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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$$-
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Ne%ro$e(ti) ma$ignant syndromeNe%ro$e(ti) ma$ignant syndrome
# S%at% reaksi idiosinkrasi ak%t t*d- o,at .
ne%ro$e(tik aki,at ,$okade res(tor do(a.
mine sentra$-
# /isa !%ga ,%kan o,at ne%ro$e(tik" meto)$o.
(ramide+ dom(eridone+ am(*etamine+ re.
ser(ine+ tetra,ena5ine+ tri)y)$i) antide(.
ressants dg-$it*i%m ata% dg- MA in*i,itordan (eng*entian o,at1 anti.Parkinson-
N $ i $i
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Ne%ro$e(ti) ma$ignantNe%ro$e(ti) ma$ignant
syndrome&$an!'syndrome&$an!'# %ga (engg%naan )o)aine dan 6- met*y. $ene
dioFymet*am(*etamine &MDMA' =
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Ne%ro$e(ti) ma$ignant syndromeNe%ro$e(ti) ma$ignant syndrome
&$an!'&$an!'
Pengo,atan"
. Sto( o,at
.Kontro$ tem(erat%r
. Monitor /P+ %rine+ e$ektro$it+ tem(erat%r-
. Pem,- /romo)ri(tine @> .4 mg2*ari me.
$a$%i NGT. Dantro$ene sodi%m i-v kmd- ra$-
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Lain.$ain"Lain.$ain"
# Levodo(a,er,agai gerakan a,norma$
,erkaitan dg- dosis-
# /romo)ri(tine+ anti)*o$inergi) dr%gs+
(*enytoin+ )ar,ama5e(ine+ am(*etamine+
$it*i%m dan ora$ )ontra)e(tive,isa !%ga.
menim,%$kan )*orea
# D$$-