Pengaruh durasi pemberian fenitoin terhadap gangguan fungsi eksekutif pada pasien epilepsi tonik klonik
https://doi.org/10.22146/bns.v19i2.69199 Kinanti Sekarsari(1*), Astuti Astuti(2), Ismail Setyopranoto(3)
(1) KSM Saraf, RS Universitas Islam Indonesia, Yogyakarta
(2) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(3) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author
Abstract
One comorbid in epilepsy patients is impaired executive function caused by antiepileptic drugs. Phenytoin is a widely used antiepileptic drug especially for generalized tonic clonic epilepsy therapy which cause cognitive impairment if given in long-term duration. This study aims to determine the relationship between duration of phenytoin monotherapy use and the decrease of the specific domain of cognitive executive function of mental flexibility, planning, verbal fluency, and working memory in adult generalized tonic clonic epileptic patient. Retrospective cohort studies were performed by conducting executive function assessments with Trail Making Test B, Clock Drawing Test, Digit Span Test, and Animal Verbal Fluency Test at the time of study, then the duration of phenytoin use was taken from the patient’s medical records during the first phenytoin therapy. Of the 102 subjects, bivariate analysis results showed a significant correlation between the duration of phenytoin therapy and executive function in mental flexibility domain (p
=0.001; RR =1.88), verbal fluency domain (p =0.002; RR =3.24), planning domain (p =0.008; RR =7.46), and on domain working memory (p =0.000; RR =6.16). In a multivariate analysis logistic regression showed that the executive domain function of working memory disorder was an independent factor due to phenytoin >1 year in patients with generalized tonic clonic epileptic seizures (p =0.005).
ABSTRAK
Salah satu komorbid pada pasien epilepsi adalah gangguan fungsi eksekutif yang disebabkan oleh pemakaian obat antiepilepsi. Fenitoin adalah obat antiepilepsi yang banyak digunakan terutama untuk terapi epilepsi dengan bangkitan umum tonik klonik yang memiliki efek menyebabkan gangguan kognitif jika diberikan dalam durasi jangka panjang. Penelitian ini bertujuan mengetahui adanya hubungan antara durasi penggunaan monoterapi fenitoin dengan penurunan domain kognitif spesifik fungsi eksekutif yaitu mental flexibility, planning, verbal fluency, dan working memory pada pasien epilepsi dewasa bangkitan umum tonik klonik. Penelitian kohort retrospektif dilakukan dengan melakukan asesmen fungsi eksekutif dengan tools Trail Making Test B, Clock Drawing Test, Digit Span Test, dan Animal Verbal Fluency Test pada saat studi, kemudian durasi pemakaian fenitoin diambil dari catatan medis pasien saat dilakukan terapi fenitoin yang pertama kali. Dari 102 subjek, hasil analisis bivariat terdapat korelasi yang bermakna durasi penggunaan terapi fenitoin dengan gangguan fungsi eksekutif pada domain mental flexibility (p =0,001; RR =1,88), pada domain planning (p =0,008; RR =7,46), domain verbal fluency (p =0,002; RR =3,24) dan pada domain working memory (p =0,000; RR =6,16). Pada analisis multivariat regresi logistik menunjukkan bahwa gangguan domain fungsi eksekutif working memory merupakan faktor independen akibat pemberian fenitoin >1 tahun pada pasien epilepsi bangkitan umum tonik klonik (p =0,005).
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DOI: https://doi.org/10.22146/bns.v19i2.69199
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