Download - e p i l e p s i by Dr. Poppy
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 1/63
E P I L E P S I
dr. Poppy Chandra Dewi, Sp.S, M.Sc
Fakultas Kedokteran
Universitas Islam e!eri "akarta
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 2/63
Tujuan belajar
•Memahami epilepsi secara garis besar,meliputi:
- definisi epilepsi
- klasifikasi epilepsi
- epileptogenesis
- etiologi epilepsi
- jenis serangan epilepsi- manajemen epilepsi
- jenis-jenis obat anti-epilepsi
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 3/63
DEFINISI EPILEPSI
Suatu gangguan kronik yang ditandai denganadanya bangkitan epileptik berulang akibatgangguan fungsi otak secara intermiten yang terjadioleh lepas muatan listrik abnormal neuronneuronsecara paroksismal! akibat berbagai etiologi
"L#SIFI"#SI EPILEPSI
"lasi$kasi IL#E %&'% untuk tipe serangan
epilpsi"lasi$kasi IL#E %&'& untuk sindroma epilpsi
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 4/63
(#N)"I*#N EPILEPSI
#dalah manifestasi klinis dari bangkitan serupa+stereotipik, yg berlebihan dan abnormal! ber langsung
secara mendadak dan sementara! dg atau tanpaperubahan kesadaran! disebabkan oleh hiperakti-itaslistrik sekelompok neuron di otak yg bukan disebabkanoleh suatu penyakit otak akut +unpro-oked,
SIND./0# EPILEPSI
#dalah sekumpulan gejala atau tanda klinisepilepsi yg terjadi bersamasama meliputi berbagaietiologi! umur onset! jenis serangan! faktor pencetus!
kronisitas1
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 5/63
Anatomi dan fisiologi otak Otak memiliki > 15 miliar neuron ang
membangun substansia alba dan grisea
Otak merupakan organ ang sangat kompleksdan sensitif
Otak berfungsi sebagai pengendali danpengatur akti!itas: motorik, sensasi, berpikir,dan emosi
Otak merupakan tempat kedudukan memori
dan pengatur akti!itas in!oluntar atau otonom
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 6/63
"alam keadaan normal: otak secara konstanmenghasilkan listrik secara teratur danberirama
#eurotransmite merangsang ataumenghambat cetusan listrik
#euron seperti sistem telepon di dalam otak:mengirim cetusan listrik dari satu titik ketitik lainna
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 7/63
$el-sel otak bekerja bersama-sama,berkomunikasi melalui signal-signal listrik
%adang-kadang dapat terjadi cetusan listrikang berlebihan dan tidak teratur padasekelompok sel ang kemudian menghasilkan
serangan atau sei&ure
$istem limbik merupakan bagian otak angpaling sensitif terhadap serangan
'kspresi akti!itas otak secara abnormal dapatberupa gangguan motorik, sensorik, kognitif,psikis, otonom dan(atau gangguan fungsi luhur
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 8/63
E*I/L/)I EPILEPSI Idiopatik
"riptogenik Simtomatik
IDI/P#*I"2 biasanya berupa epilepsi dg bangkitankejang umum! penyebab tak diketahui! umumnyagenetik1
".IP*/)ENI"2 dianggap simtomatik tetapi
penyebabnya blm diketahui! tmsk disini sindr1 3est!sindr1 Lenno4 )estaut dan Epilepsi 0ioklonik1 "linisberupa ensefalopati difus1
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 9/63
SI0*/0#*I"2 *rauma! Infeksi! "elainan kongenital! S/P! Stroke! *o4ic +alcohol! obat,! 0etabolik! "elainan Neurodegenerati-
DI#)N/SIS
%1 #namnesis51 Pemeriksaan +$sik umum! neurologik,
61 EE)
71 8* Scann! 0.I
91 Laboratorium
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 10/63
Cere#ral lesions,
$iochemical disorders,
Cere#ral trauma,
%arious sei&ure disorders
'((ected neurons more permea#le
and reactive to hyperthermia,
hypo)ia, hypo!lycemia,
hyponatremia,or
repeated sensory stimulus *repeatedly depolari&e with
Increasin! amplitude * (re+uency
Clinical manifestations of seizure
'
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 11/63
Cere#ral lesions,
#iochemical disorders,
cere#ral trauma, *
various sei&ure disorders
'((ected neurons more permea#le
and reactive to hyperthermia,hypo)ia, hypo!lycemia,
hyponatremia, or
repeated sensory stimulus *
repeatedly depolari&e with
increasin! amplitude * (re+uency
Prodroma - a mani(estation that
may occur hours to days prior to
the actual sei&ure
'ura - a partial sei&ure or
sensory warnin! that
precedes !enerali&ed sei&ure
activity
Clinical manifestations of seizure
hat is the pathophysiolo!y o( the aura
'
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 12/63
P r o d r o m a
During the prodromal phase slightalterations in neurological function may
or may not be detected.Often the patient might report a moodchange or you might observe a
behavior change.What come next?
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 13/63
Depolari&ation spreads throu!h ad/acent normal neurons via
corticocortical synapses
Depolari&ation spreads throu!h
intrahemispheric tracts to
contralateral corte), #asal !an!lia,thalamus * #rainstem
'ura - a partial sei&ure or sensory warnin! that
precedes !enerali&ed
sei&ure activity
hat is the clinical mani(estation o( this ne)t step
$
C
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 14/63
A u r a
•Many times the patient will report the auraas a peculiar smell, taste, feeling, or sound.
•Sometimes patients will experience sudden
onset of dizziness, headache, “spots beforetheir eyes”, or even cry out.
•Once the patient experiences this aura,more pronounced seizure activity is soon to
follow.•What happens next?
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 15/63
Depolari&ation spreads throu!h
intrahemispheric tracts to
contralateral corte), #asal !an!lia, thalamus * #rainstem
Impaired or loss o(
consciousness
Spread o(
depolari&ation
throu!h
spinal cord
0onic phase o( muscle
contraction as
impulse reaches
motor units
C
1 2 3
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 16/63
Loss of consciousness
•A loss of consciousness does occurbefore more generalized manifestations
begin.
•Let’s look at what happens next…..
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 17/63
Depolari&ation spreads throu!h
Intrahemispheric tracts tocontralateral corte), #asal !an!lia,
thalamus * #rainstem
Spread o( depola4
ri&ation throu!h
spinal cord
Inhi#itory neurons in corte),
anterior thalamus * #asal
!an!lia #e!in to inhi#it
cortical e)citation
Increased cere#ral #lood
(low and o)y!en5!lucose
consumption
hat are these three symptoms
C
1
2
3
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 18/63
)nhibitor neurons in corte*, anterior
thalamus, and basal ganglia begin to
inhibit cortical e*citation
2
+lonic phase of muscle contracting(
rela*ing as sporadic impulses are lessened
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 19/63
'
$
C
1 2 3
Cere#ral hypo!lycemia
Cere#ral hypo)ia
Meta#olic acidosis
Status epilepticusDeath
ith prolon!ed sei&ure
activity, these may
#ecome critical
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 20/63
1 2 3
eurons reset to
normal restin!
state
Intermittent clonic
#ursts #ecome less
(re+uent until cessation
Consciousness returns
6 7
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 21/63
Spread o(
depolari&ation
throu!h spinal
cord
Inhi#itory neurons in corte),
anterior thalamus * #asal
!an!lia #e!in to inhi#it
Cortical e)citation
Increased cere#ral
#lood (low * o)y!en5
!lucose consumption
eurons reset to
ormal restin! state
Cere#ral #lood (low
* meta#olism returns
to pre4sei&ure level
Intermittent clonic #ursts
#ecome less (re+uent until
cessation
Consciousness returns
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 22/63
+erebral lesions,
biochemical disorders,
cerebral trauma,
!arious sei&ure disorders
Affected neurons more permeable
and reacti!e to hperthermia,
hpo*ia, hpoglcemia,
hponatremia, or repeated sensor
stimulus repeatedl depolari&e ith
increasing amplitude fre.uenc
"epolari&ation spreads
through adjacent normal
neurons !ia
corticocortical snapses
+linical manifestations of sei&ure
/rodroma 0 a manifestationthat ma occur hours to das
prior to the actual sei&ure
Aura 0 a partial sei&ure or
sensor arning that preceeds
generali&ed sei&ure acti!it
1
2
3
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 23/63
"epolari&ation spreads
through intrahemispheric
tracts to contralateral corte*,
basal ganglia, thalamus,
brainstem
3
)mpaired or loss of
consciousness
$pread of depolari&ation
through spinal cord
)nhibitor neurons in
corte*, anterior thalamus,
basal ganglia begin to
inhibit cortical e*citation
)ncreased cerebral blood
flo o*gen(glucose
consumption
a
b
c
Tonic phase of muscle
contraction as impulse
reaches motor units
+lonic phase of muscle
contraction(rela*ing as
sporadic impulses are
lessened b inhibitoractions
5a
5b
3
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 24/63
)ncreased cerebral blood
flo and o*gen(glucoseconsumption
+erebral hpoglcemia
+erebral hpo*ia
Metabolic acidosis
+erebral blood flo
metabolism returns to
pre-sei&ure le!el
#euron resets to normal resting state
5a 5b
)ntermittent clonic bursts
become less fr.uent
until cessation
+onsciousness returns
$tatus epilepticus
" e a t h2
3
4
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 25/63
$erangan 6sei&ure7
#euron mencetuskan listrik secara salah:cetusan listrik muncul pada saat tidakdiperlukan, dan sebaliknya tidak
mencetuskan listrik pada saat diperlukan
8asilna: aktivitas listrik abnormal di otak
yang bersifat mendadak dan tidak terkontrol
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 26/63
$erangan 6seizure7
$erangan berupa efek fisik dari energilistrik abnormal di otak
$ignal ang terganggu diteruskan keseluruh tubuh melalui jalur saraf
9enis serangan bergantung pada jumlahneuron ang terlibat dan area otak angterkena: gangguan kesadaran, perilaku,motorik, sensorik, otonom, in!oluntar
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 27/63
Ambang serangan 6seizure threshold 7
Ambang serangan adalah batas tingkatrangsang 6stimulus7 ang memungkinkan
otak mengalami serangan atau tidak
/enderita epilepsi memiliki ambangserangan ang lebih rendah daripada orang
normal : hana denga sedikit rangsangan6dibandingkan dengan orang normal7 makaserangan dapat terjadi
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 28/63
Ambang serangan
$ebagian besar ambang serangandiariskan secara genetik
mur muda 6; 5 tahun7 mempunaiambang serangan ang lebih rendah
"emam menurunkan ambang serangan
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 29/63
/earisan ambang serangan
o $etiap indi!idu mearisi ambang
serangan ang menentukan seberapa jauh tingkat kerentanan indi!idu
terhadap serangan
o Apakah indi!idu mengalami serangan
atau tidak: masalah lain
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 30/63
/earisan ambang serangan
o <akta: sebagian besar kasus epilepsi tanpalatar belakang riaat epilepsi
o /opulasi normal: insidensi epilepsi 1-=
o Orang tua ang mengalami epilepsi: 2keturunanna mengalami epilepsi
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 31/63
o )nstabilitas neuron diariskan, terutamapada epilepsi umum 6 generalized epilepsy)
o Mekanisme instabilitas neuron masih dalam
penelitian mendalam
o Abnormalitas terletak pada struktur
membran neuron bagian luar angmemudahkan terjadina instabilitas aruslistrik
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 32/63
'pileptogenesis 617
• #eurotransmiter eksitatorik: asamglutamat, asam aspartat, asetilkolin
• #eurotransmiter inhibitorik: ?A@A,glisin, noradrenalin, dopamin, serotonin
• %edua kelompok neurotransmiter taditermasuk neurotransmiter ang bekerjacepat: berpengaruh langsung terhadappembukaan saluran ion 6ion channel7
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 33/63
'pileptogenesis 6=7
•/eran neurotransmiter dalam epilepsi
diduga meliputi:
- pembentukan kondisi epileptik
- permulaan serangan
- lamana serangan- penghentian serangan
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 34/63
'pileptogenesis 67
•'pileptogenesis primer:
- ?elombang paku 6spikes7 berulang angmenetap di dalam neuron
- Terjadi depolarisasi ang cukup lama,disebabkan oleh penurunan inhibisisi6?A@A7, perubahan eksitatori 6reseptor
#M"A dan glutamat7, perubahan potensialmembran dan aktupenutupan(pembukaan saluran #aB, +aBB,dan %B
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 35/63
'pileptogenesis 67
•'pileptogenesis sekunder:
- Terjadina fokus cetusan listrik abnormalsebagai tanggapan atas adanaabnormalitas di area otak tertentu
- Terjadi perubahan morfologi dalam halinhibisi, eksitasi berulang, dan transmisi
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 36/63
'tiologi epilepsi
Merupakan kombinasi antara ambangserangan 6genetik7, abnormalitas jaringanotak 6predisposisi7, dan faktor lingkungan6presipitasi7/enebab ang spesifik: belum diketahui
62C7
)diopatik: tak diketahui penebabna$imtomatik: diketahui penebabna%riptogenik: penebabna tersembuni
6sulit diidentifikasi7
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 37/63
'tiologi epilepsi
•%husus pada neonatus:
-'nsefalopati hipoksik-iskemik
-infeksi $$/
-perdarahan intrakranial
-infark otak
-malformasi otak
-hipoglikemia-hiokalsemia
-ketergantungan terhadap piridoksin
-inborn errors of metabolism
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 38/63
/encetus serangan epilepsi
o %urang tiduro $tres emosionalo %elelahan fisik
o )nfeksio "emamo Alkoholo Dangsangan cahaa
o Obat tertentuo /erubahan hormonalo Dangsangan suara
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 39/63
'kspresi serangan epilepsi
•Motorik:- %ejang- ?erakan abnormal, aneh
•$ensorik:
- #eri- /arestesi
•<ungsi luhur:- ?angguan kesadaran- Afasia
•<ungsi otonom:- #gompol- Eomitus- @erkeringat- 'pistaksis
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 40/63
)nternational +lassification of
Epileptic Seizures 61417
)F/artial sei&ures 6sei&ures beginning locall7:AF $imple partial sei&ures 6consciousness not impaired7:
1FGith motor smptoms=FGith somatosensor or special sensor
smptoms
FGith autonomic smptomsFGith pschic smptoms
@F +omple* partial sei&ures 6ith impairment ofconsciousness7
1F@eginning as simple partial sei&ures and
progressing to impairment of consciousness:aFGith no other featuresbFGith features as AF1-cFGith automatisms
+F /artial sei&ures secondaril generali&ed
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 41/63
)nternationalH6=7
))F ?enerali&ed sei&ures 6bilaterall smmetricaland ithout local onset7:AF 1F Absence sei&ures
=F Atpical absence sei&ures
@F Moclonic sei&ures+F +lonic sei&ures"F Tonic sei&ures'F Tonic-clonic sei&ures
"F Atonic sei&ures
)))F nclassified epileptic sei&ures 6inade.uateor incomplete data7
) i l +l ifi i f ' il i
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 42/63
)nternational +lassification of 'pilepsies
and Epileptic syndromes 6147
1FIocali&ation-related 6focal, local, partial7: Idiopathic (primary7:
-@enign childhood epileps ith centro-temporal spike
-+hildhood epileps ith occipital paro*sms
-/rimar reading epileps
Cryptogenic (secondary)
-Temporal lobe epileps
-<rontal lobe epileps
-/arietal lobe epileps
-Occipital lobe epileps-+hronic progressi!e epilepsia partialis continua of
childhood
-$ndrome characteri&ed b sei&ures ith specific
modes of precipitation
) t ti l 6=7
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 43/63
)nternationalH6=7=F ?enerali&ed
Idiopathic:-@enign neonatal familial con!ulsions
-@enign neonatal con!ulsions-@enign moclonic epileps in infanc-+hildhood absence epileps 6pknoleps7-9u!enile absence epileps-9u!enile moclonic epileps-'pilepsies ith grand mal sei&ures on aakening-Other idiopathic generali&ed epilepsies-'pilepsies ith sei&ures precipitated b specific modes of
acti!ationCryptogenic or symptomatic:
-Gest sndrome-Ienno*-?astaut sndrome-'pileps ith moclonic-astatic sei&ures
-'pileps ith moclonic sei&ures onspecific etiology:!'arl moclonic encephalopath-'arl infantile epileptic encephalopath ith suppression bursts-Other smptomatic generali&ed epilepsies
Specific syndromes:-'pileptic sei&ures ma complicate man disease states
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 44/63
)nternational H67F ndetermined epilepsies
-Gith both generali&ed and focal sei&ures-#eonatal sei&ures-$e!ere moclonic epileps in infanc-'pileps ith continuous spike-a!es during slo
a!e sleep
-Ac.uired epileptic aphasia 6Iandau-%effnersndrome7-Other undetermined epilepsies-Githout une.ui!ocal generali&ed or focal features
F $ituation-related sei&ures 6?elegenheitsanfalle7:-<ebrile con!ulsions-)solated sei&ure or isolated status epilepticus-$ei&ures occuring onl hen there is an acute or to*ic
e!ent due to factors such as alcohol, drugs, eclampsia,nonketotic hperglcemia
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 45/63
$erangan umum tonik-klonik Mendadak berteriak, kemudian jatuh, tak sadar
$eluruh tubuh kaku 6tonik7, kemudian menentak-nentak 6klonik7
@ola mata terputar ke atas, mulut berbuih
%ulit kebiruan, napas dangkal atau terhentiIidah dapat tergigit
%adang-kadang ngompol
$erangan berlangsung beberapa menit
%etika serangan reda: napas menjadi teraturkembali, kesadaran pulih secara bertahap, penderitatampak bingung
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 46/63
$erangan umum absence•/enderita menghentikan akti!itasna secaramendadak
•Mata terbuka, seolah-olah melihat jauh ataumelamun
•@erlangsung selama beberapa detik
•/enderita kemudian melanjutkan akti!itasnakembali, seolah-olah tak terjadi apa-apa
•/enderita tidak sampai terjatuh
•%adang-kadang disertai mata berkedip-kedipsecara cepat, mulut komat-kamit
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 47/63
/emeriksaan klinis 617•Anamnesis:
- apakah serangan-serangan memiliki pola ang samaJ- apakah munculna serangan berkaitan dengansituasi(kondisi tertentuJ- apakah serangan muncul pada saat tidur atau tidakJ- apakah serangan terjadi di sembarang tempatJ
- apakah serangan melibatkan fungsi motorik, sensorik,otonom, fungsi luhur, atau kombinasiJ- apakah ada saksi mataJ- berapa kali serangan dalam satu hari, minggu, atau
bulanJ
- setiap kali serangan: berapa lamaJ- apakah ada faktor pencetusnaJ- apakah ada riaat ang sama di keluarganaJ- apakah sebelumna mengalami penakit tertentuJ- apakah ada gejala-gejala lainnaJ
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 48/63
/emeriksaan klinis 6=7
•/emeriksaan fisik:
- inspeksi
- palpasi
- perkusi
- auskultasi- fungsi motorik, sensorik, dan otonom
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 49/63
/emeriksaan penunjang
•'lektroensefalografi
•Iaboratorium:
- bergantung umur, hasil anamnesis dan
pemeriksaan fisik
• euroimaging:
- bergantung hasil pemeriksaan fisik
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 50/63
"iagnosis
"iagnosis epilepsi didasarkan atas buktiklinisK ''? membantu penentuan jenisepilepsi
9enis serangan perlu dideskripsikan:untuk keperluan terapi
"iupaakan agar mencapai diagnosisetiologik
/enampaian diagnosis kepada penderitamemerlukan penjelasan ang cukupsekaligus disertai rencana terapi
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 51/63
T e r a p i 617
•/emilihan OA':
- sesuai dengan jenis serangan
- monoterapi(monofarmasi
- dosis tunggal, mulai dengan
minimal
- pertimbangan harga
- pertimbangan efek samping
- pertimbangan kondisi(penakitlain
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 52/63
Terapi 6=7:Mekanisme aksi OA':
Meningkatkan inhibisi neuronal 6?A@Aergictransmission7:
-meningkatkan aksi ?A@A pada reseptor ?A@AA
-menghambat pemecahan ?A@A di sinapsis-blokade ambilan ?A@A di terminal presinaptik
Menurunkan eksitasi neuronal 6glutaminergictransmission7:
-menurunkan pelepasan glutamat-blokade aksi glutamat di #M"A(AM/A(reseptorkainat
@lokade terhadap !oltage-gated #a channels
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 53/63
Terapi 67
• Obati(atasi serangan epileptik, bukan ''?L
• Mulailah dengan dosis rendah dan bilaperlu dosis dinaikkan secara bertahap
• #aikkan dosis OA' sampai mencapai efekklinis, atau toksik
• Monitor kadar OA' dalam serum
• 8entikan OA' secara bertahap
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 54/63
T e r a p i 67
•Monitor(e!aluasi:
- apakah OA' efektif atau tidak efektif
- apakah ada efek samping
- apakah ada rasa bosan minum obat
- perubahan berat badan
- perubahan jenis serangan
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 55/63
/ertolongan aktu serangan
9angan panik
@iarkan serangan berlalu karena seranganakan berhenti dengan sendirina
Amankan penderita dari lingkungan angmembahaakan penderita
Ionggarkan pakaian ang ketat
/osisi kepala dimiringkan 6bila kejang sudahberhenti7
@ila serangan berkepanjangan: kirim ke D$
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 56/63
<aktor psikososial
+enderung dikucilkan dari lingkungan
+enderung ditolak untuk sekolah
$ulit mencari pekerjaan
Merupakan aib bagi keluarga
Menurunkan rasa percaa diri
Iebih mudah mengalami cedera
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 57/63
%esempatan bekerja
• /ada dasarna tidak ada larangan untukbekerja bagi penderita epilepsi
• /ekerjaan disesuaikan dengan jenis
serangan• /enderita harus paham tentang penakit
ang dideritana
• "ukungan positip dari keluarga danlingkungan kerja
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 58/63
%esempatan untuk sekolah
o Tidak larangan untuk sekolah
o @ila perlu guru dan orang tua penderitaberkonsultasi dengan dokter ang
meraatnao Antara orang tua dan guru diperlukan sifat
terbuka dan saling mengerti
o Masalah ang ada pada penderita bukansekedar cerdas atau bodoh
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 59/63
%esempatan untuk menikah
• Menikah adalah hak a&asi manusia
• /erhatian lebih khusus pada penderitaperempuan 6menstruasi, hamil, melahirkan,
menusui7
•$uami-isteri harus selaras
• %eputusan pahit: jangan hamil
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 60/63
Mengemudi kendaraan bermotor
#anti duluL
Ada prasarat ang harus dipenuhi
penderita$ifatna sangat terbatas
Iebih aman apabila penderita tidak
mengemudi kendaraan 6bermotor7/enderita harus memahami kondisina
sendiri secara jujur
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 61/63
S*#*:S EPILEP*I":S +SE,
De$nisi SEBangkitan epilepsi yang berlangsung terus menerusatau tanpa pemulihan kesadaran selama 30 menitatau lebih.
"lasi$kasi SE
•Konvulsive
•Non konvulsive
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 62/63
13.A 21-year-old cocaine-abusing man developsseizures that persist for more than 30 min before
emergency medical attention is available. Whenexamined nearly 1 h later, he is still exhibiting tonic-clonic movements and has never recoveredconsciousness. (SELECT 1 SEIZURE TYPE)
a. Generalized tonic-clonic
b. Generalized absence
c. Complex partial
d. Tonic-clonic status epilepticus
7/21/2019 e p i l e p s i by Dr. Poppy
http://slidepdf.com/reader/full/e-p-i-l-e-p-s-i-by-dr-poppy 63/63
Thank You