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"Latar belakang. Depresi merupakan salah satu gangguan psikiatri yang sering terjadi pada pasien epilepsi. Prevalensinya adalah 20-80%. Depresi bukan merupakan suatu pemeriksaan yang rutin dilakukan di poliklinik neurologi karena membutuhkan waktu yang cukup lama, sehingga banyak pasien yang tidak terdiagnosis dan akhirnya tidak terobati, untuk itu diperlukan pemeriksaan yang singkat. The Neurological Disorders Depression Inventory for-Epilepsi (NDDI-E) merupakan pemeriksaan skrining depresi yang terdiri dari 6-aitem. Tujuan. Menentukan akurasi dan titik potong NDDI-E versi Indonesia sebagai skrining depresi pada pasien epilepsi dewasa. Metode. Penelitian uji diagnostik yang dilakukan di poliklinik epilepsi RSCM. Pemeriksaan dilakukan pada semua pasien epilepsi yang memenuhi kriteria inklusi. Pasien mengisi sendiri formulir NDDI-E tanpa bantuan orang lain. Kemudian dilakukan pemeriksaan the International Neuropsychiatric Interview Mini ICD-10 (MINI-ICD10) sebagai standar baku. Hasil. Dari 105 orang subyek penelitian terdapat 23 orang mengalami gangguan depresi mayor berdasarkan MINI-ICD 10. Didapatkan kurva Receiver Operating Characteristic (ROC) yang mendekati 100%, titik potong 11, dengan Sensitifitas 91,3% Spesifisitas 89% PPV 70% dan NPV 97,3%. Secara statistik NDDI-E versi Indonesia masuk dalam klasifikasi yang kuat, karena nilai Area Under the Curve (AUC) 97,5% dengan interval kepercayaan (95%CI 95%-99%). Kesimpulan. NDDI-E versi Indonesia memiliki nilai akurasi yang tinggi untuk menentukan gangguan depresi mayor pada pasien epilepsi dewasa pada titik potong 11.

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Background. Depression is a common psychiatric disorder in epilepsy. The prevalence is 20-80%. The depression is not a routinely assessed in neurology clinics, because the assestment takes a long time. So, many patients are under diagnosed and untreated. The Neurological Disorders Depression Inventory for-Epilepsy (NDDI-E) is a depression screening examination consist of only 6-aitem.

Purpose. To determine the accuracy and cut-off point of NDDI-E Indonesian version as a screening depression examination for adult epilepsy patients.

Method. Diagnostic test study was conducted at epilepsy clinic on RSCM. All the epilepsy patient who met the inclusion criteria was examined. The patient took the NDDI-E Indonesian version as a self assesment. Then there were assest with used the International Neuropsychiatric Interview Mini ICD-10 (MINI-ICD10) as a gold standar.

Results. From the 105 subjects, there were 23 people suffered from major depression by MINI-ICD10. Receiver Operating Characteristic (ROC) curve obtained which is close to 100%, cut-off point at 11, with Sensitivity 91.3% Specificity 89% PPV 70% and NPV of 97.3%. It was statistically classified as strong because the value of Area Under the Curve (AUC) is 97.5% with a confidence interval (95% CI 95% -99%).

Conclusion. NDDI-E Indonesian version has a high accuracy to determine major depressive disorder in adult epilepsy patients with the cut-off point at 11."

"Latar belakang - Untuk menentukan sindrom epilepsi selain anamnesis juga diperlukan adanya bukti gelombang elektroensefalografi EEG yang spesifik Salah satu cara dengan melakukan teknik hiperventilasi HV untuk membangkitkan abnormalitas gelombang EEG Stimulasi hiperventilasi dapat menimbulkan bangkitan umum dan parsial Dengan mengetahui hal tersebut dapat menentukan terapi dan prognosis pasien epilepsi Tujuan - Mengetahui waktu terjadinya gelombang epileptiform tertinggi selama durasi HV 5 menit pada pemeriksaan EEG untuk meningkatkan manfaat pemeriksaan penunjang yang mendukung kearah diagnosis epilepsi Metode - Penelitian ini merupakan penelitian prospektif secara historis menggunakan teknik hiperventilasi selama 5 menit saat pemeriksaan EEG untuk mencari aktivitas epileptiform pada EEG pasien epilepsi dan atau dengan bangkitan epileptik di Rumah Sakit Cipto Mangunkusumo Hasil - Dari 70 subyek penelitian didapatkan paling banyak tipe bangkitan parsial dengan sindrom epilepsi lobus temporal sebagai jenis sindrom terbanyak Pada menit ke 2 stimulasi hiperventilasi terjadi aktivitas epileptiform paling banyak sedangkan pada menit ke 1 dan ke 5 terdapat aktivitas epileptiform paling sedikit Terdapat hubungan yang bermakna antara bangkitan terkontrol obat dengan aktivitas epileptiform dan atau dengan bangkitan epileptik p 0 043 Pada subyek yang tidak terkontrol obat mempunyai resiko mengalami aktivitas epileptiform 0 22 kali lebih besar dibandingkan dengan yang terkontrol obat Sedangkan faktor lainnya seperti jenis sindrom tipe onset dan frekuensi bangkitan tidak menunjukkan perbedaan yang bermakna p 0 119 p 0 392 p 0 636 p 1 000 Simpulan - Penelitian saat ini menunjukkan aktivitas epileptiform paling banyak terdapat pada menit ke 2 stimulasi hiperventilasi Terdapat kecenderungan pasien epilepsi yang tidak terkontrol obat mempunyai resiko mengalami aktivitas epileptiform 0 22 kali lebih besar dibandingkan dengan yang terkontrol obat pada pemeriksaan hiperventilasi selama 5 menit

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Background - Diagnosis of epilepsy syndrome beside clinical judgement is also required specific wave evidence from electroencephalography EEG One of the method is to perform the hyperventilation techniques HV which can generate wave EEG abnormalities Stimulation of hyperventilation can cause general and partial seizures By knowing these things we can determine further treatment and prognosis of the epilepsy patients

Objective - To determine the highest timing of the wave emergence during 5 minutes hyperventilation in the EEG to improve the benefits of supporting the investigation towards the diagnosis of epilepsy

Methods - The study was conducted using a historical prospective study design All samples were collected in Cipto Mangunkusumo Hospital and undergo EEG with 5 minutes hyperventilation technique to look for epileptiform activity

Results - From 70 subjects obtained most of it are partial seizures with temporal lobe epilepsy syndrome as the most syndrome types In the 2nd minute of hyperventilation stimulation occurs epileptiform activity most widely while at minute 1 and 5 are less epileptiform activity There is a significant relationship between controlled drug patients with epileptiform activity and or with epileptic seizures p 0 043 In subjects who are at risk of uncontrolled drug had epileptiform activity 0 22 times larger than the controlled drug While other factors such as the type of syndrome type onset and frequency of seizure showed no significant difference p 0 119 p 0 392 p 0636 p 1 000

Conclusions - The present study showed epileptiform activity are most common in the 2nd minute stimulation hyperventilation There is a tendency of uncontrolled epilepsy patients who are at risk of experiencing epileptiform activity 0 22 times greater than the drug controlled patients during 5 minutes hyperventilation techniques"

"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."

"Puasa Ramadan dapat menyebabkan perubahan pola tidur dan makan yang memengaruhi pasien dengan penyakit neurologis kronis. Penelitian ini bertujuan mengevaluasi kualitas tidur pasien selama puasa Ramadan. Studi potong lintang ini melibatkan 40 pasien dengan penyakit neurologis kronis di Poliklinik Saraf RSUPN Dr. Cipto Mangunkusumo dari Februari hingga Juni 2023. Kualitas tidur diukur menggunakan Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), dan STOP-BANG. Hasil menunjukkan 77,5% subjek mengalami gangguan tidur setelah puasa, dengan perubahan signifikan pada tingkat insomnia (ISI) dan risiko obstructive sleep apnea (OSA). Namun, tidak terdapat perubahan signifikan pada kualitas tidur menurut ESS dan PSQI. Mayoritas subjek (75%) adalah perempuan dengan usia rata-rata 40,25 tahun. Kesimpulannya, meskipun puasa dapat memicu gangguan tidur, manajemen yang tepat memungkinkan pasien menjalankan puasa tanpa dampak buruk yang signifikan terhadap kualitas tidur. Hal ini memberikan harapan bagi pasien dengan penyakit neurologis kronis untuk tetap menjalankan puasa secara aman.

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Ramadan fasting can lead to changes in eating and sleeping patterns that affect patients with chronic neurological diseases. This study aimed to evaluate the sleep quality of patients during Ramadan fasting. A cross-sectional study was conducted involving 40 patients with chronic neurological diseases at the Neurology Clinic of RSUPN Dr. Cipto Mangunkusumo from February to June 2023. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and STOP-BANG. The results showed that 77.5% of the subjects experienced sleep disturbances after fasting, with significant changes in insomnia severity (ISI) and the risk of obstructive sleep apnea (OSA). However, there were no significant changes in sleep quality as measured by ESS and PSQI. The majority of subjects (75%) were female, with an average age of 40.25 years. In conclusion, while fasting may trigger sleep disturbances, proper management enables patients to fast without significant adverse effects on sleep quality. This finding provides hope for patients with chronic neurological diseases to safely observe Ramadan fasting."

"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.

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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."

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

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

"Penggunaan Obat Anti-Epilepsi (OAE) jangka panjang merupakan strategi terapi yang optimal setelah diagnosis epilepsi. Kepatuhan terhadap pengobatan merupakan salah satu masalah utama dalam keberhasilan terapi jangka panjang pada pasien epilepsi. Salah satu faktor yang berpotensi kuat mempengaruhi kepatuhan adalah adanya Reaksi Obat yang Tidak Dikehendaki (ROTD). Epilepsi Lobus Temporal (ELT) merupakan tipe epilepsi fokal yang paling banyak; lebih dari 80% pasien ELT berpotensi resisten obat. Penelitian ini bertujuan untuk melihat ROTD OAE pada pasien ELT dan hubungannya dengan kepatuhan pengobatan. Metode penelitian yang digunakan adalah cross sectional study yang membandingkan ada/tidaknya ROTD menggunakan kuisioner Liverpool Advesre Event Profile (LAEP) dengan tingkat kepatuhan menggunakan kuisioner Morisky Adherence Questionaire (MAQ). Subyek penelitian adalah pasien ELT di Unit Rawat Jalan Departemen Neurologi RSUPN Dr. Cipto Mangunkusumo periode Agustus-Oktober 2019. Hasil penelitian menunjukkan dari 88 pasien, 78.40% mengalami kejadian ROTD dan sebanyak 47.73% pasien memiliki tingkat kepatuhan sedang-rendah. Terdapat hubungan yang signifikan antara kejadian ROTD dan tingkat kepatuhan (p=0.039;OR 4.313). Hasil ini menunjukan pasien ELT yang mengalami kejadian ROTD memiliki kecenderungan untuk tidak patuh terhadap pengobatannya. Faktor lain yang berpengaruh secara signifikan terhadap kepatuhan pengobatan pasien yaitu jenis OAE (p=0,011; OR 0,249)). Jenis OAE yang memperlihatkan hubungan yang signifikan terhadap tingkat kepatuhan pengobatan adalah jenis OAE kombinasi (generasi lama dan generasi baru). Perlu dilakukan intervensi konseling secara berkala oleh farmasis untuk meningkatkan pemahaman mengenai ROTD yang terjadi selama penggunaan OAE dan edukasi terkait pentingnya kepatuhan pengobatan pasien.

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The long-term use of Anti-Epileptic Drugs (AED) is an optimal therapeutic strategy after the diagnosis of epilepsy. Adherence to treatment is one of the main problems in the long-term success of therapy in epilepsy patients. One factor that has the potential to strongly influence adherence is the presence of Adverse Drug Reaction (ADR). Temporal Lobe Epilepsy (TLE) is the most common type of focal epilepsy; more than 80% of TLE patients are potentially drug resistant. This study aimed to explore the ADR of AED in TLE patients and its correlation with medication adherence. The research method used was a cross sectional study comparing the presence of ADR using the Liverpool Adverse Event Profile (LAEP) questionnaire with the level of compliance using the Morisky Adherence Questionaire (MAQ). The research subjects were TLE patients in the Outpatient Unit of the Department of Neurology, Dr. Cipto Mangunkusumo Hospital, August-October 2019.

The results showed that of 88 patients, 78.40% experienced ADR and 47.73% of patients had moderate-low adherence. There is a significant correlation between the incidence of ADR and the level of compliance (p = 0.031;OR = 4.35). Another factor that significantly affected patient adherence was type of AED (p = 0.011; OR 0.249). The type of AED that shows a significant relationship to the level of medication adherence is combination of old and new generation AED. These findings indicate that patients who experience ADR have a tendency to disobey their treatment. Interventions programmed by pharmacists need to be done to increase the understanding of ADR that occurs during AED use and education related to the importance of medication adherence. "

"Latar belakang: Prevalensi ketidakpatuhan pasien pada pengobatan epilepsi cukup besar. Penyebab ketidakpatuhan terdiri dari banyak faktor, yang dapat diklasifikasikan menjadi intensional ataupun non intensional. Perilaku kepatuhan pasien dibentuk oleh bagaimana pasien melakukan representasi terhadap penyakit yang dideritanya, sehingga pengetahuan, sikap, dan perilaku (PSP) pasien epilepsi dinilai dapat berhubungan dengan kepatuhan pasien. Penelitian ini dilakukan untuk menilai hubungan tersebut.Metode penelitian: Penelitian ini dilakukan dengan desain potong lintang. Populasinya adalah pasien epilepsi yang berobat ke poli neurologi RSUPNCM bulan Agustus – September 2022. Sampel diambil dengan cara consecutive sampling. Analisis statistik menggunakan regresi logistik.Hasil: Rerata nilai pengetahuan sebesar 15,41+/-3,827 dengan rentang 7-35 (nilai 7 mengindikasikan ukuran pengetahuan paling baik). Median nilai sikap adalah 18 (10-27)dengan rentang 8-40 (nilai 8 mengindikasikan sikap paling baik). Median nilai perilaku adalah 10 (5-20), dengan rentang 5-25 (nilai 5 menunjukkan perilaku paling baik). Nilai kepatuhan pasien pada penelitian ini adalah 55,7%. Analisis multivariat menunjukkan bahwa semakin buruk nilai pengetahuan maka akan meningkatkan probabilitas terjadinya ketidakpatuhan sebesar 1,271 kali.Kesimpulan: Pengetahuan mengenai epilepsi memiliki hubungan dengan kepatuhan pengobatan, sedangkan sikap dan perilaku pasien epilepsi tidak memiliki hubungan dengan kepatuhan pengobatan

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Background: There was a high prevalence of patient’s non-adherence to anti-seizure medication (ASM). It caused by many factors and classified as intentional or non intentional. Patient’s adherence was formed when they represent their ilness, so knowledge, attitudes, and behavior of patient with epilepsy (PWE) are considered to be related to their adherence. This study was aimed to assess this relationship.

Methods: We conducted a cross sectional study on PWE who came to RSUPNCM Neurology outpatient clinic from August to September 2022. All consecutive patients were asked to complete the given questionnaire. We used a logistic regression for statistical analysis.

Results: The mean score of knowledge was 15,41+/-3,827 (range, 7-35), with score of 7 indicated the best knowledge. The median score of attitudes was 18, interquartile range (IQR) 10-27 (range, 8-40), with score of 8 indicated the best attitudes. The median score of behavior was 10, IQR 5-20 (range, 5-25), with score of 5 indicated the best behavior. Fifty-five-point seven percent were estimated to be adherent. The multivariate analysis showed that with the worse score of knowledge, the probability of non-adherence will increase by 1,271 times.

Conclusion: Knowledge about epilepsy has a relationship with ASM adherence, while attitude and behavior of PWE has no relationship with ASM adherence"

"Latar belakang: Hampir 50% epilepsi adalah wanita terjadi pada usia reproduksi 15-49 tahun. Banyak penelitian menyebutkan bahwa terdapat interaksi antara epilepsi dengan hormon reproduksi wanita. Epilepsi temporolimbik dapat mengganggu regulasi aksis hipothalamus- hipofisis-ovarium (HHO) sehingga mengganggu hormon reproduksi dan pada akhirnya menyebabkan gangguan menstruasi. Oleh karena itu dilakukan penelitian yang bertujuan untuk mengetahui perubahan hormon reproduksi yang terjadi pada wanita dengan epilepsis. Pada penelitian ini juga akan dilakukan klasifikasi gangguan menstruasi pada wanita dengan epilepsi berdasarkan kriteria The International Federation of Gynecology and Obstetrics (FIGO), dimana kriteria ini merupakan kriteria baru untuk mendefinisikan perdarahan uterus abnormal.Metode penelitian: Penelitian ini dilakukan dengan studi potong lintang (cross sectional) untuk mengetahui karakteristik hormon reproduksi dan gangguan menstruasi pada wanita dengan epilepsi di RSUPN Cipto Mangunkusumo pada September hingga Desember 2021. Data primer dan sekunder diperoleh dari rekam medis dan electronic health record (EHR) pada pasien wanita dengan epilepsi dan wanita tanpa epilepsi yang berobat ke RSUPN Cipto Mangunkusumo. Analisis data yang digunakan adalah bivariat Chi Square dan Mann Whitney. Hasil: Pada penelitian ini diperoleh 67 subjek wanita dengan epilepsi dan 50 subjek wanita tanpa epilepsi dengan rata-rata usia wanita dengan epilepsi 29,27  9,26 tahun. Onset terjadinya epilepsi adalah 18,57  9,857 tahun dengan usia menarche adalah 12,85  1,317 tahun. Onset epilepsi setelah menarche banyak terjadi sekitar 70,1%. Epilepsi lobus temporal merupakan sindrom epilepsi terbanyak sekitar 70,8%, dengan sisi kanan terbanyak sekitar 46,8%. Peningkatan hormon reproduksi khususnya hormon luteinizing hormon (LH) 10,1 (0,1-100,3) mIU/mL (p: 0,008) dan hormon estradiol 71,2 (0-3350) pg/mL didapatkan pada wanita dengan epilepsi dibandingkan dengan wanita tanpa epilepsi. Gangguan pada volume darah mentruasi didapatkan pada wanita dengan epilepsi lobus temporal dibandingkan dengan lobus ekstratemporal RR 4,255 (1,188-15,231), dengan nilai p: 0,022.Kesimpulan: Peningkatan hormon LH dan estradiol pada wanita dengan epilepsi berhubungan dengan bangkitan epileptik yang mengganggu regulasi aksis hipothalamus- hipofisis-ovarium sehingga mengganggu hormon reproduksi.

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Background : Approximately 50% of epilepsy occurs in women with the reproductive age of 15-49 years. Many studies said that there is an interaction between epilepsy and female reproductive hormones. Temporolimbic epilepsy can interfere the regulation of the hypothalamic-pituitary-ovarian (HPO) axis so that it interferes reproductive hormones and ultimately causes menstrual disorders. Therefore, this study aimed to determine the changes in reproductive hormones that occur in women with epilepsy. This study will also classify menstrual disorders in women with epilepsy based on the criteria of The International Federation of Gynecology and Obstetrics (FIGO), where this criterion is a new criterion for defining abnormal uterine bleeding.

Method : This study was conducted with a cross sectional study to determine the characteristics of reproductive hormones and menstrual disorders in women with epilepsy at Cipto Mangunkusumo General Hospital from September to December 2021. Primary and secondary data were obtained from medical records and electronic health records (EHR) from women with epilepsy and women without epilepsy who seek treatment at Cipto Mangunkusumo General Hospital. Analysis of the data used Chi Square and Mann Whitney bivariate.

Result : In this study, there were 67 female subjects with epilepsy and 50 female subjects without epilepsy with the average age of women with epilepsy is 29,27  9,26 years. The onset of epilepsy was 18,57  9,857 years with the age of menarche is 12,85  1,317 years. The onset of epilepsy after menarche is mostly about 70.1%. Temporal lobe epilepsy is the most common epilepsy syndrome around 70.8%, with the right side being the most common around 46.8%. Increased reproductive hormones, especially luteinizing hormone (LH) 10.1 (0.1- 100.3) mIU/mL (p: 0.008) and estradiol hormone 71.2 (0-3350) pg/mL were found in women with epilepsy compared to women without epilepsy. Disorders of menstrual blood volume were found in women with temporal lobe epilepsy compared with extratemporal lobe epilepsy RR 4.255 (1.188-15.231), with p value: 0.022.

Conclusion : Elevated LH and estradiol hormones in women with epilepsy are associated with epileptic seizures that disrupt the regulation of the hypothalamic-pituitary-ovarian axis, thereby disrupting reproductive hormones."

"Latar belakang: Status epileptikus non-konvulsivus (SENK) dapat terjadi setelah status epileptikus konvulsivus (SEK). SENK yang terjadi pasca-SEK memiliki mortalitas sebesar 34,9%. Sehingga, pada keadaan penurunan kesadaran pasca-SEK harus dicurigai suatu SENK yang dibuktikan dengan pemeriksaan elektroensefalografi (EEG) untuk menegakkan diagnosis agar luaran pasien menjadi lebih baik. Penelitian ini bertujuan untuk mengetahui insiden SENK pasca-SEK dan faktor-faktor yang mempengaruhinya. Metode Penelitian: Penelitian ini menggunakan desain potong lintang menggunakan data sekunder. Sampel di ambil dengan metode total sampling yaitu pada subjek yang mengalami penurunan kesadaran pasca-SEK dari bulan Maret 2019-Oktober 2020 di Rumah Sakit Dokter Cipto Mangunkusumo (RSUPN Dr. Cipto mangunkusumo) Jakarta. Penegakan diagnosis SENK menggunakan EEG dengan kriteria modified salzburg consensus criteria for non-convulsive status epilepticus (mSCNC) Hasil Penelitian: Sebanyak 74 subjek mengalami penurunan kesadaran pasca-SEK. Median usia 46 (18-80) tahun dengan dominasi perempuan. Median frekuensi bangkitan epileptik saat SEK sebanyak 4(1-30) kali, SEK terjadi selama 1-5 menit pada 73% subjek. Median derajat kesadaran pasca SEK skala koma Glasgow (SKG) 11(5-14). Etiologi tersering adalah intrakranial (66,2%) yang terjadi akut (71,6%) akibat iskemia otak (20,3%). Riwayat epilepsi didapatkan pada 36,5% subjek. Insiden SENK dari Maret 2019 – Oktober 2020 sebesar 33,8%. Berdasarkan kriteria mSCNC, SENK definit 24%, sebesar 12% masing-masing berupa bangkitan epileptiform > 2,5Hz dan aktivitas ritmik disertai evolusi spasiotemporal. Sementara possible SENK 56% dengan gambaran tersering berupa aktivitas ritmik tanpa fluktuasi. Pada subjek yang tidak SENK didapatkan gambaran EEG abnormal sebanyak 87,3% dengan gambaran nonepileptiform berupa perlambatan (71,4%). Tidak terdapat perbedaan demogarafi dan klinis bermakna pada kedua kelompok, namun pada kelompok SENK didapatkan median usia lebih tua (52 vs 44 tahun). Sedangkan pada kelompok tidak SENK, lebih banyak didapatkan riwayat epilepsi (44,9%) dibandingkan kelompok SENK (20%) (p = 0,035). Analisa multivariat menunjukkan risiko mengalami SENK saat tidak memiliki riwayat epilepsi adalah sebesar 3.259 kali (p = 0,040; IK95% 1,053-10,091). Kesimpulan: Insiden SENK didapatkan sebesar 33,8%. Berdasarkan kriteria mSCNC, definit 24%, sebesar 12% masing-masing berupa bangkitan epileptiform > 2,5Hz dan aktivitas ritmik disertai evolusi spasiotemporal. Sementara possible SENK 56% dengan gambaran tersering berupa aktivitas ritmik tanpa fluktuasi. Pasien tanpa riwayat epilepsi, memiliki resiko sebesar 3,259 kali mengalami SENK pasca-SEK.

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Background: Nonconvulsive status epilepticus (NCSE) may occur following convulsive status epilepticus (CSE), with the mortality rate of 34.9%. Therefore, in persistent loss of consciousness following CSE, NCSE must be considered and electroencephalography (EEG) should be performed to ensure the diagnosis and improve the outcome. This study aimed to describe the incidence of NCSE following CSE and its associated factors.

Methods: This was a cross-sectional study using secondary data of every subjects with loss of consciousness following CSE from March 2019 to October 2020 in Cipto Mangunkusumo National General Hospital, Jakarta. The diagnosis of NCSE was performed using modified Salzburg consensus criteria for non-convulsive status epilepticus (mSCNC).

Results: There were 74 subjects with loss of consciousness following CSE. The median age of 46 (18-80) years predominantly female. The median frequency of seizure at CSE was 4 (1-30) times and occurred for 1-5 minutes in 73% of subject. The median degree of consciousness following CSE Glasgow Coma Scale (GCS) 11 (5-14). The most common etiology was related to intracranial etiology (66.2%) that occurs in acute (71,6%) due to cerebral ischemia (20.3%). A history of epilepsy was found in 36.5% subject The incidence of NCSE from March 2019 to October 2020 was 33.8%. Based on mSCNC criteria, the definite NCSE was 24%, 12% respectively was epileptiform discharge >2.5 Hz and rhythmic activity with spasiotemporal evolution. The possible NCSE was 56 % with the most common EEG finding was rhythmic activity without fluctuation. In group NCSE, there was abnormal EEG 87.3% with non-epileptiform in form of slowing. There were no significant demographic and clinical differences in two group, but in NCSE group the median age was older (52 vs 44 years). Meanwhile, in the non NSCE group, there was more history of epilepsy (44.9) than NCSE group (20%) (p=0.035). Multivariate analysis showed the risk of NCSE when no history of epilepsy was 3.259 times (p = 0,040; IK95% 1,053-10,091).

Conclusion: The incidence of NCSE following CSE was 33.8%. Based on mSCNC criteria, the definite NCSE was 24%, 12% respectively was epileptiform discharge >2.5 Hz and rhythmic activity with spasiotemporal evolution. The possible NCSE was 56 % with the most common EEG finding was rhythmic activity without fluctuation. Subjects without history of epilepsy had 3.259 higher risk to develop NCSE following CSE."