Tesis

Epilepsi Terkait Tumor Otak Primer, Kontrol Bangkitan serta Faktor- faktor yang Memengaruhinya di RSUPN Dr. Cipto Mangunkusumo, Indonesia = Primary Brain Tumor-related Epilepsy and Seizure Control in Dr. Cipto Mangunkusumo National Center General Hospital, Indonesia.

Latar Belakang. Epilepsi merupakan gejala yang sangat sering ditemukan pada tumor otak, terutama tumor otak primer. Adanya epilepsi akan memperburuk kecacatan dan meningkatkan risiko kematian yang sudah tinggi. Terlebih lagi, pada epilepsi dengan bangkitan yang tidak terkontrol, penurunan kualitas hidup tampak semakin jelas. Sampai saat ini masih belum banyak penelitian terkait epilepsi dan kontrol bangkitan pada tumor otak primer. Studi ini bertujuan untuk mendapatkan prevalensi epilepsi dan kontrol bangkitan pada tumor otak primer, mengetahui karakteristik klinis, serta mengetahui faktor-faktor yang memengaruhi kejadian epilepsi dan kontrol bangkitan pada pasien tumor otak primer di RSUPN Dr. Cipto Mangunkusumo. Metode. Studi potong lintang dengan data registri dan rekam medis di RSUPN Dr. Cipto Mangunkusumo pada pasien yang terdiagnosis tumor otak primer secara histopatologis sejak Januari 2020-Desember 2023. Dilakukan evaluasi terhadap karakteristik demografis dan klinis tumor otak dan epilepsi, dilanjutkan analisis faktor-faktor yang berhubungan terhadap kejadian epilepsi dan kontrol bangkitan secara multivariat. Hasil. Dari 128 subjek tumor otak primer, mayoritas adalah perempuan (63,3%) pada rerata usia 47 tahun. Karakteristik tumor didominasi oleh meningioma (50,8%) derajat rendah (52,3%) yang berlokasi di supratentorial dan melibatkan lobus frontal (51,6%) dan korteks (62,5%). Epilepsi ditemukan pada 68,65% subjek, yang sebagian besar memiliki bangkitan yang terkontrol (58,6%), dengan durasi epilepsi 27,5 (1 - 210) bulan. Semiologi bangkitan yang paling banyak adalah focal to bilateral tonic clonic (61,4%) dan tidak memiliki riwayat status epileptikus. Mayoritas subjek epilepsi patuh mengonsumsi OAB (84,1%) dan menggunakan OAB non-enzyme-inducer (89,8%). Sebanyak 58% subjek epilepsi menggunakan deksametason dan sedang dalam penurunan dosis (66,7%). Pada uji bivariat, derajat tumor rendah serta lokasi lesi dengan keterlibatan frontal dan korteks berhubungan dengan kejadian epilepsi, namun pada uji multivariat, hanya lokasi lesi yang melibatkan frontal (aOR 3,49 (IK95% 1,45-8,47; p=0,005) dan korteks (aOR 2,59 (IK95% 1,08-6,29; p=0,034) yang berhubungan dengan kejadian epilepsi. Pada uji bivariat, faktor-faktor yang berhubungan dengan kontrol bangkitan, yakni riwayat status epileptikus, kemunculan bangkitan, jumlah OAB, kepatuhan konsumsi OAB, penggunaan deksametason, dan derajat tumor. Namun, pada uji multivariat, hanya kemunculan bangkitan prapembedahan (aOR 7,9 (IK95% 1,59-40,09); p=0,012), kepatuhan konsumsi OAB (aOR 4,76 (IK95% 1,18-18,86); p=0,012), dan derajat tumor (aOR 7,03 (IK95% 1,86-26,59; p=0,004) yang berhubungan dengan kontrol bangkitan. Kesimpulan. Prevalensi epilepsi terkait tumor otak primer di RSUPN Dr. Cipto Mangunkusumo cukup tinggi (68,65%) namun sebagian besar memiliki bangkitan yang terkontrol (58,6%). Faktor-faktor yang berhubungan secara independen terhadap kejadian epilepsi terkait tumor otak adalah lokasi lesi yang melibatkan korteks dan lobus frontal, sedangkan faktor-faktor yang berhubungan secara independen terhadap kontrol bangkitan pada epilepsi terkait tumor otak adalah kemunculan bangkitan prapembedahan, kepatuhan konsumsi OAB, dan tumor derajat rendah.
Kata kunci: epilepsi terkait tumor otak; tumor otak primer; kontrol bangkitan


Background. Epilepsy is commonly found in brain tumors, especially the primary brain tumors. The presence of epilepsy adds to the already high morbidity and mortality rates. Moreover, in epilepsy with uncontrolled seizure, the decline in quality of life is even more pronounced. Lately, studies related to epilepsy and seizure control in primary brain tumors are limited. This study aims to obtain the prevalence of epilepsy and awakening control in primary brain tumors, determine clinical characteristics, and determine factorsassociated the incidence of epilepsy and awakening control in primary brain tumor patients at Dr. Cipto Mangunkusumo Hospital. Methods. A cross-sectional study with registry and medical record data at Dr. Cipto Mangunkusumo Hospital on patients diagnosed with histopathological primary brain tumors from January 2020-December 2023. Demographic and clinical characteristics of brain tumors and epilepsy were evaluated, followed by multivariate analysis of factors associated with epilepsy incidence and awakening control. Results. Of the 128 primary brain tumor subjects, the majority were female (63.3%) at a mean age of 47 years. Tumor characteristics were dominated by meningiomas (50.8%), low grade (52.3%), and located supratentorially that involve the frontal lobe (51.6%) and cortex (62.5%). Epilepsy was found in 68.65% of subjects and most of them had controlled seizures (58.6%), with the median epilepsy duration of 27.5 (1 - 210) months. The most common seizure semiology was focal to bilateral tonic clonic (61.4%) and had no history of status epilepticus. Most of the epileptic subjects (84,1%) used non-enzyme-inducer anti seizure medication (ASM) (89.8%), also complied with the ASM. A total of 58% of epileptic subjects were taking dexamethasone and were on a dose reduction (66.7%). In the bivariate analysis, low grade tumor and lesion involving frontal and cortex were associated with the incidence of epilepsy, but in the multivariate analysis, only the brain lesion involving frontal (aOR 3.49 (95% CI 1.45-8.47; p=0.005) and cortex (aOR 2.59 (95% CI 1.08-6.29; p=0.034) were associated with epilepsy incidence. In the bivariate analysis, factors associated to seizure control were history of status epilepticus, occurrence of seizure, number of ASM, ASM compliance, dexamethasone used, and tumor grade. However, in the multivariate analysis, only the occurrence of seizure presurgical (aOR 7.9 (95% CI 1.59-40.09); p=0.012), ASM compliance (aOR 4.76 (95% CI 1.18-18.86); p=0.012), and grading tumor (aOR 7.03 (95% CI 1.86-26.59; p=0.004) were associated with seizure control. Conclusion. The prevalence of primary brain tumor-associated epilepsy at Dr. Cipto Mangunkusumo Hospital was high (68.65%) but most of them had controlled seizures (58.6%). Factors that were independently associated with the incidence of brain tumor-associated epilepsy were the location of the lesion involving the cortex and frontal lobe. The factors that were independently associated with seizure control in brain tumor-associated epilepsy were the occurrence of pre-surgical seizure, ASM compliance, and low-grade tumors.
Keywords: Brain tumor-related epilepsy; primary brain tumor; seizure control