Penatalaksanaan Status Epileptikus dengan Infeksi Sistem Saraf Pusat di Unit Perawatan Intensif: Laporan Kasus
Laporan Kasus
DOI:
https://doi.org/10.55175/cdk.v53i05.1548Kata Kunci:
Laporan kasus, infeksi sistem saraf pusat, unit perawatan intensif, kejang, status epileptikusAbstrak
Pendahuluan: Status epileptikus (SE) adalah keadaan darurat neurologis kritis ditandai dengan aktivitas kejang berkepanjangan yang berhubungan dengan risiko neurologi yang signifikan dan kematian; keadaan ini membutuhkan penanganan segera dan efektif untuk mencegah morbiditas dan mortalitas. SE dapat ditimbulkan oleh berbagai penyebab, termasuk gangguan neurologi primer, gangguan metabolik, dan faktor iatrogenik. Di unit perawatan intensif (ICU), toksisitas obat dan gangguan keseimbangan elektrolit merupakan pemicu yang umum ditemukan, yang merupakan 30%−35% pemicu kejang. Memahami penyebab yang mendasarinya, seperti infeksi sistem saraf pusat atau ensefalitis autoimun, adalah krusial untuk pengobatan yang ditargetkan dan memperbaiki luaran pasien. Kasus: Seorang pria berusia 21 tahun dengan SE dan komplikasi infeksi sistem saraf pusat (SSP) dirawat di ICU. Kontrol kejang dicapai dengan infus midazolam dan phenytoin secara kontinu. Strategi perawatan juga mencakup perawatan suportif dengan ventilasi mekanik dan stabilisasi hemodinamik menggunakan norepinephrine. Kondisi pasien membaik dengan signifikan. Pembahasan: Kasus ini menunjukkan bahwa luaran klinis yang baik pada SE dengan komplikasi infeksi SSP sangat bergantung pada sedasi berkelanjutan, pemilihan antibiotik dengan penetrasi SSP yang optimal (seperti linezolid), serta pemantauan hemodinamik di ruang intensif. Simpulan: Kasus ini menyoroti pentingnya diagnosis dini, pengobatan yang ditargetkan, dan kolaborasi interdisiplin.
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Referensi
Behrouz R, Chen S, Tatum WO. Evaluation and management of status epilepticus in the neurological intensive care unit. J Am Osteopath Assoc. 2009;109(4):237–45. PMID: 19369512.
Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definition and classification of status epilepticus - report of the ILAE Task Force on classification of status epilepticus. Epilepsia. 2015;56(10):1515–23. doi: 10.1111/epi.13121.
Trinka E, Hofler J, Zerbs A. Causes of status epilepticus. Epilepsia. 2012;53(suppl. 4):127–38. doi: 10.1111/j.1528-1167.2012.03622.x.
Marek A. Mirski. Status epilepticus. Handbook of Neurocritical Care. Springer; 2015. p. 213–28.
Mazurkiewicz-Bełdziska M, Szmuda M, Zawadzka M, Matheisel A. Current treatment of convulsive status epilepticus-a therapeutic protocol and review. Anaesthesiol Intensive Ther. 2014;46(4):293–300. doi: 10.5603/AIT.2014.0048.
Brophy GM, Bell R, Claassen J, Alldredge B, Bleck TP, Glauser T, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17(1):3–23. doi: 10.1007/s12028-012-9695-z.
Nguyen L, Wang C. Anti-NMDA receptor autoimmune encephalitis: diagnosis and management strategies. Int J Gen Med. 2023;16:7–21. doi:10.2147/IJGM.S397429.
Michels R, Last K, Becker SL, Papan C. Update on coagulase-negative staphylococci—what the clinician should know. Microorganisms. 2021;9(4):830. doi: 10.3390/microorganisms9040830.
Pugh MJ V, Hesdorffer D, Wang CP, Amuan ME, Tabares J V, Finley EP, et al. Temporal trends in new exposure to antiepileptic drug monotherapy and suicide-related behavior. Neurology 2013;81(22):1900–6. doi: 10.1212/01.wnl.0000436614.51081.2e.
Krumholz A, Wiebe S, Gronseth GS, Gloss DS, Sanchez AM, Kabir AA, et al. Evidence-based guideline: management of an unprovoked first seizure in adults. Neurology 2015;84(16):1705–13. https://doi.org/10.1212/WNL.0000000000001487.
Zhang P, Yang Y, Zou J, Yang X, Liu Q, Chen Y. Seizures and epilepsy secondary to viral infection in the central nervous system. Acta Epileptol. 2020;2(1):12. https://doi.org/10.1186/s42494-020-00022-0.
Herzig-Nichtweiß J, Salih F, Berning S, Malter MP, Pelz JO, Lochner P, et al. Prognosis and management of acute symptomatic seizures: a prospective, multicenter, observational study. Ann Intensive Care. 2023;13(1):85. doi: 10.1186/s13613-023-01183-0.
Hu LY, Zou LP, Zhong JM, Gao L, Zhao JB, Xiao N, et al. Febrile seizure recurrence reduced by intermittent oral levetiracetam. Ann Clin Transl Neurol. 2014;1(3):171–9. doi: 10.1002/acn3.34.
Angurana SK, Suthar R. Efficacy and safety of levetiracetam vs. phenytoin as second line antiseizure medication for pediatric convulsive status epilepticus: a systematic review and meta-analysis of randomized controlled trials. J Trop Pediatr. 2021;67(2):fmab014. doi: 10.1093/tropej/fmab014.
Asghar MA, Rehman AA, Raza ML, Shafiq Y, Asghar MA. Analysis of treatment adherence and cost among patients with epilepsy: a four-year retrospective cohort study in Pakistan. BMC Health Serv Res. 2021;21(1):72. doi: 10.1186/s12913-021-06085-0.
Ascoli M, Ferlazzo E, Gasparini S, Mastroianni G, Citraro R, Roberti R, et al. Epidemiology and outcomes of status epilepticus. Int J Gen Med. 2021;14(June):2965–73. doi: 10.2147/IJGM.S295855.
Huang Y, Yuan D, Hou X, Gui L. Nonconvulsive status epilepticus in Neurological ICU patients. Neuro Endocrinol Lett. 2023;44(2):68–73. PMID: 37182228.
Negishi Y, Aoki Y, Itomi K, Yasuda K, Taniguchi H, Ishida A, et al. SCN8A-related developmental and epileptic encephalopathy with ictal asystole requiring cardiac pacemaker implantation. Brain Development. 2021;43:804–8. doi: 10.1016/j.braindev.2021.03.004.
Shahan B, Choi EY, Niever G. Cerebrospinal fluid analysis. Am Fam Physician. 2021;103(7):422–8.
Mansour MA, Tahir M, Ahmadi Z. Neurocysticercosis presenting as a locked-in lateral ventricle: A case report and evidence-based review. IDCases. 2023 Apr 27;32:e01778. doi: 10.1016/j.idcr.2023.e01778.
Gower DJ, Baker AL, Bell WO, Ball MR. Contraindications to lumbar puncture as defined by computed cranial tomography. J Neurol Neurosurg Psychiatry. 1987;50(8):1071–4. doi: 10.1136/jnnp.50.8.1071.
Salter M, Lane AS. Limbic encephalitis and refractory status epilepticus in the ICU: classification, diagnosis and treatment. J Intensive Care Soc. 2014;15(4):347–51. https://doi.org/10.1177/175114371401500417.
Chen HA, Yang CJ, Tsai MS, Liao CH, Lee CH. Linezolid as salvage therapy for central nervous system infections due to methicillin-resistant Staphylococcus aureus at two medical centers in Taiwan. J Microbiol Immunol Infect. 2020;53(6):909–15. doi: 10.1016/j.jmii.2020.08.004.
Hashemian AM, Zamani Moghadam Doloo H, Saadatfar M, Moallem R, Moradifar M, Faramarzi R, et al. Effects of intravenous administration of fentanyl and lidocaine on hemodynamic responses following endotracheal intubation. Am J Emerg Med. 2018;36(2):197–201. doi:10.1016/j.ajem.2017.07.069.
Hawkes MA, Hocker SE. Systemic complications following status epilepticus. Curr Neurol Neurosci Rep. 2018;18(2):1–9. doi: 10.1007/s11910-018-0815-9.
Saredi G, Pirola GM, Ambrosini F, Barbieri S, Berti L, Pacchetti A, et al. Feasibility of en bloc thulium laser enucleation of the prostate in a large case series. Are results enhanced by experience? Asian J Urol. 2019;6(4):339–45. doi: 10.1016/j.ajur.2019.01.005.
Rossetti AO, Milligan TA, Bromfield EB. Status epilepticus severity score (STESS): a tool to orient early treatment strategy. J Neurol.2008;255(10):1561–6. doi: 10.1007/s00415-008-0989-1.
Giovannini G, Monti G, Tondelli M, Marudi A, Valzania F, Leitinger M, et al. Mortality, morbidity and refractoriness prediction in status epilepticus: comparison of STESS and EMSE scores. Seizure. 2017;46:31–7. doi: 10.1016/j.seizure.2017.01.004.
Wolter A, Gebert M, Enzensberger C, Kawecki A, Stessig R, Degenhardt J, et al. Outcome and associated findings in individuals with pre- and postnatal diagnosis of tetralogy of fallot (TOF) and prediction of early postnatal intervention. Ultraschall Med. 2020;41(5):504–13. doi:10.1055/a-0753-0008.
Yuan F, Damien C, Gaspard N. Severity scores for status epilepticus in the ICU: systemic illness also matters. Crit Care [Internet]. 2023;27:19. doi: 10.1186/s13054-022-04276-7.
Shen JY, Saffari SE, Yong L, Tan NCK, Tan YL. Evaluation of prognostic scores for status epilepticus in the neurology ICU: a retrospective study.J Neurol Sci [Internet]. 2024;459:122953. doi: 10.1016/j.jns.2024.122953.
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