Kejadian Epilepsi pada

Pasien SLE

Ivan Veriswan

Supervisor
Prof. DR. dr. Harsoyo N, DTM&H, Sp.A (K)
Dr. Wistiani, Msi. Med, Sp.A (K)
dr. Galuh Hardaningsih, Msi. Med,SpA
Laporan Kasus
Seorang Anak Perempuan Usia 11
tahun 9 bulan dengan SLE, Nefritis
lupus, Epilepsi, Gizi buruk
Marasmus
Identitas
Nama : Laeli Izzati
Tanggal Lahir/umur : 09 Agustus 2007/11 th 9 bl
MRS : 03 Mei 2019
 Anamnesis
Dilakukan alloanamnesis dengan ayah pasien
Keluhan : Demam
Riwayat Penyakit Sekarang :
± 5 hari SMRS anak demam naik turun, suhu tidak diukur. Anak juga
mengeluh sariawan di mulut banyak, batuk jarang, pilek (-), wajah kemerahan
(+), ruam kemerahan di wajah (+). Anak sulit makan dan minum karena
sariawan.
± 3 hari SMRS anak diare, lembek cair, warna coklat kehitaman, keluar lendir
kemerahan dari vagina, BAK sedikit karena anak tidak mau minum
 Anamnesis
Riwayat Penyakit Dahulu:

Anak terdiagnosa SLE sejak 2 tahun yang lalu. Konsumsi obat Myfortic
terakhir minum saat rawat inap terakhir sejak tanggal 22 Maret 2019.
Anak juga memiliki riwayat krisis hipertensi dan riwayat kejang berulang dan
mendapat terapi karbamazepin.
 Pemeriksaan Fisik Mulut
Leher
: sianosis (-), oral thrush (+), krusta (+)
: kaku kuduk (-), pembesaran limfonodi (-),
KU : sadar, tampak lemah Thorax : simetris, retraksi (-)
Cor : BJ I-II normal, bising (-), thrill (-), gallop (-)
Tanda vital : Pulmo : Suara dasar Vesikuler +/+ +/+
HR : 88 x/mnt Suara nafas tambahan
Nadi : reguler, isi dan Hantaran -/- -/-
tegangan cukup Ronkhi -/- -/-
TD : 100/70 mmHg Wheezing -/- -/-
RR : 20x/menit Abdomen : datar, supel, BU (+)normal , hepar/lien tak
t : 36,4 °C teraba
SpO2 : 99% WAZ : NA Ekstremitas : Akral hangat +/+ +/+
BB : 16 kg HAZ : -3.94 SD Capillary refill time ‹2” ‹2”
TB : 123 cm BMI : -5.02 SD Striae -/- -/-
Kepala : alopesia (+), abses kepala tertutup kassa (+), rembes (-) Oedem -/- -/-
Wajah : ekskoriasi (+), malar rash (-), moon face (-) Atrofi otot -/- +/+
Mata : konjungtiva palpebra anemis (-/-), ikterik (-/-), Kaki kanan post skin graft +
pupil isokor +/+, r.cahaya +/+, sekret +/+
Hidung : nafas cuping hidung (-)
Assessment
• SLE on flare
• Nefritis lupus
• Oral thrush
• Epilepsi
• Gizi buruk Marasmus
• Ulkus kepala
• Hipertensi on theraphy
• Riwayat NAFLD
• Dislipidemia
Terapi
• Myfortic 180mg 2-1-0
• Valsartan 80mg/ 24 jam
• Metilprednisolon 4mg 1 ½ -1-0 (0,5mg/kg/hari)
• Karbamazepine 50mg/8 jam (10mg/kg/hari)
• Captopril 25 mg/ 24 jam
• Bisoprolol 2,5 mg/ 24 jam
• Spironolakton 12,5 mg/ 12 jam
• Furosemid 20mg/ 12 jam
• Nystatin drop 1 ml/ 8 jam
• Betadine gargle
• Kenalog oral base Cr ue/ 12 jam
 Introduction
• Systemic lupus erythematosus (SLE) is a well-known inflammatory
autoimmune disease  Neuropsychiatric manifestations (active
systemic diseases, psychiatric and neurologic disorders)
• Epilepsy  a common and clinically heterogeneous condition
• An increased risk of seizures has been described in several
inflammatory/autoimmune disorders, including systemic lupus
erythematosus (SLE) and multiple sclerosis.
 Figure Mean age-specific incidence and
prevalence of epilepsy identified in the general
population and in patients with SLE from
1997–2010 in Taiwan.

Abbreviation: SLE, systemic lupus

erythematosus

Tsai JD, Lin CL, Lin CC, et al. Risk of epilepsy in patients with systemic lupus erythematosus
– A retrospective cohort study. Neuropsychiatr Dis Treat 2014; 10: 1635–1643.
Tsai JD, Lin CL, Lin CC, et al. Risk of epilepsy in patients with systemic lupus erythematosus
– A retrospective cohort study. Neuropsychiatr Dis Treat 2014; 10: 1635–1643.
 Kaplan–Meier method estimating the
cumulative incidence of epilepsy in the
SLEcohort and non-SLEcohort by age.

Notes: (A) Overall; (B) 20 years old; (C) 20–39

years; (D) 40–59 years; and (E) 60 years.

Tsai JD, Lin CL, Lin CC, et al. Risk of epilepsy in patients with
systemic lupus erythematosus – A retrospective cohort study.
Neuropsychiatr Dis Treat 2014; 10: 1635–1643.
 Conclusion
• Retrospective cohort analysis, we found that children with SLE are at the greatest
risk of developing epilepsy.
• It is likely that the etiology of epilepsy is different between the general population
and patients with SLE
• The lower incidence and prevalence of epilepsy in older SLE patients may be due
to higher mortality from SLE.
• the current study  seizures tend to appear early in the course of SLE.
• An epilepsy prevention program for young SLE patients deserves greater attention

Tsai JD, Lin CL, Lin CC, et al. Risk of epilepsy in patients with systemic lupus erythematosus
– A retrospective cohort study. Neuropsychiatr Dis Treat 2014; 10: 1635–1643.
 Conclusion – When to stop AED
• Once a patient has entered a seizure-free interval  withdrawing
• Unfortunately, there is no clear consensus on these topics for either adults or
children.
• Camfield and Camfield (2008)  seizure remission period of 2 years is reasonable
before attempting a drug withdrawal in children

Hixson, John D. Stopping Antiepileptic Drugs: When and Why? Current Treatment Options
in Neurology (2010) 12:434–442
Thank You