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"Latar Belakang: Status epileptikus (SE) merupakan salah satu kedaruratan neurologis dengan mortalitas yang tinggi. SE dengan gejala motorik yang menonjol dan gangguan kesadaran disebut sebagai status epileptikus konvulsivus (SEK). Tujuan tatalaksana SEK adalah menghentikan bangkitan secara cepat dan efektif karena pada SEK yang berkepanjangan akan menyebabkan kerusakan neuron dan gangguan sistemik yang luas. Tujuan penelitian ini adalah mengetahui gambaran tatalaksana farmakologis dan faktor-faktor yang mempengaruhi waktu terminasi SEK di RSUPN dr. Cipto Mangunkusumo (RSCM).Metode: Desain penelitian dengan potong lintang pada 22 pasien SEK secara retrospektif. Data yang didapatkan merupakan data dari penelurusan rekam medik. Dilakukan pencatatan usia, jenis kelamin, komorbid, riwayat epilepsi, etiologi, bentuk kejang, kelainan metabolik, onset kejang, jenis, lini, dosis, dan jumlah obat anti kejang yang didapat. Kemudian dilakukan pencatatan waktu dari tatalaksana SEK hingga terminasi SEK.Hasil: Dari 22 subjek, 16 subjek dapat diterminasi <60 menit (72,7%). Kelompok terminasi <60 menit memiliki rerata usia lebih muda, memiliki riwayat epilepsi, dan sebagian besar tidak memiliki komorbid. Pada kedua kelompok terminasi etiologi tersering adalah etiologi akut. Seluruh subjek dengan semiologi SEK kejang konvulsif umum tonik klonik dan kejang umum tonik termasuk dalam kelompok terminasi <60 menit. Sedangkan bentuk kejang lainnya terdapat sebagian kecil subjek termasuk dalam kelompok terminasi >60 menit. Median onset kejang pada penelitian ini didapat lebih lama pada kelompok terminasi <60 menit. Kelainan metabolik hipoalbumin dan gangguan hepar didapatkan sedikit lebih banyak pada kelompok terminasi <60 menit. Sedangkan subjek dengan kelainan ginjal didapat persentase yang sama. Sebagian besar subjek cukup mendapat lini I, diazepam IV, dan 1 jumlah obat anti kejang dalam terminasi SEK. Pada subjek kelompok terminasi >60 menit mendapat dosis diazepam IV dan fenitoin IV lebih besar. Pada subjek yang mendapat levetiracetam oral dan midazolam IV seluruhnya terdapat dalam kelompok terminasi >60 menit.Kesimpulan: Tatalaksana farmakologis SEK di RSCM sesuai dengan alogaritme SE dan sebagian besar dapat diterminasi <60 menit. Distribusi demografis dan klinis subjek penelitian seperti usia muda, riwayat epilepsi, dan tidak adanya komorbid serta kelainan metabolik hipoalbumin dan kelainan hepar distribusinya lebih banyak pada kelompok terminasi <60 menit.

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Background: Status epilepticus (SE) is one of the neurological emergencies with high mortality. SE with prominent motor symptoms and impaired consciousness is called a convulsive status epilepticus (CSE). The goal of treatment for CSE is to stop seizures quickly and effectively because prolonged CSE will cause extensive neuronal damage and systemic disturbances. The purpose of this study was to determine the description of pharmacological management and the factors that influence the termination of CSE in Cipto Mangunkusumo Hospital.

Method: It was a retrospective cross-sectional study design in 22 CSE patients. The data was retrieved from medical records including age, sex, comorbid, history of epilepsy, etiology, form and onset of seizures, metabolic disorders, type, line, dose and amount of anti-seizure drugs were carried out. The duration from time-point of CSE management up to the CSE termination was recorded.

Result: Among 22 subjects, there were 16 subjects who had CSE termination <60 minutes (72.7%). The <60 minutes termination group had a younger age, had a history of epilepsy and most of them had no comorbidities. All three subjects with a history of epilepsy were also included in the <60 minutes termination group. In both groups the most common etiology of termination was acute. All subjects with the semiology convulsive generalized tonic-clonic seizures and generalized tonic seizures were included in the <60 minutes termination group. While other forms of semiology, a small proportion of subjects were included in the group termination >60 minutes. Median seizure onset in this study was longer in the termination group <60 minutes. Hypoalbumin metabolic and hepatic disorders were slightly more in the <60 minutes termination group. Among <60 minutes termination group, the most common anti-convulsant was first line drug which was Diazepam IV, wherease the most common one in >60 minutes termination group was second line drug which was Phenytoin IV. Subjects in the group terminated> 60 minutes received larger doses of IV diazepam and IV phenytoin. Subjects receiving oral levetiracetam and IV midazolam were all in the> 60 minutes termination group.

Conclusion: CSE management in Cipto Mangunkusumo Hospital was already in accordance with the SE management algorithm. Demographic and clinical distribution of study subjects such as younger age, history of epilepsy, absence of co-morbids and metabolic disorders of hypoalbumin and liver disorders were common in the <60 minutes termination group."

"Latar Belakang Status epileptikus adalah kondisi kegawatdaruratan Neurologi yang dapat terjadi pada anak. UKK Neurologi IDAI menerbitkan Rekomendasi Penatalaksanaan Status Epileptikus IDAI 2016 agar terdapat keseragaman tata laksana serta menghindari over dan underteatment. Tujuan Mengkaji dan mengevaluasi penerapan Rekomendasi Penatalaksanaan Status Epileptikus UKK Neurologi IDAI 2016 dan variabel yang memengaruhi tata laksana status epileptikus oleh dokter spesialis anak di Indonesia. Metode Metode penelitian menggunakan studi potong lintang dengan instrumen penelitian berupa kuesioener daring yang berisi 16 pertanyaan kesesuaian tata laksana, dengan total skor 21. Penelitian dilakukan selama bulan Oktober 2023. Respondens merupakan dokter spesialis anak di Indonesia yang tergabung dalam Ikatan Dokter Anak Indonesia (IDAI). Hasil Rerata skor kesuaian tata laksana status epileptikus dari 129 subjek adalah 11,68 dari 21,00. Rentang skor subjek adalah 2,00 hingga 19,00. Proporsi dokter spesialis anak yang mengetahui rekomendasi adalah 97,3% dan yang pernah mendapatkan sosialisasi adalah 82,9%. Signifikansi uji komparatif rerata skor kesesuaian kategori usia <41 tahun, 41-60 tahun, >60 tahun adalah p=0,071, kategori tahun kelulusan ≤10 tahun dan >10 tahun p=0,04, kategori tempat kerja klinik/praktik pribadi, rumah sakit tipe B/A dan rumah sakit tipe C/D adalah 0,309, kategori lokasi kerja kota madya dan kabupaten adalah p=0.279, serta kategori riwayat sosialisasi dan tidak p=0,139. Terdapat perbedaan kemampulaksanaan rekomendasi tata laksana antara lokasi kerja praktik/klinik pribadi dan rumah sakit sebesar p=0,287 dan rumah sakit tipe B/A dan rumah sakit tipe C/D sebesar p=0,013, serta berdasarkan tempat kerja sebesar p=0,798. Kesimpulan Terdapat perbedaan rerata skor kesesuaian rekomendasi tata laksana yang secara statistik bermakna pada kategori tahun kelulusan ≤10 tahun dan >10 (p=0,04), serta perbedaan kemampulaksanaan rekomendasi di rumah sakit tipe B/A dan rumah sakit tipe C/D (p=0,013).

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Introduction Status epilepticus is a neurological emergency condition that can occur in children. Indonesian Pediatric Society (UKK Neurologi IDAI) issued the IDAI 2016 Recommendations for the Management of Status Epilepticus to ensure consistent management of status epilepticus. Objective To assess and evaluate the implementation of the UKK Neurologi IDAI 2016 Recommendations for the Management of Status Epilepticus and the variables influencing the management of status epilepticus by pediatric specialists in Indonesia. Method The research methodology used a cross-sectional study design with an online questionnaire as the research instrument, consisting of 16 questions on the appropriateness of management, with a total score of 21. The research was conducted in October 2023. The respondents were pediatric specialists in Indonesia who are members of the Indonesian Pediatric Society (IDAI). Results The mean score of compliance with the managementguuidelines recommendations based on workplace in hospital type B/A and hospital type C/D (p=0.013). guidelines for status epilepticus from 129 subjects is 11.68 out of 21.00. The range of subject scores is from 2.00 to 19.00. The proportion of pediatric specialists who are aware of the recommendations is 97.3%, and those who have received training is 82.9%. The significance of the comparative test for the mean scores of compliance in the age categories <41 years, 41-60 years, and >60 years is p=0.071. p=0.04 For the categories of years since graduation ≤10 years and >10 years, p=0.309. for the categories of workplace in clinics/private practice, hospital type B/A, and hospital type C/D, p=0.795 for the categories of working location in rural and urban area, and p=0.139 for the categories of history of training and no training. The difference in the implementation of management guideline recommendations based on working location with a significance of p=0.287 in clinic/private practice and hospitals, and p=0.013 in hospital type B/A and hospital type C/D. The difference in the implementation of management guideline recommendations based on workplace with a significance of p=0.798 in rural and urban area. Conclusion There is a statistically significant difference in the mean scores of compliance with the management guideline recommendations in the categories of years since graduation ≤10 years and >10 years (p=0.04), and difference in the implementations of management."

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

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