Gambaran Quantitative Electroencephalography (QEEG) sebagai faktor prediktor prognosis keberhasilan terapi Methylphenidate dalam penatalaksanaan Attention-Deficit/Hyperactivity Disorder (ADHD)

PANDHITA S., Gea, Dr.dr. Sri Sutarni Sp.SK

2004 | Tesis | S2 Ilmu Kedokteran Klinik

Latar belakang: Attention-deficit / hyperactivity disorder (ADHD) merupakan gangguan neurobehavioral dan tumbuh kembang onset anak-anak yang paling sering terjadi dan memiliki dampak besar bagi masyarakat dan individu. Psikostimulan methylphenidate merupakan pilihan utama penatalaksanaan ADHD pada anak, namun 15 – 20 % pasien tidak berespon baik dengan terapi tersebut. Beberapa peneliti telah mencoba menganalisis peran gambaran quantitative electroencephalography (QEEG) sebagai faktor prediktor prognosis keberhasilan terapi methylphenidate, namun hasilnya belum konklusif. Tujuan. Mengukur besar peran gambaran QEEG sebagai faktor prediktor prognosis keberhasilan terapi methylphenidate dalam penatalaksanaan ADHD pada anak. Metode. Studi kohort prospektif. Subyek penelitian adalah penderita ADHD anak usia 7 – 12 tahun yang baru terdiagnosis menderita ADHD, direncanakan mendapat terapi rutin methylphenidate, dan berobat ke klinik rawat jalan tumbuh kembang anak RS Dr. Sardjito atau klinik P3TKA Yogyakarta. Pengambilan sampel dilakukan secara berurutan (consecutive sampling). Outcome utama yang dinilai adalah perbaikan gejala inti ADHD, berdasarkan I/O conners rating scale, setelah tiga minggu terapi rutin. Subyek penelitian akan dibagi menjadi dua kelompok berdasarkan gambaran QEEG, yaitu kelompok cortically hypoaroused dan noncortically hypoaroused. Data akan diolah secara deskriptif dan analitik. Variabelvariabel yang mungkin berperan sebagai perancu akan ikut dianalisis. Uji tindependen, korelasi-regresi, dan anova akan digunakan untuk analisis univariat, sedangkan untuk analisis multivariat akan digunakan regresi multipel. Manfaat. Penelitian ini diharapkan dapat memberikan informasi mengenai peran gambaran QEEG sebagai faktor prediktor prognosis keberhasilan terapi methylphenidate dalam penatalaksanaan ADHD pada anak, sehingga dapat digunakan sebagai salah satu pertimbangan pengambilan keputusan medis, khususnya dalam pemilihan farmakoterapi psikostimulan.

Background: Attention-deficit / hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood, and frequently encountered childhood-onset neurodevelopmental disorder. The impact of ADHD on individual and society is enormous. Methylphenidate is the most researched and prescribed pharmacological treatments for ADHD, but about 15 – 20 % of patients having no benefit or aversive side effects from medication. Few studies have investigated the use of quantitative electroencephalography (QEEG) measurement in predicting which children with ADHD respond positively to methylphenidate, but the result is not conclusive yet. The use of QEEG for predicting outcome is based on the ability to identified the underlying cortical dysfunctions. Objective. To measure the role of QEEG profile in predicting which children with ADHD respond positively to methylphenidate. Methods. A prospective cohort study base on consecutive children with ADHD of 7 – 12 years old that have recent diagnosed, and plan to receive methylphenidate in Dr. Sardjito Hospital and P3TKA clinic. The primary outcome is reduction of the core symptoms of ADHD over three weeks, based on I/O conners rating scale. All subjects will have an QEEG assessment. The QEEG profile will be divided into two groups consisting of cortically hypoaroused and non-cortically hypoaroused. Independent ttest, correlation-regression, and analysis of variance will be used in univariate analysis, and multiple regression will be used in multivariate analysis. It is hoped that this study result will give information about the role of QEEG profile in predicting which children with ADHD respond positively to methylphenidate, and to move towards the classification of ADHD children based on the underlying cortical dysfunctions, to predict important clinical features, such as treatment outcomes.

Kata Kunci : Kedokteran Klinik,Terapi Methylphenidate,ADHD, attention-deficit / hyperactivity disorder – methylphenidate – quantitative electroencephalography – predictor – prognosis