Penggunaan Obat Anti Epilepsi untuk Terapi Profilaksis Bangkitan pada Cedera Otak Traumatik

Rovina Ruslami, Tatang Bisri

Abstract


Cedera otak traumatik (COT) merupakan salah satu penyebab bangkitan dan epilepsi. Bangkitan pasca COT (post traumatic seizure/PTS) didefinisikan sebagai bangkitan dini (early PTS) jika terjadi dalam 7 hari pasca COT, atau sebagai bangkitan lanjut (late PTS) bila terjadi sesudah 7 hari pasca COT. Sampai saat ini tidak cukup data yang mendukung rekomendasi level I untuk terapi profilaksis PTS. Kejadian early PTS tidak berhubungan dengan luaran terapi yang lebih buruk. Namun karena insidensinya cukup tinggi, terapi profilaksis dapat menurunkan insidensi early PTS, dan sebagian epilepsi berhubungan dengan cedera kepala sebelumnya, maka terapi profilaksis dapat dipertimbangkan. Terapi profilaksis diindikasikan hanya untuk mencegah early PTS pada kasus COT berat (GCS <8). Terapi profilaksis tidak direkomendasikan untuk mencegah late PTS karena belum ada bukti yang mendukung. Fenitoin (phenytoin=PHT) merupakan obat yang paling banyak diteliti dan digunakan untuk mencegah early PTS, diberikan segera selama 1 minggu. PHT memiliki profil farmakokinetik yang rumit, berbagai efek samping yang memerlukan pemantauan klinis yang ketat dan pemeriksaan kadar obat dalam darah. Obat anti epilepsi (OAE) lain seperti valproat, karbamazepin, dan fenobarbital masih sangat terbatas datanya, memiliki isu keamanan dan farmakokinetik, sehingga saat ini tidak direkomendasikan untuk terapi profilaksis bangkitan pada COT. Levetiracetam (LEV) merupakan OAE yang lebih baru dengan profil farmakokinetik yang lebih “bersahabat”, namun data terkait efikasi dan keamanan masih terbatas. Diperlukan studi lebih lanjut untuk memperlihatkan jika LEV dapat menggantikan PHT dalam terapi profilaksis bangkitan pasca COT.

The Use of Antiepileptic Drugs for Posttraumatic Seizure Prophylaxis

after Traumatic Brain Injury
 
Traumatic brain injury (TBI) is one of the cause of seizure and epilepy. Post traumatic seizure (PTS) is classified as early PTS if occurs within 7 days after injury, and as late PTS if occurs after 7 days following injury. The incidence of PTS is rather high, and seizure prophylaxis could decrease the incidence of early PTS. Furthermore, part of epilepsy are thought to be the result of previous head trauma. Therefore, prophylaxis therapy can be considered. Currently, there are insufficient data to support a Level I reccomendation for seizure prophylaxis after TBI. Early PTS is not associated with worse outcome. It is only indicated for preveting early PST in severe TBI (GCS <8), and not recommended for preventing late PTS due to lack of evidence to support it. Phenytoin (PHT) has been extensively studied and used for prophylaxis of PTS; it is administered during the first seven days after TBI. PHT has numoerus side effects and drug interactions, has complex non-linear pharmacokinetics that require therapeutic drug monitoring. Data from other AEDs like valproate, carbamazepine, and phenobarbital are very limited. They also have sevral safety and pharmackinetics issues. Therefore they are not recommended for preventing PTS. Levetiracetam (LEV) is a newer AED with a more friedly characteristics. However the data regarding the efficacy and safety is limited. Further investigations is needed to evaluate if LEV is a reasonable alternative to PHT for preventing PTS in patients with TBI.


Keywords


bangkitan; cedera otak traumatik; epilepsi; fenitoin; levetiracteam; epilepsy; levetiracetam; phenytoin; post traumatic seizure; traumatic brain injury

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DOI: https://doi.org/10.24244/jni.vol5i1.60

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