Efikasi repetitive transcranial magnetic stimulation sebagai terapi epilepsi refrakter
https://doi.org/10.22146/bns.v19i2.69200 Baruno Adi Christiantoro(1*), Harsono Harsono(2), Cempaka Thusina Srie Setyaningrum(3)
(1) KSM Saraf, RS Panti Rapih, Yogyakarta
(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
Epilepsy is one of the most prevalent noncommunicable neurologic disease. It is estimated to affect almost 70 million people worldwide. Epidemiological data indicate that 20–40% of the patients with newly diagnosed epilepsy will become refractory to treatment. Only 5-10% of this population will be candidate of surgical resection which is a superior therapy in refractory epilepsy.
Repetitive Transcranial Magnetic Stimulation (rTMS) is considered as a future therapeutic method for refractory epilepsy which is non-invasive, relatively safe, and inexpensive. Low frequency rTMS promotes intracortical inhibition. Antiepileptic effects of low frequency rTMS induce long term depression like phenomena by increasing GABAergic inhibition.
Some research suggests that low-frequency rTMS may reduce the frequency of seizures and epileptiform discharges in refractory epilepsy, especially in localized epileptiform zone as in congenital malformation of cortical development. Antiepileptic effect of low frequency rTMS last up 2-4 weeks after treatment. Figure of eight rTMS coil stimulation above epileptogenic area is more effective than other regions. Further clinical studies are needed to determine rTMS protocol patient’s inclusion criteria and assessment of outcomes that provide benefit for patients with refractory epilepsy.
ABSTRAK
Tujuh puluh juta penduduk dunia diperkirakan mengalami epilepsi. Sekitar 30% penderita epilepsi dipertimbangkan mengalami refrakter. Hanya 5-10% dari populasi ini yang dapat menjadi kandidat bedah reseksi yang merupakan terapi superior epilepsi refrakter.
Repetitive TMS dapat dipertimbangkan sebagai salah satu terapi masa depan noninvasif, aman, dan tidak mahal pada pasien epilepsi refrakter. Stimulasi rTMS frekuensi rendah dapat mempromosikan inhibisi intrakortikal. Efek antiepilepsi TMS frekuensi rendah adalah dengan menginduksi long term depression dengan cara meningkatkan inhibisi GABAergik.
Beberapa penelitian menunjukkan rTMS frekuensi rendah dapat mengurangi frekuensi bangkitan dan gelombang epileptiform pada pasien epilepsi refrakter, terutama epilepsi dengan zona epileptiform kortikal terlokalisasi seperti malformasi kongenital pada perkembangan kortikal. Efek antiepilepsi TMS tersebut berlangsung setidaknya 2-4 minggu. Efek rTMS frekuensi rendah lebih bermakna bila stimulasi dilakukan dengan koil bentuk “eight” di atas area epileptogenesis. Studi klinis lebih lanjut diperlukan untuk menentukan protokol rTMS, kriteria inklusi pasien, efek OAE, dan penilaian luaran yang memberikan keuntungan bagi pasien epilepsi refrakter.
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DOI: https://doi.org/10.22146/bns.v19i2.69200
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