Article Per Year (5 Year)
p-Index From 2021 - 2026
2.109
P-Index
This Author published in this journals
All Journal Sari Pediatri Paediatrica Indonesiana Jurnal Respirologi Indonesia Oto Rhino Laryngologica Indonesiana Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia Narra J Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Junior Medical Journal
Irawan Mangunatmadja
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia Jakarta
Religion Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

Published : 52 Documents Claim Missing Document
Claim Missing Document
Check
Articles

Found 52 Documents
Search

 2   3   4   5   6 
Therapeutic reassessment of first-line antiepileptic drugs in pediatric patients unresponsive to second-line agents: a randomized trial in Jakarta Perdani, Roro Rukmi Windi; Arozal, Wawaimuli; Mangunatmadja, Irawan; Kaswandani, Nastiti; Handryastuti, Setyo; Medise, Bernie Endyarni; Wardani, Amanda Saphira; Thandavarayan, Rajarajan Amirthalingam; Oswari, Hanifah; Lee, Hee Jae
Paediatrica Indonesiana Vol. 65 No. 6 (2025): November 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Background Epilepsy has a significant incidence in children, with 20-25% resistance to standard antiepileptic drugs (AEDs). Drug-resistant epilepsy (DRE) refers as the failure of two or more AEDs, either as monotherapies or in combination, to achieve seizure freedom, which includes the absence of all seizure types, even auras. Treatment algorithms for children with epilepsy range from starting with the lowest effective dose to using add-on or substitution therapy of AEDs. It usually started from using first-line AEDs (valproic acid, phenytoin, phenobarbital, carbamazepine) with titrated dose based on the patient condition, if seizure persist, another first-line AEDs may be added or substituted. Second-line AEDs (topiramate, levetiracetam, oxcarbazepine) are introduced when seizure persist despite optimal doses of first-line drugs with good compliance. Epilepsy treatment response is a dynamic process, not a fixed state. In some cases, repeating the medication cycle remains an option, as patient may initially appear drug-resistant but later respond to treatment. Thus, first-line AEDs may also serve as substitution therapy in children unresponsive to second-line agents as studies show comparable effectiveness between the two regimens. Objective To evaluate the efficacy and safety of first-line AEDs as substitution therapy (intentional replacement of patient’s current medication) in children resistant to second-line AEDs. Methods This 12-week, open-label, multicenter, randomized controlled trial was conducted in 91 epileptic children. Children aged 1 – 18 years with DRE, were randomized into the intervention (patients who received substitution therapy:  one AEDs was changed to first-line of AEDs) and control (patients who got standard therapy: one AEDs was changed to second-line of AEDs) groups. The primary outcome was the difference in the proportion of responders between the two groups. Secondary outcomes were analyzing the different improvements in quality of life (QoL), EEG feature, and time to achieve seizure reduction in both groups. The QoL was assessed by Quality of Life in Childhood Epilepsy Questionnaire 55 (QOLCE-55) to assess cognitive, emotional, social, and physical functions. Results There were no significant differences in the proportion of responders between the substitution therapy group (62.5%) and the standard therapy group (68.4%). Both groups experienced substantial reductions in seizure frequency, ranging from 78% to 80%. For further analysis, the average difference of seizure frequency before and after intervention was statistically significant in each group, it was P=0.000 in substitution group and P=0.00 in standard group. The analysis of quality of life showed the mean of total score in both groups was low even though the score was higher in the substitution group. For spesific function of quality of life, the cognitive and social function, was improved significantly in the group p<0.05). However, there were no significant differences of EEG improvement, seizure duration, time to achieve seizure frequency reduction, or adverse effects between the two groups. Conclusions First-line AEDs have comparable efficacy as second-line AEDs with mild to moderate adverse effects in DRE children. Thus, the repeated use of first-line AEDs as substitution therapy might be an option for children who resistant to second line AEDS.
Effectiveness of short-term modified Atkins diet and classic ketogenic diet in pediatric intractable epilepsy: a systematic review and meta-analysis Maulena, Ufik; Agustina, Nenden Nursyamsi; Mangunatmadja, Irawan
Paediatrica Indonesiana Vol. 65 No. 6 (2025): November 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Background Dietary treatments such as the classic ketogenic diet (cKD) and the modified Atkins diet (MAD) have shown promise in the medical management of refractory epilepsy. Objective To investigate the efficacy of the modified Atkins diet and classic ketogenic diet in managing intractable epilepsy in children by systematic review and meta-analysis. Methods This systematic review followed the preferred reporting items for systematic review and meta-analysis (PRISMA). We carried out an overview on Google Scholar, Scopus, and PubMed to find pertinent studies. Only researches that directly compared cKD and MAD were included in this study. A random-effect model was used to calculate pooled effect sizes as risk ratios (RRs) with 95% confidence intervals (CIs). The primary outcome was seizure frequency reduction (SFR) >50%. Secondary outcomes included SFR >90% and seizure freedom. Results Of 1,013 articles screened, 7 studies with a total of 455 patients (214 on MAD and 241 on cKD) met the inclusion criteria. There were no significant differences in the proportion of patients with seizure frequency reduction (SFR >50% (RR 1.12; 95%CI 0.70 to 1.80; P=0.64), SFR >90% (RR 0.83; 95%CI 0.57 to 1.20; P=0.33, respectively), or those who were seizure free (RR 1; 95%CI 0.7 to 1.42; P=0.99, respectively). However, each study in our review revealed that both cKD and MAD groups achieved significantly more SFR >50%,  SFR >90%, and seizure-free than before the diet. No improvement were seen in these outcomes after diet intervention. Conclusion In managing refractory childhood epilepsy, the efficacy of cKD and MAD are not significantly different.
Co-Authors A. C. Van Huffelen Abdul Latief Adrian Prasetya Sudjono Agatha Geraldyne Agung Putra Agung Triono Agus Firmansyah Agus Firmansyah Agus Firmansyah Agustina, Nenden Nursyamsi Alan Roland Tumbelaka Alifiani H. Putranti Aman Pulungan Amanda Seobadi Andreas, Yana Anna Tjandradjani Anton Dharma Saputra Antonius H. Pudjiadi Antonius Pudjiadi Aryono Hendarto Asep Aulia Rachman Ayuningtyas, Talitha Rahma Bambang Tridjadja, Bambang Bambang Tridjaja AAP, Bambang Tridjaja Bernie Endyarni Medise Budiati Laksmitasari Citra Raditha Conny Tanjung Cut Nurul Hafifah Daisy Widiastuti Danu, Nugroho Darlan, Dewi M. Darmawan B. Setyanto Daulay, Rini S. Deasy Grafianti Dedy Rahmat Dheeva Noorshintaningsih Dina Indah Mulyani, Dina Indah Dini Prima Utami Dwi P. Widodo Dwi Putro Widodo Dwi Putro Widodo Dwi Putro Widodo E S Herini Elisabeth Siti Herini Endang Windiastuti Eva Devita Harmoniati Evita Bermansyah Ifran Fathy Pohan Fatmawaty Fatmawaty Fijri Auliyanti H F Wulandari Hanifah Oswari Hardiono D Pusponegoro Hardiono D. Pusponegoro Hardiono D. Pusponegoro Hardiono D. Pusponegoro, Hardiono D. Hartono Gunardi Hartono Gunardi Haryanti Fauziah Wulandari Herlina Herlina Hidra Irawan Satari Hikari Ambara Sjakti, Hikari Ambara I. Budiman Idham Amir, Imral Chair Inez Ayuwibowo Sangwidjojo Iqbal Taufiqqurrachman Irene Yuniar, Irene Irma Rochima Puspita Iskandar Japardi Isman Jafar Ismy, Jufitriani Jasin, Madeleine Ramdhani Joanna Erin Hanrahan KHOIRUL ANAM Kristian Kurniawan Lee, Hee Jae Lenny S. Budi Lily Rundjan Luh Karunia Wahyuni, Luh Karunia Mardjanis Said Mardjanis Said Marissa Tania Stephanie Pudjiadi Masayu Rita Dewi Maulena, Ufik Melinda Harini Merci Monica br Pasaribu Mulya Rahma Karyanti, Mulya Rahma Mulyadi M. Djer Murti Andriastuti, Murti Muzal Kadim Nahari Arifin Najib Advani Nastiti Kaswandani Nia Kurniati Nur Hayati Pamungkas, Indra Parmaditya Partini Pudjiastuti Trihono Purboyo Solek Pustika Amalia Pustika Amalia Putri, Armitha Putri, Shally Adhina Adhina R. H. J. M Gooskens Rachmawati, Elvie Zulka Kautzia Rafli, Achmad Rina W Sundariningrum Rinawati Rohsiswatmo Rini Sekartini Risma Kerina Kaban Rismala Dewi Rizal Agus Tiansyah Ronny Suwento, Ronny Roro Rukmi Windi Perdani, Roro Rukmi Rosalina Roeslani Rosary Rosary Rulina Suradi Rulina Suradi Rulina Suradi Rusda, Muhammad Safarina G. Malik Santoso, Dara Ninggar Sari, Teny T. Setyanto, Darmawan Budi Setyo Handryastuti Sisca Silvana, Sisca Soebadi, Amanda Soedjatmiko Soepardi Soedibyo Sri Rezeki Hadinegoro Sri Sofyani, Sri Sudigdo Sastroasmoro Sudjatmiko Sudjatmiko Sudung O Pardede, Sudung O Sudung O. Pardede Sudung O. Pardede, Sudung O. Sukman Tulus Putra Sukmono, Suryawati Susanti Himawan Tantri, Aida Rosita Taralan Tambunan Taralan Tambunan Taralan Tambunan Taralan Tambunan Tatang M. Puspandjono Teny Tjitra Sari, Teny Tjitra Thandavarayan, Rajarajan Amirthalingam Titis Prawitasari, Titis Tri Lestari Handayani Tuty Victor Prasetyo Poernomo Vimaladewi Lukito Wahyuni Indawati, Wahyuni Wardani, Amanda Saphira Wawaimuli Arozal Wicaksono, Yuda Satrio Winny N Wishwadewa Wulandari, Harjanti F Yazid Dimyati Yeti Ramli Yeti Ramli Yuliarti, Klara Zizlavsky, Semiramis