KELUHAN UTAMA

Kejang
ANAMNESIS
RPS:

3 TSMRS os pertama kali mengalami kejang. Saat kejang tangan

kanan menekuk ke arah kepala dan kaku, kepala menengadah
serta mengeluarkan air liur. Kejang berlangsung selama 1-2 menit
dan os tidak sadar. Setelah kejang berhenti, os bingung dan
merasa pusing. Kejang biasanya muncul jika os kelelahan atau
kurang tidur. Kejang terjadi 1-2 kali dalam sebulan. Os sudah
menjalani pengobatan selama 8 bulan, rutin mengkonsumsi 3
jenis obat setiap hari (Phenytoin 2x1, asam folat 1x1, topamax
1x1). Kejang terakhir kali kambuh 2 bulan lalu.
 HMRS pasien kontrol rutin bulanan, mengatakan tidak ada
kekambuhan kejang.

 RPD:  RPK:
Riw. Kejang demam (-) Keluhan serupa (-)
Riw. Sering terjatuh dari
motor akibat hilang
kesadaran mendadak (+)

 Riw. Psikososial
Kegiatan sehari-hari os adalah membantu usaha orangtua. Os
merupakan anak pertama dari dua bersaudara, tinggal
berempat bersama dengan orangtua dan saudaranya.
Pembiayaan menggunakan BPJS.
 PEMERIKSAN FISIK (4/3/19)
Keadaan Umum : Baik, CM
Tanda Vital
HR : 84 x/min RR : 18 x/min
TD : 120/70 mmHg NPS : -
Kepala : CA (-), SI (-), pupil isokor Ø3 mm, nystagmus (-),
lnn ttb
Thoraks : Simetris, retraksi (-)
Cor : S1-S2 tunggal reguler, bising (-)
Pulmo: Vesikuler +/+, ronchi -/-, wheezing -/-
Abdomen: BU (+), timpani, supel, NT (-), hepar lien ttb
Ekstremitas: Akral hangat, nadi teraba kuat, CRT <2”
PEMERIKSAAN NEUROLOGIS
 Nn. Cranialis
 N. I : Tidak terdapat penurunan daya penghidu
 N. II : Daya penglihatan OD 6/6 OS 6/6
 N. III : RC +/+, pupil isokor Ø 3mm, ptosis (-), gerakan mata
ke medial, atas dan bawah dbn
 N. IV : Gerakan mata ke lateral bawah dbn
 N. V : Sensibilitas simetris, RK +/+
 N. VI : Gerakan mata ke lateral dbn
 N. VII : Kerutan kulit dahi, kedipan mata, meringis, sudut mulut,
menggembungkan pipi, lakrimasi dbn.
 N. VIII : dbn
 N. IX : dbn
 N. X : dbn
 N. XI : dbn
 N. XII : dbn
Ekstremitas
G B B K 5 5 Rf +2 +2 Rp - -
B B 5 5 +2 +2 - -

Tn N N Tr E E Cl - -
N N E E

Sensibilitas : Dbn
Vegetatif : Dbn
PEMERIKSAAN PENUNJANG
EEG (27/7/2018)
- Polymorphic delta activity
- EEG perekaman abnormal epileptiform
- EEG saat ini dapat sesuai dengan klinis bangkitan umum
DIAGNOSIS
Diagnosis klinis : Bangkitan epilepsi complex
partial seizure
Diagnosis topis : Korteks serebri
Diagnosis etiologi : Idiopatik
TATALAKSANA
Phenytoin 100 mg 2x1
Asam folat 1 mg 1x1
Topamax 25 mg 1x1
REFLEKSI KASUS
EPILEPSI
STATUS EPILEPTICUS
SE was defined as 5 min or more of (i) continuous
clinical and/or electrographic seizure activity or
recurrent seizure activity without recovery (returning
to baseline) between seizures.

Status epilepticus (SE) is defined as continuous seizure

activity of at least 30 min duration or intermittent
seizure activity of at least 30 min duration during
which consciousness is not regained.
CLASSIFICATION
SE should be classified as either
convulsive SE (convulsions that are associated with
rhythmic jerking of the extremities) or
non-convulsive SE (seizure activity seen on EEG
without the clinical findings associated with
convulsive SE)
Refractory SE : SE that does not respond to the
standard treatment regimens, such as an initial
benzodiazepine followed by another AED.
 “Status epilepticus (SE) requires emergent,
targeted treatment to reduce patient morbidity
and mortality.”
REFERENSI
“Treatment of Convulsive Status Epilepticus in
Children and Adults,” Epilepsy Currents 16.1 - Jan/Feb
2016.
B. Gretchen et al., 2012. Guidelines for the Evaluation
and Management of Status Epilepticus. Neurocrit
Care.
E. Trinka et al., 2015. A definition and classification of
status epilepticus – Report of the ILAE Task Force on
Classification of Status Epilepticus. Epilepsia,
56(10):1515–1523, 2015.
TERIMA KASIH
PHASES
Stabilization phase (0-5 minutes of seizure activity),
includes standard initial first aid for seizures and
initial assessments and monitoring.
Initial therapy phase (5-20 minutes of seizure
activity) when it is clear the seizure requires medical
intervention, a benzodiazepine (specifically IM
midazolam, IV lorazepam, or IV diazepam) is
recommended as the initial therapy of choice, given its
demonstrated efficacy, safety, and tolerability.
Second therapy phase (20-40 minutes of seizure activity) when
response (or lack of response) to the initial therapy should be
apparent. Reasonable options include fosphenytoin, valproic acid
and levetiracetam. There is no clear evidence that any one of these
options is better than the others. Because of adverse events, IV
phenobarbital is a reasonable second-therapy alternative if none
of the three recommended therapies are available.
Third therapy phase (40+minutes of seizure activity). There is
no clear evidence to guide therapy in this phase. The guideline
found strong evidence that initial second therapy is often less
effective than initial therapy, and the third therapy is substantially
less effective than initial therapy. Thus, if second therapy fails to
stop the seizures, treatment considerations should include
repeating second-line therapy or anesthetic doses of either
thiopental, midazolam, pentobarbital, or propofol (all with
continuous EEG monitoring).