PEMBACAAN JURNAL

Presentan : dr. Arief Yulianto Pembimbing : DR.dr.E.S.Herini, SpA(K)

Stase Neuropediatric. Kamis, 22 Juli 2010

Latar Belakang
Status epileptikus (SE)
Kegawatan neurologi Sering terjadi pada anak Management dan penanganan cepat dan tepat menghentikan kejang

Terapi

Inisial terapi masih kontroversi Diazepam and Lorazepam

Tujuan

Membandingkan efikasi lorazepam dengan kombinasi diazepam - phenytoin pada status epilepticus

Metode
Randomized Controlled Trial

Subjek
Kriteria Inklusi
Anak usia 1 sampai 12 tahun. Diagnosis klinis status epileptikus

Kritera Eksklusi

Menerima obat anti epilepsi dalam waktu 4 minggu Menderita trauma kepala Menderita Jaundice Gagal ginjal Diare Riwayat keracunan

Subjek

Randomisasi

Studi Protokol

 Menilai keseluruhan Outcome keberhasilan terapi dalam menghentikan primer kejang

Outcome

Outcome sekunder
Outome sekunder
awal kejang - berhenti setelah pemberian obat pertama. Jumlah dosis dan penggunaan antikonvulsan tambahan.
Frekuensi kejang dalam 18 jam. Depresi pernapasan Jumlah pasien yg di transfer ke ICU Jumlah pasien yg membutuhkan obat alternatif

Outcome sekunder

Analisis Statistik

HASIL

Diskusi
Status Epileptikus adalah kejang yang berlangsung selama 5 menit atau lebih.

Penggunaan lorazepam dan kombinasi diazepam phenytoin sama efektif pada status epileptikus.

Pengobatan dikatakan berhasil jika kejang berhenti dalam waktu 7 sampai 8 menit setelah pemberian obat.

Kelemahan

Subjek diatas 1 tahun

Aplikasi terbatas > 1 tahun

Kesimpulan
Tidak ada perbedaan yang signifikan antara kedua kelompok dalam menghentikan kejang pada SE.

Lorazepam lebih direkomendasikan dalam menghentikan kejang pada SE

RATING SCALE FOR ARTICLE ON THERAPY

Result 1. Is an estimate of the treatment effect given? 2. Is it an clinical importance? 2 2

3. Is it estimate of the treatment effect sufficiently precise ?

Validity Selection 4. Was the spectrum of patients well defined? 5. Was the diagnosis of the disease well defined ? 6. Were suitably broad eligibility criteria used? 7. Were eligibility criteria suitable narrow ?

2 2 2 2

RATING SCALE FOR ARTICLE ON THERAPY

Measurement 8. Was assignment to treatment stated to be random? 9. Was the method of randomization explained? 10. Were all patients acounted for after randomization ? 11. Were loses to follow-up <10% 12. Were the treatment grup similar in important factors at the start of trial ? 13. Were all patient otherwise treated alike ? 14. Were patient health care workers and investigators blind to treatment ? 15. Was assesment of outcome blind ? 2 2 2 2 2 2 0 2

16. Was the occurrence of side effects explicitly looked for ?

17. If yes, were estimates of their frequency severity given ?

2
0

RATING SCALE FOR ARTICLE ON THERAPY

Statistical analysis 18. Was the main analysis on intention to treat ? 19. If yes, was a sensitivity analysis performed? 20. Were additional clinically relevant factor allowed for ? 21. Were appropriate statistical methods used? 22. Were any unusual methods explained or justified? 23. If subgrup analyses were done,were they explicity presented as such ? Utility 24. Do the result help me choose treatments ? 2 0 2 2 2 2 2

TOTAL

40

OVERALL RATING

85%