Gangguan Involuntary Movement

7/23/2019 Gangguan Involuntary Movement

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GANGGUANGANGGUAN

EKSTRAPIRAMIDALEKSTRAPIRAMIDAL

= Movement disorders= Movement disorders

= Penyakit degeneratif= Penyakit degeneratif


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!enis gerakan" !enis gerakan"

# Gerakan vo$%nter

# Gerakan semivo$%nter &=%nvo$%ntary'

# Gerakan invo$%nter

# Gerakan a%tomatik


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Movement disordersMovement disorders

= gangg%an ekstra(iramida$

Gangg%an reg%$asi aktivitas motorikvo$%nter tan(a se)ara $angs%ng

mem(engar%*i tenaga otot+ sensi,i$itas+

ata% f%ngsi sere,e$$%m-


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Gangg%an ekstra(iramida$Gangg%an ekstra(iramida$

# Gangg%an *i(erkinetik" gerakan.gerakan

invo$%nter a,norma$

# Gangg%an *i(okinetk" ,erk%rangnya

gerakan-

= Movement disorders aki,at disf%ngsi

,asa$ gang$ia-


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/asa$ gang$ia"/asa$ gang$ia"

# N%k$e%s ka%dat%s

# P%tamen

# G$o,%s (a$$id%s# N%k$e%s s%,ta$amik%s

# S%,stansia nigra


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Penyakit 0 sindroma dg-ge!a$aPenyakit 0 sindroma dg-ge!a$a

gerakan1 a,norma$"gerakan1 a,norma$"

# Tremor esensia$ &fami$ia$ 2 ,enign'

# Parkinsonism

# Progressive s%(ran%)$ear (a$sy# Idio(at*i) torsion dystonia

# 3*orea syden*am

# Sindroma Gi$$es de $a To%rette# Dr%g.ind%)ed movement disorders+ d$$-


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Parkinsonisme = SindromaParkinsonisme = Sindroma

ParkinsonParkinson

4- Primer 2 Idio(atik

= Para$isis agitans = Parkinson disease

1- Sek%nder 2 Simtomatik

= Penye,a, diketa*%i+ a-$" . arteriosk$erosis

. anoksia 2iskemia sere,ra$

. o,at.o,atan

. 5at toksik . ensefa$itis d$$-


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Parkinsonisme &$an!'Parkinsonisme &$an!'

6- Para(arkinson 2 Parkinson ($%s

. Peny- 7i$son

. 8%ntington disease . 8idrosefa$%s normotensif


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Parkinson diseaseParkinson disease

= Parkinson idio(atik

= Para$isis agitans

. Pa$ing sering di!%m(ai

. Usia menenga* sam(ai t%a


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Etio$ogi dan (atogenesisEtio$ogi dan (atogenesis

# Etio$ogi yg (asti ,e$%m diketa*%i

# PP ter!adi aki,at degenerasi se$.se$ do(amine di s%,st-nigra


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AK ................................. DA

I

DA

AK I

AK

i DA


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8i(otese"8i(otese"

# Proses (en%aan" kematian ne%ron

do(aminergik 999 Mekanisme anti :

oksidatif.(rotektif ,er &.'

# Toksin $ingk%ngan" . $ogam ,erat &,esi+

seng+ merk%ri d$$' . MPTP

# Ke(ekaan genetik

# Stress oksidatif" reaksi do(amine

radika$ ,e,as


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Pato$ogi-Pato$ogi-

Pemotongan mid.,rain"

degenerasi 0 kematian ne%ron1 yg

mengand%ng me$anin di s%,stansia.nigra-Mikrosko(is"

Pada 5ona )om(a)ta"

. se,agian ,esar ne%ron *i$ang

. sisa" terisi Le;y.,odies


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Le;y ,odies (d-s%,s-nigra"Le;y ,odies (d-s%,s-nigra"


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Ge!a$a k$inis-Ge!a$a k$inis-

# Trias ge!a$a" . rigiditas

. tremor

. ,radikinese

4- tremor" . (i$$ ro$$ing tremor

. (ada keadaan tension 999+ tid%r .

*i$ang . resting tremor = Parkinsonian :

tremor


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Ge!a$a k$inis&$an!'Ge!a$a k$inis&$an!'

1- Rigiditas " - Distonia

?- Parkinsonian fa)ies


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Ge!a$a k$inis &$an!'Ge!a$a k$inis &$an!'

C- free5ing" ta*a( $an!%t+ ti,a1 ter*enti 2

tergangg% !a$annya

4- /i)ara $am,at dan monoton44- Gerakan ok%$er" . kedi( mata !arang

. ggn gerakan ,o$a mata

. ref$eks G$a,e$$a ,isa&'41- Pain" (arastesi ekstremitas


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Ge!a$a k$inis &$an!'Ge!a$a k$inis &$an!'

46- Gangg%an f%ngsi ANS"

. sa$iva 2 keringat ,anyak

. inkontinensia %rine d$$-4- Sa$iva 999sia$orr*ea

4>- 8i(otensi*i(otensi ortostatik

4?- De(resi4@- Demensia


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Gait"Gait"


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Tremor"Tremor"


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D%d%k"D%d%k"


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8y(omimia"8y(omimia"


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Retro(%$si"Retro(%$si"


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Bree5ing"Bree5ing"


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Prosed%r diagnostikProsed%r diagnostik

# Diagnosa ditegakkan se)ara k$inis

,erdasarkan ge!a$a1 k$inis yg ada-

# Pem- EEG " ,isa (er$am,atan dif%s

# MRI 0 3T S)an " ,isa di!%m(ai atrofi

kortika$-


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Pengo,atan-Pengo,atan-

Diangga(" defisiensi do(amine di SSP-

4- Levodo(a

1- Anti)*o$inergi) dr%gs" tri*eFy(*enidy$6- Anti*istamin" di(*en*ydramine

- /romo)ri(tine

>- Amantadine?- Se$egi$ine


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T8 DD

L.tyrosine ..... $.do(a ..... DA

T8" en5im tyrosine *ydroFy$ase

DD" en5im do(a.de)ar,oFy$ase

DA yg ,erada di$%ar vesike$ akan di.degrada

si o$e* en5im "

MA&monoamine.oksydase' d$m se$ ne%ron3MT&)ate)*o$.o.met*y$.tranverase' di$%ar

se$ ne%ron-


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Di (erifer"

4- $.do(a

do(amine I

do(a.de)ar,oFy$ase

v

H

do(a.de)ar,oFy$ase in*i,itor

= )ar,ido(asinemet

= ,ensera5idemado(ar


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1- $.do(ado(amine

I )ate)*o$..met*y$transferase &3MT'

v

H

3MT : in*i,itor " . to$)a(one

. enta)a(one


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Prognose"Prognose"

masi* !e$ek -


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Penyakit 0 sindroma dg-ge!a$aPenyakit 0 sindroma dg-ge!a$a

gerakan1 a,norma$"gerakan1 a,norma$"

# Tremor esensia$ &fami$ia$ 2 ,enign'

# Parkinsonism

# Progressive s%(ran%)$ear (a$sy# Idio(at*i) torsion dystonia

# 3*orea syden*am

# Sindroma Gi$$es de $a To%rette# Dr%g.ind%)ed movement disorders+ d$$-


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Parkinsonisme = SindromaParkinsonisme = Sindroma

ParkinsonParkinson

4- Primer 2 Idio(atik

= Para$isis agitans = Parkinson disease

1- Sek%nder 2 Simtomatik

= Penye,a, diketa*%i+ a-$" . arteriosk$erosis

. anoksia 2iskemia sere,ra$

. o,at.o,atan

. 5at toksik . ensefa$itis d$$-


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Parkinsonisme &$an!'Parkinsonisme &$an!'

6- Para(arkinson 2 Parkinson ($%s

. Peny- 7i$son

. 8%ntington disease . 8idrosefa$%s normotensif


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TREMR ESENSIALTREMR ESENSIAL

# < Bami$ia$ tremor - Ne%ro$e(ti) ma$ignant syndrome

?- Lain.$ain-


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Parkinsonism-Parkinsonism-

Kom($ikasi (em,erian o,at1 yg mem,$okir

rese(tor do(amine"

. (*enot*ia5ine. ,%tyro(*enone

. t*ioFant*ene

. meto)$o(ramide


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Parkinsonism &$an!'Parkinsonism &$an!'

Ge!a$a " . rigiditas

. m%ka to(eng

. ,radikinese . tremor &!arang'

Pengo,atan" . sto( o,at

. o,at1 anti.ko$inergik &tri*eFy. (*enidy$'


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A)%te dystonia 2 dyskinesiaA)%te dystonia 2 dyskinesia

# ,$e(*aros(asm

# torti)o$$is

# fa)ia$ grima)ingsete$a* (em,erian (*enot*ia5ine-

Pengo,atan" (em,erian i-v- anti)*o$inergi).

dr%g &,en5tro(ine 1 mg ata% di(*en*ydra.mine > mg'-


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/$e(*aros(asme/$e(*aros(asme


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Akat*isiaAkat*isia

# Kege$isa*an motorik+ tidak ,isa diam ata%

*anya ,isa d%d%k se,entar+ se$a$% ,erdiri

ata% ,er!a$an-

# Pemakaian (*enot*ia5ine

# Pengo,atan"

. ka$a% m%ngkin dosis dit%r%nkan

. (ro(rano$o$ .41 mg2*ari

. anti)*o$inergi) dr%gs 2 ,en5odia5e(ine


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Tardive dyskinesiaTardive dyskinesia

# Gerakan1 invo$%nter ,er%$ang dari m%$%t+

,i,ir dan $ida*+ kadang1 disertai (ost%r yg

distonik ata% gerakan1 )*oreoat*etoti)

dari ,adan dan ekstremitas-

# Ke,anyakan se;akt% (em,erian ne%ro$e(

tik+ !%ga meto)$o(ramide+ anti*istamin+ tri.

)y)$i) antide(ressant dan )*roni) a$)o*o$a,%se-


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Tardive dyskinesia &$an!'Tardive dyskinesia &$an!'

# Pengo,atan"

. Do(amine antagonists " *a$o(erido$

. 3ate)*o$amine.de($eting agents" reser(ine+ tetra,ena5ine-

. /a)$ofen

. 3a$)i%m )*anne$ ,$o)king agents . vitamin E+ d$$-


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Ne%ro$e(ti) ma$ignant syndromeNe%ro$e(ti) ma$ignant syndrome

# S%at% reaksi idiosinkrasi ak%t t*d- o,at .

ne%ro$e(tik aki,at ,$okade res(tor do(a.

mine sentra$-

# /isa !%ga ,%kan o,at ne%ro$e(tik" meto)$o.

(ramide+ dom(eridone+ am(*etamine+ re.

ser(ine+ tetra,ena5ine+ tri)y)$i) antide(.

ressants dg-$it*i%m ata% dg- MA in*i,itordan (eng*entian o,at1 anti.Parkinson-

N $ i $i


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Ne%ro$e(ti) ma$ignantNe%ro$e(ti) ma$ignant

syndrome&$an!'syndrome&$an!'# %ga (engg%naan )o)aine dan 6- met*y. $ene

dioFymet*am(*etamine &MDMA' =


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Ne%ro$e(ti) ma$ignant syndromeNe%ro$e(ti) ma$ignant syndrome

&$an!'&$an!'

Pengo,atan"

. Sto( o,at

.Kontro$ tem(erat%r

. Monitor /P+ %rine+ e$ektro$it+ tem(erat%r-

. Pem,- /romo)ri(tine @> .4 mg2*ari me.

$a$%i NGT. Dantro$ene sodi%m i-v kmd- ra$-


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Lain.$ain"Lain.$ain"

# Levodo(a,er,agai gerakan a,norma$

,erkaitan dg- dosis-

# /romo)ri(tine+ anti)*o$inergi) dr%gs+

(*enytoin+ )ar,ama5e(ine+ am(*etamine+

$it*i%m dan ora$ )ontra)e(tive,isa !%ga.

menim,%$kan )*orea

# D$$-

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Gangguan Involuntary Movement