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"[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.]"

"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."

"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."