jurding hasya
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7/26/2019 jurding hasya
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Oleh:
Hasyati Dwi Kinasih 1410221013
Pembimbing:
dr. Catur Banuai! "#. "
KEPANITERAAN KLINIK DEPARTEMEN SARAF
FAKULTAS KEDOKTERAN UPN “VETERAN” JAKARTAPeriode 23 Mei – 26 Juni 2!6
JOURNAL READING
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Latar Belakang
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e r e + r o - * / i n • M e n i n $ ' # & ' # n n e u r o $ e n e / i / d i $ * r u / d e n & # & e . i ) ) o , # % ) u /
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) # d # / & r o ' e / u + # ' u & d e n $ # n $ # n $ $ u # n % o & o r i ' / e d # n $ / 6 d + e r # &
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$ n % l u s i
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• I n 1 # r ' u n i - # & e r # - ' o r & i ' # - 8 / u + ' o r & i ' # - 8 # & # u ' o r & i ' # - 0 / u + ' o r & i ' # -
• T e r ' o n 1 i r % # / i o - e . T / , # n # & # u M R I o & # '
•
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. i n $ $ # + e r # & 9 & o & # - S ' o r F u $ - 0 M e * e r 9 F M A : – ; < :
• M e % i - i ' i / & # & u / r # # & i n # ) • U / i # ! ; 0 ; & # . u n
& % s % l u s i
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• K e - # i n # n . # & i 8 $ i n ( # - 8 ) e n * # ' i & ( # n & u n $ # & # u ) # r u 0 ) # r u 8
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• R i # * # & ) e % + e r i # n ) e ) & i d e ) o r , i n e + r # i n
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Alur PenelitianPenen&u#n (u%-#.
/#%)e- )o)u-#/i
Pe%eri'/##n 7 .#ri
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)-#/e+o
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'e ;02;: /e+#$#i&#%+#.#n re.#+i-i#/i
&er#)i /&#nd#r
Re.#+i-i&#/i /&#nd#r@ 2 (#% &er#)i 1i/i'8 ! (#%
&er#)i o'u)#/ion#-/e-#%# .#ri 'er(#
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T2 9+u-#n 'e 2:8 d#n T3
9+u-#n 'e 3: )#/,#&er(#din*# /&ro'e
Peru+#.#nneuro)-#/&i/i&#/ (#rin$#n
%o&or dini-#i o-e. DTId#n resting state
finctional MagneticResonance Imaging r/1MRI
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• Di+eri'#n ! '#-i /e.#rido/i/ 3 %- dien,er'#nd#-#% /#-ine 9&o&#- in1u/! %-: IV
Ke-o%)o',ere+ro-*/in
• Di+eri'#n ! %-
/#-ine IVKe-o%)o')-#/e+o
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Peni-#i#n
Ke#arahanstr'%e saat (0
0NI>SS
0 MRI un&u'%eni-#i -e/i##- d#&#diu+#. %en(#di'oordin#&&e%)-#&e o&#'%e%enu.i MNI
)ungsi m't'ri%
0e4#-u#/i FMA/##& T8 T!0 T28T3 )#/,# /&ro'e
0FMA di,#&#&&er)i/#. %en(#diFMA0UL8 FMA0LL8 d#n FMA0T
Plastisitas%'ne%si m't'ri%
0 DTI@ 1r#,&ion#-#ni/o&ro)* 9FA:8#Ci#- di11u/i4i&*9AD:8 d#n r#di#-
di11u/i4i&* 9RD:)#d# .e%i/1eri)/i-e/ion#-
0 r/1MRI
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D e / # i n
) e n e - i & i # n • D e / # i n ) e n e - i & i # n ) r o / ) e ' & i 1 8 % u - & i , e n & e r 8 # , # ' 8 d o u + - e + - i n d 8 ' o n & r o - ) - # , e + o 8 ) # r # - - e - $ r o u ) 5
A n # - i / i / ' e # % # n # n • S , r e e n i n $ d # & # # # - @ r i # * # & % e d i / - e n $ ' # ) 8 ) e % e r i ' / # # n 1 i / i ' 8 d # & #
- # + d # r i # # - 9 T : . i n $ $ # B . # r i 9 T 3 : • A d 4 e r / e e 4 e n & i n 1 o r % e d , o n / e n & d i d o ' u % e n & # / i d i e 4 # - u # / i
A n # - i / i / / & # & i / & i '
• U ' u r # n / # % ) e - 2 & # i - e d i n d e ) e n d e n & 0 & e / & • A n # - i / i / u & # % # d e n $ # n I T T 0 L O F • S P S S 4 e r / i 2 ! 5 8 ) e r + e d # # n ' e - o % ) o ' , e r e + r o - * / i n d e n $ # n ) - # / e + o
d i n i - # i d e n $ # n & 0 & e / & i n d e ) e n d e n 8 1 r e ' u e n / i ) e r + e d # # n d e n $ # n C 2 0 & e / & # & # u F i / . e r e C # , & 8 u ( i A N O V A + e r u - # n $
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P#d# #n#-i/i/ /u+$ru) den$#n
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d#/#r8 &id#' #d# )er+ed##n /i$ni1i'#n
'#r#'&eri/&i' d#/#r #n&#r# ere+ro-*/in
d#n )-#/e+o
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An#-i/i/ ITT0LOF /u+'e-o%)o'
)#/ien den$#n $$n5 Mo&ori' +er#&
9n37 ,ere+ro-*/in2
)-#/e+o!7:
E1e' /i$ni1i'#n #n&#r#
#'&u d#n (eni/ in&er4en/i
FMA0T 9F38!2 <5B68 ) =
8: FMA0UL 9F38!2
3568 ) = 8:
Terd#)#& )er+ed##n
/i$ni1i'#n )#d# FMA0T
FMA0UL )#d# T2 T3
An#-i/i/ re$re/i /eder.#n# .u+un$#n
#n&#r# FMA0T T d#n T3 di 'edu#
'e-o%)o' 9ere+ro-*/in r2 57238 ) =5! )-#/e+o r 5B!;8 ) = 5!
)enin$'#&#n FMA0T di T3 %enun(u''#n&id#' #d# .u+un$#n den$#n ni-#i
d#/#r 9T: di 'e-o%)o' ere+ro-*/in 9r2
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#n&#r# du# )en$u'ur#n 9r2 5!!;<8 )
5676:
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#n#-i/i/ /u+'e-o%)o' ITT0LOF )#/ien den$#n
$#n$$u#n %o&ori' /ed#n$
9n 2B ere+ro-*/in n !<8 )-#/e+o n ! GFMA0T di T G;<:
u(i ANOVA +eru-#n$ &id#' #d# )er+ed##n/i$ni1i'#n #n&#r# in&er#'/i #'&u d#n (eni/in&er4en/i *#n$ diu'ur o-e. /,ore FMA
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An#-i/i/ di DTI
/u+'e-o%)o' ITT0
LOF )#/ien den$#n
$#n$$u#n %o&ori'
+er#& )#d# T
in&er#'/i /i$ni1i'#n #n&#r#
#'&u d#n (eni/ in&er4en/i
un&u' ADi)/i 9F28B 25;3!8 )
= 8: d#n RDi)/i 9F28B
35<B8 ) = 8:
#n#-i/i/ ITT0
LOF /u+'e-o%)o'
)#/ien $#n$$u#n %o&ori'
/ed#n$ )#d# T8 u(i ANOVA %enun(u''#n
in&er#'/i /i$ni1i'#n #n&#r#
#'&u d#n (eni/ in&er4en/i
)#d# DTI 9FAi)/i 8 ADi)/i
d#n RDi)/i:
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r/1MRI d#&# di#n#-i/i/ d#ri 2B )#/ien 9ere+ro-*/in
n !38 )-#/e+o n !6:
Peru+#.#n d#-#%
'one'/i/en/ori%o&or
)enin$'#&#n
/i%e&ri/ 'one'&i4i&#/
1un$/ion#- #n&#r#
'or&e'/ /en/ori0
%o&ori' )ri%er+i-#&er#- 9SM!/:
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ere+ro-*/in
u(i ANOVA +eru-#n$
%enun(u''#n &id#'#d# )er+ed##n
/i$ni1i'#n
#n&#r# #'&u d#n
(eni/ in&er4en/i
d#-#%
#n#-i/i/ inde'/
-#&er#-i/#/i 9LI:
#n&#r# SM!/
+i-#&er#-
ere+ro-*/in
%enun(u''#n
)er+ed##n *#n$
/i$ni1i'#n d#-#%
)eru+#.#n LI T! d#n
T3
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Diskusi
> # / i - S & u d i • e r e + r o - * / i n / e - # % # 3 % i n $ $ u d i / & r o ' e 1 # / e / u + # ' u & ) e r + # i ' # n ) # d # 1 u n $ / i % o & o r i ' 3 + u - # n / e & e - # . o n / e & / & r o ' e H ' e - o % ) o ' ) - # / e + o
• P e n $ o + # & # n e r e + r o - * / i n / e - # % # 3 % i n $ $ u / e - # % # / & r o ' e 1 # / e / u + # ' u &
% e n u n ( u ' ' # n & i d # ' # d # e 1 e ' / # % ) i n $ / e r i u /
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S&udi )#d# .e#n %enun(u''#n 'e/#%##n d#-#% e'/)re/i $en
&er'#i& )-#/&i/i&#/ d#n &r#n/-#/i #n&#r# ##- )er'e%+#n$#n o&#'
d#n 1#/e /e%i#'u& /e&e-#. /&ro'e
"en ini d#n )ro&ein )en&in$ un&u' )er&u%+u.#n /#r#18
/*n#)&o$ene/i/ d#n )ro-i1er#/i /)ine dendri&i'5
D#-#% /&udi .e#n /&ro'e8 re.#+i-i&#/i %o&or0/en/ori' /e,#r#
/i$ni1i'#n %enin$'#& /##& )e%+eri#n ere+ro-*/in di%u-#i
d#-#% #'&u <; (#% /e&e-#. /&ro'e
Sed#n$'#n )#d# %#nu/i# di)er'ir#'#n indo )eriod un&u'
)e%u-i.#n ini #'#n -e+i. -#%# 9.#ri /d %in$$u:
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e1e' ere+ro-*/in )#d# )-#/&i/i&#/ 'one'/i %o&ori' den$#n DTI
d#n r/1MRI
An#-i/i/ ST0i/e DTI &e-#. %enun(u''#n /i$ni1i'#n/i in&er#'/i
un&u' RD d#n AD #n&#r# (eni/ in&er4en/i d#n #'&u )#d#
'e-o%)o' ,ere+ro-*/in
RD %enun(u''#n
)enin$'#&#n /e&e-#. ,eder# *#n$
*#n$ %ere1-e'/i'#n #d#n*#
de%*e-in#/i
- )enurun#n AD
%enun(u''#n 'eru/#'#n
#Con#- )#d# 1#/e #'u&
/e&e-#. ,eder#8- )enin$'#&#n AD
&er(#di '#ren# )ro/e/
de$ener#&i1 d#-#%
&#.#) 'roni/
Po&en/i ,ere+ro-*/in
&er.#d#) )er-indun$#n
de%*e-in#/i
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D#-#% )ene-i&i#n #-#u)un &id#' #d# in&er#'/i #n&#r# (eni/
in&er4en/i d#n #'&u di&un(u''#n un&u' FA
FA
%u-#i %enin$'#&
/e&e-#. T! d#-#%'e-o%)o'
ere+ro-*/in
FA &eru/ %enurun
.in$$# T3 d#-#%'e-o%)o' )-#/e+o
%un$'in %en,er%in'#n )e%u-i.#n in&e$ri&#/ 'or&i'o/)in#-i/
*#n$ didu'un$ o-e. &ind#'#n 1#r%#'o-o$i/ ere+ro-*/in5
Ke-o%)o' ere+ro-*/in %enun(u''#n )e%u-i.#n 'one'&i4i&#/
1un$/ion#- /i%e&ri/ -e+i. +#i' )#d# 1un$/i %o&ori' 'or&i'#-
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Kelemahan penelitian
&id#' +i/# %en,#)#i &u(u#n u&#%#
%en$e4#-u#/i e1e'&i4i&#/ere+ro-*/in un&u' )e%u-i.#n %o&ori' diu'ur d#ri )enin$'#&#nFMA0T )#d# )#/ien den$#n $#n$$u#n %o&ori' /ed#n$ .in$$#+er#&
(u%-#. )#/ien re-#&i1 'e,i- den$#n 'e&er-i+#&#n %o&ori' *#n$ +er#&
#n*#' 1#'&or -#in d#-#% )e%u-i.#n %o&or )#d# )#/ien /&ro'e *#n$&id#' di /,reenin$ /e,#r# -en$'#)
S&udi -e+i. -#n(u& den$#n u'ur#n /#%)e- -e+i. +e/#r #'#n
di)er-u'#n un&u' %ene-##. %#/#-#. ini5
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Kesimpulan
Studi ini menunjukkan bahwapengobatan Cerebrolysin diatas
minggu dalam kombinasi dengan terapi
rehabilitasi di stroke !ase subakut amandan menyediakan e!ek menguntungkanpada pemulihan motorik pada pasien
dengan gangguan motorik berat
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