EFEKTIVITAS REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION TERHADAP PERBAIKAN FUNGSI KOGNITIF PASIEN GANGGUAN KOGNITIF VASKULAR PASCA STROKE INFARK

BARUNO ADI C, dr. Astuti, SpS(K).; dr. Imam Rusdi, SpS(K).

2017 | Tesis-Spesialis | SP ILMU PENYAKIT SYARAF

Gangguan kognitif pasca stroke terjadi cukup sering pada pasien stroke. Prevalensi gangguan kognitif pasca stroke bervariasi antara 20-80%. Gangguan kognitif menimbulkan dampak yang ringan hingga berat. Repetitive Transcranial Magnetic Stimulation (rTMS) merupakan metode non-invasif yang dapat menghasilkan perubahan potensial terhadap rangsangan kortikal. Stimulasi rTMS mampu mendorong pemulihan fungsional pada pasien stroke dengan cara menginduksi neuroplastisitas Penelitian bertujuan untuk mengetahui efektivitas rTMS dalam memperbaiki fungsi kognitif pada pasien gangguan kognitif pasca stroke infark yang dilihat dengan tes Montreal Cognitive Assesment-Indonesia (MoCA-Ina) setelah dilakukan terapi rTMS di regio DLPFC kiri selama 10 sesi. Sebanyak 38 subjek terbagi dalam kelompok perlakuan rTMS dan kontrol mengikuti penelitian ini dengan rerata usia 58,76+4,8 tahun dan nilai MoCA-Ina 15+7,04. Hasil analisis bivariat didapatkan perlakuan rTMS secara bermakna memperbaiki selisih rerata MoCA-Ina dibandingkan kelompok kontrol baik sesaat (p <0,001) maupun 1 bulan setelah perlakuan (p <0,001). Setelah dilakukan analisis multivariat menunjukkan bahwa hanya perlakuan rTMS yang menjadi faktor independen perbaikan rerata selisih MoCA-Ina baik pada sesaat (p =0,001) maupun 1 bulan setelah perlakuan (p <0,001). Berdasarkan penelitian ini terapi rTMS memberikan perbaikan signifikan fungsi kognitif global yang dinilai dari skor MoCA-Ina pada pasien gangguan kognitif pasca stroke infark pada sesaat setelah perlakuan rTMS dan bertahan hingga 1 bulan kemudian.

Cognitive impairment after a stroke occurs frequently in post stroke patients. The prevalence of cognitive impairment after a stroke varies between 2080%. Cognitive disorders cause mild to severe impacts. Repetitive Transcranial Magnetic Stimulation (rTMS) is a noninvasive method that can produce potential changes to cortical stimulation. RTMS stimulation could encourage functional recovery in stroke patients by inducing neuroplasticity. The study aims to determine the effectiveness of rTMS in improving cognitive function in post-stroke infartion patients with cognitive impairment seen with Indonesian Montreal Cognitive Assessment (MoCA-Ina) test after therapy rTMS for 10 sessions in left DLPFC region. A total of 38 subjects divided into rTMS treatment group and the control who follow this study with a mean age of 58.76+4.8 years and 15+7.04 of MoCAIna scores. Results of bivariate analysis is rTMS treatment significantly improved the differences score in MoCA-Ina better than the control group shortly (p <0.001) and 1 month after treatment (p <0.001). After multivariate analysis showed that only the rTMS treatment which become independent factor improvement of MoCA-Ina scores either in shortly (p =0.001) and 1 month after treatment (p <0.001). Based on this research, rTMS therapy provides a significant improvement in global cognitive function as assessed in MoCA-Ina scores in patients with cognitive impairment after a stroke infarction shortly after rTMS treatment and last up to 1 month later.

Kata Kunci : rTMS, efektivitas, pasca stroke, efek samping, MoCA-Ina, rTMS, effectivity, MoCA-Ina, pasca stroke, side effect