Repetitive transcranial magnetic stimulation pada spastisitas cerebral palsy anak
https://doi.org/10.22146/bns.v18i3.55027 Rissa Nurlaila(1*), Ahmad Asmedi(2), Cempaka Thusina Srie Setyaningrum(3)
(1) KSM Penyakit Saraf, RSUD Ciamis dr. Denni Rahardjono Sp.S, Jawa Barat
(2) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(3) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author
Abstract
Cerebral palsy (CP) merupakan sekelompok gangguan perkembangan gerakan dan postur dikaitkan dengan gangguan non progresif yang terjadi saat otak sedang berkembang dengan salah satu gejala yang paling umum adalah spastisitas, di mana spastisitas ditemukan pada 50%-70% dari seluruh kasus CP. Spastisitas terjadi akibat abnormalitas di level intraspinal pada proses refleks regang, ketidakseimbangan regulasi dari level supraspinal terhadap refleks regang, atau kombinasi dari kedua kondisi tersebut yang menyebabkan terjadinya hipereksitabilitas alfa dan gama motorneuron di cornu anterior.
Tujuan dilakukannya terapi spastisitas di antaranya untuk meningkatkan aktivitas fungsional, mencegah terjadinya kelainan bentuk, mengurangi kontraktur dan nyeri. Beberapa metode terapi spastisitas tersebut adalah fisioterapi, terapi farmakologi dan operatif. Terapi intervensi non-invasive baru yang mulai digunakan dalam terapi spastisitas CP anak adalah repetitive Transcranial Magnetic Stimulation (rTMS).
Stimulasi kortikal rTMS melalui mekanisme Long Term Potentiation dan Long Term Depression akan meningkatan aktivitas korteks motorik sehingga meningkatkan inhibisi terhadap eksitabilitas spinal pada traktus kortikospinal yang akan menekan hiperaktivitas gama dan alfa motorneuron dan memperbaiki spastisitas. Dari beberapa penelitian mengenai efektivitas rTMS pada spastisitas CP anak didapatkan perbaikan spastisitas melalui penilaian Modified Asworth Scale, dan memberikan perubahan yang signifikan melalui penilaian Range of Movement, hal ini menunjukkan bahwa dari beberapa penelitian rTMS efektif dalam meningkatkan fungsi motorik dan mungkin dapat dipertimbangkan untuk direkomendasikan sebagai pilihan dalam pengobatan untuk spastisitas CP.
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DOI: https://doi.org/10.22146/bns.v18i3.55027
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