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GAMBARAN ELEKTROENSEFALOGRAFI

PADA PENDERITA KELAINAN NEUROLOGI


DI RSUP HAJI ADAM MALIK MEDAN TAHUN 2016-
2017
Isna Gita Amalia Nasution1, Haflin Soraya Hutagalung2
Email : isna.gitaamalia@ymail.com
1
Mahasiswa Fakultas Kedokteran USU angkatan 2015
2
Staff Pengajar Departemen Neurologi, Fakultas Kedokteran USU

ABSTRACT
Background. Electroencephalography (EEG) is a device that represents electrical activities occur in
the brain. EEG can be used on neurological disorder patients with seizure that will show the wave
changes from its baseline waves, hence the disrupted part of the brain could be located. Objective.
This study was conducted to determine the representation of electroencephalography on neurological
disorder patients at RSUP Haji Adam Malik Medan in 2016-2017. Results. The most common wave
types from electroencephalograph was sharp and spike waves in patients with brain tumours (75%),
meningitis (66.7%), epilepsi (50.4%), encephalitis (50%), followed by slow waves in patients with
post-stroke seizures (68.2%) and normal waves in those with head trauma (33.3%). The most observed
wave location was whole-brain in those with brain tumours (75%), meningitis (66.7%), post-stroke
seizures (54.5%) and epilepsi (39.1%), followed by temporal location in encephalitis (50%) and
unspecified in those with head trauma (33.3%). The most common gender was male in head trauma
(63%), encephalitis (60%), meningitis (58.3%), epilepsi (55.7%) and post-stroke seizures (54.5%),
whereas in brain tumours case, the male and female had similar frequency. The most common age
group was under 10 years old in meningitis (75%), encephalitis (65%), epilepsi (61.7%) and brain
tumours (50%), followed by the 10-19 years’ age group in head trauma (48.1%) and above 50 years in
post-stroke seizures (36.4%). Conclusion. There are differences in age groups, waves and
electroencephalogram locations in patients with neurological disorders.
Keywords : Electroencephalography (EEG), neurology disorder patients, seizure.

INTRODUCTION
Neurons (nerves) are electrical cell fibers that have the ability to receive, process
and send information from one neuron to another neuron (Muller-Putz et al., 2015).
Medical equipment used to measure biolytic signals in brain tissue is
electroencephalography (EEG) (Yulianto et al., 2013). EEG is one tool that works by
recording nerve electrical activity in the brain. The electrical potential in the brain
comes from the electrophysiological properties of the nervous system. The nervous
system can survive because of ion differences that cause nerve cells to become
positively and negatively charged electrically, so nerve cells can be depolarized
(positive potential) where nerve cells are carrying out stimulation or polarization
(negative potential) where the nerve is resting (Tatum et al ., 2008).

METHODS
This research uses descriptive research with cross-sectional design. The study
was conducted at Haji Adam Malik Hospital in Medan.
The sample in this study were patients who had EEG placement in patients with
head trauma, epilepsy, post-stroke seizures, brain tumors, meningitis and encephalitis
based on medical record data at Haji Adam Malik General Hospital Medan from 1
January 2016 to 31 December 2017 with a total sampling technique.
Data collection was obtained from medical records at Haji Adam Malik
Hospital Medan from 1 January 2016 - 31 December 2017 then recorded patient data
(name, age, gender) and description and location of the patient's
electroencephalographic waves. The data obtained is collected and calculated, then
analyzed.

RESULTS AND DISCUSSION


Data obtained based on medical records in patients with neurological disorders
who performed electroencephalography in the period January 2016 to December
2017 were 200 people.
Tabel 4.1 Distribusi pasien trauma kepala
Karakteristik (n) (%)
Umur (Tahun) <10 8 29,6
10-19 13 48,1
20-29 3 11,1
30-39 2 7,4
>50 1 3,7
Jenis Kelamin Laki-Laki 17 63,0
Perempuan 10 37,0
Pola Gelombang Paku 5 18,5
Lambat 2 7,4
Tajam 2 7,4
Tajam + Paku 7 25,9
Lambat + Tajam 2 7,4
Normal 9 33,3
Lokasi Gelombang Seluruh Lapangan 8 29,6
Tempo-Parietal-Oksipital 3 11,1
Fronto Sentral 7 25,9
Tidak Dinyatakan 9 33,3
Total 27 100

From Table 4.1 it can be seen that the most age group is 10-19 years, amounted
13 people (48.1), followed by the age group under 10 years as many as 8 people
(29.6%), aged 20-29 years as many as 3 people ( 11.1%), age 30-39 years as many as
2 people (7.4%), while the age group of at least 50 years is 1 person (3.7%). This is
consistent with a study by Simajuntak (2015), which states that the most common age
group with head trauma is 15-19 years in which this age group is the age group of
students. The lack of awareness of traffic discipline attributes to the high number of
head injuries caused by traffic accidents.
The distribution of head trauma patients based on the most frequent sex was
male as many as 17 people (63%), while women as many as 10 people (37%). This is
in accordance with a study by Damanik (2013) which stated that head injury patients
due to the traffic accident to men because men are mostly outside the home and the
streets and are the most vehicle users.
The distribution of head trauma patients based on the most wave pattern is
normal waves which are 9 people (33.3%), followed by sharp waves and spikes
which are 7 people (25.9%) and spike waves of 5 people (18.5%), while the least
frequency was the slow, sharp and slow and sharp waves of 2 people (7.4%). This
result is slightly different from the study of Ianof and Anghinah (2017) who say that
acute head trauma shows slow wave activity. This difference can be caused by no
recurring seizures in head trauma with normal waves.
Distribution of head trauma patients based on the most locations was not stated
as many as 9 people (33.3%), followed by the location of all brain fields as many as 8
people (29.6%) and the location of fronto central amounted 7 people (25.9%), while
the least frequency on tempo-parietal-occipital in 3 patients (11.1%).
Tabel 4.2 Distribusi pasien epilepsi.
Karakteristik (n) (%)
Umur (Tahun) <10 71 61,7
10-19 37 32,2
20-29 4 3,5
>50 3 2,6
Jenis Kelamin Laki-Laki 64 55,7
Perempuan 51 44,3
Pola Gelombang Paku 29 25,2
Lambat 3 2,6
Tajam 16 13,9
Tajam + Paku 58 50,4
Lambat + Tajam 2 1,7
Normal 7 6,1
Lokasi Gelombang Seluruh Lapangan 52 45,2
Oksipital 5 4,3
Tempo-Parietal-Oksipital 29 25,2
Fronto Sentral 22 19,1
Tidak Dinyatakan 7 6,1
Total 115 100

From Table 4.2 it can be seen that the most age group in epilepsy is under 10
years, namely 71 people (61.7), followed by the age group 10-19 years as many as 37
people (32.2%), 20-29 years as many as 4 people (3.5%), while the least age group is
above 50 years as many as 3 people (2.6%). The results of this study are in
accordance with the study of Ponnusamy (2017) who said that the highest incidence
of epilepsy was under 10 years.
The highest sex distribution in epilepsy was 64 men (55.7%), while 51 for
women (44.3%). This result is in accordance with the study of Ponnusamy (2017)
who said that there were no significant differences between men and women because
basically everyone can experience epilepsy and each person has a brain with a
respective seizure threshold.
The distribution of most wave patterns in epilepsy was sharp and spikes in as
many as 58 people (50.4%), followed by spike waves as many as 29 people (25.2%),
sharp waves as many as 16 people (13.9%), normal waves in 7 people (6.1%), as well
as slow waves in 3 people (2.6%), the least waves were slow and sharp waves in 2
people (1.7%). The results of this study are consistent with the study of Ponnusamy
(2017) that the most common type appearing in epilepsy is sharp waves and spikes
that often cause epilepsy in general attacks.
The distribution location of the most waves in epilepsy was all fields of 52
people (45.2%), followed by the tempo-parietal-occipital location of 29 people
(25.2%), central fronto as many as 22 people (19.1%), location not stated in as many
as 7 people (6.1%), while the least wave location is occipital which is as many as 5
people (4.3%). The results of this study are in accordance with the study of
Ponnusamy (2017) who stated that the location of the most common waves in
epilepsy is the entire field.
Tabel 4.3 Distribusi pasien kejang pasca stroke.
Karakteristik (n) (%)
Umur (Tahun) <10 1 4,5
10-19 2 9,1
20-29 1 4,5
30-39 4 18,2
40-49 6 27,3
>50 8 36,4
Jenis Kelamin Laki-Laki 12 54,5
Perempuan 10 45,5
Pola Gelombang Paku 1 4,5
Lambat 15 68,2
Normal 6 27,3
Lokasi Gelombang Seluruh Lapangan 15 68,2
Tempo-Parietal-Oksipital 1 4,5
Tidak Dinyatakan 6 27,3
Total 22 100

From table 4.3 it can be seen that the most age group in post-stroke seizures is
above 50 years, amounted 8 people (36.4%), followed by the age group 40-49 as
many as 6 people (27.3%), 30-39 years in 4 people (18.2%), 10-19 years of 2 people
(9.1%), and the least are under 10 years and 20-29 years of 1 person (4.5%). These
results are in accordance with previous studies that noted strokes were mostly found
at the age of 55 years because of an increase in age associated with the aging process,
in which all organs of the body experience a decline in functions including brain
blood vessels (Chaniago, 2018).
The most common sex distribution in post-stroke seizures is male, as many as
12 people (54.5%), while women as many as 10 people (45.4%). These results are in
accordance with the studies of Audina and Halimuddin (2016) which stated that there
are no significant differences between men and women due to multifactorial
properties of stroke, such as diabetes mellitus, hypercholesterolemia, smoking,
alcohol and heart disease.
The distribution of the most wave pattern in post-stroke seizures is slow wave
which is 15 people (68.2%), followed by normal waves in 6 people (27.3%) and
the least is the spike wave in 1 person (4.5% ) This result is in accordance with a
study by Handayani and Aulina (2017) which highlighted that the wave that is often
found in post-stroke seizures is general slowdown.
The distribution of the most common wave locations in post-stroke seizures is
the whole field in 15 patients (68.2%), followed by the unstated locations in as many
as 6 people (27.3%) and the least location is the tempo-parietal-occipital there is 1
person ( 4.5%). These results are consistent with a study by Handayani and Aulina
(2017) that stated EEG image abnormalities were seen in the quadrant area in the
posterior left hemisphere and right hemisphere.
Tabel 4.4 Distribusi pasien tumor otak.
Karakteristik (n) (%)
Umur (Tahun) <10 2 50,0
10-19 1 25,0
>50 1 25,0
Jenis Kelamin Laki-Laki 2 50,0
Perempuan 2 50,0
Pola Gelombang Tajam + Paku 3 75,0
Normal 1 25,0
Lokasi Gelombang Seluruh Lapangan 3 75,0
Tidak Dinyatakan 1 25,0
Total 4 100

From table 4.4 it can be seen that the most age group is under 10 years in as
many as 2 people (50%) while the age group 10-19 years and above 50 years
respectively there is 1 person (25%). This result is slightly different from the research
by Dewi (2016) which explains that tumors mostly occur at the peak age of 30-40
years.
The sex distribution of brain tumors between men and women is the same, that
is 2 people (50%). This result is slightly different from the research by Dewi (2016)
which stated that the risk of brain cancer is increased in men.
The distribution of the most wave patterns in brain tumors was sharp and spikes
as many as 3 people (75%) while the least were normal waves of 1 person (25%).
This result is slightly different from a study by Bintoro (2012) that stated the most
common wave in patients with brain tumors is slow waves.
The location distribution of the most waves in brain tumors is the whole field of
3 people (75%) and followed by the location not stated which is in 1 person (25%).
Tabel 4.5 Distribusi pasien meningitis.
Karakteristik (n) (%)
Umur (Tahun) <10 9 75,0
10-19 1 8,3
20-29 1 8,3
40-49 1 8,3
Jenis Kelamin Laki-Laki 7 58,3
Perempuan 5 41,7
Pola Gelombang Paku 1 8,3
Tajam 1 8,3
Tajam + Paku 8 66,7
Normal 2 16,7
Lokasi Gelombang Seluruh Lapangan 8 66,7
Tempo-Parietal-Oksipital 1 8,3
Fronto Sentral 1 8,3
Tidak Dinyatakan 2 16,7
Total 12 100

From table 4.5 it can be seen that the most common age group in meningitis is
under 10 years as many as 9 people (75%), followed by the age group 10-19 years,
20-29 years and 40-49 years each 1 person (8, 3%). This result is in accordance with
Simanullang's study in 2015, which explains that meningitis is more often under the
age of 5 years, because at this age the body's resistance is still low so it is very
vulnerable to environmental influences and infectious diseases.
The most common sex distribution in meningitis is 7 men (58.3%) while
women are 5 people (41.7%). These results are in accordance with a study in 2006 by
Wulandari which states that men are more than women due to sex linked factors
that affect host sensitivity, where one gene located on the X chromosome participates
in the synthesis of immunoglobulins.
The distribution of the most common wave pattern in meningitis is sharp and
spikes in as many as 8 people (66.7%), followed by normal waves of 2 people
(16.7%), while the spikes and sharp waves are 1 person (8.3%) respectively. The
results of this study are different from the theory that EEG waves in meningitis are
slow waves. Normal waves appear in uncomplicated meningitis (Niedermeyer and
Dasilva, 2005).
The most common location distribution for meningitis is the entire field of 8
people (66.7%), followed by unspecified waves of 2 people (16.7%) and at least the
tempo-parietal-occipital and fronto central locations respectively 1 people (8.3%).
Tabel 4.6 Distribusi pasien ensefalitis.
Karakteristik (n) (%)
Umur (Tahun) <10 13 65,0
10-19 7 35,0
Jenis Kelamin Laki-Laki 12 60,0
Perempuan 8 40,0
Pola Gelombang Paku 9 45,0
Tajam + Paku 10 50,0
Normal 1 5,0
Lokasi Gelombang Seluruh Lapangan 3 15,0
Tempo-Parietal-Oksipital 10 50,0
Frronto Sentral 6 30,0
Tidak Dinyatakan 1 5,0
Total 20 100

From table 4.6 it can be seen that the most common age group in encephalitis is
under 10 years as many as 13 people (65%), followed by the 10-19 year age group of
7 people (35%). This result is in accordance a study by Subanada and Kari (2013)
that encephalitis often affects children.
The most common sex distribution in encephalitis is 12 male (60%), while 8
female (40%). This result is in accordance with a study by Subanada and Kari (2013)
that encephalitis often involves children with male sex.
The distribution of the most common wave pattern in encephalitis is sharp and
spikes as many as 10 people (50%), followed by spike waves of 9 people (45%) and
normal waves of 1 person (5%). This result is consistent with the theory that the
patient's condition with encephalitis with seizures will appear abnormal epileptiform
waves (Niedermeyer and Dasilva, 2005).
The distribution of the most common wave locations in encephalitis is tempo-
parietal-occipital as many as 10 people (50%), followed by the location of fronto
central 6 people (30%), all fields 3 people (15%) and not stated 1 person (5%). These
results are consistent with Pusponegoro's (2000) study that EEG in encephalitis is
located in the temporal or frontotemporal region.
CONCLUSION AND SUGGESTION
The most common waves appear in patients with neurological disorders are
sharp waves and spikes which are found in patients with brain tumors, meningitis,
epilepsy and encephalitis, followed by slow waves in patients with post-stroke and
normal wave seizures in head trauma. The most common wave locations appear are
locations in all brain fields found in brain tumors, meningitis, post-stroke and
epilepsy seizures, followed by tempo-parietal-occipital or temporal regions in
encephalitis and wave patients whose locations are not stated in head trauma
sufferers. The frequency of the most frequent sex is men except in brain tumors there
is no difference found between men and women. The frequency of the most common
age is the age group under 10 years found in meningitis, encephalitis, epilepsy and
brain tumors, followed by the 10-19 year age group in head trauma patients and the
age group above 50 years in post-stroke seizures
Suggestions to the Haji Adam Malik General Hospital in Medan is to complete
the medical record data and store the patient's medical record file neatly, to the
patients with neurological disorders who have abnormal EEG images are seuggested
to do a routine check-up and follow doctor's recommendations so that seizures can be
overcome or controlled, this writing is expected to be able to be a reading material
and reference sources.
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