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Sunartini Sunartini
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Health Professions Medicine & Pharmacology

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Comparison of monotherapy effect of phenytoin, carbamazapine and valproic acid in pediatric general tonic clonic and partial epilepsy Muchamad Budi Nugroho; E. S. Herini; Sunartini Sunartini
Paediatrica Indonesiana Vol 48 No 1 (2008): January 2008
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (410.273 KB) | DOI: 10.14238/pi48.1.2008.37-41

Abstract

Background Problems on epilepsy do not only depend on thedisease itself but also on management and drug regimens. Drugselection is very important to yield optimal treatment effect andto prevent side effects due to long-term therapy.Objective To determine whether there are any different effectsof monotherapy of phenytoin, carbamazapine, and valproic acidon pediatric general tonic clonic and partial epilepsy.Methods We conducted a historical cohort study on one monthuntil 18-years old children diagnosed as general tonic clonic orparsial epilepsy treated with phenytoin, carbamazapine, or valproicacid routinely for more than two years in Sardjito Hospital fromJanuary 2000 until May 2007. The sample size of each group was41. The main outcome was the time of 12-month remission,whereas the secondary outcomes were withdrawal from treatment,time to remission, side effects and cure rates.Results Valproic acid increased the possibility to achieve 12-monthremission (RR 2.66; 95%CI 1.06;6.65) compared to phenytoin,whereas carbamazapine did not (RR 1.47; 95%CI 0.66;3.28).Survival analysis showed that valproic acid was better thancarbamazapine (P=0.042) and phenytoin (P=0.007). There wereno significant differences among groups in the result of withdrawalfrom treatment, time to remission, and cure variables. The sideeffects of valproic acid seemed less than those of others.Conclusions Valproic acid increases the possibility of 12-monthremission compared to carbamazapine and phenytoin asmonotherapy in pediatric general tonic clonic and partial epilepsywithout increasing side effects. Carbamazapine has similar effectsof therapy to phenytoin.
Prognostic factors of refractory epilepsy in children Ramzi Ramzi; Yati Soenarto; Sunartini Sunartini; M Hakimi
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (110.421 KB) | DOI: 10.14238/pi48.5.2008.269-73

Abstract

Background Epilepsy is one of the most common pediatricneurological disorders. Twenty percent of patients will developrefractory epilepsy. Early identification of refractory epilepsy willbe helpful to conduct adequate counseling and selecting patientswho need more intensive investigation and treatment.Objective To identify the clinical characteristics and other factorsthat are related to refractory epilepsy in children.Methods We conducted a case control study in patients of two to18 years old with epilepsy that admitted to Dr. Sardjito Hospital.There were 4 7 children with refractory epilepsy compared with122 subjects who have been one year free of seizure.Results Strong association had been noted between refractoryand several clinical factors: early onset of seizure, high initialseizure frequency, neonatal asphyxia, symptomatic etiology, statusepilepticus, abnormal neurodevelopmental status, and earlybreakthrough seizures after treatment initiation. On multivariateanalysis, more than 20 seizures prior to treatment initiation (OR3.40, 95% CI 1.03 to 11.3), and more than three seizures in thesubsequent six month after treatment initiation (OR 16.02, 95%CI 4.98 to 51.5) were independent prognostic factors related torefractory epilepsy.Conclusion Children who present high frequency seizures atonset and more than 3 breakthrough seizures subsequent to sixmonth after treatment have risks of developing refractory epilepsy.
Electroencephalogram and clinical manifestations of Rett syndrome in children E S Herini; I Mangunatmadja; Purboyo S; Hardiono D Pusponegoro; Sunartini Sunartini
Paediatrica Indonesiana Vol 43 No 4 (2003): July 2003
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (496.788 KB) | DOI: 10.14238/pi43.4.2003.121-5

Abstract

Background Rett Syndrome (RS) is a severe neurodevelopmentaldisorder. Epileptic seizures occur in 80-90%; grandmal, psychomo-tor (complex partial), and focal motor seizures have been reported.The electroencephalogram(EEG) is almost always abnormal.Objective This study aimed to investigate the EEG and clinicalmanifestations of children with RSResults We investigated EEG on 5 patients with RS aged 30–66month. One patient was in clinical stage II and 4 patients in clini-cal stage III. Four patients had history of seizures, however onlytwo patients suffered from epilepsy. The EEG demonstrated slow-ing background activity in occipital region in two patients. In addi-tion, epileptic form activities were observed in 4 of 5 patients.Conclusion We concluded that epileptic spike discharge with orwithout clinical seizures were found in almost all of our RS pa-tients. These paroxysmal discharges suggested the process andthe sequences of cortical involvement. Compelling clinical, neuro-physiological evidences were very important to decide the stageof Rett disorder
Co-Authors E S Herini E. S. Herini Hardiono D Pusponegoro I Mangunatmadja M Hakimi Muchamad Budi Nugroho Purboyo S Ramzi Ramzi Yati Soenarto