Page 352 - Abstract Book KONIKA 18

Neurology

P-NEU-031
Juvenile Myoclonic Epilepsy in 9-years-old Girl with Cystic Encephalomalacia

Putri Permata Sari, Prastiya Indra Gunawan, Riza Noviandi
Department of Child Health, Faculty of Medicine Universitas Airlangga/Dr.Soetomo General Academic Hospital,
Surabaya, East Java, Indonesia
Abstract
Background Juvenile Myoclonic Epilepsy (JME) is one kind of idiopathic generalized epilepsy that usually
develops during adolescence and affects 5% to 10% of epilepsy patients. The exact cause of JME remains
unknown. It is frequently misdiagnosed as focal onset epilepsy and even undiagnosed. Treatment for JME
with valproic acid medicine usually works well. Objective To report children with Juvenile myoclonic
epilepsy, focusing on diagnosis and treatment Case A 9-year-old girl was referred to the outpatient clinic at
Dr. Soetomo Hospital Surabaya with report of worsening seizures within the last 1 year. Myoclonic jerks,
generalized, and occasionally absence seizures occured shortly after waking up. The patient had a history
of seizures since the age of nine months, but the patient had never been treated with antiepileptic drugs
(AEDs). Family history of epilepsy was not found in this patient. An MRI was performed with the result of
cystic encephalomalacia in the right frontal and right cerebral hemiatrophy and EEG revealed spike-wave
complexes in right temporal lobe and generalized polyspike, confirming the diagnosis of JME. Valproic acid
was given to control seizure. Conclusion Raising awareness in diagnosing juvenile myoclonic epilepsy could
lead to better treatment and increase the well-being of the patient.
Keywords: juvenile myoclonic epilepsy; medicine; myoclonic jerk; cystic encephalomalacia

P-NEU-032
Treatment Outcome of Congenital Cytomegalovirus beyond the Neonatal Period,
Presenting with Subdural Empyema Comorbidity: A Case Report

Citra Raditha, Anna Tjandrajani, Pandu Caesaria Lestari
Department of Child Health, PKIAN RSAB Harapan Kita, Jakarta, Indonesia
Abstract
Background Early ganciclovir treatment for congenital CMV provides hearing and neurodevelopmental
benefit for some infants. Treatment should be initiated during the neonatal period. However, many children
present afterwards. Objective To describe ganciclovir therapy outcome in 7-month-old infant with congenital
CMV and subdural empyema. Case A 5.5-month-old male infant reffered from Bengkulu with prolonged fever,
vomiting and recurrent seizures. Less active motoric and response of sound. Normal head circumference,
left-sided hemiparesis, upper motor neuron sign. Electroencephalography revealed focal epileptiform
discharge. Head computerized tomography (CT) scan indicated subdural empyema, calcification in dextra
frontoparietotemporal, ventriculomegaly. Laboratory result from Bengkulu showed high titre of anti-
CMV IgG serology (1469 IU/mL). In our center, we found positive urine CMV polymerase chain reaction
(PCR). Brainstem evoked response audiometry (BERA) result was mild dextra sensorineural hearing loss.
Negative sign of chorioretinitis. Patient underwent brain empyema drainage, administration of prolonged
antibiotic and anticonvulsants. Afterwards, we decided to administer ganciclovir at the age of 7-month-old,
6 mg/kg/time, 2 times daily, for 6 weeks. Upon discharge, clinical conditions were improved with normal
laboratory screening. Anti-CMV IgG serology showed decreased titre (994.1 IU/mL). At 10-month-old,
patient exhibited free-seizure condition, advance motoric strenght, capability to sit with support, babbling,
adequate response of sound and acknowledgement of his name. Laboratory, BERA, PCR evaluation were
scheduled. Conclusions Infant with congenital CMV received ganciclovir beyond neonatal period indicated
a favourable outcome. Hearing and neurodevelopmental improvement can be a goal of treatment in case of
mild or moderate hearing loss as in ours.
Keywords: congenital CMV; ganciclovir; beyond neonatal; outcome

304 KONIKA XVIII Abstract Book