Gambaran Elektromiografi sebagai Faktor Penentu Prognosis Guillain Barre
Tahun 1998 Volume 33 Nomor 4
Oleh : Agus Sunarko, M.I. Widiastuti Samekto
Tujuan : Membuktikan apakah abnormalitas neurofisiologik kecepatan hantar saraf, latensi dan amplitudo gelombang M, latensi dan amplitudo gelombang F dan H saraf tepi, pada fase awal atau fase plateau, menunjukkan korelasi dengan manifestasi klinis fungsi motorik saat itu dan 6 minggu sesudahnya.
Metodologi Penelitian : Penelitian prospektif, observasional. Populasi semua pasien SGB (diagnosa sesuai kriteria dari NINCDS) yang dirawat di bangsal saraf RS Dr. Kariadi Semarang, mulai Maret 1995. Usia 14 – 40 tahun. Onset kurang dari 2 minggu. Skala derajat berat penyakit manurut Hughes minimal 2. Diekslusi : pasien dengan gagal napas, pasien dengan penyakit kronis berat : hipertensi, DM, hati dan ginjal, gangguan elektrolit, miopati. Jumlah sampel 16 orang. Semua pasien diperiksa EMG dan Skor Indeks Motorik pada fase plateau, kemudian SIM diulang 6 minggu sesudahnya. Semua pasien mendapat penanganan terapi dan rehabilitasi dengan program yang sama.
Hasil Penelitian : Pasien SGB 14 laki-laki (93.3%) dan 1 perempuan (6.7%). Usia rata-rata 20.9 tahun. Dengan paraparese inferior 3 orang dan tetraparese 12 orang. Didahului ISPA 66.7%. Protei LCS meningkat (pada minggu I) pada 73.3% kasus. Hasil EMG saraf tepi ekstremitas superior bagian distal, masih normal. Sedang pada ekstremitas inferior amplitudonya abnormal pada 87% kasus. Gelombang F 86.7% normal. Gelombang H 80% abnormal dan menunjukkan korelasi positif dengan SIM 6 minggu setelah plateau. Amplitudo n. tibialis menunjukkan korelasi positif dengan SIM fase plateau dan 6 mg sesudahnya.
Kesimpulan : Dari penelitian ini besar amplitudo n. tibialis dapat dipergunakan untuk menentukan prognosis SGB.
Background : Most of Guillain Barre Syndrome patients show prominent neurologic deficits which interfere with their daily activities, they need prolonged time to cured and have the great probability to have respiratoric arrest, so far more comprehensive management prognostic information is extremely needed.
Objective : To seek evidence whether there are correlations between conduction velocity, latency and amplitude of M wave, latency and amplitude of F and H wave of peripheral nerves, with overt motorik dysfunction of plateau phase or 6 weeks afterwards.
Research Methodology : A prospective observational study was designed. The population were GBS patients (diagnosed according to the criteria of NINCDS), admitted at neurology department ward dr. Kariadi hospital, starting from March 1995. Age between 14 – 40 years old. The onset was not more than 2 weeks. The Hughes scale was minimally 2. Respiratoric failure, severe chronically ill patients such as hypertension, diabetes mellitus, liver, and kidney diseases, miopati and electrolite disturbance, were excluded. All patients underwent EMG examination at the plateau phase, and motoric assessment (by Index Motoric Score assessment) for both superior and inferior extremity. All cases receive the same therapeutic and rehabilitation programs. Spearmans correlation statistic was used for data analysis.
Result : Fifteen GBS cases consisted of 14 males (93.3%) and 1 female (6.7%), average age was 20.9 years old. Three cases with paraparese and 12 cases tetraparase. Upper tract infection preceded 66.7% of them. Protein CSF were increased in 73.3% cases (during the 1st week after onset). EMG examination of distal peripheral nerves of upper extremity were normal, whereas inferior extremity resulted in abnormal amplitudo (87% cases). F wave were normal in 86.7% cases. While H wave 80% were abnormal and showed positive correlation with IMS of inferior extremity taken 6 weeks after plateau phase. The amplitude of n. tibialis posterior showed positive correlation both with IMS at plateau phase and 6 weeks afterwards.
Conclusion : According to this study the magnitude of tibial nerve amplitude can be used for determining prognosis of GBS patients.