Kejang Pada Anak & Status Epileptikus

8/19/2019 Kejang Pada Anak & Status Epileptikus

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Penyebab Kejang Kelainan "isiologis #

Kejang demam, epilepsiKelainan anatomis #

$rauma, tumor %n"e!si SSP #

&eningitis, ense"alitis

Kelainan metaboli! #ipernatremia,'iponatremia,'ipo!alsemia,'ipogli!emia,'ipomagnesia


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KelainanFisiologis


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SERING, 2,5% < 5 TH

ORANG TUA CEMAS

KELUMPUHAN, GGN. PSIKIS, EPILEPSI


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BANGKITAN KEJANG, BI / 3 - 5 TH

PANAS (>38 C!, PROSES EKSTRA

KRANIAL LAINN"A

#IBE#AKAN$

( K. #. SE#ERHANA / BENIGNA( K. #. KOMPLEKS / MALIGNA / EPILEPSI

"ANG #IPRO OKASI #EMAM


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( Bersi"at umum( )ama !ejang * + menit( Fre!-ensi + / periode demam

( Bersi"at "o!al( )ama !ejang + menit

( Fre!-ensi + / periode demam


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LAMA KEJANG &'%, 5 ) *5%, 2' ) 2%, > + JAM

SI AT UMUM, +5 % OKAL

8'-85% KLONIK) +&% TONIK

UMUR BLN - 3TH) < BLN (+ - 2%!) 5TH. (+- %!

KELAMIN L > P (+,+ $ + S/# & $ +!

PANAS MENIT - 2 HARIPEN". PEN"ERTA ISNA

GENETIK


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KEMATIAN

REKURENSI 25 - &' %

REK. *5% #LM. + TH.

(UMUR, TIPE KEJANG, KELAMIN,

KEL. NEUROLOGIS, RI A"AT!

EPILEPSI KEL. NEUROLOGIS, > +5

> + SERANGAN 2& JAM, RI A"AT KEL.

+ AKTOR 20

2 AKTOR ATAU > +'0


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KEL. NEUROLOGIS PARESE

RETAR#ASI MENTAL REKURENSII1 LBH


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$ BERANTAS KEJANG (ANTI KON ULSAN! O 2 OKSIGENASI PANAS ATASI IN EKSI

MENGATASI KEJANG$#IA EPAM ',25 4/K4 BB I. ',& 4/K4 BB ',5 4/K4 BB

RECTAL/SUPP $ BB


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PRO ILAKSIS KONTINU $

( CEREBRAL PALS", MIKROSE ALI, R.M

( >+5 , OKAL, KEL. SARA

( RI A"AT KEJANG TANPA #EMAM

S/# USIA & TH ATAU SELAMA 2 TH

PEN"EBABN"A PANAS >> PROGNOSIS BAIK

( CARA ATASI PANAS

( PERTOLONGAN PERTAMA KEJANG

( BILA TH/ KONTINU MAN AAT, E EK SAMPING

PENERANGAN ORANG TUA$


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L; = =?=@ 9 ? 9: >>>, 9 ; 9@: 7@ ; - ; @; 7@ 7?=:

G4@ D9 97 7 9 , 97:9 9=, =@=?7 9 =?= 9 ;6

K; . N; 7 749 : 7@9

#9?=@6=9 =@4:9?=@ ; 9 ; 9 ; =@4P= 7: 9 = , 7@?=@, =@4 =@4

BANGKITAN

EPILEPSI


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Klasifikasi epilepsi

P; 9@=?= Birth insult

I@D;: 9

T = = G;@;?9:

PENCETUS $ S;@ 7 9:

S9 ?; 9:

M;@?=

K =@4 ?96

L; =

OAE ?7 ?9 =-?9 =


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P= ?9= ( D7:= , 7F= ! ;9 ;

G;@; = 9 ;6 9; ;

S9 ;

C7 ; E 7 9@4 ?7 GTC

A ;@F; M 7F 7@9F C 7@9F

T7@9F T7@9F F 7@9F A?7@9F


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T; = 9

ANAMNESA PEMERIKSAANISIK

PEMERIKSAANPENUNJANG

O@ ;?

K; =6= =@

L= =

N; 7 749

MR

P; :; =@4=@

EEG

LAB

CT F=@


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T =@ B; = ; =@4=@ ?=@ = 4=@44 =@D @4 9 @7 =

K= =

OAE

B9 9@4=@ 9:7 7 9=


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I@69:= 9

P; @= =@4:9?=@ ; 9 ; 9

;:. > + /? @, ; . > 2

=:?7 ;@F;?

P 9@ 9

S; =9 ;@9 ; 9 ; 9 S=? =F= #7 9 :; =@4

; OAE =@4 =9@

OAE $ 2 & ?= @

T @:=@ +2 =@


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• K= = = ; 9@ P= ?9= ;9 ;

• ;@7 = 9?= P= ?9= , T7@9F-F 7@9F

• ;@9?79@ P= ?9= , T7@9F-F 7@9F• A . = 7=? M 7F 7@9F

• C 7@= ; = A ;@F;, M 7F 7@9F

• #LL


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P; ; 9: ==@ @; 7 749

L; 9 ? :? 7?=:

S=? =@4:9?=@

@4 9 9@?; ;:

R; 7@ ? 6 OAE

O@ ;? =@4:9?=@

;: ;@ 9

A6= =@4:9?=@ ?; ?;@?

EEG


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B=@4:9?=@ = ?9= / D7:=

( K 9@9 , EEG + =49=@ ; 9 D; !

S9 ; C7 ;

T=@ =4=@44 =@ :; =6= =@

P;@ @=@ :; =6= =@O?7 =?9 = 9


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B=@4:9?=@

( K 9@9 , EEG :;-2 H; 9 D; !

T7@9F-F 7@9F A ;@F;

= ; D ;: 9

= ; ;: ?;@ 9

= ; : 7@9: = ; 7 ? 9:?=

N7@ :7@ 9D T9 9:= A?9 9:=

S;6; =@= K7 ;:

O?7 =?9 = 9


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Infeksi Sistem Saraf

Pusat


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P; =6=@4=@ ; = ? 7?=:

I@67@; 9=

I@D;: 9 = 9 7 ; :; ; =?=@

I@D;: 9 SSP +' ; = ;@ =:9? P= 9@4 =@ =: M;@9@49?9

A@4:= :; =?9=@ $ +8 - &' %

A@4:= :;F=?=?=@ $ 3' - 5' %

K;F=F=?=@ $ 4=@44 =@ ;@6;@4= =@, 44@ ;@4 9 =?=@,

44@ ; = = , 44@ 9F= =, ;?= 6= 9 ;@?= ,

96 7 ;D= , = ; 9 =@447?= 4; =:.


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P; =6=@4=@ ; . O?=:

=@4 69?=@6=9 6;@4=@ ;@9@4:=?=@ ; PMN

6= = LCS 6=@ ?; :?9=6=@ = =:?; 9 ;@ ; = 9@D;: 9 6= = LCS


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H. I@D ;@ =; ?9 ; B

S. P@; 7@9=; N. M;@9@49?969

E. C7 9

S. B. H; 7 9?9:B= 9 = = 9


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+. M; = 9 = 9 =@ 6= = ( ; =?74;@ !

2. L=@4 @4 ( ; :7@?9@ 9?=? !

OMSK, I@D;: 9 6=; = THT

3. I =@?= 9 =@4 @4

T = = :; = = ?; :=, 9; 7:;

T9@6=:=@ ;6= 7?=:, P @: 9 =

H; =?74;@ = 9@4 ; 9@4

T; =? = : ( P7 ? # ;@? !

M :7 = = . @=D=


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B=:?; 9 ; ;:=? =6= :7 = @= 7D= 9@4

M;@; 9@?=@4=@ :7 =

#= = ; ; =@ =: 69 9 ( =:?; ; 9=!

M= : LCS

M; ; =@ =: 69 9 6= = LCS

M;@9 :=@ ; =6=@4=@ ; = ? 7?=:


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+. G; = = 9@D;: 9 =: ? $

#; = , @?= , ; , 4; 9 = /9 9?= ; ,

=@7 ;: 9=2. G; = = ;@9@449=@ ?;:. I@? =: =@9=

M @?= 7 ;:?9 , :; =@4

:; =6= =@ ;@ @

94 9?F F ( = 9!

UUB ?;4=@4 6=@ ;@7@ 7


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3. G; = = =@4 =@4 ;@9@4;= $ :=: : 6 : ?=@6= :; @94 ( !

?=@6= 6 9@ :9 ( !

G; = = ?96=: : =

( T= =: ; = , = = 9@ / ;@;?;:, @?=

( K; =6= =@ ;@ @

( #; = ?96=: ; = =6= (5'% := !

P=6= = 9 = = 9


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( G; = = ?96=: =6= =@4 =?74@7 7@9:( M; =: :=@ = @: 9

T =@ $ ; ; 7 ; 9: 7 ; ; 7 9@=

P; ; 9: ==@ $

J ; , 7?;9@, 4 :7 =,

; ;:? 7 9?, : ? : =@ ;69==@ =@4 @4


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NORMAL MEN-BAK

ARNA JERNIH KERUH/PUS

JML SEL < 5/ 3*5% LIM OSIT

> 5/ 3#OMINAN PMN

PROTEIN 2'-&' 4/6 MENINGKATSEKALI

GLUKOSA > 5'% 4/6*5% #ARI KA#ARGLUKOSA #ARAH

< *5% KA#ARGLUKOSA

#ARAH


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KAUSAL $

A@?9 97?9: E?97 749

9= =@ = $ :7 9@= 9 A 9 9 9@ 6=@ : 7 = D;@9:7

SUPORTI / SIMTOMATIK

( P; ; 9 = ==@ ;@?9 = 9

( C=9 =@ 6=@ @ ? 9 9( M;@ @:=@ =@=( M;@4=?= 9 :; =@4( P;@F;4= =@ :7 9:= 9

P@; 7@9= 7 ?7 ?=?9:, 6;: 9?


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Kelainan Metabolik iponatremia, 'ipernatremiaipogli!emia

ipo!alsemia, 'iper!alsemiaipomagnesia


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KEJANG

Diazepam 0,3-0,5mg/lg ivAtau

Diazepam pr: BB


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KEJANG

#A $%DAK

5-10menit

Diazepam 0,3-0,5mg/kg iv atauDiazepam per rektalHipoglikemi: D25 2ml/kg

STOP


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KE !"#

$!ST!T S KO" 4S% S

T%D!K

12 am kemu ia*:

e*itoi* 5-6mg/kg iv

e*o(ar(ital 10-20mg/kg im


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KE !"#

$! T%D!K

%*tu(a i i % 12 am kemu ia*:e*o(ar(ital 3-7mg/kg im

8 .e*itoi* 5-6mg/kg iv

9i azolam 0,2mg/kg,Dila* utka* e*ga* rumata*Depre i ala* *a.a ve*tilator


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Tujuan ::!sigenasi ota!&emberantas !ejang 5!linis/ 0028;ega' !ejang berulang;ari "a!tor pen


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Penunjang :

)ab 5A2D, 2lu!osa, ;alsium, 0le!trolit,ematologi leng!ap8

)P002;$= S


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= $anda >ital= AB;= %? line dengan Na;l 4,6 @ = ambil dara' untu! pemeri!saan

'-5 ;@9?

-Q ;@9?Bolus D @# =


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+'-3' ;@9? =P ;@ ?79@ + = 4 mg/!gBB dlm Na;l4,6@ bolus %? lambat !e


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= - M96= 7 = 4, mg/!gBB bolus %?, dilanjut!an= dengan in"us mi!rogram, atau

= #9= ; = drip 4 mg dilarut!an dalam 4

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Kejang Pada Anak & Status Epileptikus