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All Journal Medicinus : Jurnal Kedokteran Magna Neurologica
Samudra, Edeline
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Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Journal : Magna Neurologica

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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.
Efficacy and Safety of Evobrutinib in Relapsing Multiple Sclerosis: A Systematic Review of Randomized Controlled Trials Samudra, Edeline; Anyeliria Sutanto
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.v3i2.1929

Abstract

Background: Evobrutinib is a selective Bruton’s tyrosine kinase (BTK) inhibitor that crosses the blood-brain barrier. BTK regulates B lymphocytes and myeloid cells, significantly contributing to multiple sclerosis (MS) inflammation. While current MS treatments alleviate relapses and disability, they have a limited impact on inflammation within the central nervous system. Objective: We aim to evaluate the efficacy and safety of evobrutinib in relapsing MS. Methods: A systematic search of databases, including PubMed, Elsevier, NEJM, BMJ Journals, and Neurology, was conducted. Inclusion criteria: Studies within 5 years, randomized controlled trials, and interventions with evobrutinib. Exclusion criteria: Incomplete reporting, non-phase two trials, and JADAD score < 3. The quality of the included studies was evaluated using the JADAD scale. Results: The literature search yielded 552 studies, of which eight were included in the final analysis. All studies consistently demonstrated significant benefits in reducing disease activity. The efficacy of evobrutinib 75 mg BID showed a significant reduction in ARR (mean ARR = 0.10) and gadolinium-enhancing lesions compared to placebo (mean ARR = 0.37). SEL volume was significantly reduced, especially in patients with higher disability and longer disease duration. The safety profile of evobrutinib was comparable to that of a placebo, with similar rates of TEAEs. Liver enzyme elevations were noted in one study but were generally manageable. Stability in EDSS scores over extended treatment periods suggests effective disease control. Conclusion: Evobrutinib is a promising therapeutic option for managing MS, particularly relapsing forms, due to its efficacy in reducing disease activity and favorable safety profile.
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 Anyeliria Sutanto Jane Florida Kalumpiu, Jane Florida Ketaren, Retno Jayantri Made Agus Mahendra Inggas, Made Agus Mahendra