Meiti Frida, Basjiruddin A

Bagian Saraf Fakultas Kedokteran Universitas Andalas,

RS. DR. M. Djamil Padang

Abstract

Non convulsive status epilepticus (NCSE) is defined as mental status changes from baseline of at least 30 minutes duration association with continuous ictal discharge of EEG. The EEG characteristic of NCSE are heterogenous, include typical spike-wave (TSW) discharge, multi spike wave discharge (MSW) and rhytmic delta activity with intermixed spike (RDIS).

NCSE is somewhat complicated but can be simplify devided into three types : complex partial status (CPSE), absence status (AS), and hypsarrhytmia. The clinical features of which vary widely depending upon the region of the brain affected by seizure including subtle memory deficits, bizarre behaviour, psychosis or coma. The diagnosis of these conditions is critically dependent on EEG, when the EEG demonstrates typical ictal patterns, the diagnosis is usually straight forward. Indeed the prognosis of NSCE is usually dependent on the underlying etiology rather than persistence of EEG discharges. Treatment focuses on correcting underlying pathologic abnormalities, infection, drug toxicity and initiating pharmacologic therapy. Intravenous benzodiazepin are considered the first line treatment for NCSE, and these are so effective that the response is diagnostic. Lorazepam at 0.05 – 0.1 mg/kg is the benzodiazepin of choice

Keywords : NCSE, EEG, Clinical feature, treatment

PENGARUH PEMAKAIAN OBAT ANTIEPILEPSI JANGKA PANJANG TERHADAP DENSITAS TULANG DAN KADAR ALKALI FOSFATASE PADA PENDERITA EPILEPSI

YANG BEROBAT DI POLIKLINIK SARAF RS. DR. M. DJAMIL PADANG

Meiti Frida

Abstract

Background : Epilepsy is considered as one health problem that could impact medical, social, psikosocial and economic status in community. Epilepsy therapy itself may also result many problems, associated with long-term therapy and other aspects. General principle of epilepsy therapy is to keep patients in non convulsion state without having any significant adverse effects. The use of long-term anti epileptic drugs could affect bones, decreasing bone mineral density and increasing alkaline phospatase level.

Methods : A cross sectional study was performed since November 1st 2007 until April 30th 2008. The subject of the study is epilepsy patients receiving long-term anti epileptic drugs in neurology out-clinic DR.M.Djamil Hospital Padang. The information were obtained from questionnaire and medical record data. A Student’s t test and Mann Whitney test were then used to compare the difference between groups.

Results : 49 patients were evaluated in this study. 23 were male and 26 were female. Mean age is 33,16 years old. There was significant difference between anti epileptic drugs and bone mineral density in female patients (p<0,05). No significant difference between anti epileptic drugs with bone mineral density nor alkaline phospatase level were found in male patients, although a decreasing bone mineral density feature was captured in the field.

Conclusions : Long-term anti epileptic drugs affects bone mineral density, particularly in female patients. Further study is needed to observe the effect of mono and poli therapy on bone mineral density in patients with epilepsy.

Keyword : anti epileptic drugs, mineral density, alkaline phospatase.

Meiti Frida

Department of Neurology, Medical Faculty of University of Andalas

Dr. M. Djamil Hospital, Padang

Abstrak

Gejala dan tanda neuropati perifer cukup sering ditemukan pada pasien usia lanjut, dan seringkali dianggap sebagai bagian dari proses penuaan. Berbagai kondisi pada usia tua seperti diabetes, alkoholisme, defisiesi nutrisi, infeksi, keganasan maupun kelainan autoimun, dapat mempengaruhi kualitas fungsional saraf yang mengakibatkan neuropati. Selain itu seringkali penderita usia lanjut mengalami neuropati perifer dengan sebab yang tidak diketahui. Prevalensinya tidak banyak diketahui, dan cenderung terbatas pada penyakit maupun kelainan yang mendasarinya. Gangguan ini pada usia lanjut mengakibatkan penurunan kualitas hidup yang bermakna. Keadaan tersebut akan membatasi fungsi fisik sehingga meningkatkan beban bagi keluarga dan sistem kesehatan.

Basjiruddin A 

Professor of Neurology, Medical Faculty, University of Andalas/Dr.M.Djamil Hospital-Padang

Abstract

Parkinson`s disease (PD) is a relentlessly progressive disease without definitive curative, restorative or stabilizing treatments. As PD advances, there is progressive degeneration of dopaminergic neurons mostly in the nigrostriatal pathway, and non dopaminergic neurons including neuroadrenergic, cholinergic, serotoninergic in widespread areas of the brain. These cellular changes lead to clinical manifestation with progressive motor complication include fluctuation and dyskinesias, and non motor include depression, hallucinations, psychosis, and dementia. The treatment of advanced PD is challenging as the presence of each of these symptoms must be considered when developing a pharmacological approach.

Goal of management are “reduce off time”, make the response as predictable, and alteration in medications should be gradual with as few as possible. Options available for treating motor fluctuations include CR carbidopa/levodopa, MAO B inhibitor, COMT inhibitors and dopamine agonist. Amitriptiline may be considered for depresium, clozapine for psychosis, and for PD with dementia, rivastigmin and donepezil are probably effective