106
CDK 161 / vol. 35 no. 2 Mar-Apr 2008
Tabel 3. Pedoman Penatalaksanaan Status Epileptikus (Perdossi)
(1)
Status epileptikus merupakan keadaan darurat; yang didefi nisi-
kan sebagai: suatu keadaan bangkitan epilepsi yang berlang-
sung terus menerus, atau bangkitan berulang tanpa pemulihan
kesadaran, selama periode 30 menit atau lebih
(1)
Tabel 1. Gambaran Klinis Status Epileptikus Menurut Jenis Eepilep-
sinya
(2)
Tabel 2. Presentasi SE Nonkonvulsif Yang Mirip Dengan Keadaan
Klinis Lain
(3)
Qsblujt
Tipe
Umum
Tonik klonik umum
Lena (absence)
Mioklonik
Tonik
Klonik
Parsiil
Parsiil sederhana
Motorik
Somatosensorik
Visual
Auditorik
Afasik
Parsial kompleks
Gambaran klinis
Fase tonik disusul fase klonik
Kebingungan,mata berkedip-
kedip,gerak motorik canggung
Gerak mioklonik persisten
Kesadaran baik pada jenis
primer; menurun jika akibat
gangguan metabolik
Kaku otot ekstensor
Gerak ritmik (kelojotan)
Gerak ritmik ekstremitas,
terutama atas
Gejala sensorik fokal
Buta kortikal atau skotoma
Tuli kortikal
Motorik, sensorik, global
`bengong', automatisme,
tingkah laku aneh
Keterangan
EEG: paku-ombak
3/detik
Prognosis sangat
buruk jika disebab-
kan anoksi
Terutama pada
anak (Sindrom Len-
nox-Gastaut)
Sering pada bayi
baru lahir
Epilepsi partialis
continua
Mungkin tanpa
gejala klinis
Tidak ditemukan pada
status epileptikus
Afasik saat serangan
Sering dianggap
gejala psikiatrik
PRESENTASI KLINIS
· Letargi dan kebingungan (confusion)
· Kebingungan, agitasi
· Tidak ada respons, katapleksi
· Agitasi, kebingungan,konfabulasi
· Halusinasi/agitasi
· Letargi/obtundasi
· Mutisme
· Tertawa,menangis tidak pada tempatnya
ANGGAPAN DIAGNOSIS
· Keadaan pascakejang
· Ensefalopati metabolik
· Psikogenik/konversi
· Intoksikasi alkohol/zat
· Psikosis
· Hiperglikemi/ketoasidosis DM
· Psikogenik/depresi/stroke
· Labilitas emosi/psikosis
STAGE OF
STATUS
PREMONITORY
(0-10 minutes)
EARLY
(0-30 minutes)
ESTABLISHED
(30-60/90 minutes)
REFRACTORY
( > 60 minutes)
GENERAL
MEASURES
· Assess cardiorespira-
tory function
· Secure airways
· Give oxygen
· Institute monitoring
· i.v access
· Emergency investiga-
tions
· Give 50% Glucose
(50 ml)
· Give Thiamine where
appropriate
· Treat acidosis
· Establish aetiology
· Identify and treat
medical complication
· Pressor therapy if
needed
· EEG monitoring
· Monitor seizure EEG
AND cerebral function
· Intracranial pressure
monitoring IF ap-
propriate
AED TREATMENT
· Diazepam
(i.v. bolus , p.r.)
· Midazolam
(i.m.,i.v. bolus, p.r)
· Paraldehyde
(i.m.,p.r)
· Lorazepam
(i.v. bolus),
· Diazepam
(i.v.bolus)
SECOND LINE:
· Lignocaine
(i.v.bolus &infusion)
· Clonazepam
(i.v.bolus)
· Paraldehyde (i.m.)
· Phenytoin (i.v.bolus)
· Phenobarbitone
(i.v loading & infu-
sion)
· Phenytoin
(i.v.loading & infu-
sion)
· Chlormethiazole
(i.v.loading & infu-
sion)
SECOND LINE:
· Clonazepam
(i.v.bolus OR infu-
sion)
· Paraldehyde
(infusion)
· Diazepam
(short infusion)
· Midazolam
(short infusion)
· Thiopentone
(i.v.bolus & infusion)
· Propofol
(i.v.bolus & infusion)
SECOND LINE:
· Pentobarbitone
(i.v.bolus & infusion)
· Isofl urane
(inhalation)
· Etomidate
(iv.bolus & infusion)
STATUS
EPILEPTIKUS
CDK 161 / vol. 35 no. 2 Mar-Apr 2008
107
Tabel 4. Pedoman Penatalaksanaan Status Eepileptikus (WHO-
Searo)
(4)
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The usage of Somatic Cell Nu-
clear Transfer (SCNT) technique
has lead scientists over the world
to be able to carry out repro-
ductive and therapeutic cloning
research. SCNT technique is a
cloning technique used to trans-
fer nucleus from donor cell into
enucleated oocyte. Reproductive
cloning plays important role in
KEPUSTAKAAN
1. Kelompok Studi Epilepsi. Pedoman Tatalaksana Epilepsi. Epi-
lepsi 2004; 9(1):29-44
2. DeLorenzo RJ, Pellock JM, Towne AR et al. A prospective,
population-based epidemiologic study of status epilepticus in
Richmond,Virginia. Neurology 1996;46:1029-35
3. Bleck TP. Convulsive disorders: status epilepticus. Clin. Neuro-
physiol.1991;14:191-198
4. Epilepsy: a manual for physicians. WHO-SEARO, 2004
the preservation of nearly extinct
animals while therapeutic cloning
may overcomes immune rejec-
tion in stem cell transplantation
therapy. The success of the em-
bryonic stem cell creation from
monkey's embryo with SCNT
technique recently has directed
researchers worldwide to move a
step closer to create human em-
bryonic stem cell from adult so-
matic cell which may reduce risk
of immune rejection. Indeed, the
advancement of embryonic stem
cell research depends on the res-
olution of ethic issues regarding
the usage of donor oocytes.
Cermin Dunia Kedokt.2008;35(2): hal 72-6
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CDK-160, vol. 35 no. 1, halaman 47; edisi
Januari-Februari 2008.
Kolom rubrik `Informatika Kedokteran',
no. 22 pengelolanya tertulis Ilyas, dr., SpA
Seharusnya M. Rizal Altway, dr., SpA.
Penulis mohon maaf adanya.
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