di-request adek2 Dokter Muda buat nentir ttg kejang, so, yang singkat n praktis2 aja dalam diagnosis kejang.. (sambil bertanya-tanya, ujian bakal kayak apa ya?)
met belajar!^^v
4. Systemic Disturbances
• Metabolic, Endocrine
• Syncope
Neurologic Disturbances
• Migraine, Vertigo
• Cerebrovascular disorder
• Sleep disorder
• Myoclonus
• Movement disorder
Psychiatric Disturbance
• PNES
• Episodic dyscontrol
• Discociative disorder
• Panic disorder
• OCD
• Psychoses
Engel & Pedley,
Epilepsy: A Comprehensive Textbook,
2nd Ed, 2008
Disorders That
Can Be Confused
with Epilepsy
4Ersifa's
5. ATTACK FEATURE PSYCHOGENIC SEIZURE EPILEPTIC SEIZURE
Stereotypy of attack May be variable Usually stereotypical
Duration May be prolonged Brief
Diurnal variation Daytime Nocturnal or daytime
Injury Rare Can occur with tonic-
clonic seizures
Tongue biting Rare Can occur with tonic-
clonic seizures
Ictal eye closure Common Rare (eyes generally open)
Urinary incontinence Rare Frequent
Motor activity Prolonged, uncoordinated; pelvic
thrusting
Automatisms or coordinated tonic-
clonic activity
Prolonged loss of muscle tone Common Rare
Postictal confusion Rare Common
Postictal crying Common Rare
Relation to medication changes Unrelated Usually related
Triggers Emotional disturbances No
Interictal EEG findings Normal Frequently abnormal
Reproduction of attack by
suggestion
Sometimes No
Ictal EEG findings Normal Abnormal
Presence of secondary gain Common Uncommon
Psychiatric disturbances Common Uncommon
Bradley: Neurology in Clinical Practice, 5th ed
5Ersifa's
6. Epileptic Seizure
• Manifestasi klinik
– tiba-tiba
– sementara
– perubahan perilaku
stereotipik
– gangguan kesadaran /
motorik / sensorik/
otonomik/ psikik
• Aktivitas listrik otak
abnormal-berlebihan
sekelompok neuron
Epilepsi
• Bangkitan epileptik
• Berulang
• Selang >24 jam
• Tanpa provokasi
Pedoman Tatalaksana Epilepsi, PERDOSSI, 2012
8. 5 Axes of Epilepsy Diagnosis
1. Ictal
phenomenology
2. Seizure type
3. Syndrome
4. Etiology
5. Impairment
9. Ictal Phenomenology
pre - durante - post
Kondisi saat bangkitan Duduk, berdiri, berbaring, tidur berkemih
Gejala awitan Aura, gerakan/ sensasi awal
Apa yg tampak selama bangkitan Bentuk bangkitan, lidah tergigit, inkontinensia,
deviasi mata, pucat, berkeringat
Kondisi setelah kejadian Bingung, terjaga, nyeri kepala, tidur, gaduh
gelisah, Todd’s
Faktor pencetus Alkohol, kurang tidur, hormonal, dll
Pola bangkitan lain/perubahan
Pedoman Tatalaksana Epilepsi, PERDOSSI, 2012
18. Beghi et al, Recommendation for a definition of acute symptomatic seizure. Epilepsia,51(4):671–675,2010
19. Beleza P
Acute Symptomatic Seizures
A Clinically Oriented Review
The Neurologist Volume 18, Number 3, May 2012
20. General rules
Seizure in the setting of two causes where one cause would
classify the seizure as acute symptomatic
If a person has preexisting epilepsy, a seizure that meets criteria
for acute symptomatic will still be so classified.
Cerebrovascular disease, cerebral hypoxia Within 7 days onset
TBI, intracranial surgery Within 7 days onset
CNS infections Beyond 7 days, ~ clinical & lab findings
Multipe sclerosis Within 7 days of relapse
Metabolic Blood sample within 24 h of seizure
Alcohol Within 7-48 h of last drink
Beghi et al, Recommendation for a definition of acute symptomatic seizure. Epilepsia,51(4):671–675,2010
22. “Kenapa saya kejang,
sedangkan kamu tidak kejang?”
Beghi et al, Recommendation for a definition of acute symptomatic seizure. Epilepsia,51(4):671–675,2010
24. Anamnesis Kejang
Gejala sebelum, selama, sesudah bangkitan
Riwayat penyakit saat ini yang mungkin menjadi penyebab
Usia onset, durasi, frekuensi, interval terpanjang
Riwayat epilepsi dalam keluarga
Riwayat keluarga dengan penyakit neurologik lain/ psikiatrik/ sistemik
Riwayat saat dalam kandungan/ kelahiran/ tumbuh kembang
Riwayat bangkitan neonatal/ kejang demam
Riwayat trauma kepala/ infeksi SSP, dll
Pedoman Tatalaksana Epilepsi, PERDOSSI, 2012
31. Disfungsi Sel Glia
• Mengatur fungsi konsentrasi ion Kalium
ekstrasel di sekitar neuron & terminal
presinaps
Buku Ajar Ilmu Penyakit Saraf, FK Unair, 2011