Page 348 - Abstract Book KONIKA 18

Neurology

P-NEU-023
Effects of Covid-19 Pandemic to Pediatric Neurology Outpatient Care
at Dr. Cipto Mangunkusumo Tertiary General Hospital, Jakarta

Nadia Chairunnisa, Achmad Rafli, Irawan Mangunatmadja, Setyo Handryastuti, Amanda Soebadi
Department of Child Health, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Tertiary General
Hospital, Jakarta, Indonesia

Abstract
Background COVID-19 pandemic has resulted in millions of infections and thousand hundreds of
deaths worldwide. As hospitals became overrun with COVID-19 patients, the risk of visits of children
with neurology disease (e.g. epilepsy) began to outweigh the risk of deferred care. In many centers, this
pandemic have disrupted health care delivery and led to innovations, such as expansion of telemedicine.
Objective To evaluate the effect of COVID-19 on access to care and practice patterns for neurology
examination (e.g. electroencephalography (EEG), electromyography (EMG), and brain evoked response
audiometry (BERA) at Dr.Cipto Mangunkusumo Tertiary General Hospital Jakarta (CMTGHJ).
Methods We conducted a cross-sectional and used secondary data from outpatient clinic registries in
Neurology Divisions of Department of Child Health, CMTGHJ. We analyze number of patients before
and after pandemic during January 2019 - July 2021. Results The number of outpatient visits to Pediatric
Neurology Clinic was dropped by 23.8%. The number of patients who undergo EEG, EMG, BERA
examination as diagnostic procedure also dropped by 28.7%, 22.1%, and 16.7% respectively. In addition,
epilepsy as the majority case in our clinic, has dropped by 44,4%. Since their monthly visit are required, the
pandemic has disrupted our patients treatment. Conclusion To reduce the risk of COVID-19, parents could
visit the hospital without carrying their children. To maintain our healthcare, telemedicine can be used as
procedure to examine the children (especially children with epilepsy). For neurology examination such as
EEG, EMG and BERA, patient must come up with a schedule to prevent crowd.
Keywords: COVID-19; epilepsy; children; outpatient care; telemedicine

P-NEU-024
IVIG Administration accelerates Recovery in Pediatric Miller Fisher Syndromes:
A Case Report
Rahmad Ramadhani, Nurul Hidayah, Ruslan Muhyi
Departement of Child Health, Faculty of Medicine Universitas Lambung Mangkurat/Ulin General Hospital,
Banjarmasin, South Borneo, Indonesia
Abstract
Background Miller Fisher Syndrome (MFS) is a subtype of Guillain Barre Syndrome (GBS) and only
account about 5% of GBS case with clinical triad: ophtalmoplegia, ataxia and areflexia. The disease usually
has a benign course and recovery occurred after a mean time period of 10 weeks. In adult study, Intravenous
Immunoglobulin (IVIg) for MFS seem not to have influenced patients' outcomes, presumably because of
good natural recovery. Objectives To demonstrate favorable response of IVIg administration to the recovery
of pediatric MFS patient. Case A 12-year-old boy was referred with suspected MFS. He had dysphagia,
blurred vision, unsteady walk and a tendency to stumble since 3 weeks before and unable to stand by
himself on admission. On physical examination we found bilateral ptosis, cranial nerve paresis (Nervus VII
& IX), absent of physiological reflexes and pathological reflexes and decreased motoric strength of lower
extremity. A CSF analysis showed cytoalbumin dissociation (leucocytes 4/UL and albumin 320 mg/dL).
An EMG showed demyelinating sensoric and motoric polyneuropathy suggestive acute motor and sensory
axonal neuropathy (AMSAN). We administered IVIg 400 mg/kgBW/day for 5 consecutive days at 7th days
of treatment because no clinical improvement. On the 4 day of IVIg administration motor weakness, ptosis
th
and cranial nerve paresis improved. He was discharged after IVIG administration and continued outpatient
physiotherapy. Two weeks after IVIg administration (6 weeks from 1st symptom) he was able to carry out
his usual activities like walking, running, cycling and swimming. Conclusion IVIG administration may
accelerate recovery in pediatric MFS, and need further investigation.
Keywords: Miller Fisher syndrome; intravenous immunoglobulin

300 KONIKA XVIII Abstract Book