Prastiya Indra Gunawan
Divisi Syaraf Anak, Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Airlangga - RSUD Dr. Soetomo, Jl. Mayjen Prof. Dr. Moestopo 6-8, Surabaya, Indonesia

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Faktor Risiko Kejang Demam Berulang pada Anak Gunawan, Prastiya Indra; Saharso, Darto
MEDIA MEDIKA INDONESIANA 2012:MMI VOLUME 46 ISSUE 2 YEAR 2012
Publisher : MEDIA MEDIKA INDONESIANA

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Abstract

Risk factors of recurrent febrile seizures in childrenBackground: Febrile seizures (FS) are the most common seizure disorder in childhood. Recurrent febrile seizures (RFS) occur in one third of children who experience a first FS. About nine percent had three or more recurrence. Little is known about predictors of recurrence. The aim of this study is to determine the incidence and the risk factors of RFS in children with FS at Dr. Soetomo Hospital Surabaya.Method: This is a cohort prospective study. Data was taken from all children with first FS aged 6 month-old to 5 year-old who were admitted at pediatric ward Dr. Soetomo Hospital from August 2009 to November 2010. They were observed for one year period to ascertain wether FS recurred. Logistic regression statistic was used to analyze those variables including sex, age, body temperature during the fever episode, family history of seizures, diagnosis at the first onset, maternal illness, abnormal delivery and recurrence ofFS.Results: Recurrent FS occured in 65% of the 100 children at one year observation, and 26% of them had further attack. Male to female ratio was 2:1. Thirty-one (77.5%) of subjects were less than 12 months-old. Body temperature ≤38.5OC (OR=5.50, 95%CI, p=0.019) and complex FS (OR 5.03, 95%CI, p=0.025) were related to increase risk of reccurence.Conclusions: The risk of RFS increased with body temperature ≤38.5OC and diagnosed as complex FS at the first FS.Keywords: Children, risk factors, recurrent febrile seizures ABSTRAKLatar belakang: Kejang demam (KD) adalah kasus kejang yang sering dialami anak-anak. KD berulang terjadi pada sepertiga anak yang mengalami KD pertama. Sekitar 9% dari penderita KD mengalami tiga atau lebih kejadian berulang. Hanya sedikit yang diketahui tentang prediktor berulangnya KD. Tujuan penelitian untuk mengetahui angka kejadian KD berulang dan menentukan faktor risiko terjadinya KD berulang pada anak yang mengalami KD di RSUD Dr. Soetomo Surabaya.Metode: Studi kohort prospektif dilakukan pada bulan Agustus 2009 sampai November 2010. Subyek diambil dari anak usia 6 bulan sampai 5 tahun yang menderita KD pertama yang MRS di RSUD Dr. Soetomo. Subyek diamati selama 1 tahun untuk menentukan apakah KD terjadi berulang. Analisis antar variabel jenis kelamin, usia, suhu badan saat terjadi demam, riwayat kejang pada keluarga, diagnosis awal, penyakit ibu, kelahiran yang tidak normal dan kejadian KD berulang, dilakukan dengan regresi logistik.Hasil: KD berulang terjadi 65% pada 100 anak yang diobservasi selama 1 tahun pertama dan 26% mengalami KD lebih dari 2 kali. Rasio laki-laki dibanding perempuan adalah 2:1. Tiga puluh satu (77,5%) anak berusia kurang dari 12 bulan. Faktor risiko suhu badan ≤38,5OC (OR=5,50, 95%CI, p=0,019) dan KD komplikata (OR 5,03, 95%CI, p=0,025) bermakna secara signifikan untuk kejadian berulangnya KD.Simpulan: Risiko KD berulang pada anak meningkat pada suhu badan ≤38,5OC dan diagnosis KD komplikata pada saat KD pertama.
Management of Lowe syndrome: a case report Prasetyo, Risky Vitria; Setiawan, Heru; Soemyarso, Ninik Asmaningsih; Noer, Mohammad Sjaifullah; Irwanto, Irwanto; Gunawan, Prastiya Indra; Loebis, Rozalina; Utomo, Sri Andreani; Tirthaningsih, Ni Wayan
Paediatrica Indonesiana Vol 55 No 3 (2015): May 2015
Publisher : Indonesian Pediatric Society

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Abstract

Lowe syndrome (the oculocerebrorenal syndrome of Lowe, OCRL) is a multisystem disorder characterized by anomalies affecting the eyes, nervous system and kidneys.1-3 The disorder was first recognized by Lowe et al. in 1952, and described as a unique syndrome with organic aciduria, decreased renal ammonia production, hydrophthalmos, and mental retardation. In 1954, renal Fanconi syndrome was recognized as being associated with Lowe syndrome and in 1965, a recessive X-linked pattern of inheritance was determined.2,4 Lowe syndrome is a very rare disease, with an estimated prevalence in the general population of 1 in 500,000. According to the Lowe Syndrome Association (LSA) in the USA, the estimated prevalence is between 1 and 10 affected males in 1,000,000 people, with 190 living in the year 2000. The Italian Association of Lowe Syndrome estimated that there were 34 Lowe syndrome patients (33 boys and one girl) living in Italy in the year 2005.2,4,5 It almost exclusively affects males.6 Physicians may not be familiar with Lowe syndrome due to its rarity.4
Profil Epilepsi Anak dan Keberhasilan Pengobatannya di RSUD Dr. Soetomo Tahun 2013 Andrianti, Pravita Tri; Gunawan, Prastiya Indra; Hoesin, Faroek
Sari Pediatri Vol 18, No 1 (2016)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Latar belakang. Epilepsi adalah satu dari tiga kelainan neurologis tersering yang ditemui di praktek pediatri. Insiden epilepsi di negara berkembang dua kali lebih banyak daripada negara industri.Tujuan. Mengetahui profil epilepsi pada anak dan keberhasilan pengobatannya di RSUD Dr. Soetomo, Surabaya.Metode. Studi deskriptif retrospektif menggunakan rekam medis,variabel meliputi jumlah kasus baru, usia, jenis kelamin, riwayat keluarga, EEG, CT-scan, MRI dan keberhasilan terapi selama 2013 di RSUD Dr. Soetomo Surabaya.Hasil. Terdapat 103 kasus baru epilepsi anak terbanyak usia 1-5 tahun (45,63%), laki-laki (71,84%), tanpa pengobatan sebelumnya (32,04%), riwayat keluarga kejang/epilepsi (93,20%), kelainan perinatal (83,50%), maupun gangguan tumbuh kembang (63,11%). Hasil EEG 72,84% abnormal, 61,53% CT-scan kepala normal dan 57,14% MRI normal. Tipe bangkitan 55,34% general. Obat yang diberikan adalah asam valproat (89,32%) dan 75,73% kejang dapat terkontrol.Kesimpulan. Terdapat 103 kasus baru epilepsi anak, terbanyak usia 1-5 tahun dan laki-laki. Hasil pemeriksaan EEG umumnya abnormal di lobus temporal, tetapi lebih dari separuh kasus memperlihatkan CT-scan kepala dan MRI normal. Asam valproat terbanyak digunakan mengontrol kejang.
Efikasi dan Toleransi Monoterapi Topiramate pada Epilepsi Gunawan, Prastiya Indra
Sari Pediatri Vol 15, No 3 (2013)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Abstract

Latar belakang. Epilepsi merupakan masalah besar dalam bidang pediatri, masih terdapat 10%-15% pasien yang resisten terhadap pengobatan. Topiramate sebagai obat antiepilepsi baru mempunyai spektrum luas untuk anti kejang. Penelitian sebagai add on therapy dan monoterapi dewasa membuktikan topiramate mempunyai potensi yang baik. Data efektifitas dan efek samping topiramate sebagai monoterapi pada anak-anak masih sulit didapatkan.Tujuan. Menilai efikasi dan toleransi topiramate untuk monoterapi pasien pediatri dengan epilepsi.Metode. Penelitian pra-eksperimental dilakukan di Poliklinik Neurologi Anak RSUD Dr Soetomo, Surabaya dengan 15 subjek. Subjek yang sesuai kriteria diberikan terapi topiramate dan dilakukan pengukuran frekuensi kejang, serta efek samping pada minggu 1, 4, 8, 12, 16, 20, dan 24. Gambaran EEG dan pemeriksaan laboratorium dilakukan sebelum dan sesudah terapi selama 6 bulan. Analisis statistik menggunakan T-test for related samples dan McNemar.Hasil. Frekuensi kejang awal 2,7 (1,16) menjadi 0,13 (0,51) dengan 93,7% pasien bebas kejang pada minggu ke-20 (p=0,000). Gambaran EEG awal menunjukkan aktifitas epileptiform menjadi normal pada 20% subyek. Tigapuluh persen sampel mengalami penurunan nafsu makan pada saat awal terapi, dan 7% mengalami rasa kantuk.Kesimpulan. Terdapat reduksi frekuensi kejang dan tidak terdapat perubahan EEG pasca pemberian pemberian topiramate. Efek samping yang ditemukan adalah mengantuk dan penurunan nafsu makan.
Age decreases quality of life in adolescents with intractable epilepsy Gunawan, Prastiya Indra; Limanto, Theresa Laura; Suharso, Darto
Universa Medicina Vol 34, No 2 (2015)
Publisher : Faculty of Medicine, Trisakti University

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BackgroundIntractable epilepsy considerably affects both the private and social life of the patient. The objective of this study was to determine the quality of life of intractable epileptic adolescents and its correlated factors. Methods A cross sectional study was conducted in the Pediatric Neurology outpatient clinic of Dr. Soetomo Hospital. All intractable epileptic adolescents aged between 10 to 16 years were asked to complete a questionnaire on quality of life in epilepsy for adolescents (QOLIE-AD-48). A multiple linear regression was used to analyze the data through SPSS v17.0.ResultsThirty one patients with mean age of 12.41 ± 1.40 years were enrolled in the study. The mean duration of diagnosed intractable epilepsy was 6.12 ± 4.30 years. Mean score for impact of epilepsy was 57.11 ± 24.50, for memory and concentration 53.54 ± 26.66, physical functioning 65.56 ± 23.67, social stigma 52.23 ± 17.48, social support 52.64 ± 22.69, behavior at school 57.51 ± 26.50, attitude 53.40 ± 16.70 and health perception 61.51 ± 11.30. Multiple linear regression results showed that quality of life (QOL) was not significantly correlated with duration of epilepsy, sex and nutritional status (p>0.05), but increasing age was significantly decreases quality of life (p<0.05). ConclusionsIntractable epileptic adolescents have higher scores for physical functioning and health perception, but lower scores for social stigmatization. Social support has extremely low scores. Increasing age decreases quality of life in adolescents with intractable epilepsy.
Topiramate sprinkle is effective in the treatment of childhood epilepsy Gunawan, Prastiya Indra; Suharso, Darto
Universa Medicina Vol 31, No 1 (2012)
Publisher : Faculty of Medicine, Trisakti University

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Abstract

BackgroundEpilepsy remains one of the most frequently occurring pediatric problems. Approximately 10-15% patients do not respond to conventional therapy. Topiramate as a novel antiepileptic drug has a broad spectrum activity, presumably indicative of multiple anti-seizure mechanisms. Previous studies of topiramate as adjunctive and monotherapy in adults have shown beneficial effects. The objective of this research was to evaluate the efficacy and tolerability of topiramate sprinkle monotherapy in pediatric epilepsy.MethodsThis experimental research was conducted in the Pediatric Neurology outpatient clinic department, Soetomo hospital, Surabaya, involving 18 consecutive subjects. Subjects meeting the inclusion criteria were treated with topiramate sprinkle adjusted dose. Seizure frequency and side effects were observed in weeks 1, 4, 8, 12, 16, 20 and 24, respectively. Electro encephalogram (EEG) and laboratory examinations were performed prior to and after 6 months of treatment. The t-test for related samples and McNemar test were utilized for statistical analysis. ResultsA total of 15 subjects completed the study. Topiramate-treated patients showed a statistically significant difference of seizure frequency reduction from 2.7 ± 1.16 to 0.13 ± 0.51 (p=0.000) with 93.7% patients being seizure free in 20 weeks. EEG recordings did not differ statistically in decrement of epileptiform activity in 20% subjects. About 7% subjects developed drowsiness and 33.3% subjects suffered from appetite suppression in the initial treatment. Laboratory results showed no abnormalities. ConclusionsThere was reduction of seizure frequency and no EEG recording alterations after topiramate sprinkle monotherapy. Topiramate as a monotherapy is highly effcicacious in childhood epilepsy.
Seizure increases electroencephalographic abnormalities in children with tuberculous meningitis Gunawan, Prastiya Indra; Saharso, Darto
Universa Medicina Vol 34, No 3 (2015)
Publisher : Faculty of Medicine, Trisakti University

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BackgroundTuberculous meningitis (TBM) is a severe intracranial infection with fatal outcomes, permanent disabilities, and electroencephalographic (EEG) abnormalities. Seizures may occur in TBM. The EEG findings in TBM vary according to the site of the inflammatory process. There are few studies describing the EEG patterns and clinical manifestations of TBM. The objective of this study was to investigate the correlation between clinical findings and EEG patterns in children with TBM. MethodsA study of cross-sectional design using medical records was conducted on 12 children with TBM, with their EEG patterns classified as abnormal and normal. Clinical manifestations such as seizures, altered consciousness, headache or fever were collected. A positive cerebrospinal fluids Mycobacterium tuberculosis culture was considered to indicate definitive TBM. Abnormal EEG descriptions were classified into abnormal I, II or III. Correlation between EEG pattern and clinical manifestation were analyzed with Fisher’s exact test. ResultsThe study found cases of 12 children with TBM, the majority presenting with seizures, decreased consciousness and fever. Abnormal EEGs were found in 75% of children and 77% of them showed epileptogenic activities. The EEG results mostly described epileptogenic potentials in the frontotemporal region. There was a significant correlation between EEG abnormality and seizures in children with TBM (p<0.05).ConclusionsThe EEG pattern in children with TBM varies, and EEG abnormalities were more frequently localized in the frontotemporal region. Seizures were associated with EEG abnormalities in children with TBM. EEG abnormalities occurring simultaneously with seizures may predict the occurrence of seizures.
Tuberous sclerosis complex in a child: diagnosis and management Gunawan, Prastiya Indra; Harahap, Aminuddin; Saharso, Darto
Paediatrica Indonesiana Vol 50 No 3 (2010): May 2010
Publisher : Indonesian Pediatric Society

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Abstract

Tuberous sclerosis complex (TSC) is a multisystem, autosomal dominant disorder affecting children and adults, resulted from mutations in one of two genes, TSC1 (encoding hamartin) or TSC2 (encoding tuberin) genes located on chromosomes 9 and 16 respectively.1,2 Synonyms of TSC are Bourneville Pringle syndrome, epiloia, or tuberosclerosis. This disorder is characterized by seizures, mental disability, and small noncancerous tumors on the skin and other body tissues, such as brain, eye, lung, and kidney. The classic triad are seizures, mental retardation, and cutaneous angiofibromas.3
Profil Klinis dan Faktor Risiko Hidrosefalus Komunikans dan Non Komunikans pada Anak di RSUD dr. Soetomo Rahmayani, Denisa Dwi; Gunawan, Prastiya Indra; Utomo, Budi
Sari Pediatri Vol 19, No 1 (2017)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Latar belakang. Hidrosefalus merupakan salah satu kelainan kongenital tersering pada anak yang dapat menyebabkan penurunan kualitas hidup anak. Penyebab hidrosefalus masih belum banyak diketahui dan faktor risikonya belum banyak dipelajari. Tujuan. Mengevaluasi dan mengidentifikasi faktor risiko yang berhubungan dengan terjadinya hidrosefalus komunikans dan non komunikans pada anak. Metode. Penelitian analitik observasional pada 80 pasien anak yang menderita hidrosefalus dengan menggunakan data sekunder di pusat rekam medis RSUD dr. Soetomo. Analisis menggunakan chi-square dan regresi logistik. Hasil. Prevalensi hidrosefalus komunikans dan non komunikans adalah 41,25% dan 58,75%. Hasil analisis menunjukkan meningoensefalitis memiliki hubungan dengan hidrosefalus komunikans (p=0,023). Data statistik menunjukkan bahwa manifestasi klinis terbanyak pada hidrosefalus adalah edema otak. Kesimpulan. Meningoensefalitis merupakan faktor risiko hidrosefalus komunikans.
The Outcome after Surgery of Patients with Congenital Cataract in the Outpatient Clinic of RSUD Dr. Soetomo Surabaya in January 2014 – January 2017 Nuramalia, Lady Sherly; Wahyuni, Indri; Gunawan, Prastiya Indra
JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga Vol 10, No 2 (2019): VOL X, NO. 2 (2019) : Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga
Publisher : Faculty of Medicine Universitas Airlangga

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Introduction: Congenital cataract is a leading cause of childhood blindness. Congenital cataract is characterized by an opacification of the lens that has existed from birth or shortly after birth. Congenital cataract can occur unilateral or bilateral. The cause of congenital cataract can be idiopathic, hereditary, chromosomal disorders, metabolic disorders, and infections. The use of intraocular lens implantation can provide better visual results. Whereas the results of cataract surgery with aphakia glasses correction showed poor results. This study aims to find out the outcome after surgery of congenital cataract patients in the outpatient clinic of RSUD DR. Soetomo Surabaya.Methods: This research was a descriptive retrospective study. Samples were patients with congenital cataract diagnosis in the Outpatient Clinic of RSUD Dr. Soetomo Surabaya in January 2014 – January 2017.Results: The results showed that there were 21 patients with congenital cataract. The most outcome after surgery of the patients with congenital cataract OS and OD were IOL positive, there were 14 (70%) for OS and 14 (77.77%) for OD.Conclusion: Most patient outcomes after surgery was IOL positive.