epilepsi dan parkinson

7/25/2019 Epilepsi Dan Parkinson

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EPILEPSI & PARKINSON


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EPILEPSI


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Pendahuluan

EpilepsiBerasal dari bahasa Yunani epilepsiato take hold

atau to seize

Epilepsi

Suatu gangguan yang ditunjukkan adanya kejangberulang

KejangGangguan aktivitas listrik pada otak yang bersifat

sementara atau sesaat

Kejang adalah gejala pada epilepsi

ngka prevalensi! "# dari populasi$ semua usia


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%iagnosis Banding Kejang


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Patofisiologi Kejang

&ormal GB

inhibisi dis'harge listrik yang berlebihan GB reseptor diblok(hythmi' and repetitive

hypersyn'hronus dis'harge of neuronskejang

Eksitatorik &)'h$ spartat$ dan Glutamat jugaberpengaruh terjadi kejang

*ntra'ellular re'ording sho+s burst of rapid a'tion potentialfiring +ith redu'tion of transmembrane potential,

inhibitory system -e.'itationgenesis ofseizures

bnormalitas pada kanal ion &a-$K-$ /a0 kejang12rolongation of depolarization state3


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Klasifikasi & Sindrom Epilepsi


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Epilepsi vs PseudoepilepsiKarakteristik Epilepsi Pseudoepilepsi

am!aran Klinis

4nset )iba0tiba bertahap

Gerakan tubuh )onik$ tonik0klonik %ibuat0buat$ asinkron

Gigitan 5idah Bibir$ tangan$ lainnya

6iksi Sering 7arang

%efekasi Sesekali 7arang

Self0injury Sering 7arang

2osti'tal /onfusion da )idak ada

Kesadaran )urun (etensi komplit8parsial

%urasi 9: detik ; beberapa menit 5ebih lama

Stop 86un'ul dg sugesti )idak Ya

EE

*nteriktal < bnormal < bnormal

*'tal bnormal rtifak tetap

Neuroendokrin

2rolaktin 6eningkat )etap"ithdra#al antikonvulsan Kejang meningkat )idak ada peningkatan


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angguan Perilaku

=enomena *ktalSimple0partial seizures

/omple.0partial seizures

=enomena 2ost0*ktalutomatismepada post0i'tal 'onfusional state

2asien bi'ara sendiri$ mondar0mandir$ disorientasi$

amnesia

=enomena *nter0*ktalura kognitifderealisasi$ depersonalisasi$ dreamystates$ for'ed thought$ gangguan persepsi +aktu

P ! h P il k d K j P i l


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Peru!ahan Perilaku pada Kejang ParsialE$ALA IN%ELEK%AL E$ALA PSIKO'O%OR

fasia Embarassment utomatisme simpel >erbal reiteration

Gang, 6emori nger$ irritabel *nkoordinasi ffe'tive automatism

%?j@ vu$ 7amais vu 2siko sensori &egativism Gelasti' epilepsy%eja 8jamais entendu *lusi Staring %a'rysti' epilepsy 1/ry3

%eja pensea Aalusinasi 2ushing /omple. automatism

2erubahan kognitif uditorik Groping /ursive epilepsy 1run3

%reamy state >isual Sear'hing %rinking%epersonalisasi Gustatorik /he+ing ndressing

=or'ed thingking 4lfaktorik S+allo+ing 6asturbation

)hought blo'king )aktil Spitting 2rolonged t+ilight states +8automatism

Gejala mood Gejala e.perential 5ip sma'king /ompund forms

(asa takut =eeling a presen'e (ubbing )emporal lobe mar'h

%epresi =eeling possessed 2lu'king *'tal psy'hosis

2leasant e.perien'e$ serenity$e'stasy

=eeling dead Spee'h automatism

npleasant e.perien'e =eeling of impendingdoom

Shouting

n.iety S'reaming


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Psikopatologi

C:0D:# gangguan psikiatri terjadi pd pasien

epilepsi

2sikosis$ depresi$ gangguan kepribadian$ ggn

perilaku lain

662*! peningkatan skala skizofrenia dan paranoia 2sikosis$ ggn kepribadianC09. lebih banyak

pada kejang parsial komplek

D:0D# pasien epilepsi de+asa

ada fokus padalobus temporal

2sikis aura yg disertai perasaan negatif

1ketakutan$ jamais vu3predisposisi psikosis

atau gangguan kepribadian


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Psikopatologi pada Epilepsi

PER(A)AN KEPRI(A*IANAasil kejang berulang tidak terkontrol

no.ia berulang atau 'edera kepala

kibat terapi obat toksik

Efek pera+atan lama

*solasi sosial

Dissociative experience, Fugue states, Wondering

epilepsy, Borderline personality disorder, Multiple

personality


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PSIKOSISS'hizophrenia0like psy'hosis

":: anak dengan kejang partial komplek9:

thn":# gang, psikotik

C. lebih besar pd epilepsi dibanding umum

(esiko! epilepsi dg fokus 5obus )emporal

=okus sebelah kiri C. lebih sering

2E)! predominan hipometabolisme dari lobus

temporal


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ANAN 'OO*/ommonepilepsi

9:# gejala depresi

2arietal$ i'tal$ posti'tal$ F interi'tal

/ommon)5E

5eft0side (ight0side

Epilepsi - Sui'idalitykepribadian borderline F

impulsif


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ANSIE%AS)imbul akibat reaksi psikologis terhadap diagnosa

epilepsi

2erubahan psikologis sebelum terjadi kejang

Sebagai aura

Bagian dari psikosis atau gang$ mood pada

epilepsi

kibat brain injury2erubahan mood akibat obat antikonvulsan


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Patofisiologi gejala neuropsikiatri pada

pasien dengan epilepsi

No more understood than that of the idiopathicpsychiatric disorders

6en'ari tahu=aktor risiko yang dapat menyebabkan gejala

neuropsikiatri

5etak anatomi lesi yang berhubungan dengan kondisi

neuropsikiatri

Efek obat yang dapat menghilangkan gangguan epilepsi

dan perilaku

=aktor risiko4nset kejang pada remaja muda$ perempuan$

gangguan kognitif


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O!at Anti EpilepsiEpilepsy )ype =irst05ine Se'ond05ine )hird05ine

2artial and 8orSe'ondary G)/S

/arbamazepine5amotrigine4.'arbazepine

)opiramateS, >alproate1in'hildren3

S, >alproate)iagabineGabapentin

/lobazam2henytoin2henobarbital>igabatrin'etazolamide

2rimary G)/S S, >alproate 5amotrigine)opiramate/arbamazepine

2henytoinGabapentin2henobarbital)iagabine'etazolamide

bsen'e S, >alproate

5amotrigine

Ethosu.imide /lonazepam

'etazolamide

6yo'loni' S, >alproate /lonazepam 2ira'etam5amotrigine

2henobarbital


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Indikasi & *osisE% Seizure type %ose

range

1mg8day3

%osesper

day

)herapeuti'

range1Hmol853

/arbamazepine

2artial$Se'ondary G)/S$ CI:0C:::

C09 9:0I:

Sodium

>alproate

2rimary F Se'ondary

G)/S$bsen'e$ 6yo'lonus

J::0

CI::

"0C &

2henytoin 2artial$ Se'ondary G)/S "I:09I: " J:0:

5amotrigine 2artial$ se'ondary G)/S CI0I:: "0C &

5orazepam Status Epilepti'us J i,v, 00 &

/lonazepam 2artial 1adjun'tive3$6yo'lonus

"0 C0J &

Ethosu.imide /hildhood bssen'e I::0"I::

C C::0::

)opiramate 2artial$ se'ondary G)/S C::0D:: "0C &

2henobarbital 2artial$ se'ondary G)/S D:0":: " I:0"I:


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PARKINSON & ANANPERERAKAN LAINN+A


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Gangguan pergerakan

sering terjadineuropsikiatri

Skizofreniasterotipi$ manerism$ katatonia

Efek samping terapi gang, 2erilaku

parkinsonism$ tremor$ distonia

2enyakit Ganglia BasalisGejala neuropsikiatri

%epresi$ ansietas$ +aham$ apatis$ iritabel$ disinhibisiGangguan kognitif

Gang, =ungsi eksekutif F dementia


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Pen,akit anglia (asalis

2arkinsonLs disease%ementia +ith2rogressive/orti'obasal*diopathi' Basal Ganglia /al'ifi'ation4therMilsonNs %iseaseAuntingtonNs %isease&euroa'anSydenhamNs /horea%ystoniata.ias)remor


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Sikuit -rontal Su!kortikal


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angguan motorik


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angguan pergerakan EkstrapiramidalAkineti.rigids,ndome

Parkinson/s disease0 Parkinsonism in other neurodegenerative disorders0 Se.ondar,parkinsonism 1drugs0 to2ins0 tumors0 h,dro.ephalus0 .ere!rovas.ulardisease3

%ystonia *diopathi' =amilial8non0familial dystonia$ Spasmodi' torti'ollis$ *diopathi'orofa'ial dystonia$Blepharospasm 16eigeLs syndrome3$ 2aro.ysmal dystonia$ Se'ondary dystonia

)remor Essential )remor$ *ntention tremor 1/erebellar )remor3$ (est )remor 1isolated or +ithparkinsonism3$ 2hysiologi' )remor$ 4ther spe'ifi' tremors 1rubral$ dystoni'$ orthostati'$ et'3$Se'ondary

6yo'lonus Essential 6yo'lonus$ *nfe'tious$ Se'ondary$ +ith epilepsy

/horea AuntingtonLs disease$ syndenham 'horea$ 'horea Gravidarum$ Benign Aereditary 'horea$&euroa'antho'ytosis$ Senile 'horea$ Kinesiogeni' 'horeathetosis$ +ith other neurodegenerativedisorders$ se'ondary

thetosis 2erinatal is'haemi' disorder$ kerni'terus

Balism Subthalami'infar'tion$ neoplasma

)i's *diopathi' 1)ransient$ persistent$ 'hroni'3$ Gilles de la )ouretteLs syndrome$ se'ondary

kathisia Mith 2arkinsonLs disease$ Se'ondary

4ther 2eriodi' leg movement $painful legs and moving toes syndrome$ restless legs syndrome$stereotypies and mannerisms$ hemifa'ial spasm$ psy'hogeni'


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Pen,akit Parkinson

/ommon

lansia prevalensi"D: per "::$::: orang

Kaukasia frika F sia

2ria ManitaSebelum terapi kontemporerdurasi penyakit

antara 0": tahun

2emakaian levodopa"I tahun survival


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ejala KlinisGejala klasik

)remor

resting tremor(igiditas'og+heel$ poker fa'e

Bradikinesiagerakan lambat$

gang, Kunyah$ telan$ bi'ara

2ostur abnormalinstability$membungkuk$ resiko jatuh

6i'rographia$ tulisan semakin

lama semakin ke'il

Shuffling gait$ panjang langkah

berkurang$ festination$ tendensi

memper'epat 1spee'h8gait3


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Neuropatologi

Ailangnya neuron padasubstansia nigra$ ventral

tegmental area$ lo'us

'eruleus F nu'leus

basalis 5e+y Bodiesinklusi

eosinofilik sitoplasmik

pada sel0sel nigral)emporal F frontal 'orte.$

entorhinal area$ anterior

'ingulate 'orte.$ F insular

'orte.


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Neuropatologi

/ell loss in the


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*iagnosis (anding

dementia +ith


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%erapi

%opaminergi' 1improve dopamin fun'tion35evodopa

%opamine re'eptor agonis

mantadine

/ate'hol040methyltransferase inhibitorSelegiline$1 64 B *nhibitor3neuroprote'tive

nti'holinergi' agents tremor$ bradykinesia and

rigidity,

2allidotomy or deep brain stimulation$ thalmotomy,

/holinesterase *nhibitorsfor 'ognitive

symptoms


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Neurops,.hiatri. aspe.t

/ognitive defi'itsE.e'utive fun'tion disorder or mild sub'orti'al

dementiadiffi'ulty +ith +ord list generation

a retrieval defi'it disorder type of memory impairment

abnormalities of organizational skills +hen 'opying

'omple. figures$

%epression

n.iety

pathy

Sleep atta'ks


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%ementia +ith 5e+y Bodies

%ementia in 9:# 0 J:# of patients +ith2arkinsonNs disease

2rogressive dementia syndrome

=lu'tuating 'ognition +ith pronoun'ed variation in

attention F alertness

(e'urrent visual hallusinations +ell formed F

detail

2arkinsonism


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%ystonia

Geneti' Basis! mutation in the %Y)" gene on OP9J

Se'ondary dystonias ! asso'iated +ith movement disorders

indu'ed by long0term use of dopamine0blo'king agents

pathophysiology

not 'ertain, 2E) studies !

abnormal brain net+orks involving the frontal lobe and basal

ganglia

disso'iation bet+een a'tivity of the lentiform nu'leus 0 thalami'

nu'lei hypera'tivity of supplementary motor and prefrontal areas

4ften misdiagnosed as a 'onversion disorder


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Ata2ia

6anifestation of 'erebellar or sensory dysfun'tionleading to disePuilibrium,

finger0to0nose and heel0to0shin test$ past pointing

+hen asked to tou'h a point

hypotonia and a variety of eye signs$ refle'ting

loss of 'oordination of o'ular movements,

autosomal re'essive8dominant$ en'ephalopathies$

'ongenital malformations of the 'erebellum$ inbornerrors of metabolismQ vitamin defi'ien'iesQ

hypothyroidismQ infe'tious illnessesQ vas'ular

disordersQmultiple s'lerosisQ traumati' brain injury$

heatstroke$ variety of to.ins


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%remor

/ommon$ neuropsy'hiatri' disorders

/&S)ension$ an.iety$ and distresse.aggerate any

e.isting tremor,

2sy'hiati' drugsindu'e tremor

Beta0blo'kers 1propranolol and metoprolol3$

primidone$ or benzodiazepines 'entral tremor,

%opaminergi' or anti'holinergi' agents

parkinsonian0type rest tremors


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4atatonia

idiopathi' psy'hiatri' disorders$ neurologi'aldiseases$ metaboli' en'ephalopathy$ or to.i'

'onditions

s'hizophrenia$ 'atatoni' symptoms 'ommonly 'o0

o''ur +ith features of formal thought disorder$affe'tive blunting$ and neurologi'al sign

patients must undergo 'omprehensive evaluation

for neurologi'$ metaboli'$ and to.i' 'auses of'atatoni' phenomenon

Benzodiazepine$ E/)$ 4''asional mood

stabilizer$ anti'holinergi' agents$ atypi'al


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%rug0*ndu'ed 6ovement %isorders

'ute dystoni' rea'tionsfenotiazin$

buterofenon$ th8 antikolinergik$ benzodiazepine

kathisiaantidepressant$ et', th8 beta blo'ker

2arkinsonismkineti'0rigid syndrome$ (est

tremor$ (abbit syndrome)remor

6yo'lonus

/horeoathetosis

)ardive dyskinesia

&eurolepti' malignant syndrome hyperthermia$

mus'le rigidity$ autonomi' dysfun'tion$ and mental

status 'hanges


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Parkinsonism

bout C +eeks of therapy +ith neurolepti' agents dete'table in I:0:# of patients

)he elderlyhigh risk

*ndu'ed by Aigher0poten'y neurolepti's$ typi'al

antipsy'hoti's 1less likely3

6anagement! redu'ing the dose of the in'iting agent

treatment anti'holinergi' drug)ypi'ally resolves +ithin C0J +eeks of intervention$

but may persist for "C0" months


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%ERI'A KASI)September C:"I

epilepsi dan parkinson

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