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THE EFFECTIVENESS OF INTERFERON BETA-1A IN MANAGEMENT OF MULTIPLE SCLEROSIS: A CASE REPORT Puspitasari, Vivien; Sutanto, Anyeliria; Pangestu, Aristo Rinaldi
MNJ (Malang Neurology Journal) Vol. 6 No. 2 (2020): July
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

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Multiple sclerosis is a chronic autoimmune disease that attacks myelin in the central nervous system. About 2.5 million people worldwide have been diagnosed with multiple sclerosis. Its clinical presentation could vary according to the location of the lesion. Interferon beta is the most commonly used as immunomodulation therapy. However, its effectiveness for long-term use is still questionable. We report a case of 24-year-old woman with complaints of ataxia and limb weakness which were diagnosed as multiple sclerosis relapsing remitting (MSRR) and treated with interferon beta 1a for five years. During routine interferon beta 1a treatment three times a week, patient has still experienced four episodes of relapse in spite of good compliance. Hence, the rare presence of neutralizing antibodies was suspected. It commonly occurs after a year of interferon therapy, which is consistent with the patientâ€™s treatment history. Further biomarker testing of drug-specific antibodies might be valuable to find out the possibility of interferon resistance

Role of Span-75 in Determining Prognosis of Non-Thrombolysis Acute Ischemic Stroke Patients Sutanto, Anyeliria; Simanungkalit, Astra Dea; Yunita, Evelyn; Chandra, Anastasya; Pangestu, Aristo; Tiffani, Pamela
Medicinus Vol 9, No 2 (2020): February : 2020
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v7i7.2759

Introduction: The SPAN-75 index is a modification of the SPAN-100 index as a prognostic tool in acute ischemic stroke patients. Previous studies were using SPAN index in cases of ischemic stroke patients treated with rTPA and in cases of intracerebral hemorrhage.Aim: To determine the role of the SPAN-75 index as a prognostic scoring in patients with acute ischemic stroke who did not get thrombolysis therapy.Method: The subjects were acute ischemic stroke patients at Siloam Hospitals Lippo Village who were not treated with thrombolysis therapy and had no disability before stroke onset during January to April 2019. Subjects were classified into a positive and negative of SPAN-75 index group. Disability due to stroke was assessed with Modified Rankin Score (mRS) at the time of admission and discharged from the hospital. This prospective study was analyzed by the Kruskal-Wallis test.Result: Forty subjects (average age of 57 years old) consisted of 31 negative and 9 positive of SPAN-75. Based on the Kruskal-Wallis test, the SPAN-75 index was positively associated with a more severe degree of stroke disability at the time of admission (p = 0.002), but not related to the change in the degree of disability when the patient was discharged from the hospital (p = 0.807). Age (p = 0.445) and gender (p = 0.578) had no significant relationship with the degree of disability of acute ischemic stroke.Conclusion: The SPAN-75 index is related to the degree of disability of acute stroke patients at the time of admission.

Clinical Spectrum of Neurological Complaints in COVID-19: Experiences from a COVID-19 Referral Hospital in Indonesia Situmeang, Rocksy Fransisca V.; Simanungkalit, Astra Dea; Sutanto, Anyeliria; Pangestu, Aristo
Medicinus Vol 10, No 3 (2021): June 2021
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v9i1.4195

Background: The main feature of COVID-19 is symptoms of respiratory system disorder, however, there has been an increase in reports of neurological symptoms that appear in COVID-19 patients. Several previous studies have linked SARS-CoV-2 with nervous system damage. Research studying neurological complaints in confirmed COVID-19 patients in Indonesia is still lackingAim: To identify neurological, laboratory, and imaging findings in COVID-19 patients with neurological symptoms.Methods: This study was a cross-sectional observational study conducted at Siloam Hospitals Mampang, a COVID-19 referral hospital in South Jakarta. We analyzed medical records of confirmed COVID-19 patients during the period of April - July 2020. The data collected included demographic data, comorbidities, neurological manifestations, laboratory examinations, and neuroimaging.Results: There were 22 confirmed COVID-19 patients with neurological complaints referred to a neurologist. The mean age of patients was 60.4 (SD 15.8) years. The most common neurological complaints were altered mental status (50%), hemiparesis (27.3%), and tremors (22.7%). More than half of the patients (81.8%) had a comorbid condition or past history related to neurological symptoms. Laboratory examination results showed increased NLR (neutrophil-lymphocyte ratio) (50%), anemia (45.5%), and leukocytosis (40.1%). The most common neuroimaging feature was infarct (50%) in the brain CT scan.Conclusion: The neurological complaints in COVID-19 patients are mostly associated with exacerbation of pre-existing comorbidities as a result of the severe inflammatory process triggered by COVID-19. Further research is needed to establish the mechanism of nervous system dysfunction in COVID-19.

Role of Span-75 in Determining Prognosis of Non-Thrombolysis Acute Ischemic Stroke Patients Sutanto, Anyeliria; Simanungkalit, Astra Dea; Yunita, Evelyn; Chandra, Anastasya; Pangestu, Aristo; Tiffani, Pamela
Medicinus Vol. 9 No. 2 (2020): February : 2020
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v7i7.2759

Introduction: The SPAN-75 index is a modification of the SPAN-100 index as a prognostic tool in acute ischemic stroke patients. Previous studies were using SPAN index in cases of ischemic stroke patients treated with rTPA and in cases of intracerebral hemorrhage.Aim: To determine the role of the SPAN-75 index as a prognostic scoring in patients with acute ischemic stroke who did not get thrombolysis therapy.Method: The subjects were acute ischemic stroke patients at Siloam Hospitals Lippo Village who were not treated with thrombolysis therapy and had no disability before stroke onset during January to April 2019. Subjects were classified into a positive and negative of SPAN-75 index group. Disability due to stroke was assessed with Modified Rankin Score (mRS) at the time of admission and discharged from the hospital. This prospective study was analyzed by the Kruskal-Wallis test.Result: Forty subjects (average age of 57 years old) consisted of 31 negative and 9 positive of SPAN-75. Based on the Kruskal-Wallis test, the SPAN-75 index was positively associated with a more severe degree of stroke disability at the time of admission (p = 0.002), but not related to the change in the degree of disability when the patient was discharged from the hospital (p = 0.807). Age (p = 0.445) and gender (p = 0.578) had no significant relationship with the degree of disability of acute ischemic stroke.Conclusion: The SPAN-75 index is related to the degree of disability of acute stroke patients at the time of admission.

Clinical Spectrum of Neurological Complaints in COVID-19: Experiences from a COVID-19 Referral Hospital in Indonesia Situmeang, Rocksy Fransisca V.; Simanungkalit, Astra Dea; Sutanto, Anyeliria; Pangestu, Aristo
Medicinus Vol. 10 No. 3 (2021): June 2021
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v9i1.4195

Background: The main feature of COVID-19 is symptoms of respiratory system disorder, however, there has been an increase in reports of neurological symptoms that appear in COVID-19 patients. Several previous studies have linked SARS-CoV-2 with nervous system damage. Research studying neurological complaints in confirmed COVID-19 patients in Indonesia is still lackingAim: To identify neurological, laboratory, and imaging findings in COVID-19 patients with neurological symptoms.Methods: This study was a cross-sectional observational study conducted at Siloam Hospitals Mampang, a COVID-19 referral hospital in South Jakarta. We analyzed medical records of confirmed COVID-19 patients during the period of April - July 2020. The data collected included demographic data, comorbidities, neurological manifestations, laboratory examinations, and neuroimaging.Results: There were 22 confirmed COVID-19 patients with neurological complaints referred to a neurologist. The mean age of patients was 60.4 (SD 15.8) years. The most common neurological complaints were altered mental status (50%), hemiparesis (27.3%), and tremors (22.7%). More than half of the patients (81.8%) had a comorbid condition or past history related to neurological symptoms. Laboratory examination results showed increased NLR (neutrophil-lymphocyte ratio) (50%), anemia (45.5%), and leukocytosis (40.1%). The most common neuroimaging feature was infarct (50%) in the brain CT scan.Conclusion: The neurological complaints in COVID-19 patients are mostly associated with exacerbation of pre-existing comorbidities as a result of the severe inflammatory process triggered by COVID-19. Further research is needed to establish the mechanism of nervous system dysfunction in COVID-19.

Factors Affecting Progonosis in Tuberculous Meningoencephalitis Puspitasari, Vivien; Sutanto, Anyeliria; Stevano, Reza; Djuanda, Gerald
Acta Neurologica Indonesia Vol. 1 No. 01 (2023): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v1i01.7

Introduction: Cases of tuberculosis is still highly prevalent in the world, including Indonesia.Tuberculous meningoencephalitis (TBME) is the most severe form of tuberculosis. This study aims to establish the factors affecting prognosis in TBME. Objective: To Identify the clinical factors that affect the prognosis of tuberculous meningoencephalitis patients. Material and Methods: This is cross-sectional study evaluating factors (clinical features, imaging, and treatment) affecting prognosis in TBME patients who underwent treatment in Siloam Hospitals Lippo Village. Univariate analyses was done, followed by bivariate analyses with logistic regression to compare factors between good (Glasgow outcome scale [GOS] 4-5) and poor (GOS 1-3) prognosis. Results and Discussion: 64 patients were included. On univariate analysis, significant differences was found between Glasgow coma scale (GCS) scores (p=0.012), clinical features of meningeal irritation (p=0.004), findings of hydrocephalus (p=0.023) and vasculitis/infarction (p=0.020) on imaging, antibiotic use (p=0.013), and MRC grading (p=0.008). On logistic regression, 4 factors were found to be significant: headache (OR 5.398 95% CI 1.165-25.008, p=0.031), meningeal irritation (OR 0.146 95% CI 0.026-0.813, p=0.028), hydrocephalus (OR 0.167 95% CI 0.032-0.881, p=0.035), and antibiotic use (OR 0.155 95% CI 0.034-0.717, p=0.017). Conclusion: Clinical manifestations of meningeal irritation and altered consciousness, imaging findings of hydrocephalus and vasculitis/infarction, and antibiotic usage is associated with poor prognosis, while presence of headache is associated with a better prognosis.

Dilemmatic Intersection in Cryptococcal Meningitis Treatment: Side Effects, Drug Resistance, and Efficacy Japutri, Josephine; Lalisang , Lilie; Sutanto, Anyeliria
Acta Neurologica Indonesia Vol. 3 No. 04 (2025): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v3i04.64

Background Fluconazole resistance in Cryptococcus neoformans is progressively increasing over the past 10 years, particularly in developing countries, which reached 43.6% resistance rate. This case demonstrates the emerging dilemma of cryptococcal meningitis management with antifungal resistance. Case Summary A 31-year-old male with HIV presented with severe headache, hearing loss, and fever. Brain imaging was within normal limits, and CSF analysis showed increased cell count (86, PMN 10, MN 76), elevated protein, glucose ratio <0.4, positive India ink, and positive Cryptococcus Ag, leading to a diagnosis of cryptococcal meningitis. He was treated with IV Amphotericin B for 14 days and Fluconazole, but developed acute kidney injury (AKI), delaying further fluconazole therapy. One month later, he returned with severe headache; CSF re-analysis showed positive Cryptococcus culture and fluconazole resistance. The patient was treated again with IV Amphotericin B for 14 days. Discussion Azole resistance in Cryptococcus spp is associated with ERG11 gene mutation which is the fluconazole’s target. Interruption of fluconazole in cryptococcal meningitis during the theraphy phase could be the risk factor for acquired resistance. The minimum inhibitory concentrations (MIC) test can help in the selection of therapy with Cryptococcus breakpoint for fluconazole susceptibility is MIC < 8 μg/mL. In previous cases, itraconazole and voriconazole were proven to replace fluconazole. However, in this case, there were limitations in costs and treatment coverage. Conclusion Drug evaluation in parallel with treatment in Cryptococcal meningitis, with prior fluconazole use or delayed therapy, is recommended. Keywords: Cryptococcal Meningitis, HIV, Fluconazole resistance

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