Frekuensi kejang pada Meningoensefalitis akut sebagai prediktor Outcome gangguan perkembangan pada anak

DEWI, Dyan Roshinta Laksmi, Prof.Dr.dr. Samekto Wibowo, P.Far.K.,SpFK(K).SpS(K)

2007 | Tesis | PPDS I Ilmu Penyakit Saraf

Latar Belakang : Morbiditas dan mortalitas meningoensefalitis pada bayi dan anak masih tinggi dengan komplikasi gejala neurologi sisa berupa gangguan perkembangan, epilepsi, spastisitas dan ketulian. Beberapa faktor yang mempengaruhi outcome gangguan perkembangan yaitu berat lahir rendah, koma, penurunan perfusi, penggunaan inotropik, angka lekosit, hitung netrofil, protein cairan serebrospinal, abnormalitas EEG dan durasi kejang. Belum ada penelitian mengenai frekuensi kejang sebagai prediktor timbulnya outcome gangguan perkembangan pasca meningoensefalitis. Tujuan : Mengetahui peran frekuensi kejang pada fase akut meningoensefalitis sebagai prediktor terjadinya outcome berupa gangguan perkembangan. Metoda : Kohort retrospektif, tingkat kemaknaan dengan nilai p, ketepatan pengukuran dengan Confident Interval (CI) 95%, Relative Risk (RR) menunjukkan risiko mengalami outcome gangguan perkembangan pada kelompok frekuensi kejang tinggi dibanding kelompok frekuensi kejang rendah, bermakna bila p< 0,05. Denver II digunakan untuk menilai gangguan perkembangan anak. Hasil : Didapat 89 subjek rerata umur 22,35 ± 21,44 bulan. 35 subjek (39,3%) dengan hasil Denver II normal dan 54 subjek (60,7%) abnormal yaitu pada sektor bahasa (43%), motorik halus (42%), motorik kasar (16%) dan personal sosial (9%). Pada analisis univariat frekuensi kejang ≥10 kali (RR=2,723, 95% CI= 1,253-4,162, p=0,00) dan penurunan kesadaran (RR=2,723, 95% CI= 1,253-4,162, p=0,00) bermakna secara statistik. Pada analisis multivariat, frekuensi kejang ≥10 kali (Exp (B)=3,04, 95%CI=1,885-4,904, p=0,00) dan penurunan kesadaran (Exp (B)=3,9, 95%CI=2,183-6,968, p=0,00) bermakna secara statistik. Simpulan : Frekuensi kejang tinggi ≥ 10 kali pada fase akut dan penurunan kesadaran saat masuk rumah sakit atau keduanya terbukti merupakan prediktor gangguan perkembangan anak pasca menderita meningoensefalitis.

Backgrounds: Meningoencephalitis remain an important cause of morbidity and mortality in children despite the availability of highly effective antibiotics and improved management during critical illness. Few studies have investigated the specific outcomes associated with meningoencephalitis, notably developmental delayed, cognitive function, epilepsy and hearing loss. The factors associated with the sequelae were coma, duration of seizure, low birth weight, leucocyte, neutrophyl, cerebrospinal fluid protein and abnormality of EEG finding. The role of seizure during acute periods as a predictor of neurodevelopmental sequelae is not conclusive yet. Objectives: The purpose of this study are to determine whether the frequence of seizure in meningoencephalitis acute are associated with sequelae for developmental delayed. Methods: The subjects in this retrospective cohort study were meningoencephalitis children that appropiate with eligibility criteria. Denver Developmental Screening Test II (Denver II) was using to determine the abnormality of each developmental sectors. Results: 89 subject (mean age 22,35 of month) were evaluated with Denver II during 1- 8 month post meningoencephalitis. 39,3% subject had normal result and 60,7% subject have delayed in language sector (43%), fine motor adaptive (42%), gross motor (16%) and personal social (9%). The frequence of seizure ≥10 times (RR=2,723, 95% CI= 1,253- 4,162, p=0,00) and unconsiousness (RR=2,723, 95% CI= 1,253-4,162, p=0,00) were significant as a predictors for developmental delayed. In regression analysis, the frequence of high seizure (RR=3,04,95%CI=1,885-4,904,p=0,00) and unconsiousness (RR=3,9,95%CI=2,183-6,968,p=0,00) were remain statistically significant. Conclusions: The frequent of seizure ≥ 10 times during acute phase and decrease of consiousness or both of them were predictors for developmental delayed sequelae in children after meningoencephalitis.

Kata Kunci : Meningitis,Frekuensi Kejang,Perkembangan Anak, frequence of seizure, acute meningoenchepalitis, developmental delayed