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All Journal MEDICINUS Jurnal Kedokteran Meditek
Gabriella, Nadia
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Laporan Kasus: Tantangan dalam Manajemen Epilepsi Katamenial pada Menstruasi Tidak Teratur Gabriella, Nadia; Kennytha Yoesdyanto
MEDICINUS Vol. 38 No. 8 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/kmv0je25

Abstract

Introduction: Catamenial epilepsy (CE) is characterized by periodic seizures, defined as ≥2-fold increase in seizure frequency during a specific period of the menstrual cycle. The prevalence of CE ranges from 10 to 70%, affecting over 40% of women with epilepsy. It is particularly prevalent among women with focal epilepsy, especially in cases of temporal lobe epilepsy (TLE). Exacerbation of seizures in CE is attributed to the fluctuations in reproductive steroid levels, which affect neuronal excitability. As of now, there is no definitive treatment available for CE. We reported a case of CE in a female patient with TLE.Case Report: A 20-year-old female patient with irregular periods presented with cluster seizures occurring within three days of her menstrual period. Seizure semiology is described as focal to generalized tonic-clonic seizures, with rightsidelateralization. No neurological deficits were found. Brain magnetic resonance imaging showed no abnormality. The electroencephalogram revealed sharp waves in both left and right temporal lobe. The patient was already treated with phenytoin 400 mg/day. However, due to persistence of seizures during the perimenstrual period, clobazam 20 mg/day was added. Seizure frequency has decreased but the patient remains under close observation.Discussion: The patient has been diagnosed with CE due to the cyclic exacerbation of seizures coinciding with her menstrual cycle. Her seizures consistenly occur within the perimenstrual phase, which is marked by a sudden withdrawal of progesterone and corresponding increase in seizure frequency. The recommended approach involves administering an add-on antiepileptic drug (AED) prior to and during menstruation. However, given the patient’s irregular periods, the mainchallenge lies in determining the optimal timing for this intervention.
Paradoxical Reaction in Tuberculous Meningitis and Tuberculoma: Diagnostic Challenges Following Incomplete Treatment Situmeang, Rocksy Fransisca V; Gabriella, Nadia
Jurnal Kedokteran Meditek Vol 31 No 6 (2025): NOVEMBER
Publisher : Fakultas Kedokteran Universitas Kristen Krida Wacana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36452/jkdoktmeditek.v31i6.3856

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Introduction: Exacerbation of clinical or radiological findings in tuberculous meningitis (TBM) may result from a paradoxical reaction (PR), an immune-mediated response occurring in 6–30% of cases during or after anti-tuberculosis treatment (ATT). This case highlights the potential for PR to occur in the context of an incomplete ATT regimen. Case Illustration: A 20-year-old female presented with a 1-month history of headache, fever, double vision, nuchal rigidity, and bilateral abducens palsy. Cerebrospinal fluid analysis revealed pleocytosis and elevated protein, while brain MRI demonstrated leptomeningeal enhancement with multiple tuberculomas. She received standard ATT (RHZE), but discontinued therapy before completion due to symptom resolution and medication burden. One year later, she developed altered sensorium and behavioral changes; MRI showed new tuberculomas with edema despite negative serology. A diagnosis of PR was made, and high-dose intravenous corticosteroids were administered, resulting in clinical and radiological improvement. Discussion: PR remains a diagnostic challenge, often mistaken for microbiological relapse, drug resistance, or treatment failure. It arises from a distinct immune response to mycobacterial antigens, distinguishing it from relapse or drug resistance. Conclusion: Clinicians should suspect PR in worsening TBM cases, even in the setting of incomplete ATT, to prevent misdiagnosis and initiate prompt treatment.  
Non-motor Symptom Burden and Its Clinical Correlates in Parkinson’s Disease: A Cross-sectional Study in Indonesia Situmeang, Rocksy Fransisca V; Gabriella, Nadia
Jurnal Kedokteran Meditek Vol 32 No 4 (2026): JULI
Publisher : Fakultas Kedokteran Universitas Kristen Krida Wacana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36452/jkdoktmeditek.v32i4.4204

Abstract

Introduction: Non-motor symptoms (NMS) are increasingly recognized to have disabling impact on the quality of life of idiopathic Parkinson’s disease (PD) patients, comparable to motor symptoms. However, their relationship with clinical and demographic factors remains obscure in local populations. Purpose: To determine the prevalence of NMS in idiopathic PD and evaluate their correlation with clinical variables, including disease duration, Hoehn & Yahr (H&Y) stage, and PD subtype. Methods: This cross-sectional study consecutively included idiopathic PD subjects evaluated between July-October 2025. Data collected included age, gender, age at onset, disease duration, H&Y stage, and PD subtype. NMS were assessed using the Indonesian version of Non-Motor Symptoms Questionnaire (NMS-Q). Correlation and multiple linear regression analyses performed. Results: Fifty-three subjects were included (mean age 66.9±10.5 years; 50.9% male). Median disease duration was 5 years (IQR 1–7.5), with majority in H&Y stage 2 (49%). Mean total NMS-Q score was 10.7±5.2. The most frequent NMS was urinary urgency (66%), with urinary domain being the most affected (64.2%). Total NMS-Q scores correlated with H&Y stage (r=0.427, p=0.001) and disease duration (r=0.309, p=0.025). Only H&Y stage independently predicted total NMS-Q scores (B=2.657, p=0.010). Conclusion: This study provides additional evidence from an Indonesian population using a standardized assessment tool, demonstrating that disease severity is an independent predictor of NMS burden, thus highlighting the importance of early and systematic evaluation of NMS in idiopathic PD.
Co-Authors Kennytha Yoesdyanto Situmeang, Rocksy Fransisca V