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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1.Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, Jacobsson B, Damiano D. Proposed definition and classification of cerebral palsy. Developmental Medicine and Child Neurology. 2004;47:571–576.
2.Morris C & Bartlett D. Gross Motor Function Classification System: impact and utility. Developmental Medicine and Child Neurology. 2004;46:60–65.
3.Surman G, Heming K, Platt M J, Green A, Hutton J, Kurincuk J J. Children with cerebral Palsy; severity and trends over time. Pediatric Perinatal Epidemiology. 2009;23(6):513-521.
4.Feng J, Du L, Shan L, Wang B, Li H. Infra-low Frequency Transcranial Magnetic Stimulation Effectively Improves the Motor Function in Children with Spastic Cerebral Palsy. J Neurology Neurophysiology. 2015;6:291.
5.Sanger T D, Delgado M R, Gaebler-Spira D, Hallett M, Mink J W. Classification and definition of disorders causing hypertonia in childhood, Clinical Pediatrics. 2003;111:pp.e89-e97.
6.Gupta M, Bablu L, Rajak, Bhatia D, Mukherjee A. Effect of r-TMS over standard therapy in decreasing muscle tone of spastic cerebral palsy patients. Journal Medical English Technology. 2016;40(4):210-216.
7.Aree-uea B, Auvichayapat N, Janyacharoen T, Siritaratiwat W, Amatachaya A, Prasertnoo J, Tunkamnerdthai O, Thinkhamrop B, Jensen M P, Auvichayapat P. Reduction of spasticity in cerebral palsy by anodal transcranial direct current stimulation. Journal Medical Association Thailand. 2014;97(9):954-62.
8.Valle A C, Dionisio K, Pitskel N B, Pascual-Leone A, Orsati F, Boggio P S, Lima M C, Riggonati S, Fregni F. Low and High Frequency repetitive Transcranial Magnetic Stimulation for The Treatment of Spasticity. Developmental Medicine & Child Neurology. 2007;49:534-538.
9.Pascual-Leone A, Amedi A, Fregni F, Merabet L. The plastic human brain cortex. Annual Review of Neuroscience. 2005;28:377-401.
10.Gunduz A, Kumru H, Pascual-Leone A. Outcomes in Spasticity after Repetitive Transcranial Magnetic and Transcranial Direct Current Stimulation. Neural Regeneration Research. 2013;9(7):712-718.
11.Rosenbaum P, Paneth N, Leviton A. The Definition and Classification Of Cerebral Palsy. Developmental Medicine & Child Neurology. 2007;109:8-14.
12.Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Gross Motor Function Classification System Expanded and Revised Can Child Centre for Childhood Disability Research Canada. Developmental Medicine & Child Neurology. 2007;109:1-4.
13.Li S & Francisco G E. New insights into the pathophysiology of post-stroke spasticity. Front. Human Neuroscience. 2015;9:192
14.Trompetto C, Marinelli L, Mori L, Pelosin E, Curra A, Molfetta L, Abbruzzese G. Pathophysiology of Spasticity: Implications for Neurorehabilitation. Hindawi Publishing Corporation BioMed Research International; 2014.
15.Bar-On L, Molenaers G, Waage P, Campenhout A V, Feys H. Spasticity and Its contribution to Hypertonia in Cerebral Palsy. Biomed Research Internasional. 2014.
16.Berker N, Yalcin S, Root L, Stahelli L, Papavasilliou A, Ganjwala D, Koloyan G, Eti Z. The Help Guide to Cerebral Palsy. Global Help. Washington. 2011;2.
17.Miller F. Physical Therapy of Cerebral Palsy. Wilmington: Springer. 2007;354-391.
18.Mukherjee A, Bhatia D, Gupta M, Bablu, Rajak L.epetitive Transcranial Magnetic Stimulation for spastic Cerebral Palsy. Journal of Medical Engineering Technology. 2013;p.210-216.
19.Wagner T, Antoni, Valero-Cabre, Pascual-Leone A. Noninvasive Human Brain Stimulation. Annual Review of Bio medical Engineering. 2007;9:527-265.
20.Pascual-Leone A, Amedi A, Fregni F, Merabet L. The plastic human brain cortex. Annual Review of Neuroscience. 2005; 28: 377-401.
21.Drobyshevsky A, Takada S H, Luo K, Derrick M, Yu L, Quinlan K A, Vasquez V J, Noguiera M I, Tan S. Elevated spinal monoamine neurotransmitter after antenatal hypoxia ischemia in rabbit cerebral palsy model. Journal Neurochem. 2015;Feb,132(4):394-402.
22.Shaw C, McEachern J. Toward a theory of neuroplasticity. London. Psychology Press; 2001.
23.Gomez-Pinilla F. The Therapeutic Potential of Diet and Exercise on Brain Repair (3rd ed.). Boca Raton, FL: CRC Press, Taylor & Francis Group; 2010.
24.Rossi S, Hallett M, Rossini PM, Pascual-Leone A. Safety of TMS Consensus Group. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009;120(12).
25.Nicoll R A, Schmitz D. Synaptic plasticity at hippocampal mossy fibre synapses. Nature Reviews Neuroscience. 2005;6:863-876.
26.Cooke S F& Bliss T V. Plasticity in The Human Central Nervous System. Brain. 2006;1659-1673.
27.Bak L K, Schousboe A, Waagepetersen H S. The glutamate/GABA-glutamine cycle: aspects of transport, neurotransmitter homeostasis and ammonia transfer. J Neurochem. 2006;98:641-653.
28.Kim L, Chun M H, Kim B R, Lee S J. Effect of repetitive transcranial magnetic stimulation on patients with brain injury and Dysphagia. Ann Rehabil Med. 2011;35:765-771.
29.Cousijn H, Haegens S, Wallis G, Near J, Stokes M G. Resting GABA and Glutamate concentaraio. 2014.
30.Hsu W Y, Cheng C H, Liao K K, Lee I H, Lin Y Y. Effects of repetitive transcranial magnetic stimulation on motor functions in patients with stroke. Stroke. 2012;43:1849-1857.
DOI: https://doi.org/10.22146/bns.v18i3.55027
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