EFEKTIVITAS REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION TERHADAP PERBAIKAN AFASIA NONFLUENT PASCA STROKE INFARK

RISSA NURLAILA, dr. Astuti, Sp.S(K).; dr. Indarwati Setyaningsih, Sp.S(K)

2017 | Tesis-Spesialis | SP ILMU PENYAKIT SYARAF

Stroke dapat menyebabkan afasia, diperkirakan sekitar 21%-38% pasien stroke akut mengalami afasia. Pemulihan afasia setelah stroke tergantung secara signifikan pada tingkat neuroplastisitas setelah terjadinya kerusakan. TMS merupakan metode non-infasif yang aman digunakan untuk menginduksi atau meningkatkan perubahan neuroplastisitas sel otak. Penelitian ini bertujuan untuk mengetahui efektivitas pemberian rTMS frekuensi 5Hz sebanyak 10 sesi di area Broca terhadap perbaikan afasia nonfluent pasca stroke infark yang dinilai dengan peningkatan skor TADIR. Penelitian menggunakan rancangan kuasi eksperimental, dengan subjek penelitian berjumlah 24 pasien afasia pasca stroke infark pertama onset kurang dari 6 bulan. Kelompok rTMS terdiri dari 12 subjek mendapat terapi repetitive TMS 5Hz (10 sesi, 5 hari berturut-turut selama 2 minggu), terapi standar dan stimulasi kognitif. Kelompok kontrol dengan 12 subjek mendapat terapi standar dan stimulasi kognitif. Outcome penelitian dinilai dengan skor TADIR untuk komponen menyebut, komponen menamai, komponen pemahaman, dan komponen meniru. Dilakukan analisis Mann-Whitney perbandingan perubahan skor TADIR baseline, setelah pemberian terapi pada minggu ke-2 dan ke-6 antara kelompok rTMS dan kontrol. Dari hasil analisis pada kedua kelompok didapatkan peningkatan komponen kemampuan menyebut, menamai, pemahaman, dan meniru setelah pemberian terapi, akan tetapi perbedaan yang signifikan hanya pada kemampuan pemahaman (p =0,033) dan menamai (p =0,028) setelah 2 minggu pemberian terapi. Berdasarkan penelitian ini, terapi rTMS frekuensi 5Hz sebanyak 10 sesi di area broca efektif terhadap perbaikan afasia nonfluent pada komponen fungsi penamaan dan pemahaman jangka pendek yang dinilai dari skor TADIR

Aphasia is one of the most common consequences of stroke approximately 21-38%. The restoration of aphasia after a stroke depends significantly on the level of neuroplasticity after damage. TMS is a non-invasive and safe method used to induce or improve neuroplasticity of brain cell changes. The aim of this study was to investigate effectivity repetitive transcranial magnetic stimulation (rTMS) 5Hz 10 times over the Brocas area in improves TADIR score in post stroke nonfluent aphasia patients. The study used an experimental quasi-design with 24 nonfluent aphasic patients in the early stage (up to 6 months) of a first-ever left hemisphere infarction stroke. Divide in two groups. The rTMS group consisted of 12 subjects receiving TMS 5Hz repetitive therapy (10 sessions, 5 consecutive days in 2 weeks), standard therapy and cognitive stimulation. The control group with 12 subjects received standard therapy and cognitive stimulation. The outcome measures of the study was assessed by the TADIR score for the component fluency, naming, comprehension, and the repetitif component. Mann-whitney analysis was performed on comparing TADIR baseline score changes, immediately after 2weeks of experimental treatment and 6 weeks between rTMS and control groups. The results of analysis, although both groups improved their fluency, naming, comprehension, and repetition abilities after treatment, significant differences were noted between the rTMS and control groups in comprehension (p =0,033) and naming (p =0,028) abilities at immediately after 2 weeks of experimental treatment. Based on this study rTMS 5Hz frequency therapy of 10 sessions in brocas area are effective to nonfluent aphasia improvement on naming and comprehension components in short-term according TADIR score.

Kata Kunci : rTMS, aphasia, stroke infark, TADIR, aphasia, infarction stroke