The Outcome of Status Epilepticus and

Long-Term Follow-Up
Hasil dari Tindak Lanjut Jangka Panjang
Status Epileptikus
dr. Dicky Lesmana
CPPDS Neurologi Universitas Andalas
Abstrak
Objektif : Penelitian ini bertujuan untuk mengetahui hasil dari status epilepticus (SE) yang dihubungkan dengan
terapi antiepilepsi selama SE dan dalam masa pengontrolan, faktor risiko termasuk usia, komorbiditas,
riwayat epilepsi, dan etiologi di wilayah Hungaria Timur.

Metode : Secara prospektif cross-sectional. Data didapatkan dari dokumen rawat jalan pasien pada tahun 2013
sampai dengan tahun 2017. Kontrol berakhir pada 30 Juni 2018.

Hasil : 135 episode (laki-laki: 68, 50,4%) dievaluasi, usia rata-rata dan waktu kontrol berturut-turut 64,1 ± 13,9
tahun dan 39,9 ± 14,2 bulan. Dari 89 pasien dengan riwayat epilepsi, 34 pasien tidak mengunjungi unit
rawat jalan secara teratur. Angka kematian kasus adalah 25,2% dan 31 pasien (30,7%) meninggal
karena penyakit penyerta; waktu kelangsungan hidup rata-rata 10,44 ± 8 bulan. Epilepsi tipe fokal,
umum dan gabungan didiagnosis pada 67 pasien (49,6%), 47 pasien (34,8%), dan 21 pasien (15,6%)
SE. Sembilan pasien mengalami SE non-konvulsif (NCSE). Rata-rata periode bebas kejang adalah 6,8 ± 6,9
bulan. Pasien yang memakai karbamazepin (20,9%; OR: 0,37, 95% CI: 0,16-0,82; p = 0,018),
levetiracetam (27,5%; ATAU: 0,51, 95% CI: 0,27–0,97; p = 0,041), atau valproate (11,1%; OR: 0,18,
95% CI: 0,05-0,61; p = 0,0043) diharapkan bebas kejang setelah SE. Hasil terburuk terkait dengan usia
lanjut, etiologi, status onset baru epileptikus, NCSE, dan status epilepsi fokal.

Kesimpulan: Studi ini menyimpulkan bahwa pentingnya perawatan rutin dan kontrol pasien.
 STATUS
Pendahuluan EPILEPTIKUS

m
Metode
EEG & MRI
Subjek
Dirawat di unit
Cakupan mengklasifikasikan
masalah jenis kejang (SE
neurointensive dan
kejang) dan untuk
di terapi sebagai
• Usia memonitor
SE. pasien di
• Jenis kelamin keefektifan terapi
follow up hingga
• Penyebab (pasca SE)
Data 30/06/2018
• Riwayat epilepsi
• Riwayat operasi
Diambil dari rekam
medis pasien dalam intrakranial
• Riwayat terapi
periode 1/1/2013 sd
31/12/2017 secara AED saat sebelum, Analisis
retrospektif selama, dan setelah statik
SE
• Komorbiditas SPSS & Microsoft
Excel 2007
Hasil
KARAKTERISTIK DASAR
• Diagnosis ditegakan pada 121 pasien. Dari 121 pasien, 89
pasien berusia 40-80 tahun
• 89 pasien memiliki riwayat epilepsy (usia 62 tahun), dan 32
pasien tidak diketahui ada riwayat epilepsi/tidak.
Hasil
ETIOLOGI
• Tidak diketahui penyebab = 9 kasus
• Penyebab SE pada pasien dengan riwayat epilepsi  infeksi,
stroke, alkoholisme, & ketidakpatuhan berobat (Gambar 1)
• Pada pasien dengan onset baru SE  infeksi, alkoholisme,
stroke dan tumor.
• < 50% kasus termasuk epilepsy fokal 41 pasien, 30.4% dan
epilepsy fokal dengan generalisasi sekunder 26 pasien, 19.3%,
epilepsy umum 47 pasien, 34.8%. Epilepsi tipe gabungan 21
pasien, 15.6%
• 9 pasien NSCE  3 pasien kejang umum & 4 pasien epilepsy
Gambar 1. Penyebab paling umum dari SE pada pasien dengan riwayat epilepsy dan pasien SE onset baru (*pasien mungkin memiliki beberapa etiologi)
Applicability
• Manfaat kontrol secara berkala sangat penting dalam pemberian obat anti epilepsi karena dapat
berpengaruh terhadap pencegahan epileptikus.
• Kita bisa mencegah tidak terdiagnosisnya NCSE yang dimana pasien diberikan terapi penyakit
utama tanpa melihat gangguan pada neuroemergensinya.
• Mengetahui diagnosis pasien dengan cepat agar dapat mengevaluasi status epileptikus yang
berdampak pada peningkatan mortalitas terhadap etiologi tertentu.
• Pemberian AED terbaru seperti levatiracetam dapat meningkatkan periode bebas kejang.
• Hasil penelitian utama mampu membuktikan bahwa terapi levatiracetam, karbamazepin, dan
valproat dapat meningkatkan periode bebas kejang sehingga dokter dapat mempertimbangkan
pemberian terapi tersebut pada pasien SE.
• Selain itu dari gambar 2 menunjukan bahwa angka mortalitas tertinggi ditemukan pada NOSE
dibandingkan dengan Pre-existing SE. hal ini dapat menjadi perhatian pada dokter untuk lebih
memperhatikan terapi yang tepat dan segera pada pasien-pasien SE sehingga angka mortalitas
karena NOSE dapat ditekan.
• Pentingnya EEG jangka panjang pada perawatan intensif untuk mengurangi late diagnosis dari
NCSE
Hasil
ETIOLOGI
• <50% kasus adalah epilepsi fokal ( 41 pasien, 30.4% ), dan
epilepsy fokal dengan generalisasi sekunder (26 pasien, 19.3%)
• Epilepsi umum (47 pasien, 34.8%)
• Epilepsi gabungan (21 pasien, 15.6%)
• NCSE (9 pasien)  3 pasien pernah mengalami kejang umum
dan 4 pasien pernah mengalami kejang fokal (sebelum NCSE)
Hasil
Obat Anti Epilepsi
Hasil
• 22 pasien yang meninggal (saat penanganan di RS)
diklasifikasikan dengan diagnosis simptomatik yang
tandanya tidak bisa ditentukan pengaruh epilepsy
terhadap kematian.
Kesimpulan
• Tidak ada pengaruh yang signifikan pada usia terhadap
riwayat epilepsy sebelumnya untuk menegakan diagnosis
epilepsy
• Penelitian ini tidak bias dibilang valid karena pasien dengan
NCSE perlu dilakukan pemeriksaan EEG sedangkan pasien
tidak rutin diperiksa EEG, bisa saja pasien sedang periode
epilepsy tapi tidak ditangani.
• Mengapa EEG harus dilakukan secara rutin? Karena bisa
saja pasien meninggal karena NCSE, namun pada kasus ini
dikatakan pasien meninggal karena etiologi.
Table of Contents.

01. 02. 03.

About the Patient Discussion Diagnosis
Here you could describe Here you could describe Here you could describe
the topic of the section the topic of the section the topic of the section

04. 05.
Treatment Monitoring
Here you could describe Here you could describe
the topic of the section the topic of the section
Introduction.

Mercury is the closest planet to

the Sun and the smallest one in
the Solar System—it’s only a bit
larger than the Moon. The planet’s
name has nothing to do with the
liquid metal, since Mercury was
named after the Roman messenger
god
Identifying Information.

Mars Jupiter Venus

Despite being red, Mars It’s a gas giant and the Venus has a beautiful
is actually a cold place biggest planet in the name and is the second
full of iron oxide dust Solar System planet from the Sun
01.
About the
Patient
You could enter a subtitle
here if you need it
Patient Medical History.

Age Gender Allergies Location

32 years old Female Pollen Madrid, Spain

Health Record

2005 2010 2020

Despite being red, Mercury is the Saturn is a gas giant
Mars is a cold place smallest planet and has rings
Review of Systems.

Mars Jupiter Saturn Mercury

Despite being red, Jupiter is a gas giant Saturn is a gas giant Mercury is the
Mars is actually a and the biggest composed mostly of closest planet to the
cold place full of planet in the Solar hydrogen and Sun and the smallest
iron oxide dust System helium one
Brain Examination.

Mars
Despite being red,
Mars is a cold place
Saturn

Venus Saturn is the ringed

one and a gas giant
Venus has a
beautiful name
Jupiter

Neptune It’s a gas giant and

the biggest planet
It’s the farthest
planet from the Sun
A Picture Is
Worth a
Thousand
Words.
Findings.
Expansion Prevalence

Venus Saturn

Mars

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Mars Venus change the data and paste the new graph here
Discussion.

“Despite being red, “Venus has a beautiful

Mars is actually a cold name, but its
place. It’s full of iron atmosphere is very
oxide dust” poisonous”
Dr. Jenna Doe Dr. John James
Discussion Summary.

Mercury is the closest planet to

the Sun and the smallest one in
the Solar System—it’s only a bit
larger than the Moon. The planet’s
name has nothing to do with the
liquid metal, since Mercury was
named after the Roman messenger
god
Comparison.

Jupiter Mars Venus Saturn

Diagnosis.

Mercury Venus Mars

Mercury is the closest Venus is the second Despite being red, Mars
planet to the Sun planet from the Sun is actually a cold place

Jupiter Saturn Neptune

Jupiter is a gas giant It’s composed of Neptune is the farthest
and the biggest planet hydrogen and helium planet from the Sun
Treatment.

Venus Mercury
Venus has a beautiful name, Mercury is the closest planet
but its atmosphere is to the Sun and the smallest
extremely poisonous one in the Solar System
Patient Monitoring.
Mars Venus

Week 1 Week 2 Week 3 Week 4

Despite being red, Saturn is a gas giant Jupiter is the biggest Venus is the second
Mars is a cold place and has rings of them all planet from the Sun
8,300,000
Big numbers catch your audience’s attention
Contraindications & Indications.
● Here you can describe a
reason to stop the treatment
● Here you can describe a
reason to stop the treatment
● Here you can describe a
reason to stop the treatment
● Here you can describe a
reason to start the treatment
● Here you can describe a
reason to start the treatment
● Here you can describe a
reason to start the treatment
Post-Prevention.

Healthy Food Active Mind

Mercury is the closest Jupiter is a gas giant
planet to the Sun and the biggest planet

Sports Eye Protection

Venus is the second Neptune is the farthest
planet from the Sun planet from the Sun
Case Timeline.

Day 1 Day 2
Mercury is the closest Jupiter is a gas giant
planet to the Sun and the biggest planet

Day 3 Day 4
Venus is the second Neptune is the farthest
planet from the Sun planet from the Sun
Conclusions.
Mercury is the closest planet
to the Sun and the smallest
one in the Solar System
● Here you can detail the
conclusions
● Here you can detail the
conclusions
● Here you can detail the
conclusions
● Here you can detail the
conclusions
References.

● AUTHOR (YEAR). Title of the publication. Publisher

● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
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