Irawan Mangunatmadja
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Luaran Klinis Anak dengan Epilepsi yang Mengalami Relaps Setelah Penghentian Obat Antiepilepsi Agung Triono; Elisabeth Siti Herini; Irawan Mangunatmadja
Sari Pediatri Vol 20, No 6 (2019)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (386.059 KB) | DOI: 10.14238/sp20.6.2019.335-41

Abstract

Latar belakang. Penghentian obat antiepilepsi (OAE) yang terburu-buru meningkatkan risiko relaps. Risiko resistensi obat pada anak dengan epilepsi yang mengalami relaps sangat tinggi. Hingga saat ini belum ada kesepakatan mengenai pengobatan kejang pasca relaps. Tujuan. Penelitian ini bertujuan untuk mengetahui insiden relaps, karakteristik, prediktor, luaran, dan perjalanan elektroensefalografi (EEG) anak dengan epilepsi setelah mengalami relaps. Metode. Penelitian dilakukan pada Juni-Desember 2016. Desain studi adalah potong lintang, multisite dari rekam medis tahun 2012-2016. Subjek adalah anak dengan epilepsi yang mengalami relaps. Hasil. Epilepsi relaps terjadi paling banyak dalam tahun pertama setelah dosis OAE diturunkan, 41,3% relaps terjadi dalam 6 bulan, dan 31,7% antara 6-12 bulan. Riwayat waktu kejang terkontrol lama (≥1 tahun) pada kejang sebelumnya merupakan faktor yang memengaruhi (RP 1,846 95% IK 1,056 – 3,228) kejang yang tidak terkontrol dalam waktu 6 bulan pasca relaps. Sementara variabel lain tidak signifikan berpengaruh terhadap terkontrolnya kejang dalam 6 bulan pasca relaps. Kesimpulan. Anak dengan epilepsi relaps yang memiliki riwayat waktu terkontrol kejang lama (≥1 tahun) akan lebih sulit mencapai remisi kedua pasca relaps. 
Risk factors influencing the outcomes in infants with epilepsy Setyo Handryastuti; Irawan Mangunatmadja
Paediatrica Indonesiana Vol 47 No 5 (2007): September 2007
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (203.589 KB) | DOI: 10.14238/pi47.5.2007.202-6

Abstract

Background Epilepsy in young children should always beconsidered as a symptom of an underlying brain disease. Parentsand caregivers often asked whether the seizures can be controlledand whether the epilepsy will affect the child development.Objective To find out risk factors influencing the outcomes ininfants with epilepsy.Methods This was a retrospective study on infants aged 1 monthuntil 12 months with recurrent epileptic seizures. We looked forthe risk factors as sex, types of medication, age at onset of seizure,epilepsy syndrome, etiology of epilepsy, history of neonatal seizure,first EEG features, and type of seizure for the last 6 month-period.The outcomes evaluated were controlled seizure and developmentalstatus.Results Hundred forty infants with epilepsy were reviewed,consisted of 84 (60%) infants with symptomatic epilepsy, and 56(40%) infants categorized as idiopathic. Forty-six (33%) infantshad controlled seizure, while 94 (67%) infants had uncontrolledseizure. Abnormal developmental status was found in 75 infants(54%). Abnormal developmental status was more found in infantswith polytherapy, age at onset of 1-4 months, symptomaticepilepsy, positive remote symptomatic, history of neonatal seizure,abnormality of first EEG, and uncontrolled seizure. Uncontrolledseizure of epilepsy was more found in infants with polytherapy,early age at onset (1-4 month old), symptomatic epilepsy, positiveremote symptomatic, history of neonatal seizure, and abnormalityof first EEG.Conclusion Our data indicate that classifying syndrome of epilepsythrough diagnostic screening and age of onset are important todetermine the outcomes.
Brainstem auditory evoked potentials in children with microcephaly Irawan Mangunatmadja; Dwi Putro Widodo; Hardiono D Pusponegoro
Paediatrica Indonesiana Vol 43 No 1 (2003): January 2003
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (230.801 KB) | DOI: 10.14238/pi43.1.2003.28-30

Abstract

Background Hearing loss (HL) is commonly found in childrenwith microcephaly. The aim of this study was to reveal hearing lossand auditory brainstem pathways disorders in children with micro-cephaly and other handicaps.Methods There were 194 children who were referred for hearingevaluation. Subjects with history of congenital perinatal infection(TORCH) were excluded. Data were collected from the results ofBrainstem Auditory Evoked Potentials (BAEP) recordings, includ-ing sex, age, clinical manifestations, latency and interlatency be-tween waves I, III, V, and the hearing levels of each ear.Results Moderate to profound HL were found in fourteen ears(58%) of patients with microcephaly. Moderate to profound HL (28%)and endocochlear damage (15%) were found in the ears of pa-tients with microcephaly and delayed speech. Moderate to pro-found HL (39%) and endocochlear damage (11%) were detectedin the ears of patients with microcephaly and delayed develop-ment. Moderate to profound HL (21%) and endocochlear damage(16%) were found in the ears of microcephalic patients with bothdelayed speech and delayed development. Moderate to profoundHL (26%) and endocochlear damage (32%) were detected in theears of patients with microcephaly and cerebral palsy.Conclusion This study revealed the importance of early HL de-tection in microcephalic patients especially those with other handi-caps such as delayed speech, delayed development, and cere-bral palsy
Intracranial hemorrhage in hemorrhagic disease of the newborn Irawan Mangunatmadja; Rina W Sundariningrum; Hardiono D Pusponegoro; Endang Windiastuti
Paediatrica Indonesiana Vol 43 No 3 (2003): May 2003
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (229.199 KB) | DOI: 10.14238/pi43.3.2003.82-4

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Background Hemorrhagic disease of the newborn (HDN) repre-sents a special case of vitamin K deficiency because the four vita-min K-coagulation factors (factors II,VII,IX,X) are already at physi-ologically low levels in the newborn. It responds to vitamin Ktherapy.Objective The aim of this study was to review the incidence, clini-cal manifestation, and outcome of HDN.Methods This was a retrospective cross sectional study on 22patients hospitalized for HDN in the Department of Child Health,Cipto Mangunkusumo Hospital from January 1997 until Decem-ber 2001. Data were obtained from medical records.Results The commonest age group (17 out of 22) was 1–3 month-old. Normal delivery was found in 19 patients and only 3 patientsreceived prophylaxis vitamin K. Almost all of them (20 out of 22)were exclusively breastfed. Seizure, pallor, decreased conscious-ness, and bulging of the anterior fontanel were significant clinicalmanifestations found in 21, 21, 13, and 9 patients respectively.Based on brain USG and/or CT scan, intracranial hemorrhage wasfound in 19 patients. Six out of 22 patients died and 7 patientssurvived with handicapConclusion Intracranial hemorrhage due to vitamin K mostly oc-curred at the age of 1 to 3 month-old. The commonest clinical mani-festations were seizure, pallor, decreased consciousness, andbulging of the anterior fontanel. Prevention by giving vitamin K rou-tinely to all newborn babies is recommended
Rett syndrome in childhood: the clinical characteristics E S Herini; Irawan Mangunatmadja; Purboyo Solek; Hardiono D Pusponegoro
Paediatrica Indonesiana Vol 44 No 4 (2004): July 2004
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (689.964 KB) | DOI: 10.14238/pi44.4.2004.160-4

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The prevalence rate of RS in various coun-tries is from 1:10,000 to 1:23,000 female livebirths. RS is most often misdiagnosed as autism,cerebral palsy, or non-specific developmental de-lay. While many health professionals may not befamiliar with RS, it is a relatively frequent cause ofneurological dysfunction in females. There are nobiological markers for this disease, the diagno-sis is established by history taking and clinical find-ings. We reported two patients, both girls, with RS.
Predictors for the recurrent febrile seizures after the first complex febrile seizures Conny Tanjung; Irawan Mangunatmadja; Sudigdo Sastroasmoro; I. Budiman
Paediatrica Indonesiana Vol 46 No 5 (2006): September 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (341.95 KB) | DOI: 10.14238/pi46.5.2006.204-8

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Background Complex febrile seizures (CFS) have been shownto be related to recurrence and epilepsy. Many studies were doneto determine the predictors of recurrence in both simple and com-plex febrile seizures. To our knowledge until now there is no pub-lished data that specially looks for predictors of recurrence after afirst CFS.Objective To find out clinical and demographical characteristicsof a first CFS and to define the predictors for the recurrent febrileseizures.Methods Prospective survival analysis study was done in chil-dren with first CFS who visited Cipto Mangunkusumo Hospital,Jakarta, over 14 months periods. The predictors for developmentof recurrence were analyzed by SPSS for Windows 11.5 usingKaplan-Meier test and Cox regression model with a level of signifi-cance <0.05.Results There were 62 subjects completed this study. Male-to-female ratio was 1.4:1. The mean age at onset was 18.2 months.Recurrence occurred in 9 subjects (14.5%). Body temperaturebetween 38-38.5°C (7 of 26 subjects, P=0.02), upper motor neu-ron type of delayed development (3 of 7 subjects, P=0.03), andepileptic history in the family (2 of 2 subjects, P<0.05) were asso-ciated with recurrence in bivariate analysis. In multivariate analy-sis only body temperature between 38-38.5°C (HR 1.6, 95% CI1.0;23.9) and epileptic history in the family (HR 16.9, 95% CI2.8;101.4) were identified as predictors.Conclusion Low body temperature at the first seizures and epi-leptic history in the family were independent predictors for the re-currence after a first CFS
The role of hearing capability test as a screening test for the possibility of hearing disorder in children with speech delay Fatmawaty Fatmawaty; Hartono Gunardi; Ronny Suwento; Abdul Latief; Rulina Suradi; Irawan Mangunatmadja
Paediatrica Indonesiana Vol 46 No 6 (2006): November 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (307.364 KB) | DOI: 10.14238/pi46.6.2006.255-9

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Background Hearing disorder may cause speech delay so thatevery child with speech delay should undergo hearing test. Thegold standard for audiometric test is otoacustic emission (OAE)and brainstem evoked response audiometry (BERA). They havehigh sensitivity and specificity, but the availability is limited andexpensive. Hence, both tests are not available at the primary healthcare centers. In 1997, the Department of Health, Republic of Indo-nesia, established a simple subjective test instrument, i.e. the hear-ing capability test (HCT).Objective To asses the accuracy of HCT compared to the goldstandard hearing tests (OAE and/or BERA).Methods This study was a cross sectional study on 89 childrenaged less than 5 years who had speech delay and came to theGrowth and Development Outpatient Clinic or the General Outpa-tient Clinic, Pediatric Neurology Clinic of the Department of ChildHealth, Cipto Mangunkusumo (CM) Hospital; and Center for EarCare and Communicative Disorders (CECCD), Department of ENT,CM Hospital, during March to August 2005.Results HCT sensitivity and specificity were 92.9% and 27.7%,respectively. Positive predictive value (PPV), negative predictivevalue (NPV), positive likelihood ratio (PLR), and negative likehoodratio (NLR) were 84%, 50%, 1.9, and 0.7, respectively.Conclusion The sensitivity and specificity of HCT as a screeningtest of hearing disorder in children with speech delay were 93%and 28%, respectively. Based on this result, HCT should only beused as screening test and not as a diagnostic test
Neonatal seizures: clinical manifestations and etiology Daisy Widiastuti; Irawan Mangunatmadja; Taralan Tambunan; Rulina Suradi
Paediatrica Indonesiana Vol 46 No 6 (2006): November 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (335.002 KB) | DOI: 10.14238/pi46.6.2006.266-70

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Background Neonatal seizures or fits are signs of central ner-vous system (CNS) diseases, metabolic disorders, or other dis-eases disrupting the CNS. Neonatal seizures are poorly classi-fied, under-recognized and often difficult to treat. It is important torecognize the type of neonatal seizures that might be the only signof a CNS disorder.Objective To recognize the type and etiology of neonatal sei-zures in several hospitals in Jakarta.Methods This was an observational case series study on full-termand preterm infants who had seizures during hospitalization in CiptoMangunkusumo, Harapan Kita, and Fatmawati Hospitals betweenJanuary-June 2005. Neonatal seizures were defined as seizuresoccurring in the first 28 days of life of a term infant or 44 completedweeks of the infant’s conception age of preterm infant.Results There were 40 neonates who born within the study periodand had seizures. Girls were outnumbered boys. Most neonateswere full-term with birth weight of more than 2500 grams. Analy-ses were done on 38 neonates with epileptic and non-epilepticseizures, while the other two who had mixed clinical manifestationwere not included. Most seizures occurred in the first 3 days of life(23/38). The most common type was focal clonic (12/14) followedby general tonic (11/24) and motor automatism or subtle (10/24).The most common etiology was hypoxic ischemic encephalopa-thy (HIE) (19/38) followed by metabolic disturbances, mainly hy-pocalcaemia (11/38).Conclusion Common types of seizures in neonates were focalclonic, general tonic, and motor automatism (subtle). The mostcommon etiology was HIE followed by metabolic disturbances,mainly hypocalcaemia
Electrodiagnosis in Clinical Neurology - The Challenge for Pediatric Neurology in Indonesia Irawan Mangunatmadja; A. C. Van Huffelen; R. H. J. M Gooskens
Paediatrica Indonesiana Vol 36 No 11-12 (1996): November - December 1996
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi36.11-12.1996.228-38

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IntroductionIn most cases the diagnosis in neurology is based upon clinical manifestations, anatomical abnormalities, physiological disturbances and biochemical investigations. Clinical manifestations can be investigated by history of illness and neurological examinations. Neurophysiological examination (electrodiagnosis) can provide information on physiological abnormalities of the central nervous system (CNS). In recent years computer tomography (CT) and magnetic resonance imaging (MRI) have made it possi¬ble to visualize the morphologic anatomy of the CNS in detail and to diagnose the lesion.1IntroductionIn most cases the diagnosis in neurology is based upon clinical manifestations, ana­tomical abnormalities, physiological disturbances and biochemical investigations. Clinical manifestations can be investigated by history of illness and neurological ex­aminations. Neurophysiological examination (electrodiagnosis) can provide information on physiological abnormalities of the central nervous system (CNS). In recent years computer tomography (CT) and magnetic resonance imaging (MRI) have made it possi­ble to visualize the morphologic anatomy of the CNS in detail and to diagnose the lesion.1
Side effects of long-term antiepileptic drugs on renal tubules of Indonesian children Partini Pudjiastuti Trihono; Deasy Grafianti; Irawan Mangunatmadja; Mulya Rahma Karyanti
Paediatrica Indonesiana Vol 58 No 2 (2018): March 2018
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (227.755 KB) | DOI: 10.14238/pi58.2.2018.84-9

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Background Long-term treatment with antiepileptic drugs such as valproic acid (VPA) and carbamazepine (CBZ) may disrupt renal tubular function. Urinary N-acetyl-beta-D-glucosaminidase (NAG) may reflect tubular function and may be useful in detecting early-stage tubular injury. To date, no study has investigated the toxic effect of VPA and CBZ on renal tubules using urinary NAG in Indonesian children. Objectives To determine the toxicity of long-term VPA and/or CBZ treatment on renal tubules in children with epilepsy by measuring urinary NAG index (iNAG). Methods This cross-sectional study was conducted from January to March 2015 at Cipto Mangunkusumo Hospital and Anakku Clinic Pondok Pinang, Jakarta. We included children aged 3 to 16 years with epilepsy on VPA (n=36), CBZ (n=14), or VPA-CBZ combination (n=14) therapy. We measured urinary levels of creatinine and NAG. The urinary NAG reference value was obtained from age-matched healthy controls (n=30). To eliminate diurnal variations in NAG, iNAG was calculated by dividing urinary NAG by urinary creatinine. A urinary iNAG of more than two standard deviations above the mean for healthy children was considered elevated. Results Mean urinary iNAG values for the control, VPA, CBZ, and combination groups were 3.01, 5.9, 4.07, and 6.9 U/g, respectively. All treated groups had higher mean urinary iNAG values compared to the control group. Urinary iNAG was increased in 11/36 children on VPA, 2/14 children on CBZ, and 9/14 children on combination therapy. Conclusion Long-term VPA use may impair renal tubular function, as shown by the increased urinary iNAG. Combination therapy increases damage in the renal tubules.