Epilepsy Dan KD SM
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Transcript of Epilepsy Dan KD SM
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Profilaksis Kejang Demam
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2 Company Confidential© 200X Abbott
Pengobatan profilaksis terus menerus diberikan jika:
Pengobatan profilaksis terus menerus diberikan jika:
1. Kejang lama lebih dari 15 menit.
2. Anak mengalami kelainan neurologis yang nyata sebelum atau sesudah kejang, misalnya hemiparesis, paresis Todd, Cerebral Palsy, retardasi mental, hidrosefalus, mikrosefali.
3. Kejang fokal atau parsial
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3 Company Confidential© 200X Abbott
Presentation TitleDate
Profilaksis terus Menerus Dipertimbangkan Jika:
1. Kejang berulang dua kali atau lebih dalam 24 jam.
2. Kejang demam terjadi pada bayi kurang dari 12 bulan
3. Kejang demam sering berulang, lebih dari 4x per tahun
Yang dimaksud dipertimbangkan adalah:
Pemberiannya didiskusikan terlebih dahulu dengan orangtuanya
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4 Company Confidential© 200X Abbott
Penatalaksanaan Kejang Demam
FASE
AKUT
PENCEGAHAN INTERMITEN
PENCEGAHAN TERUS MENERUS
Gejala klinis Kejang (+)
Demam (+)
Kejang (–)
Demam (+)
Kejang (–)
Demam (–)
Pengobatan Diazepam
DAN
Antipiretik
Diazepam
DAN
Antipiretik
Valproate DEPAKENE
15-40 mg/kgBB/hari
ATAU
Phenobarbital
Lama terapi Selama kejang Selama demam 1 tahun bebas kejang
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Bukti Klinis Valproate untuk Profilaksis Kejang Demam
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6 Company Confidential© 200X Abbott
Depakene® dalam Pencegahan Kejang Demam Kompleks
Well designed, Double blinded, RCT Open,randomized,therapeutic trial
Febrile Seizures, Baram, Shinnar 2002: 278
59
33
4
19
35
0
5
10
15
20
25
30
35
Reccurrence Rate (%)
Ngwane&Bower Mamelle et all
VPAPHBNo Treat
An
gka
rek
ure
nsi
dal
am 1
tah
un
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7 Company Confidential© 200X Abbott
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Profilaksis Terus Menerus / Kontinuous (UKK)
Pemberian obat fenobarbital atau asam valproat setiap hari efektif dalam menurunkan risiko berulangnya kejang
Obat yang dipakai untuk profilaksis terus menerus:
1.Asam valproat
Dosis : 15-40 mg/kgBB/hari dibagi 2-3 dosis
2. Phenobarbital
Dosis : 4-5 mg/kgBB/hari dibagi 2 dosis, dengan maksimum 200 mg/hari
Lama pemberian obat 1 tahun bebas kejang
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8 Company Confidential© 200X Abbott
Dosis Depakene
DOSIS UNTUK KEJANG DEMAM:
15-40 mg/kg BB/hari
CARA PENGHENTIAN OBAT:
Harus Tappering off / diturunkan bertahap
1 bulan I 1 bulan-2 1 bulan 3 1 bulan-4
kurangi 25% kurangi 25% kurangi 25% kurangi 25%
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Epilepsy
Management Strategies
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10 Company Confidential© 200X Abbott
PRINSIP PENGOBATAN EPILEPSI
Menurut Pedoman Tata Laksana Epilepsi PERDOSSI 2010:
1. Diagnosis epilepsi sudah dipastikan
2. Pastikan faktor pencetus bangkitan dapat dihindari (misalnya : alkohol, kurang tidur, stress, dll)
3. Terdapat minimum 2 kali bangkitan dalam setahun.
4. Setelah penyandang dan atau keluarganya menerima penjelasan tentang tujuan pengobatan
5. Pasien dan /atau keluarganya telah diberitahu tentang kemungkinan efek samping
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11 Company Confidential© 200X Abbott
Selection of the appropriate antiepileptic drug
Epilepsy - Management Guidelines
Partial Tonic-clonic Absence Myoclonic Tonic & Atonic
Myoclonic
Valproic acid
Carbamazepine
Phenytoin
Ethosuximide
Clonazepam
Felbamate
Lamotrigine
GABA
Topiramate
Spectrum of Activity
No Activity
Valproate – The Broad Spectrum Anticonvulsant
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12 Company Confidential© 200X Abbott
Broad Spectrum Anti Epilepsy - Adult
Pedoman Tatalaksana Epilepsi PERDOSSI 2010
* Obat belom tersedia di Indonesia
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13 Company Confidential© 200X Abbott
Broad Spectrum Anti Epilepsy - Pediatric
Pedoman Tatalaksana Epilepsi PERDOSSI 2010
* Obat belom tersedia di Indonesia
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14 Company Confidential© 200X Abbott
Antiepileptic drugs which may WORSEN specific Syndrome
Antiepileptic drug Epileptic syndrome/seizure typeCarbamazepine, Vigabatrin, Tiagabine, Phenytoin
Childhood absence epilepsy, Juvenille absence epilepsy, Juvenille myoclonic epilepsy
Vigabatrin Absences & Absences status
ClonazepamGeneralized Tonic-Status in Lennox - Gestaut Syndrome
LamotrigineDravet̀ s syndrome
Juvenille myoclonic epilepsySource: SIGN, Diagnosis & Management Epilepsies in Children & Young people - March 2005
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Bukti Klinis Valproate untuk Epilepsi
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16 Company Confidential© 200X Abbott
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17 Company Confidential© 200X Abbott
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18 Company Confidential© 200X Abbott
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19 Company Confidential© 200X Abbott
Depakote in Generalized SeizureSummary of Key Studies Evaluating Valproate Monotherapy in Patients with Primary Generalized Seizures:
Authors Patients Receiving
VPA Monotherapy
Seizure Free Patients
N %
Burgeois et al 118 98 83%
Covanis et al 240 200 83%
Turnbull et al 37 27 73%
Wilder et al 34 25 73%
Wilder BJ, Polypharmacy to Monotherapy in the Treatment of Epilepsy, Nindermere communications Inc, 1987
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Profil Produk Depakene / Depakote
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21 Company Confidential© 200X Abbott
Struktur Kimia Depakene / Depakote
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22 Company Confidential© 200X Abbott
Mekanisme Kerja Depakene / Depakote
GABA synthesis
activates GABA synthesising enzyme GAD
GABA Turnover
Inhibits Succinic semi-aldehyde dehydrogenase
Gamma hydroxy butyric acid
Inhibits aldehyde reductase
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23 Company Confidential© 200X Abbott
Farmakokinetik Depakene / Depakote
• T1/2: 6-16 jam, rata-rata 10.6 jam
• Absorpsi cepat dan komplit melalui sal. pencernaan dari oral.
• Metabolisme di hepar
• Ekskresi di urin (metabolit)
• Jika diberikan bersamaan atau sesudah makan akan sedikit memperlambat penyerapan tapi tidak mempengaruhi jumlah dan efektivitas
• plasma binding protein 90%. (McNamara 1996, Dollery 1990)
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24 Company Confidential© 200X Abbott
Farmakokinetik Depakene / Depakote
Depakene DepakoteKonsentrasi plasma puncak
1 - 2 jam setelah pemberian
2 - 4 jam setelah pemberian
Depakote diubah --> btk aktif Depakene
Melewati plasenta & ASI 10% 10%
Tingkat terapeutik total plasma
50 - 100 ug/ml (Epilepsi)
50 - 100 ug/ml (Epilepsi)
Msk otak & cairan serebrospinal Cepat Cepat
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Valproate in Once Daily dose
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When Once-daily Dosing May be Useful1,2
:
• When administering medication is time and labor intensive
• When patients are likely to refuse medication
• When multiple doses per day are inconvenient
1. Zlotnick S, Prince T, Frenchman IB. Cost analysis of immediate- versus controlled-release medication administration in long-term care.The Consultant Pharmacist. 1996;11(7):689-692. 2. Stahl SM. At long last, long-lasting psychiatric medications: an overview ofcontrolled-release technologies. J Clin Psych. 2003 April;64.
Once-daily Dosing May Enhance Patient Convenience and Simplify TreatmentOnce-daily Dosing May Enhance Patient Convenience and Simplify Treatment
Please see slides 8-10 for dosing considerations.
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DEPAKOTE ER Provides Once-daily Dosing1-5
DEPAKOTE ER features a hydrophilic polymer matrix controlled-release tablet system to provide more consistent blood levels over 24 hours. This system of polymer wetting, polymer hydration, drug diffusion, and polymer erosion results in the release of drug in the stomach, small intestine, and large intestine over an 18- to 24-hour period of time.
1. DEPAKOTE ER package insert, Abbott Laboratories. 2. Data on file, Abbott Laboratories. 3. Stahl SM. At long last, long-lasting psychiatric medications: an overview of controlled-release technologies. J Clin Psych. 2003 April;64. 4. Valesco M, et al. Influence of drug: hydroxypropyl methylcellulose ratio, drug and polymer particle size and compression force on the release of diclofenac sodium from HPMC tablets. Journal of Controlled Release.1999;57:75-85. 5. Ford J, et al. Importance of drug type, tablet shape and added diluents on drug release kinetics from hydroxypropyl methylcellulose matrix tablets. International Journal of Pharmaceutics. 1987;40:223-234.
0 hours 24 hours
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28 Company Confidential© 200X Abbott
Relationship between formulation, plasma concentration and risk of side effects and loss of efficacy
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Preparations
Depakote® 250mg
Film coated tablet
250 mg sodium hydrogen divalproate
Depakene® syrup
5 ml = 250 mg valproic acid
ASKES
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30 Company Confidential© 200X Abbott
Depakote ER® 250 mg
250 mg divalproex sodium Extended Release
Depakote ER® 500 mg
500 mg divalproex sodium Extended Release
Preparations
ASKES
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Thank You
Terima Kasih