Faktor Risiko Kejang Demam Berulang pada Anak

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

Acanthamoeba Infection in a Drowning Child

BACKGROUND: Acanthamoeba infection is a potential life-threatening complication of drowning. The management of drowning-associated Acanthamoeba infection remains controversial. Survival reports on Acanthamoeba infection have been on case reports only.CASE DETAILS: A 2-year-old, previously healthy Indonesian boy presented with decreased consciousness and inadequate breathing, followingdrowning. The event was unsupervised with unknown estimated time of submersion. Resuscitation was commenced and mechanical ventilated was applied. Sputum specimen revealed alive Acanthamoeba with pseudopods and cysts. Sputum culture resulted in Pseudomonas aeruginosa and cerebrospinal fluid was supportive for Acanthamoeba with 1-3 trophozoites and cyst. Imaging of the head showed cerebral edema and encephalitis. The patient received intravenous ceftazidime, metronidazole, fluconazole and rifampicin. The patient’s consciousness was unsatisfactory regained resulting in an altered mental status.CONCLUSION: No treatment so far has given a succesful outcome for Acanthamoeba. In this case, management with metronidazole, rifampicin and fluconazole showed regain of consciousness resulting in altered mental status.KEYWORDS: Acanthamoeba, Pneumonia, Encephaliti

Combination of encephalo-myo-pial-synangiosis and encephalo-arterio-pial-synangiosis procedure in pediatric moya-moya disease

Background: Moya-moya disease in children is a cerebrovascular disorder that may cause cerebral ischemic or hemorrhage.Case Details: We report an 8-year-old boy that was admitted with the chief complaint of repeated sudden half left body paralyze. MRA showed acute thrombotic infarction in the right hemisphere and internal carotid artery stenosis in the form of puffs of smokes. Indirect revascularization surgical procedure with combination of Encephalo-myo-pial-synangiosis (EMS) and Encephalo-arterio-pial-synangiosis (EAS) was performed. It resulted in a good response.Conclusion: Moya-moya disease can lead to permanent neurological disability if untreated. Satisfactory outcome was noted following combination surgery management with EMS and EAS.Keywords: Moya-moya disease, Encephalo-myo-pial-synangiosis, Encephalo-arterio-pial-synangiosis, childre

Hemispherectomy Procedure in Proteus Syndrome

How to Cite This Article: Gunawan PI, Lusiana L, Saharso D. Hemispherectomy Procedure in Proteus Syndrome. Iran J Child Neurol.Summer 2016; 10(3):86-90 ObjectiveProteus syndrome is a rare overgrowth disorder including bone, soft tissue, and skin. Central nervous system manifestations were reported in about 40% of the patients including hemimegalencephaly and the resultant hemicranial hyperplasia, convulsions and mental deficiency. We report a 1-month-old male baby referred to Pediatric Neurology Clinic Soetomo Hospital, Surabaya, Indonesia in 2014 presented recurrent seizures since birth with asymmetric dysmorphic face with the right side larger than the left, subcutaneous mass and linear nevi. Craniocervical MRI revealed hemimegalencephaly right cerebral hemisphere. Triple antiepileptic drugs were already given as well as the ketogenic diet, but the seizures persisted. The seizure then was resolved after hemispherectomy procedure.ReferencesBeachkofsky TM, Sapp JC, Biesecker LG, Darling TN. Progressive overgrowth of the cerebriform connective tissue nevus in patients with Proteus syndrome. J Am Acad Dermatol 2010;63:799-804.Biesecker L. The challenges of Proteus syndrome: diagnosis and management. Eur J Hum Genet 2006;14:1151-7.Yamatogi Y, Ohtahara S. Early-infantile epileptic encephalopathy with suppression-bursts, Ohtahara syndrome; its overview referring to our 16 cases. Brain Dev 2002;24:13-23.Bastos H, da Silva PFS, de Albuquerque MAE, Mattos A, Riesgo RS, Ohlweiler L, et al. Proteus syndrome associated with hemimegalecephaly and Ohtahara syndrome: Report of two cases. Seizure 17(4):2008.Turner JT, Cohen MM, Jr., Biesecker LG. Reassessment of the Proteus syndrome literature: application of diagnostic criteria to published cases. Am J Med Genet A 2004;130A:111-22.Cohen MM, Jr. Proteus syndrome: clinical evidence for somatic mosaicism and selective review. Am J Med Genet 1993;47:645-52.Bilkay U, Tokat C, Ozek C, Gundogan H, Erdem O, Gurler T, et al. Proteus syndrome. Scand J Plast Reconstr Surg Hand Surg 2003;37:307-10.Biesecker LG, Happle R, Mulliken JB, Weksberg R, Graham JM, Jr., Viljoen DL, et al. Proteus syndrome: diagnostic criteria, differential diagnosis, and patient evaluation. Am J Med Genet 1999;84:389-95.Caraballo R, Bartuluchi M, Cersosimo R, Soraru A, Pomata H. Hemispherectomy in pediatric patients with epilepsy: a study of 45 cases with special emphasis on epileptic syndromes. Childs Nerv Syst 2011;27:2131-6.Moosa AN, Gupta A, Jehi L, Marashly A, Cosmo G, Lachhwani D, et al. Longitudinal seizure outcome and prognostic predictors after hemispherectomy in 170 children. Neurology 2013;80:253-60.

Stem Cell Research In Cerebral Palsy Option of treatment in Future?

Childhood cerebral palsy is a non-progressive brain disease that results from various cerebral insults that can occur before birth and 1 month after birth. Patient primarily present with motor developmental delay or motor dysfunction and possible mental retardation, epilepsy, behavioural disorders and sensory and perceptual disturbances. Conventional therapies for treating cerebral palsy include physical therapy, motor function training, language training, surgery and instramuscular injections of botulinum toxin. However these methods have not improved cerebral injuries in patients with moderate-to-severe cerebral palsy

Clinical Features of Childhood Brain Tumor in Dr. Soetomo Hospital, Surabaya

Brain and central nervous system (CNS) tumors are the most common solid tumor and the second leading cause of cancer related death in individuals 0 to 19 years of age in the United States and Canada. There are >100 different histologic subtypes of CNS tumors with the incidence of each varying by age and histologic subtype. Childhood CNS tumor incidence varies by country from 1.12 to 5.14 cases per 100,000 persons. CBTs are more common in males, though this varies by histologic type. In the United States, whites and AAsians Pacific Islanders have a higher CBT incidence than blacks and American Indians/Alaska Natives, whereas nonHispanics have higher incidence thans Hispanics. Subtype incidence and survival rates are reviewe. here we report a 3 years experience of managing Childhood Brain Tumors (CBTs) in Soetomo Hospital, Surabaya

A case of juvenile dermatomyositis responding to methotrexate and steroid

A 4-year-old patient presented with skin rash and muscle weakness. She was diagnosed with juvenile dermatomyositis based on Bohan and Peter criteria as well as laboratory testing. She received steroid and combined with methotrexate. The treatment resulted in a good response

Efficacy aand Tolerability of Intravenous Paracetamol Compared to Oral Paracetamol for the Treatment of Childhood Fever

ABSTRACT Introduction: Paracetamol is widely used as antipiretic in children and has complete rute. The use of enteral rute is limited because of high variability of bioavailability. Intravenous paracetamol commonly used as accessible analgetic in adult. There are limited data about efficacy and tolerability intravenous paracetamol compares to oral paracetamol as antipiretic in children. The aim of the study is to analyse efficacy and tolerability intravenous paracetamol compared to oral paracetamol for treating fever in children. Methods: A randomized, controlled, and open labelled clinical trial was conducted at pediatric ward Soetomo hospital Surabaya. Eligible patients received either intravenous paracetamol or oral paracetamol 10 mg/kgBW and were examined for temperature at 15, 30, 45, 60, 120, 180 and 240 minutes. Tolerability evaluations included adverse event (AE), physical exam and laboratory assessments. Results: Of 104 patients, 52 received intravenous paracetamol intravena and 52 received oral paracetamol. Mean temperature intravenous group were lower than oral groups, with higher degree of decrease. The difference were achieved at 30, 45, and 60 minutes with p=0.005, 0.002, and 0.006 respectively. Maximum decrease from baseline were achieved at 120-minute for intravenous grup and 180-minute for oral groups. Normal temperature achievement were higher in intravenous group than oral. The adverse event were comparable between the intravenous and oral groups. Conclusion: Intravenous paracetamol is more effective and as safe as oral paracetamol in reducing fever in children. Key words: Accessible, Efficacy, Fever, Intravenous paracetamol, Tolerabilit

C-REACTIVE PROTEIN (CRP) AS A SUPPORTING MARKER OF ANTIBIOTIC EFFECTIVENESS ON CENTRAL NERVOUS SYSTEM (CNS) INFECTIONS

Infection of the central nervous system in pediatric patients have a high mortality as well as acute and chronic neurological sequelae. Signs of the disease are unclear, so cerebrospinal fluid (CSF) test is used as a gold standard for diagnosis, but the investigation has faced many obtacles. Empiric antibiotic therapy is the key factor in reducing morbidity and mortality. Microbiological culture result is obtained within 5-7 days. The effectiveness of empirical antibiotic use is questionable. Therefore, other investigations are conducted to determine the effectiveness of antibiotics by using one marker, the CRP. This study was to analyze CRP level in supporting antibiotic therapy effectiveness in pediatric patients with central nervous system (CNS) infections. A prospective cohort study was conducted to determine the relationship of CRP with other parameters, including clinical, microbiological and laboratory, in pediatric patients with central nervous system infections. Patients meeting blood samples criteria were taken before (H0), the third day (H3) and the fifth day (H5) after antibiotics administration. This study involved 10 patients with central nervous system infections (meningoencephalitis, encephalitis and encephalitis with cerebral edema). Six patients were male, with ages less than a year. Antibiotic treatment effectiveness was associated with improved condition of the patients' CRP level. It was 3.558 ±3.196 before (H0), 3.878±2.813 on the third day (H3) and 3.891±2.204 on the fifth day (H5) after antibiotic administration. Leukocyte levels were 13.680±1.660 before (H0), 17.832±7.213 on the third day (H5), and 10.546±3.671 on the fifth day (H5) after antibiotic administration. Pearson's correlation test analysis performed on CRP and WBC parameters showed H0 p=0.981, CRP and WBC H3 p=0.621, while CRP and WBC H5 obtained significance p=0.644. There was no significant correlation observed between CRP and WBC parameters before and after antibiotic administration. In conclusion, there was no correlation of CRP levels with clinical, laboratory and micobiological parameters in patients with central nervous system infections

Cortical visual impairment in children with acute encephalitis syndrome

Background: Acute encephalitis syndrome (AES) is one of cortical visual impairment (CVI) causes. There were only few studies about cortical visual involvement in children with AES. Objective: To describe CVI in children with AES. Methods: This study included all children with AES during January to March 2014, were examined for visual evoked potential (VEP) to evaluate cortical visual pathway. AES was defined as clinical condition characterized by acute onset of fever, a change in mental status, and/or new onset of seizures. CVI was defined as vision loss caused by central nervous system damage confirmed by VEP. Results: There were 9 children with AES and all showed bilateral CVI. The age range between 6 to 48 months old, with 7 males and 2 females. Visual evoked potential result showed 8 children with demyelinating type and 1 with axonal type. Conclusion: Type of CVI caused by AES can be demyelinating type or axonal type