array detector at wavelength of 210 nm; and nonanoic acid as internal standard. The optimal sample preparation was carried out by liquid-liquid extraction method using phosphoric acid and n-hexane extracted using 150 µL triethylamine 0.5%; vortex-mixing for 2 minutes; and centrifugation for 10 minutes. The results of validation fulfilled the acceptance criteria of validation method based on EMEA Bioanalytical Guideline 2011. The method was linear at concentration range of 2.0 – 200.0 µg/mL with r > 0.9992. Validated method analysis was applied to determine valproic acid concentration in one healthy volunteer after oral administration of 500 mg valproic acid extended release caplet.

Abstrak :
Kejang demam, riwayat keluarga dan pencitraan merupakan faktor-faktor yang dapat memengaruhi klasifikasi epilepsi berdasarkan ILAE 1989. Penentuan jenis klasifikasi berguna untuk penatalaksanaan pasien. Penelitian ini dilakukan dengan menggunakan data rekam medis tahun 1995-2010 Departemen Ilmu Kesehatan Anak RSCM. Penelitian ini merupakan penelitian analitik dengan desain cross-sectional. Data diolah dengan multivariat regresi logistik. Dari hasil penelitian ini, didapat sampel sebanyak 99 orang dengan rincian laki-laki 53,4%, perempuan 46,5%. Pasien terbanyak pada kelompok umur 0-2 tahun 12 bulan (37,4%). Terdapat kebermaknaan yang signifikan pada hubungan antara pencitraan dengan klasifikasi epilepsi (p < 0,001). Tidak terdapat kebermaknaan yang signifikan terhadap hubungan antara riwayat epilepsi keluarga (p = 0,393) dan riwayat kejang demam ( p = 0,161) dengan klasifikasi epilepsi. Pencitraan merupakan faktor yang berpengaruh paling besar (OR = 16,725) terhadap penentuan jenis klasifikasi epilepsi bila dibandingkan dengan riwayat epilepsi keluarga dan riwayat kejang demam. ......Febrile seizure, family history, and imaging are factors that determine the classification of epilepsy based on ILAE 1989. The classification is important to patient's treatment.This study used medical record from Pediatric Department of RSCM in 1995-2010. This study is a cross-sectional analytic. The data was proceed with multivariate logistic regression. There are 99 sample, 53.4% are male and 46.5% female. The most distribution of patient's age is in 0-3 years (37.4%). There is significant results in correlation between imaging with epilepsy classification (p<0.001) and there are less significant results between family history (p=0.393) and febrile seizure (p=0.161) with epilepsy classification. Imaging is the most powerful factor (OR = 16.725) that contribute to determine classification of epilepsy compared to family history and febrile seizure.

Abstrak :
Pendahuluan: Epilepsi merupakan salah satu kelainan neurologis terbanyak di dunia, kurang lebih 20-30% diantaranya merupakan epilepsi resistan obat. Salah satu penyebab epilepsi resistan obat adalah autoimun, yang diperantari antibodi saraf. Antibodi saraf yang paling sering ditemukan dan diteliti adalah antibodi anti N-Methyl-D-Aspartate (NMDAR). Diagnosis pasti epilepsi autoimun adalah ditemukannya antibodi saraf di serum atau cairan serebrospinal (CSS), namun saat ini ketersediaanya terbatas dan harganya cukup mahal di Indonesia. Skor Antibody Prevalence in Epilepsy and Encephalopathy 2 (APE2) dan Antibody Contributing to Focal Epilepsy Signs and Symptoms (ACES) merupakan dua piranti klinis yang dapat digunakan untuk menduga adanya antibodi saraf, namun belum ada penelitiannnya di Indonesia. Tujuan: Penelitian ini adalah uji diagnostik untuk menilai kemampuan APE2 dan ACES dalam menduga adanya antibodi saraf anti NMDAR di serum pasien epilepsi resisten obat. Metode: Pasien epilepsi resistan obat yang datang ke Poli Neurologi Anak Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo Jakarta dan Rumah Sakit Umum Daerah dr. Soetomo Surabaya pada bulan Maret hingga Agustus 2023 dinilai menggunakan APE2 dan ACES lalu diperiksa serum antibodi anti NMDAR. Hasil: Didapatkan 90 subyek penelitian yang memenuhi kriteria inklusi dan eksklusi penelitian. Antibodi NMDAR serum ditemukan pada 10 dari mereka. Skor APE2 memiliki sensitivitas 60%, spesifisitas 82,5%, PPV 30%, NPV 94,3%, LR+ 3,43, dan LR- 0,48. Poin skor APE2 yang memiliki nilai bermakna adalah perubahan status mental (p 0,042) dan gejala prodormal sebelum kejang (p 0,005). Skor ACES memiliki sensitivitas 85,71% spesifisitas 72,22%, PPV 37,5%, NPV 96,3%, LR+ 3,08, dan LR- 0,198. Poin skor ACES yang memiliki nilai bermakna adalah gangguan kognitif (p 0,033) dan gangguan bicara (p 0,028). Pada kejang fokal, APE2 memiliki nilai sensitivitas, PPV, NPV dan LR+ yang lebih rendah namun spesifisitas dan LR- yang lebih tinggi dibandingkan dengan ACES. Kesimpulan: Skor APE2 kurang sensitif namun cukup spesifik dengan NPV yang tinggi. Skor ACES cukup sensitif dan spesifik dengan NPV yang tinggi. Keduanya dapat digunakan untuk skrining awal epilepsi terutama bila ada gejala perubahan status mental, gejala prodormal virus, gangguan kognitif dan gangguan bicara sebelum atau saat awal awitan kejang. Diperlukan penelitian lanjutan untuk menilai antibodi saraf lain, dengan pemeriksaan antibodi di CSS dan tidak terbatas pada epilepsi resisten obat saja serta yang awitan kejangnya dibawah 1 tahun.

Kata kunci: ACES, APE2, epilepsi autoimun, epilepsi resisten obat, NMDAR ......Epilepsy is one of the most common neurological disorders in the world, approximately 20-30% of which are drug-resistant epilepsy. One cause of drug-resistant epilepsy is autoimmune disease, mediated by neural antibodies. The most frequently found and studied neural antibody is the anti-N-Methyl-D-Aspartate (NMDAR) antibody. The definitive diagnosis of autoimmune epilepsy is the discovery of neural antibodies in serum or cerebrospinal fluid (CSF), but currently their availability is limited and the price is quite expensive in Indonesia. The Antibody Prevalence in Epilepsy and Encephalopathy 2 (APE2) score and Antibody Contributing to Focal Epilepsy Signs and Symptoms (ACES) are two clinical tools that can be used to suspect the presence of neural antibodies, but there has been no research in Indonesia. Purpose: This research is a diagnostic test to assess the ability of APE2 and ACES to predict the presence of anti-NMDAR neural antibodies in the serum of drug-resistant epilepsy patients. Methods: Drug-resistant epilepsy patients who seek treatment at the Pediatric Neurology Outpatient clinic at the National Central General Hospital, dr. Cipto Mangunkusumo Jakarta and the Regional General Hospital dr. Soetomo Surabaya from March to August 2023 were assessed using APE2 and ACES, then checked for serum anti NMDAR antibody. Results: There were 90 research subjects who met the research inclusion and exclusion criteria. Serum NMDAR antibodies were found in 10 of them. The APE2 score has a sensitivity of 60%, specificity of 82.5%, PPV of 30%, NPV of 94.3%, LR+ 3.43, and LR- 0.48. In this study, the APE2 score points that had significant values were changes in mental status (p 0.042) and prodromal symptoms before seizures (p 0.005). The ACES score has a sensitivity of 85.71%, a specificity of 72.22%, PPV 37.5%, NPV 96.3%, LR+ 3.08, and LR- 0.198. In this study, the ACES score points that had significant values were cognitive symptoms (p 0.033) and speech problem (p 0.028). In focal seizures, APE2 has lower sensitivity, PPV, NPV and LR+ values but higher specificity and LR- compared to ACES. The APE2 score is less sensitive but quite specific with a high NPV. The ACES score is quite sensitive and specific with a high NPV. Both can be used for initial epilepsy screening, especially if there are symptoms of changes in mental status, viral prodromal symptoms, cognitive symptoms and speech problem before or at the onset of seizures. Further research is needed to assess other neural antibodies, examining neural antibodies in CSF and also including those whose seizure onset is less than 1 year, not limiting to drug-resistant epilepsy only.

Abstrak :
ABSTRAK Orang tua sebagai family caregiver utama memegang peranan penting dalam tumbuh kembang serta anak dengan epilepsi (ADE). Penelitian ini bertujuan untuk melihat hubungan antara affiliate stigma, caregiver burden, dan dampak keduanya pada kualitas hidup. Sebanyak 48 orang tua yang merupakan caregiver primer dengan usia minimal 25 tahun dan memiliki ADE yang berusia maksimal 16 tahun diminta untuk berpartisipasi pada penelitian korelasional dengan mengisi kuesioner daring maupun luring. Affiliate stigma diukur menggunakan Affiliate Stigma Scale, caregiver burden diukur menggunakan Zarit Burden Interview (ZBI), dan kualitas hidup family caregiver ADE diukur menggunakan WHOQOL-BREF yang dikembangkan oleh WHO. Berdasarkan analisis korelasi menggunakan Pearson Product Moment didapatkan hasil korelasi yang

signifikan dan negatif antara affiliate stigma dan kualitas hidup (r (48) = -0,393, p < 0,01), caregiver burden dan kualitas hidup (r (48) = -0,516, p < 0,01). Selain itu, affiliate stigma

dan caregiver burden juga memiliki hubungan positif yang signifikan (r (48) = 0,657, p < 0,01). Dengan demikian, dapat dikatakan bahwa semakin besar skor affiliate stigma dan caregiver burden, semakin rendah skor kualitas hidup family caregiver ADE. Hasil penelitian ini sesuai dengan penelitian terdahulu yang melihat hubungan antara ketiganya pada populasi caregiver. Temuan ini dapat digunakan sebagai landasan untuk rancangan intervensi pada family caregiver epilepsi untuk meminimalisir affiliate stigma dan caregiver burden yang dialami.

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ABSTRACT Parents usually act as a primary caregiver and have an important role in children with epilepsy (CWE) development. This study aims to analyse the relationship between affiliate stigma, caregiver burden, and both effects on quality of life. A total of 48 parent whom a primary caregiver of CWE aged at least 25-year old with CWE aged at least 16- year old were asked to participate in this correlational study and fill the online or offline questionnaires. Affiliate Stigma was measured by Affiliate Stigma Scale, whereas caregiver burden and quality of life was measured by Zarit Burden Interview (ZBI) and WHOQOL-BREF, respectively. Using Pearson Product Moment, the result shows significant and negative relationships between affiliate stigma and quality of life (r (48) = -0,393, p < 0,01), caregiver burden and quality of life (r (48) = -0,516, p<0,01). The analyses also shows that affiliate stigma and caregiver burden have a significant and positive relationship too (r (48) = 0,657, p < 0,01). In conclusion, the high score of affiliate stigma and caregiver burden indicates the lower score of quality of life in family caregiver CWE. This study shows a similar results with another similar study on caregiver. This finding may be useful in designing a intervention on family caregiver CWE to minimalize the felt affiliate stigma and caregiver burden.