Jakarta, IO – Epilepsy is a neurological disorder that frequently affects children. Other than lowering the child patient’s quality of life, it also restricts their social functionality and can damages the mental stability of both the child and the parents. During the Covid-19 pandemic, Dr. Cipto Mangunkusumo Hospital Jakarta noted a steep decrease in epilepsy patient visits, at 63.1% lower than the visit in the year immediately before the pandemic. The Hospital’s 2020-2022 Outpatient Polyclinic medical records show that there were only 14,402 child neurology patients in the polyclinic for the period, with 5,760 (40%) of them being epilepsy patients.
“We need a new paradigm for comprehensive treatment of child epilepsy, after the Covid-19 pandemic – it should include a better, tighter selection of anti-epilepsy medication (“AEM”) to use, the provision of National Health Social Security Administrator (Badan Penyelenggara Jaminan Sosial – “BPJS Kesehatan”) funding for child epilepsy patients, ensuring the completion of an immunization suite among children, providing referral access to Educational Hospitals for child patients, and better involvement of parents of epileptic children in the Indonesia Child Epilepsy Care Space (Ruang Peduli Epilepsi Anak Indonesia – “RPEAI”). RPEAI facilitates parents asking questions of, or receiving recommendations from, specialist doctors and expert teams, in order to ensure better medication for their children,” declares Prof. Dr. dr. Irawan Mangunatmadja, Sp.A(K), in his investiture as Permanent Professor in Pediatric Medicine in the University of Indonesia Faculty of Medicine, last Saturday (11/2/2023).
So far, there has been no agreement concerning ER procedure for treating epileptic child patients who appear with a history of seizures. Studies at the Dr. Cipto Mangunkusumo Hospital shows that 77% of patients administered with 10 mg/kg phenobarbital by IV per session no longer suffer from seizures. Unfortunately, the amount of phenobarbital IVs available in clinics and hospitals is restricted.
Drug- Resistant Patients
Prof. Irawan cites clinical data in his 2021 scientific publication, the “Risk Factors for Drug Resistance in Epileptic Children with Age of Onset Above Five Years: A Case-Control Study”, in declaring that recently, many epilepsy patients have become Drug-Resistant Epilepsy Patients (“DREPs”). To prevent this from happening more widely, AEM selection and regulation is being regulated more stringently. The administering doctor needs to determine any patient comorbidity and all other risk factors that might cause these patients to become DREPs. The initial AEM that should be selected for epilepsy patients is first-line AEM that matches the type of the patient’s seizure. If the initial AEM has been administered in its maximum dose but the patient continues to suffer from seizures, it is recommended that second-line AEM be administered, in combination with the first-line one.