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All Journal MNJ (Malang Neurology Journal) Eduvest - Journal of Universal Studies Magna Neurologica
Ketaren, Retno Jayantri
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Aerospace Engineering Computer Science & IT Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Social Sciences

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THE PREDISPOSING FACTORS OF PIRIFORMIS SYNDROME: STUDY IN A REFERRAL HOSPITAL Siahaan, Yusak Mangara Tua; Ketaren, Retno Jayantri; Hartoyo, Vinson; Tiffani, Pamela
Malang Neurology Journal Vol 5, No 2 (2019): July
Publisher : Malang Neurology Journal

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2019.005.02.5

Abstract

Background: Piriformis syndrome is a neuromuscular condition characterized by hip and gluteal pain caused by abnormality of piriformis muscle. In clinical practice, this syndrome is usually misdiagnosed with other spinal disorders. There is no specific test in diagnosing piriformis syndrome, therefore by understanding the characteristics and predisposing factors, clinicians may be more aware in diagnosing this syndrome.
Objective: To investigate the characteristics and predisposing factors of piriformis syndrome.Methods: A descriptive study was conducted on patients with gluteal pain in a referral hospital. Diagnosis was established by block injection on piriformis muscle and showed clinical improvement afterwards. Demographic characteristics, predisposing factors, and physical examination were analyzed. The data is collected and processed by SPSS 20.0.Results: The total of 65 patients were evaluated, with a male to female ratio 1:3. As much as 47.7% of patients were > 60 years old. Average weight was 60 kg and BMI (Body Mass Index) was within normal range (58.9%). Most subjects were housewives (55.4%) and the majority of subjects had history of microtrauma such as sitting on rigid surfaces (36.9%), walking or running long distances (18.5%), and cross-legged sitting (10.8%). Average sitting per day was approximately 5 hours. In 56.9% of subjects, exercises were conducted. There was no history of back pain in 81.5% of subjects.Conclusion: Our study showed age and housewives characteristics differ with other studies. The most predisposing factors were history of microtrauma, female, age, and normal BMI.
Cases of Meige’s Syndrome Controlled Following Administration of Low-Dose Botulinum Toxin Type-A: A Serial Case Series Ketaren, Retno Jayantri; Margono, Jacqueline Tasha; Stevano, Reza
Magna Neurologica Vol. 1 No. 2 (2023): July
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v1i2.700

Abstract

Background: Meige syndrome is a form of cranial dystonia characterised by blepharospasm and oromandibular dystonia, with a twice-fold higher prevalence in women as compared to men. The definitive pathophysiology underlying Meige syndrome remains unknown, but some studies have postulated the role of striatal dopaminergic activity. Currently, no curative treatments are available for Meige syndrome, but non-specific modalities include oral agents such as anti-cholinergics, dopaminergics, and benzodiazepines. Botulinum toxin Type-A (BoNTA) constitutes an effective treatment option in cases of Meige syndrome refractory to oral management. Case: We report three cases of female patients, age 42, 57, and 61 years, presenting with complaints of blepharospasm and oromandibular dystonia. Discussion: Low-dose BoNTA injections were administered, 10 units total weekly divided into the orbicularis oculi, corrugator supercilii, frontalis, procerus, nasalis, zygomaticus, mentalis, dan risorius, and orbicularis oris areas. Following repeated administrations of BoNTA injections, the three patients no longer experience symptoms up till now. Conclusion: The authors report that low-dose BoNTA injections are effective in ameliorating dystonic symptoms associated with Meige syndrome, with low incidences of side effects.
Sturge - Weber Syndrome: A Glimpse into A Rare Clinical Diagnosis Ketaren, Retno Jayantri; Cenadi, Jacob Christian
Magna Neurologica Vol. 3 No. 2 (2025): July
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v3i2.1823

Abstract

Background: Sturge-Weber syndrome is a spectrum of neurocutaneous disorders characterized by angiomas involving the face, choroid, and leptomeninges. Patients present with the typical “port wine stain”, acute seizure onset, and increasing hemiparesis. Case: A 1-year-old female presented to the ED with a seizure that coincided with a fever. The patient had two generalized tonic-clonic seizures in a day, which lasted less than 5 minutes. Before this, the patient had a history of seizures that started at 6 months old. The patient had an erythematous patch covering the right side of her face, along with left-sided weakness and positive plantar reflex on the left foot. Head non-contrast MRI scan showed a hypointense lesion/blooming artifact in the right frontal lobe on T2FFE and a prominent vascular structure on the right frontal lobe, accompanied by the widening of multiple veins and sinuses. Discussion: Sturge-Weber syndrome is complete when both facial angioma and leptomeningeal involvement are present. Diagnosis is confirmed through clinical features, with seizures and hemiparesis correlating to imaging findings. In our patient’s case, a type I Sturge-Weber syndrome diagnosis was made. The patient was started on oral anticonvulsants and future controls. Conclusion: Sturge-Weber syndrome is a clinical syndrome with many neurological complications. The lack of specific treatment urges an early diagnosis, as it can affect the patient’s outcome.
Pediatric Epilepsy Surgery in A Drug-Resistant Epilepsy Patient Aggravated by SARS-CoV-2: A Case Report Samudra, Edeline; Ketaren, Retno Jayantri; Inggas, Made Agus Mahendra
Magna Neurologica Vol. 3 No. 2 (2025): July
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v3i2.1882

Abstract

Introduction: Epilepsy is a manageable neurological disorder, but about one-third of cases are classified as drug-resistant epilepsy (DRE). DRE in pediatrics is more complex and may lead to cognitive function impairment, while surgery can offer seizure control in cases of focal DRE. Case: A 10-year-old male presented with a four-year history of recurrent seizures, thought to be caused by a left temporal cerebral cyst diagnosed five years earlier. During episodes, he experienced body stiffness, bilateral eye twitching, and drooling, with intact consciousness. After SARS-CoV-2 exposure, seizures became more frequent despite antiepileptic treatment, leading to partial resection of the left temporal lobe nine months later. Two years post epileptic surgery, he has become drug-responsive and achieved seizure control with symptomatic relief through medication. Discussion: Epilepsy is common in children, and DRE should be considered in cases of intractable epilepsy. Various factors can cause DRE, and in this patient, SARS-CoV-2 is thought to aggravate seizures by binding to ACE2 receptors in the central nervous system. This neural interaction may trigger reactive astrogliosis and neuroinflammation, disrupting the balance between glutamate and GABA levels. However, epilepsy surgery has been effective in improving the quality of life. Conclusion: Epilepsy surgery, either resective or non-resective surgery, is still rarely performed in Indonesia, while the management of DRE may require surgery. Although complete seizure freedom is not guaranteed, surgery can often convert DRE into a drug-responsive condition.
Pharmacoresistant Temporal Lobe Epilepsy Controlled by Bilateral Anterior Thalamic Nuclei Thalamotomy Inggas, Made Agus Mahendra; Ketaren, Retno Jayantri; Puspitasari, Vivien; Wahyoepramono, Julianta
Eduvest - Journal of Universal Studies Vol. 5 No. 1 (2025): Journal Eduvest - Journal of Universal Studies
Publisher : Green Publisher Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59188/eduvest.v5i1.50815

Abstract

Introduction: Several potential targets have been suggested for the treatment of pharmacoresistant epilepsy, including medial parts of temporal lobes, caudate nucleus, cerebellum, centromedian nucleus of the thalamus, subthalamic nucleus and anterior thalamic nucleus (ATN). The effectiveness of bilateral ATN thalamotomy as treatment option for pharmacoresistant temporal lobe epilepsy is a considerable approach in this recent advances. Method: Case report. Result: A 24-year old male patient presented with unknown onset of generalized tonic clonic seizures and serials of drop attacks since 4 years of age. He was also diagnosed with Attention Defcit Hyperactivity Disorder (ADHD) and a history of febrile seizures. Brain MRI was normal. He has been treated with so many combination of antiepileptic drugs (AEDs) with last combination were Valproic acid 500 mg twice daily, Clonazepam 2 mg thrice daily and Zonisamide 100 mg twice daily. Despite all polytherapy AEDs given, he was still having recurrent seizures. Vagal Nerve Stimulation (VNS) was then conducted and seizures were slightly better. After maximal VNS voltage given, seizures became more frequent. ATN bilateral thalamotomy was done five years after, where seizure was better controlled. Levetiracetam 500mg twice daily and phenobarbital 15 mg once was given in concordance to the surgery, and the patient is doing well until now. Conclusion: In pharmacoresistant temporal lobe epilepsy where AEDs and VNS showed no signifcant improvement, ATN bilateral thalamotomy is considered to be a compelling treatment option. As we know, this is a first case report for ATN thalamotomy for epilepsy in south east asia region.
EFFECT OF LOW-DOSE BOTULINUM TOXIN ON HEMIFACIAL SPASM SEVERITY Wirawan, Clarissa; Siahaan, Yusak Mangara Tua; Suryawijaya, Evlyne Erlyana; Ketaren, Retno Jayantri
MNJ (Malang Neurology Journal) Vol. 12 No. 1 (2026): January
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2025.012.01.02

Abstract

Background: Hemifacial spasm is a condition in which there are unilateral contractions of facial muscles. One of the most effective forms of treatment is botulinum toxin injections. However, this therapy only temporarily relieves symptoms, so repeated injections are necessary. This may place a significant economic strain on patients. Due to this, this study aims to see if low-dose botulinum toxin reduces the severity of hemifacial spasm. Objective: To find out whether there is an effect of low-dose botulinum toxin on the severity of hemifacial spasm. Methods: This study is a paired comparison test with a retrospective cohort design. Primary (HFS Score) and secondary (medical record) data was collected from hemifacial spasm patients at Siloam Hospitals Lippo Village Building B. Results: Data was collected from the 36 patients that fulfilled the inclusion and exclusion criteria. All patients were treated with 10 U or less of botulinum toxin. Results show that for HFS Clinical there was a decrease from a mean of 13,03 ± 2,077 to 6,44 ± 2,311 (p < 0,001), whereas HFS Subjective decreased from a mean of 401,53 ± 229,748 to 95,42 ± 151,607 (p < 0,001). Both components have a p-value < 0,001, making it statistically significant. Conclusion: Low-dose botulinum toxin affects the severity of hemifacial spasm in patients at Siloam Hospitals Lippo Village Building B.
Unknown Risk Factor in Pediatric Ischemic Stroke: Challenges in A Developing Country Samudra, Edeline; Ketaren, Retno Jayantri
Magna Neurologica Vol. 4 No. 1 (2026): January
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v4i1.2101

Abstract

Background: Stroke is a sudden neurological disturbance with high mortality rates in both children and older people. Pediatric stroke is rare but can lead to lifelong disability due to the immaturity of the brain, and its management can be challenging. Case: A 23-year-old female presented with a history of right-sided weakness and spasticity that began 11 years ago and improved over the past two years. Risk factors that could be excluded were ruled out, while congenital disorders could not be investigated due to financial constraints. Diagnosed with non-hemorrhagic stroke at age 12, an MRI revealed an old infarct in the left internal capsule. The absence of known risk factors underlying her ischemic stroke made a congenital disorder a plausible diagnosis. She was given botulinum toxin type A (BoNT-A) injections to manage spasticity, and her symptoms improved. In the past year, she developed mood disturbances and sleep difficulties, which were treated with quetiapine. Discussion: The pediatric brain is metabolically more active with higher cerebral blood flow demands, making it more susceptible to focal neurological injuries. Most pediatric strokes are ischemic, with numerous potential risk factors including cardiac issues, vasculopathy, coagulopathies, infections, and congenital disorders with vascular complications. Treatment for pediatric ischemic stroke is similar to that in adult cases. In this patient, BoNT-A injections reduced acetylcholine release, effectively treating the patient’s spasticity. Conclusion: Stroke can occur at any age, with pediatric strokes potentially resulting in worse outcomes. Therefore, thoroughly evaluating diverse potential etiologies, including congenital disorders, is crucial.
Co-Authors Cenadi, Jacob Christian Hartoyo, Vinson M.T. Siahaan, Yusak Made Agus Mahendra Inggas, Made Agus Mahendra Margono, Jacqueline Tasha Samudra, Edeline Stevano, Reza Suryawijaya, Evlyne Erlyana Tiffani, Pamela Vivien Puspitasari, Vivien Wahyoepramono, Julianta Wirawan, Clarissa