Titi nurhayati

405070112
 Klasifikasi Kejang
Klasifikasi Jenis Sifat-sifat

1. EPILEPSI PARSIAL

A. Gejala dasar ( Epilepsi •Awitan fokal—biasanya kejang unilateral atau

motorik, sensorik Jackson / E. kedut pada jari / wajah dan menyebar ke seluruh
atau otonom ) Fokal sisi tubuh yang terkena serangan
•Pola yang sama u/ gejala sensorik ( halusianasi )
•Aura sebelum serangan (rasa tidak enak di perut )
•Dejavu dan jamais vu
•Berlangsung < 2 menit

B. Gejala Kompleks Epilepsi •Biasa penderita sadar sewaktu serangan tjd, ttpi
psikomotor / tidak dapat mengingat kembali yang telah tjd
E. lobus •Ggg mental sementara dan gerakan otomatis tak
temporalis bertujuan ( bertepuk tangan )
•LAIN2 : Ingatan muncul scr tiba-tiba tentang
kejadian masa lalu, halusinasi visual/dengar,
perubahan kepribadian, tingkah laku antisosial,
perubahan mood
•Berlangsung 30 sekon – 2 menit
 Klasifikasi Jenis Sifat-sifat
2. EPILEPSI UMUM Bilateral, simetris dan tidak memiliki awitan lokal
A. Absence Petit mal •Kesadaran hilang selama beberapa
detik, ditandai dengan terhentinya
percakapan sesaat, Pandangan kosong /
kedipan mata yang cepat
•Anak-anak(hampir), Menghilang saat
remaja dan digantikan oleh e.tonik-
klonik
•15 – 20 menit
B. Tonik-Klonik ( umum ) Grand mal •Epilepsi dg serangan klasik
•Didahului aura
•Kesadaran hilang
•Spasme otot menurun secara tonik-
klonik
•Lidah tergigit
•Inkontinensia kemih dan feses
•Bingung dan amnesia thd kejadian
sewaktu serangan
 MYOKLONIC EPILEPSI
• Juvenile myoclonic epilepsy ( common )
– The seizures usually involve the neck, shoulders, and upper arms. In many
patients the seizures most often occur soon after waking up. They usually
begin around puberty or sometimes in early adulthood in people with a
normal range of intelligence. In most cases, these seizures can be well
controlled with medication but it must be continued throughout life.
– Fifteen percent of children with childhood absence epilepsy later develop
JME
• Lennox-Gastaut syndrome
– This is an uncommon syndrome that usually includes other types of seizures as well. It
begins in early childhood. The myoclonic seizures usually involve the neck, shoulders,
upper arms, and often the face. They may be quite strong and are difficult to control.
• Progressive myoclonic epilepsy
– The rare syndromes in this category feature a combination of myoclonic seizures and
tonic-clonic seizures. Treatment is usually not successful for very long, as the patient
deteriorates over time.
 ATONIC
• Disebut juga “drop attacks” atau “ drop seizure” atau
“akinetik” / without movement
• Berlangsung selama < 15 detik
• Begin in childhood
• Otot kehilangan keukuatan secara mendadak.
The eyelids may droop, the head may nod, and the
person may drop things and often falls to the ground.
• The person usually remains conscious.
• Sering luka saat terjatuh
 TONIC
• Berlangsung < 20 detik
• Peningkatan otot terjadi pada tubuh, lengan dan kaki,
Pergerakan menjadi kaku
• Consciousness is usually preserved.
• Tonic seizures most often occur during sleep and usually
involve all or most of the brain, affecting both sides of the
body.
• If the person is standing when the seizure starts, he or she
often will fall.
• Disebut juga Juvenile myoclonic epilepsy , hanya kejang ini
dapat terjadi pada segala usia
 CLONIC
• Lamanya bervariasi
• Clonic seizures consist of rhythmic jerking movements of the
arms and legs, sometimes on both sides of the body.
• contraction and relaxation of a muscle -- in other words,
repeated jerking
• Biasanya didahului dg tonic ( kaku )
• Terjadi pada berbagai umur termasuk bayi yang baru lahir
• Pada bayi, kejang terjadi cepat, bervariasi dan menghilang dg
cepat dalam waktu yang singkat
• The jittery infant also will be more alert than an infant who is
having a clonic seizure
 Etiologi
• Infeksi
– Infeksi intrakranial : meningitis, ensefalitis
– Shigellosis
• Keracunan
– Alkohol
– Teofilin
– Kokain
• Metabolik
– Hipoglikemi
– Hipoksemia
– Hipo ( Na, Ca )
– Gangguan elektrolit atau dehidrasi
– Defisiensi piridoksin
– Gagal ginjal
– Gagal hati
– Gangguan metabolik bawaan
• Lain-Lain ( Ensefalopati hipertensi, Tumor otak, Perdarahan intrakranial, Idiopatik )
 Sensory/Thought Emotional Physical No warning

Early symtoms Deja vu Fear/Panic Dizziness Sometimes seizures

(warnings )
Gejala dan Tanda
Jamais vu
Smell
Pleasant feeling Headache
Lightheadedness
come with no warning

Sound Nausea
Taste Numbness
Visual loss or blurring
Racing thoughts
Stomach feelings
Strange feelings
Tingling feeling
Seizure symptoms Black out Fear/Panic Chewing movements
Confusion Convulsion
Deafness/Sounds Difficulty talking
Electric Shock Feeling Drooling
Loss of consciousness Eyes rolling up
Smell Falling down
Spacing out Foot stomping
Out of body Hand waving
experience Incontinence
Visual loss or blurring Lip smacking
Making sounds
Staring
Stiffening
Swallowing
Tongue biting
Tremors
Twitching movements
Breathing difficulty
Heart racing
 Sensory/Thought Emotional Physical

After-seizure Memory loss Confusion Bruising

symptoms (post-ictal) Writing difficulty Depression and sadness Difficulty talking
Fear Injuries
Frustration Sleeping
Shame/Embarrassment Exhaustion
Headache
Nausea
Pain
Thirst
Weakness
Urge to
urinate/defecate
 Kejang

Inducers Inhibitors

phenobarbital erythromycin
primidone nifedipine/verapamil
phenytoin trimethoprim/sulfa
carbamazepine propoxyphene
tobacco/cigarettes cimetidine
valproate
 Pemeriksaan
• Anamnesis
– Riwayat kejang sebelunya, kondisi medis ( obat2an, trauma, infeksi ),
keluhan neurologis ( fokal, nyeri, maupun cedera akibat kejang )
• Pemeriksaan Fisik
– Tanda vital, tanda trauma akut kepala dan kelainan sistemik
• Pemeriksaan penunjang
– Laboratorium ( darah tepi lengkap, elektrolit serum, glukosa, ureum,
kreatinin, kalsium, Mg )
• Kejang demam ( Meningitis : CSS ; Ensefalitis : PCR )
– Pungsi lumbal
• AAP merekomendasikan untuk : < 12 bulan, 12-18 bulan dan 18 bulan jika ada
infeksi intrakranial (meningitis )
– Elektrosefalografi ( tidak direkomendasikan)
– Neuroimaging ( CT scan dan MRI )
• Sugery ( for adults )
– Surgery is now being performed on some patients
whose seizures have been uncontrolled for only 1
or 2 years. At least two single drugs and a
combination of two or more drugs should be
tried before surgery is considered.
– Epilepsy surgery can be especially beneficial to
patients who have seizures associated with
structural brain abnormalities, such as benign
brain tumors, malformations of blood vessels
(including disorders known as arteriovenous
malformations, venous angiomas, and cavernous
angiomas), and strokes

American Academy Neurology

 Vagus Nerves Stimulation
( for adults)
• Vagus nerve stimulation (VNS) is designed to
prevent seizures by sending regular, mild
pulses of electrical energy to the brain via the
vagus nerve. These pulses are supplied by a
device something like a pacemaker. The VNS
device is sometimes referred to as a
"pacemaker for the brain." It is placed under
the skin on the chest wall and a wire runs
from it to the vagus nerve in the neck.
VNS
American Academy of Pediatrics ( AAP )
Penatalaksanaan
 KOMPLIKASI
• Komplikasi
• Kemungkinan komplikasi hemiparesis dapat terjadi pada
penderita yang mengalami kejang lama yaitu yang
berlangsung lebih dari setengah jam, baik yang bersifat umum
atau fokal.
 PROGNOSA
• Dengan penanggulangan yang tepat dan cepat
prognosa baik dan tidak menyebabkan
kematian. Apabila tidak diterapi dengan baik,
kejang demam dapat berkembang menjadi :
– Kejang demam berulang
– Epilepsi
– Kelainan motorik
– Gangguan mental dan belajar