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Yang Yang Endro Arjuna
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Universitas Pelita Harapan, Lippo Karawaci, Tangerang, Indonesia, 15811.
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Lumina: Indonesian Journal of Neurology
Published by Universitas Pelita Harapan
ISSN : 31095658     EISSN : 3109564X     DOI : https://doi.org/10.19166
Core Subject :
Focus and Scope Lumina: Indonesian Journal of Neurology is an open-access, peer-reviewed journal dedicated to advancing the field of neurological sciences, with a focus on both basic neuroscience and clinical neurology. The journal publishes original research, reviews, and intriguing case reports. It also welcomes brief communications that highlight recent advancements in diagnostic techniques, treatments, or other relevant neurological health issues. Additionally, letters and commentaries on previously published articles are encouraged. Topics for publication include, but are not limited to: Neuroepidemiology Neurovascular Neurophysiology Epilepsy Sleep disorders Neurobehavior Neuroimmunology Neurodegenerative diseases Neurootology Neuroophthalmology Neuropediatrics Neurointervention Neuroradiology Neurorestoration Movement disorders Pain management and interventions Neuroendocrinology Neurosurgery Neuropathology Neuroinfection Neuroanesthesiology Neurooncology Neuropharmacology Neuroanatomy
Arjuna Subject : -
Articles 24 Documents
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Comparative Efficacy of Antihypertensive Drugs for Primary Stroke Prevention–A Network Meta-Analysis of Randomized Controlled Trials Dessy Natalia; Leo Deddy Pradipta; Adwin Alamsyaputra
Lumina : Indonesian Journal of Neurology Vol. 1 No. 2 (2025): August : Lumina : Indonesian Journal of Neurology
Publisher : Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/lijn.v1i2.10286

Abstract

Introduction: Hypertension is a major modifiable risk factor for stroke, making antihypertensive therapy essential for primary stroke prevention. However, the comparative efficacy of different antihypertensive drug classes remains uncertain. This study aims to evaluate the comparative efficacy of various antihypertensive drug classes in reducing the risk of stroke in patients with hypertension through a network meta-analysis of randomized controlled trials (RCTs). Methods: A search was conducted using various online databases, including PubMed, Google Scholar, Scopus, and ScienceDirect, to identify RCTs which were written in English and published before January 2025. A network meta-analysis was performed to compare the effectiveness of different drug classes, including angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), beta-blockers, and diuretics in stroke primary prevention. Independently, two reviewers (D.N. and L.D.P.), extracted the data and assess the quality of studies using Cochrane RoB 2.0. Results: This analysis included 43 RCTs involving 255299 participants with hypertension. Among the evaluated drug classes, non-dihydropyridine CCB demonstrated the highest efficacy in stroke prevention (RR 0.61; 95%CI 0.48 – 0.77), followed by dihydropyridine CCB (RR 0.62; 95%CI 0.54 – 0.72). Most of the studies had decent quality assessment with moderate heterogeneity across them with I2 = 39%. Egger’s test showed nonsignificant results (p= 0.16), suggesting the absence of publication bias in the included trials. Conclusion: This meta-analysis showed that calcium channel blocker emerges as the most effective option for reducing stroke risk, but considerations of adverse effects and individual patient profiles remain critical in treatment selection.
CANVAS Syndrome: A Comprehensive Case Report on Rare Ataxia Evlyne Erlyana Suryawijaya; Ni Nengah Rida Ariarini; Freddy Sitorus; Eva Dewati; Dinda Diafiri
Lumina : Indonesian Journal of Neurology Vol. 1 No. 2 (2025): August : Lumina : Indonesian Journal of Neurology
Publisher : Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/lijn.v1i2.10287

Abstract

Introduction: Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) is characterized by cerebellum, vestibular system, and sensory pathways impairments. It progresses slowly compared to other ataxias like Friedreich’s ataxia, and its genetic basis is complex and under investigation. Case Report: A 34-year-old male presented with worsening imbalance over the past year, vertigo, slurred speech, and hand tremors. Physical examination revealed bidirectional nystagmus, dysmetria, and cerebellar atrophy on MRI. Vestibular tests were abnormal, and neuropsychological assessments showed memory and executive function deficits. Sensory nerve conduction studies were normal. Discussion: The patient's symptoms of ataxia, vestibular areflexia, and sensory neuropathy are consistent with CANVAS. Cerebellar atrophy and Purkinje cell degeneration contribute to motor coordination deficits. Sensory neuropathy involves dorsal root ganglia degeneration. Despite supportive clinical features, genetic testing is necessary to confirm the diagnosis and exclude other genetic ataxias. Conclusion: CANVAS is a rare ataxia syndrome with autosomal recessive inheritance affecting the cerebellum, vestibular, and sensory systems. The patient's symptoms and MRI findings suggest CANVAS, but further genetic testing is required for definitive diagnosis.
Supraorbital Approach For Tuberculum Sellae Meningioma Diana Rela Oktaviani; Petra Octavian Perdana Wahjoepramono; Eka Julianta Wahjoepramono
Lumina : Indonesian Journal of Neurology Vol. 1 No. 3 (2025): December: Lumina: Indonesian Journal of Neurology
Publisher : Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/lijn.v1i3.10334

Abstract

Introduction: Tuberculum sellae meningiomas pose significant surgical challenges due to their proximity to critical neurovascular structures. Pterional craniotomy has been the conventional method for approaching anterior skull base lesions, while the supraorbital eyebrow approach has emerged as an alternative in selected cases.Case Presentation: We report the case of a 50-year-old woman with progressive left temporal hemianopia due to a tuberculum sellae meningioma. The tumor was resected via left supraorbital approach, achieving gross total resection. Estimated intraoperative blood loss 50 mL, and total operative time 185 minutes. Histopathological examination confirmed WHO Grade I meningioma. Postoperative recovery was uneventful. Contrast-enhanced brain MRI at 3-month follow-up showed no residual or recurrent tumor. Discussion: Surgical management of tuberculum sellae meningiomas is particularly challenging because of their proximity to critical structures. Conventional approaches provide wide exposure but require extensive soft tissue and bone manipulation. The supraorbital eyebrow approach offers a minimally invasive keyhole route. In our case, it allowed safe gross total resection, preservation of neurovascular function, and rapid postoperative recovery.Conclusion: This case highlights the feasibility, safety, and effectiveness of the supraorbital eyebrow approach for resecting anterior skull base meningiomas. Keywords: Anterior skull base surgery; Eyebrow craniotomy; Keyhole approach; Minimally invasive; Supraorbital approach; Tuberculum sellae meningioma
Atypical Chronic Inflammatory Demyelinating Polyneuropathy With Relapsing Sensory-Predominant Sensorimotor Neuropathy Yee Wen Yong; Bryan Setyoputra; Annisa Kusuma Dewi; Anyeliria Sutanto
Lumina : Indonesian Journal of Neurology Vol. 1 No. 3 (2025): December: Lumina: Indonesian Journal of Neurology
Publisher : Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/lijn.v1i3.10338

Abstract

Introduction: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare, acquired autoimmune neuropathy with progressive symptoms. Intravenous immunoglobulin (IVIg) and corticosteroids are effective first-line therapies; however, many patients experience residual symptoms or relapse within the first year.Case Presentation: A 39-year-old male with an initial diagnosis of carpal tunnel syndrome presented with a 13-month history of progressive sensory disturbances, evolving from lower limb paresthesia with gait instability. EMG confirmed demyelinating and axonal sensorimotor polyneuropathy consistent with CIDP. He was hospitalized and responded well to intravenous methylprednisolone and IVIg, but relapsed nine months later after a respiratory infection, presenting with distal sensory symptoms and preserved strength. Cerebrospinal fluid analysis showed albuminocytologic dissociation, while autoimmune nodopathy markers were negative. Retreatment with IVIg and methylprednisolone led to clinical improvement, with only mild exertion-related symptoms at two-month follow-up.Discussion: This case highlights a rare sensory-predominant variant of CIDP with relapse triggered by infection. Relapses often require renewed immunotherapy, with corticosteroids and IVIg as first-line treatments; long-term management may include maintenance IVIg and gradual steroid tapering.Conclusions: Early recognition, appropriate immunotherapy, and long-term monitoring are essential to sustain remission and prevent disability in sensorypredominant CIDP.Keywords: Chronic inflammatory demyelinating polyneuropathy; electrodiagnostic studies; immunotherapy; relapse; sensory-predominant
Valproic Acid For Refractory Post-Traumatic Dizziness and Photopsia Graviela Kosuhary; Azmi Farah Fairuzya; Stephen Changifer
Lumina : Indonesian Journal of Neurology Vol. 1 No. 3 (2025): December: Lumina: Indonesian Journal of Neurology
Publisher : Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/lijn.v1i3.10388

Abstract

Introduction: Post-concussion syndrome (PCS) is a collection of cognitive, vestibular, and visual symptoms that may persist after mild traumatic brain injury (mTBI). Current management is largely supportive, highlighting the need for alternative pharmacologic approaches. This case report explores the therapeutic potential of valproic acid (VPA), a compound with neuroprotective and anti-inflammatory effects.Case Presentation: A 28-year-old woman presented with persistent vertigo and visual disturbances, including photopsia, following a mild head injury sustained in a motor vehicle accident. Neurological examination and imaging were unremarkable. Symptomatic therapies provided only partial and temporary relief, prompting the trial of VPA. The patient subsequently experienced gradual clinical improvement, achieving complete symptom resolution within six months and maintaining remission after discontinuation of treatment.Discussion: The patient’s symptoms were attributed to functional disturbances involving the occipital cortex and vestibular pathways, commonly implicated in PCS. Hypothesized contributors included ionic disequilibrium, cortical hyperexcitability, and neuroinflammatory processes. Beyond its traditional use as an antiepileptic, VPA may offer therapeutic advantages in PCS through GABAergic modulation, Histone Deacetylase (HDAC) inhibition, and anti-inflammatory actions.Conclusions: This case highlights VPA as a promising pharmacologic option for refractory PCS. However, further studies are required to determine its efficacy, optimal dosage, and safety profile in this setting.Keywords: Post-Concussion Syndrome; Valproic Acid; Mild Traumatic Brain Injury; Vestibular Symptoms; Visual Dysfunction
Evaluating The Efficacy of Repetitive Transcranial Magnetic Stimulation In Treating Neurodegenerative Cerebellar Ataxia: A Systematic Review and Meta-Analysis Angelina Wandana; Jeanne Alexandra; Agung Junnata; Daniel Natanael; Raisa Kireyna Nurfajrina; Michelle Valencia Bunjamin
Lumina : Indonesian Journal of Neurology Vol. 1 No. 3 (2025): December: Lumina: Indonesian Journal of Neurology
Publisher : Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/lijn.v1i3.10400

Abstract

Introduction: Neurodegenerative diseases such as multiple system atrophy (MSA), spinocerebellar ataxia (SCA), and Friedreich’s ataxia (FRDA) progressively impair the nervous system, affecting approximately 15% of the global population. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive method, may promote neuroplasticity. The cerebellum, central to motor control and neural connectivity, is a promising rTMS target. Therefore, this research aims to evaluate the efficacy of rTMS in treating neurodegenerative cerebellar ataxia. Methods: A systematic review and meta-analysis was conducted per PRISMA guidelines, searching ten databases (to August 9, 2025). Eligible studies were RCTs comparing rTMS with sham in cerebellar ataxia. The review was registered on PROSPERO (CRD420251127471). Study quality was assessed with Cochrane RoB 2.0; meta-analysis used Review Manager 5.4.1, and meta-regression was performed in JASP 0.19.3. Results: Seven RCTs involving a total of 256 patients were included. rTMS significantly improved SARA (SMD = -0.84, p = 0.004, I² = 73%). ICARS showed no significant difference (SMD = -0.82, p = 0.43, I² = 96%). Meta-regression and sensitivity analysis were done to find key heterogeneity sources. Most studies had low bias. Conclusions: rTMS significantly improves SARA scores in neurodegenerative cerebellar ataxia if compared to sham, while ICARS shows insignificant differences. Further research is needed.Keywords: Neurodegenerative ataxia, Repetitive Transcranial Magnetic Stimulation, Sham-controlled
Carotid Endarterectomy Versus Carotid Artery Stenting With Double-Layer Micromesh Stent in Carotid Angioplasty: Network Meta-Analysis Evelyn Natalie Hailianto; Fransiska Livia; Jesselyne Aurelia Santoso Kho; Clayton Christopher Hermawan; Jason Michael Prawira; Julius July
Lumina : Indonesian Journal of Neurology Vol. 1 No. 3 (2025): December: Lumina: Indonesian Journal of Neurology
Publisher : Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/lijn.v1i3.10401

Abstract

Introduction: Carotid endarterectomy (CEA) remains the gold standard for carotid stenosis, but modern carotid artery stenting (CAS) with double-layer micromesh stents (e.g., CGuard, Roadsaver [RS]) offers potential reductions in peri-procedural embolic risk. However, comparative evidence between CEA and modern CAS remains limited. Methods: A systematic search of PubMed, ScienceDirect, and Europe PMC (June 23,2025) identified randomized and observational studies on symptomatic or high grade asymptomatic carotid stenosis using terms including “double-layer stent,” “micromesh,” “Roadsaver,” “CGuard,” and “carotid endarterectomy.” Reviews, meta analyses, and case reports were excluded. Comparisons included single-layer CAS vs. CEA, single-layer CAS vs. CGuard/RS, and indirect CEA vs. CGuard/RS. Outcomes were neurological complications and neurological death. Study quality was assessed using Cochrane RoB 2.0 and Newcastle-Ottawa Scale (NOS). A frequentist random effects network meta-analysis was performed using MetaInsight. Results: Eleven studies (7 RCTs, 4 observational; n=9483) were included. Seven had moderate RoB 2.0 risk, while three observational studies had fair quality and one study had good quality according to NOS. No significant difference was detected in neurological complications between CEA and CGuard/RS (OR 0.79; 95% CI 0.34-1.80), and neurological death was similar among CEA, CGuard/RS, and CAS. When compared with conventional CAS, CEA (OR 0.90; 95% CI 0.69–1.18) and CGuard/RS (OR 1.04; 95% CI 0.30–3.65) showed no significant differences. The direct comparison between CEA and CGuard/RS also demonstrated no significant effect (OR 0.86; 95% CI 0.24–3.11).Conclusions: This study found no significant differences in stroke prevention or safety CEA and DLMS. Larger comparative studies are required to establish their relative clinical effectiveness.Keywords: carotid artery stenting; carotid endarterectomy; micromesh stent; single layer stent; stroke
The Effect Of Coffee Consumption on Sleep Quality Kimberly Fiona Retandy; Pricilla Yani Gunawan
Lumina : Indonesian Journal of Neurology Vol. 1 No. 3 (2025): December: Lumina: Indonesian Journal of Neurology
Publisher : Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/lijn.v1i3.10432

Abstract

Introduction: Faculty of Medicine students frequently experience academic pressure and commonly consume coffee to improve alertness. Excessive coffee consumption or consumption at inappropriate times can result in sleep difficulties, disrupt deep sleep stages, and negatively impact the overall quality of nightly rest. Methods: This study investigates the impact of coffee consumption on sleep quality among students. This research employs a cross-sectional design utilizing categorical comparison. Medical students with no history of sleep disorders were included in the study. Data collected include demographic data, Perceived Stress Scale (PSS-10) questionnaire, Pittsburgh Sleep Quality Index (PSQI), and coffee consumption habits questionnaire. Results: Analysis of 96 samples revealed that in the low coffee consumption group, 35 respondents (36.5%) exhibited mild sleep disturbance, while 17 respondents (17.7%) demonstrated moderate-heavy sleep disturbance. In the moderate-high coffee consumption group, 22 respondents (22.9%) presented with mild sleep disturbance, and an equal number showed moderate-heavy sleep disturbance. There were no association between coffee consumption and sleep quality (p =0.131). Conclusions: There were no significant association between coffee consumption and sleep quality in medical students.Keywords: Coffee consumption, sleep quality, medical students
Characteristics of Epilepsy Patients in Neurology Outpatient Clinic Siloam Hospitals Lippo Village Graciela Audrey Dharmawan; Retno Jayantri Ketaren
Lumina : Indonesian Journal of Neurology Vol. 2 No. 1 (2026): April: Lumina: Indonesian Journal of Neurology
Publisher : Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/lijn.v2i1.10472

Abstract

Introduction: Epilepsy is a chronic neurological disorder affecting approximately 70 million people worldwide. Despite being a treatable condition, many patients in low- and middle-income countries especially Indonesia do not receive adequate Anti-Epileptic Drug (AED) therapy. Previous local studies have reported variations in patient characteristics but often lacked detailed data on epilepsy syndromes and neuroimaging findings. This study aimed to determine the clinical and demographic characteristics of epilepsy patients at the Neurology Outpatient Clinic of Siloam Hospital Lippo Village Methods: This study was a retrospective descriptive cross-sectional study. Secondary data were collected from 111 medical records of epilepsy patients treated at the Neurology Outpatient Clinic between 2022 and 2024. The sampling method used was non-probability convenience sampling.  Data were analyzed using univariate statistical analysis, presented as frequencies and percentages. Results: Of the 111 subjects, the majority were adults (69.4%) and male (55.9%).  The most common seizure type and epilepsy type were focal seizures (53.2%). The most frequent epilepsy syndrome was temporal lobe syndrome (21.6%), and the most frequent etiology was unknown or idiopathic (64.9%).  Monotherapy was the predominant treatment regimen (64.9%), with phenytoin (52.3%) and valproic acid (47.7%) being the most frequently prescribed AEDs. EEG findings were normal in 49.5% of subjects. Among patients with available neuroimaging data, abnormal structural findings were observed more frequently than normal findings (18.0% for CT scan and 21.6% for MRI). Conclusions: The typical patient profile was an adult male with focal epilepsy of unknown etiology receiving monotherapy treatment. Although neuroimaging data were incomplete in many medical records, available results indicated a significant portion of structural abnormalities Keywords: Epilepsy, Characteristics, Anti-epileptic Drugs, Neuroimaging
Epidurolysis is a Promising Treatment for Stage I-II Lumbar Disc Herniation at the Three-Month Follow-Up Trianggoro Budisulistyo
Lumina : Indonesian Journal of Neurology Vol. 2 No. 1 (2026): April: Lumina: Indonesian Journal of Neurology
Publisher : Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/lijn.v2i1.10738

Abstract

Introduction: About 90% of patients with lumbar disc herniation (LDH) improve with conservative treatment, while 10–19% require surgery. Epidural steroid injection (ESI) with local anesthetic provides pain relief for up to 6 months (30–40%) and up to 1 year (68.5%). Epidurolysis, using 1500 units of hyaluronidase before ESI, is often applied in patients who continue to experience pain after spinal surgery. This study compares pain intensity and activities of daily living (ADL) in Stage I–II LDH patients treated with either epidurolysis or ESI. Methods: This experimental study used a pre- and post-test control group design. Patients with Stage I–II LDH at Dr. Kariadi Hospital, Semarang, were divided into two groups: epidurolysis and ESI. NRS, Pain DETECT, and ODI scores were evaluated before treatment, at Week 3, and at Month 3, then compared across observation times. Results: From January to August 2022, 161 patients met the inclusion criteria: 84 received epidurolysis and 77 received ESI. Eighteen participants dropped out. Significant improvements in NRS, Pain DETECT, and ODI scores were observed up to Month 3 (p < 0.05). The epidurolysis group showed greater improvement, with lower NRS (1.21 ± 0.50 vs 1.51 ± 0.53), Pain DETECT (8.61 ± 2.66 vs 12.17 ± 2.78), and ODI (4.72 ± 3.34 vs 8.51 ± 3.67) scores. Demographic factors had no significant effect on ADL changes. Conclusion: Hyaluronidase reduces fibrosis and edema, enhances triamcinolone absorption, and may improve nerve recovery. Adding 1500 units of hyaluronidase before ESI results in better pain relief and functional outcomes in Stage I–II chronic LDH patients. Keywords: Stage I-II LDH, Triamcinolone, Hyaluronidase, NRS, Pain DETECT, ODI

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