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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 Indonesian Journal of Global Health Research
Irawan Mangunatmadja
Departemen Ilmu Kesehatan Anak, Fakultas Kedokteran Universitas RS Dr. Cipto Mangunkusumo, Jakarta
Religion Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Co-Infection of Tuberculosis and COVID-19 in Children: A Case Report Jasin, Madeleine Ramdhani; Ayuningtyas, Talitha Rahma; Rafli, Achmad; Mangunatmadja, Irawan; Indawati, Wahyuni; Kaswandani, Nastiti
Jurnal Respirologi Indonesia Vol 44 No 1 (2024)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v44i1.323

Abstract

Background:Coinfection TB and COVID-19 might occur, yet few evidence has been reported. Current COVID-19 pandemic also results in disruption at TB management in the community. Case: A 5-month-old boy came with recurrent seizure, with history of persistent cough and fever for 1 month prior, also positive possible TB contact. The diagnosis was disseminated TB (miliary and meningitis), coinfected with COVID-19.Discussion: During COVID-19 pandemic, TB service in the community is disrupted resulting in delay in TB diagnosis, as observed in this patient, leading to severe manifestation. Coinfection of TB and COVID-19 can occur and may lead to more severe symptoms in either both diseases. Management of TB COVID-19 coinfected children is similar to those without COVID-19. Our patient received treatment consisting of 2 RHZE then 10 RH. Monitoring of symptoms and possible sequelae is necessary.Conclusion: Coinfection TB and COVID-19 may occur in children, and both can lead to more severe manifestation of each condition, particularly if diagnosis is delayed. Strengthening TB care in the community is essential so that there will be no delay in diagnosis, also no disruption in treatment and monitoring.Keywords COVID-19, tuberculosis, coinfection, children
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

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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

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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.
Faktor Risiko Epilepsi Intraktabel pada Anak dengan Epilepsi Umum Irawan Mangunatmadja; Dina Indah Mulyani; Sudung O Pardede; Bambang Tridjadja; Harjanti F Wulandari
Majalah Kedokteran Indonesia Vol 69 No 2 (2019): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.69.2-2019-72

Abstract

Introduction: Several datas studied of intractable epilepsy risk factors areavailable in childhood epilepsy. The objectve of this reasearch to investigatethe role of early or evolution several factors on childhood with generalizedepilepsy as risk factors of intractable epilepsy. Methods: Retrospective cohort study was conducted at neurology out patient pediatric and private outpatient clinic Cipto Mangunkusumo Hospital between January 2010 to December 2013. The inclusion criteria was childhood gener-alized epilepsy with age 1 month up to 18 years old which has been treated with anti epileptic drugs for at least 6 months. Risk factors were analyzed with bivariate and multivariate analysis. Results: Prevalence of intractable generalized epilepsy is 21% of 102 subject. Bivariate analysis showed that age onset of seizure, initial seizure frequency, non-responder of early treatment, unfavorable gross motor development evo-lution and unfavorable epilepti form EEG evolution were significantly associated with intractable epilepsy. Based on multivariate analysis only non-responder of early treatment (p less than 0.001) and age onset less than 1 year old (p less than 0.001). Conclusions. Non-responder early treatment and age onset of seizure less than 1year old are strongly associated with intractable in childhood generalized epilepsy.
Characteristics and risk factors of drug-resistant epilepsy in children: a retrospective study in Jakarta from 2020–2025 Achmad Rafli; Setyo Handryastuti; Irawan Mangunatmadja; Rahmad Mulyadi; Aria Kekalih; Anggi Gayatri; Elisabeth Herini; Wisnu Ananta Kusuma; Citra Raditha; Anna Tjandrajani; Pandu Caesaria Lestari; Yarmaniani Miliati Muchtar
Paediatrica Indonesiana Vol. 66 No. 1 (2026): January 2026
Publisher : Indonesian Pediatric Society

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Abstract

Background Epilepsy is a major chronic neurologic disorder in children. Approximately 30% of pediatric epilepsy cases are drug resistant, posing several diagnostic and therapeutic challenges, as well as social burden and economic loss. Currently, there is little data on pediatric drug-resistant epilepsy (DRE) in Indonesia. Objectives To identify the characteristics of pediatric DRE and analyze for associations of clinical, electroencephalographic, and imaging findings with seizure control status after three months of pharmacologic treatment. Methods This was retrospective study of 164 children with DRE seeking treatment in two national referral hospitals in Jakarta from 2020 to 2025. We collected data on demographic and clinical characteristics, electroencephalography (EEG) results, and brain MRI results. Seizure frequency during and after completion of the first three months of treatment was noted. Results Most patients were diagnosed at <5 years of age (65.6%). The majority of patients (64.6%) received two types of anti-seizure medications (ASMs) and had generalized seizures (84.8%). The most common ASM combination was valproic acid with levetiracetam (43.90%). Interictal electroencephalograms were mostly abnormal without epileptiform patterns (42.7%), followed by abnormal with epileptiform patterns (32.3%). On multivariate analysis, seizure type consistent with an epilepsy syndrome [RR 2.93 (95%CI 1.15 to 7.44); P=0.024], EEG consistent with an epilepsy syndrome [RR 2.21 (95%CI 1.05 to 4.64); P=0.036], and the ASM combination of valproic acid, levetiracetam, and clobazam [RR 1.58 (95%CI 1.13 to 2.21); P=0.007] were significantly associated with poor seizure control. Conclusion Children with DRE who have electroclinical features consistent with an epilepsy syndrome are more likely to have poor seizure control. The ASM combination of valproic acid, levetiracetam, and clobazam is associated with poor seizure control, but causality cannot be inferred from this study.
Changes in gross motor function in children with cerebral palsy and associated factors Hidayah, Nurul; Widodo, Dwi Putro; Mangunatmadja, Irawan; Handryastuti, Setyo
Paediatrica Indonesiana Vol. 66 No. 2 (2026): March 2026
Publisher : Indonesian Pediatric Society

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Abstract

Background Cerebral palsy (CP) is a condition characterized by abnormalities in movement, muscle tone, and posture caused by non-progressive damage to immature brain tissue. Gross motor function is associated with the quality of life and prognosis of children with CP. Objective To observe gross motor changes in cerebral palsy patients based on GMFCS from the time of initial diagnosis compared to the current GMFCS. Methods This was a cross-sectional study with subjects classified into two groups based on GMFCS at the time of CP diagnosis and at the time of the study (April 2018). Group 1 consisted of level I-III GMFCS and group I consisted of level IV-V GMFCS. Data were obtained from the results of two GMFCS measurements: at diagnosis by history-taking and at the time of this study by physical examination. Subjects were 100 children who met the inclusion criteria who were treated at the Child Neurology Polyclinic and the Medical Rehabilitation Polyclinic, FKUI-RSCM. Results The most common characteristics in our CP patients were male gender (61%), full term birth (75%), tetraplegia CP type (66%), abnormal CT findings (83.3%), abnormal head circumference (83%), and epilepsy (61%). There was a significant gross motor skill improvement between the time of initial diagnosis and current gross motor skills (P<0.001) and no subjects had deteriorated. This improvement was influenced by factors such as better outcomes in females compared to males, diplegia-type cerebral palsy compared to tetraplegia, and normal vs. abnormal CT findings. Conclusion Gross motor improvement in children with cerebral palsy varies significantly from initial diagnosis, with better outcomes observed in females, those with diplegia, and those with normal CT findings.
Clinical and Neurophysiological Features of Vincristine-Induced Peripheral Neuropathy in Indonesian Children with Acute Lymphoblastic Leukemia Raden Muhammad Indra; Irsan Saleh; Irawan Mangunatmadja; Yulia Iriani; Zen Hafy; Dian Puspitasari
Indonesian Journal of Global Health Research Vol. 7 No. 6 (2025): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v7i6.584

Abstract

Vincristine-induced peripheral neuropathy (VIPN) is a common complication clinical pattern vary across populations, and data from Indonesian children remain limited. Objectives to describe the clinical and nerve conduction study (NCS) features of VIPN in children with ALL treated at a tertiary hospital in Indonesia. We conducted a cross-sectional study of children with ALL receiving chemotherapy recruited consecutively at Mohammad Hoesin Hospital, Palembang, from November 2023 to August 2025. Data were collected from detailed neurological and NCS examinations. Diagnosis of VIPN was made using NCS. Severity was graded using the Common Terminology Criteria for Adverse Events (CTCAE v5.0). Clinical features and NCS findings were evaluated. Comparisons were made between induction and maintenance phases, including the proportions of severity groups, clinical symptoms, individual nerve involvements, number of symptoms and nerves, as well as the type of lesions. A total of 118 children were enrolled; 65 (55.1%) had VIPN by NCS criteria. Neuropathy incidence was similar in induction (56.9%) and maintenance (52.8%) phases (p=0.66). Most cases were CTCAE grade 2–3. Weakness was the most frequent symptom (56.9%), while paresthesia was significantly more common in the induction phase (p=0.008). Peroneal motor nerve involvement was the most frequent NCS abnormality (91.1%), followed by median motor (50.0%) and ulnar nerves (33.7%). The induction phase was characterized by additional upper extremity nerve involvement compared to the maintenance phase, including the median (p=0.004) and ulnar (p=0.025) nerves. Sural sensory nerve abnormalities were significantly more prevalent during the maintenance phases (p=0.002). All cases demonstrated axonal, motor-predominant neuropathy, with no isolated sensory cases. VIPN is highly prevalent among Indonesian children with ALL, with motor-predominant, axonal involvement. The induction phase has more widespread nerve involvement that includes upper extremities, while the maintenance phase has more sensory sural nerve involvement, albeit more likely asymptomatic or milder. Phase-specific patterns suggest distinct pathophysiological mechanisms.
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 Amanda Soebadi Andreas, Yana Anna Tjandradjani Anna Tjandrajani Anton Dharma Saputra Antonius H. Pudjiadi Aria Kekalih Aryono Hendarto Asep Aulia Rachman Ayuningtyas, Talitha Rahma Bambang Tridjadja Bambang Tridjadja, Bambang Bambang Tridjaja AAP, Bambang Tridjaja Bernie Endyarni Medise Budiati Laksmitasari Citra Raditha Citra Raditha 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 Dian Puspitasari Dina Indah Mulyani Dina Indah Mulyani, Dina Indah Dini Prima Utami Dwi P. Widodo E S Herini Elisabeth Herini Elisabeth Siti Herini Endang Windiastuti Eva Devita Harmoniati Evita Bermansyah Ifran Fathy Pohan Fatmawaty Fatmawaty Fijri Auliyanti Fikri Mirza Putranto Freddy Guntur Mangapul Silitonga Gayatri, Anggi H F Wulandari Hanifah Oswari Hardiono D Pusponegoro Hardiono D. Pusponegoro Hardiono D. Pusponegoro Hardiono D. Pusponegoro, Hardiono D. Hariadi Edi Saputra Harjanti F Wulandari Hartono Gunardi Haryanti Fauziah Wulandari Herlina Herlina Hidra Irawan Satari Hikari Ambara Sjakti, Hikari Ambara I. Budiman Idham Amir, Imral Chair Indra Parmaditya Pamungkas Inez Ayuwibowo Sangwidjojo Iqbal Taufiqqurrachman Irene Yuniar, Irene Irma Rochima Puspita Iskandar Japardi Isman Jafar Ismy, Jufitriani Jasin, Madeleine Ramdhani Jenny Bashiruddin Joanna Erin Hanrahan KHOIRUL ANAM 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 Melinda Harini Merci Monica br Pasaribu Muhammad Irsan Saleh Mulya Rahma Karyanti, Mulya Rahma Mulyadi M. Djer Murti Andriastuti, Murti Muzal Kadim Nadia Chairunnisa Nahari Arifin Najib Advani Nastiti Kaswandani Nia Kurniati Nur Hayati NURUL HIDAYAH Pamungkas, Indra Parmaditya Pandelaki, Jacub Pandu Caesaria Lestari Partini Pudjiastuti Trihono Purboyo Solek Pustika Amalia Pustika Amalia Putri, Armitha Putri, Shally Adhina Adhina R. H. J. M Gooskens Rachmawati, Elvie Zulka Kautzia Raden Muhammad Indra Rafli, Achmad Rahmad Mulyadi Ricca Fauziyah Rina W Sundariningrum Rinawati Rohsiswatmo Rini Sekartini Risma Kerina Kaban 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 Ryan Pramana Putra Sabrina Tan Safarina G. Malik Santoso, Dara Ninggar Saptawati Bardosono Sari, Teny T. Setyanto, Darmawan Budi Setyo Handryastuti Shally Adhina Adhina Putri Sisca Silvana, Sisca Soedjatmiko Soepardi Soedibyo Sri Rezeki Hadinegoro Sri Sofyani, Sri Sudigdo Sastroasmoro Sudjatmiko Sudjatmiko Sudung O Pardede Sudung O Pardede, Sudung O Sudung O. Pardede Sudung O. Pardede Sudung O. Pardede, Sudung O. Sukman Tulus Putra Sukmono, Suryawati Susanti Himawan Talitha Rahma Ayuningtyas Tantri, Aida Rosita Taralan Tambunan Taralan Tambunan Taralan Tambunan Taralan Tambunan Tatang M. Puspandjono Teny Tjitra Sari, Teny Tjitra Thandavarayan, Rajarajan Amirthalingam Tiara Aninditha Titis Prawitasari, Titis Tjhin Wiguna Tri Lestari Handayani Tuty Valensia Vivian The Victor Prasetyo Poernomo Vimaladewi Lukito Wahyuni Indawati Wardani, Amanda Saphira Wawaimuli Arozal Wicaksono, Yuda Satrio Widodo Dwi Putro Winny N Wishwadewa Wisnu Ananta Kusuma Wulandari, Harjanti F Yarmaniani Miliati Muchtar Yazid Dimyati Yeti Ramli Yeti Ramli Yulia Iriani Yuliarti, Klara Zen Hafy Zizlavsky, Semiramis