Aplikasi Klinis Repetitive Transcranial Magnetic Stimulation (rTMS) pada Disfagia Neurogenik – Studi pada Stroke Iskemik Akut

Reynard Febrian

doi:10.36452/jkdoktmeditek.v29i3.2901

Authors

Reynard Febrian Departemen Ilmu Penyakit Saraf, Fakultas Kedokteran dan Ilmu Kesehatan, Universitas Kristen Krida Wacana, Jakarta, Indonesia

DOI:

https://doi.org/10.36452/jkdoktmeditek.v29i3.2901

Keywords:

disfagia neurogenik, rTMS, stroke iskemik akut

Abstract

Disfagia paska-stroke mengakibatkan gangguan fungsi menelan karena terjadinya ketidakseimbangan koordinasi otot-otot menelan perifer dan regulasi sentral. Disfagia menyebabkan komplikasi berupa aspirasi, malnutrisi, hingga kematian. Studi menunjukkan bahwa penggunaan rTMS pada disfagia memberikan luaran klinis yang baik. Laki-laki 55 tahun; lemah separuh tubuh sisi kanan, bicara pelo, dan sulit menelan dengan onset 15 jam. Pasien memiliki riwayat stroke 1 bulan yang lalu dengan lemah separuh tubuh sisi kiri. Pemeriksaan fisik didapatkan hipertensi, GCS E4M6Vx, afasia motorik, parese nervus kranial VII dan XII dekstra tipe sentral, hemiparese dupleks dengan kekuatan 3 pada kedua ekstremitas kanan dan 2 pada kedua ekstremitas kiri. Hipertonus, peningkatan refleks, serta refleks patologis positif pada keempat ekstremitas. Pemeriksaan computed tomography (CT) scan kepala non-kontras, menunjukkan infark serebri bilateral. Pasien mendapatkan tata laksana anti-platelet, neuroprotektor, fisioterapi, dan 5 siklus rTMS. Setelah dilakukan 5 siklus rTMS, didapatkan perbaikan fungsi menelan, yang ditunjukkan dengan perubahan skor National Institutes of Health Stroke Scale (NIHSS) dari 18 menjadi 12, skor brief bedside dysphagia screening test-revision (BBDST) dari 8 menjadi 4, dan skor modified water swallowing test (MWST) dari 1 menjadi 5. Penggunaan rTMS terbukti memberikan luaran klinis yang baik pada disfagia neurogenik akibat stroke iskemik akut.

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