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Journal : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Catamenial epilepsy Harsono Harsono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 34, No 01 (2002)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

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Abstract

The true frequency of menstrually related seizures (catamenial epilepsy) is unclear. This is due in part to the fact that at present there is no universally accepted definition of this entity. Because of such arbitrary definition, a variety of therapeutic strategies for controlling seizures related to hormonal fluctuations have been recommended. With respect to the uncertainty of catamenial epilepsy criteria, the principles of physiologic changes related to hormonal fluctuations in women with epilepsy should be understood. Based on the knowledge of hormonal changes and characteristics of epilepsy, a detailed history taking should be carried out properly. This strategy will be useful for establishing diagnosis and planning appropriate treatment.Keywords: catamenial epilepsy - definition - seizure - therapeutic strategy - hormonal fluctuations.
Prognosis Epilepsi Harsono Harsono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 30, No 03 (1998)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

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Abstract

Prognosis is defined as the chance of recovery from a certain condition. Strictly, in epilepsy this means the chance of terminal remission once a patient has established a pattern of recurrent epileptic seizures. Questions concerning duration of treatment and long-term prognosis in childhood epilepsy are often raised by parents whose children are starting therapy with antiepileptic drugs. Many studies have focused on those issues and have examined the risk factors for poor prognosis as well as the risk of recurrence of seizures. The wide variation found in the risk of recurrence among those who have had a first seizure seems to be explained by differences In study design or differences in the characteristics of the study groups. In addition, the study of the prognosis of epilepsy has been confounded because of the fact that epilepsy is an expression of so many different underlying etiologies and syndromes.Prognosis of epilepsy should be informed clearly to the patients and/or parents. The clear information will improve the patient compliance in taking medication for a long time.Key Words : prognosis of epilepsy - remission - antiepileptic drugs - risk factors - recurrent epileptic seizures
Epilepsi refrakter Harsono Harsono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 28, No 03 (1996)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

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Abstract

In most patients with epilepsy the prognosis for seizure control is very good. However, about 10-20% of patients develop chronic or refractory epilepsy despite the advent of new antiepileptic drugs and intensive monitoring. Meanwhile, the definition of refractory or intractable epilepsy may vary, and a correct diagnostic work-up is of the utmost importance for the choice of treatment. Refractory epilepsy represents a challenge for both experimental and clinical research to obtain knowledge about why and how it develops and whether the condition can be prevented by early and adequate treatment. Definitions and epidemiology, experimental models, diagnostic evaluation, consequences, risk and costs, medical management, neurosurgery, and vagus stimulation are all important elements in managing refractory epilepsy. When dealing with therapy-resistant patients, a systemic step-by-step evaluation is essential. This includes: diagnosis, seizure/syndrome classification, aetiological considerations, review of drug treatment hitherto given, and evaluation of significant learning and psychosocial problems.Key words : refractory epilepsy - seizure - diagnostic evaluation - medical management - aetiological consideration
Therapy of epilepsy Harsono Harsono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 27, No 02 (1995)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

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Abstract

Effective treatment of epilepsy requires accurate diagnosis. This relies heavily on proper identification of seizure type. Successful drug therapy requires a proper understanding of medication half-life and indications.Accurate diagnosis cannot be established easily since diagnosis of epilepsy relies on history taking and most of the patients do not show any clinical abnormality. Furthermore, diagnosis of epilepsy needs details of seizure type. This may be more difficult to be identified because information on the patients/their relatives are insufficient. Meanwhile, problems related to anti-epileptic drugs comprise poor understanding of the drugs, anticonvulsant interactions, development of adverse drug reactions, boring and poor compliance in taking medicine. Continuing medical education is one of the methods to solve the problems.Psychosocial conditions may interfere the treatment. In addition, any physician who cares epileptic patients should have comprehensive understanding of the patients condition including his/her family. On the other hand, the patients and/or their relatives should have proper information concerning the diagnosis, therapy, and prognosis of epilepsy.Health Centers, particularly ,in the rural areas, should have sufficient competence to manage epileptic patients. Good referral system will improve the competence and the patients will get some advantages.Key words: epilepsy - correct diagnosis - continuing medical education - psychosocial conditions - health centerĀ 
Stroke rehabilitation Harsono Harsono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 26, No 01 (1994)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

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Abstract

Patients with stroke, particularly during the hours following the acute episode, are in evolution, undergo various stages of pathophysiological readjustment. The brain lesion plays an important role in this process. In addition to affecting the central nervous system function, it keeps a close pathophysiological relationship with the respiratory system, the circulatory system, and all systems that participate in keeping the internal milieu in balance. These systems are often altered secondary to the brain lesion, but in other cases they are directly or indirectly responsible for the brain lesion or are worsening.The pathophysiological interrelation in all seriously ill or potentially seriously ill patients is of great importance, and of course, the same is true in stroke patient. Hence management is required that the treatment should be integrated and not divided by systems or according to the various medical specialties. The importance of comprehensive rehabilitation for the stroke patients with complex physical, psychic and social problems should be underlined. Medical, social, psychological and vocational measures must start early. They must be coordinated and usually applied more or less simultaneously.Key Words: stroke- internal milieu-medical specialty-management of treatment- comprehensive rehabilitation
Post-traumatic syndrome Harsono Harsono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 25, No 01 (1993)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

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Abstract

Post-traumatic syndrome is a constellation of symptoms that developed in a person usually following a relatively minor head injury. It can grossly in capacitating for the patient and can develop a chronicity that makes it almost a change in personality. The commonest symptoms are headache, and dizziness; but impairment of sleep, decreased concentration and libido, anxiety, depression, irritability and sensitivity to noise are also seen.The cause of the syndrome is a ,contentious issue. The question whether it is primarily of psychological or organic origin remains unanswered in many cases. Organic or phychogenic, each symptom by itself is of little consequence, but in combination they may be disabling enough to prevent useful employment. Furthennore, the development of the syndrome of any head injury is not easy to be predicted.Key Words: post-traumatic syndrome headache neurotic personality depression amnesia
Multiple Sclerosis in the Tropics: four Additional Cases Harsono Harsono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 22, No 02 (1990)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

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Abstract

Multiple sclerosis merupakan penyakit yang bersifat kronis progresif, yang dalam perjalanan kliniknya dicirikan oleh sifat yang khas, yaitu remisi dan eksaserbasi. Sampai dengan saat ini multiple sclerosis masih dianggap sebagai suatu penyakit auto-imun atau suatu penyaldtyang disebabkan oleh infeksi virus.Prevalensi multiple sclerosis di Indonesia belum diketahui. Pada umumnya prevalensi multiple sclerosis di negara-negara Asia sangatrendah, kurang dari 5 per 100 000; bahkan ada anggapan bahwa multiple sclerosis tidak diremukan di negara tropic.Dilaporkan empat kasus multiple sclerosis yang ditemukan di Daerah Istimewa Yogyakarta dalam kurun waktu 9 tahun terakhir. Di Indonesia laporan kasus ini merupakan laporan yang kedua. Pada tahun 1987 untuk pertama kali telah dilaporkan 3 kasus multiple sclerosis yang dirawat di RSUP Dr. Soetomo, Surabaya.Key Words: multiple sclerosis - atuoimmune disease - echovirus type II - latitude and disease -Schumacher criteria