status epilepticus
DESCRIPTION
STATUS EPILEPTICUSTRANSCRIPT
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STATUS EPILEPTICUSSTATUS EPILEPTICUS
Johannes H. SaingJohannes H. Saing
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DefenisiDefenisiStatus Epileptikus ( SE )Status Epileptikus ( SE )
Suatu serangan kejang yang terus-menerus selama 30 menitSuatu serangan kejang yang terus-menerus selama 30 menit
atau kejang yang berulang dengan interval sangat singkat atau kejang yang berulang dengan interval sangat singkat
tanpa pulihnya kesadarantanpa pulihnya kesadaran Marik PE, Management of Status Epilepticus,Chest Marik PE, Management of Status Epilepticus,Chest
20052005
Aicardi’s Epilepsy in Children, 2004Aicardi’s Epilepsy in Children, 2004
Kejang epileptik klinis dan elektrik yang berlangsungKejang epileptik klinis dan elektrik yang berlangsung
terus-menerusterus-menerus lebih dari 5 menit atau kejang yang berulanglebih dari 5 menit atau kejang yang berulang
lebih dari 5 menitlebih dari 5 menit tanpa pulihnya kesadarantanpa pulihnya kesadaran Holtkam M, J Neurol Neurosurg Pyshiciatry, 2005Holtkam M, J Neurol Neurosurg Pyshiciatry, 2005
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InsidensiInsidensi• 1,3 – 16% epilepsi1,3 – 16% epilepsi
• 70% usia < 1 thn70% usia < 1 thn
• 50-70% usia < 3 thn50-70% usia < 3 thn
Behera CMK, et al, MJAFI 2005;61: 174-178Behera CMK, et al, MJAFI 2005;61: 174-178 Swaiman KF, Aswal S, Pediatric Neurology, 1999Swaiman KF, Aswal S, Pediatric Neurology, 1999
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KlasifikasiKlasifikasiGeneralized convulsive SE ( GCSE )Generalized convulsive SE ( GCSE )- Primary generalized- Primary generalized- Tonic-clonic- Tonic-clonic- Myoclonic- Myoclonic- Clonic / Tonic- Clonic / TonicSecondary generalized SESecondary generalized SE- Partial seizures with secondary generalization- Partial seizures with secondary generalization- Tonic seizures- Tonic seizuresNon-convulsive SE ( NCSE )Non-convulsive SE ( NCSE )- Absance status ( Petit Mal )- Absance status ( Petit Mal )- Atypical absance status- Atypical absance status- Atonic- Atonic- NCSE due to partially treated GCSE- NCSE due to partially treated GCSEPartial SEPartial SE- Simple partial : * Typical- Simple partial : * Typical * Epilepsia partialis continua* Epilepsia partialis continua- Complex partial SE ( CPSE )- Complex partial SE ( CPSE )Neonatal SENeonatal SE
Behera CMK, et al, MJAFI 2005;61: 174-178Behera CMK, et al, MJAFI 2005;61: 174-178
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EtiologiDemamDemam 20 – 29%20 – 29%IdiopatikIdiopatik 16 – 39%16 – 39%Ggn SSP yang kronik statisGgn SSP yang kronik statis ( remote symptomatic ) 14 – 23%Simptomatik akut 23 – 40%
- Infeksi SSP- Trauma SSP- Hipoksik-iskemik- Serebrovaskular- Intoksikasi- Ggn metabolik / elektrolit- Tumor- Acute AED withdrawal
Ensefalopati yg progressif 2 – 6%
Livingston J, Epilepsy in Children, 1996Livingston J, Epilepsy in Children, 1996
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PatofisiologiPatofisiologiKetidakseimbangan antara eksitasi dan inhibisiKetidakseimbangan antara eksitasi dan inhibisisel sarafsel sarafSE terbagi 2 stadium:SE terbagi 2 stadium:1. Kompensasi: < 30 menit1. Kompensasi: < 30 menit
- Kejang tonik-klonik umum- Kejang tonik-klonik umum - Aliran darah serebral ↑- Aliran darah serebral ↑ - TD, KGD, Temp ↑, keringat, salivasi- TD, KGD, Temp ↑, keringat, salivasi
2. Dekompensasi: > 30 menit2. Dekompensasi: > 30 menit- Klinis: - Klinis: minor twitchingminor twitching- - Gagalnya autoregulasi serebralGagalnya autoregulasi serebral- Tekanan intrakranial ↑- Tekanan intrakranial ↑- Hipotensi sistemik- Hipotensi sistemik
Marik PE, Management of Status Epilepticus,Chest 2005Marik PE, Management of Status Epilepticus,Chest 2005
Scot RC, Status Epilepticus, Arch Dis Child 1998Scot RC, Status Epilepticus, Arch Dis Child 1998
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KomplikasKomplikasii
Sirven JI, Management of Status Epilepticus, Am Fam Physician, 2003Sirven JI, Management of Status Epilepticus, Am Fam Physician, 2003
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PENATALAKSANAAN SEPENATALAKSANAAN SETujuan Tujuan ::
Oksigenasi otak & fungsi jantung-paru yg adekuatOksigenasi otak & fungsi jantung-paru yg adekuatAkhiri kejang klinis & elektris sesegera mungkinAkhiri kejang klinis & elektris sesegera mungkinCegah rekurensiCegah rekurensiIdentifikasi faktor pencetus: hipoglikemi, elektrolit,Identifikasi faktor pencetus: hipoglikemi, elektrolit,kadar obat, infeksi, dan demamkadar obat, infeksi, dan demamKoreksi ggn metabolikKoreksi ggn metabolikCegah komplikasi sistemikCegah komplikasi sistemikEvaluasi & obati penyebabEvaluasi & obati penyebab
Swaiman KF, Aswal S, Pediatric Neurology, 1999Swaiman KF, Aswal S, Pediatric Neurology, 1999
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Penatalaksanaan Status EpilepticusPenatalaksanaan Status Epilepticus
Nolan M, Beca J, Neurology, Oct 2004Nolan M, Beca J, Neurology, Oct 2004
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Nolan M,Beca J, Neurology, Oct 2004Nolan M,Beca J, Neurology, Oct 2004
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The Status Epilepticus Working Party, Arch Dis Child, 2000The Status Epilepticus Working Party, Arch Dis Child, 2000
Level I, A
Level II, B
Level III, C Level III, C
Level II, BLevel II, B
Level III, C
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Sirven JI, Management of Status Epilepticus, Am Fam Physician, 2003Sirven JI, Management of Status Epilepticus, Am Fam Physician, 2003
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PrognosisPrognosisTergantung:Tergantung:
KlinisKlinisLama seranganLama seranganUsiaUsiaEtiologiEtiologi
Reccurent Convulsive SE : 17%Reccurent Convulsive SE : 17%Mortality 3 – 6%Mortality 3 – 6%Neurological sequelae 33%Neurological sequelae 33%
Marik PE, Management of Status Epilepticus,Chest 2005Marik PE, Management of Status Epilepticus,Chest 2005 Scot RC, Status Epilepticus, Arch Dis Child 1998Scot RC, Status Epilepticus, Arch Dis Child 1998
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