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All Journal Medical Journal of Indonesia Jurnal Penyakit Dalam Indonesia Neurona Acta Neurologica Indonesia
Hakim, Manfaluthy
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Health Professions Medicine & Pharmacology Neuroscience Public Health

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NILAI NORMAL LATENSI DAN AMPLITUDO GELOMBANG VISUAL EVOKED POTENTIAL PADA USIA DEWASA Wijaya, Ade; Hakim, Manfaluthy; Ibrahim, Nurhadi; Prihartono, Joedo
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 35 No 2 (2018)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v35i2.2

Abstract

NORMATIVE VALUES OF VISUAL EVOKED POTENTIALS` LATENCIES AND AMPLITUDES IN ADULTSABSTRACTIntroduction: Visual evoked potentials (VEP) is used to assess the visual pathway through the optic nerves and brain. VEP wave can be affected by physiological and non-physiological factors; some of which can be controlled, while others cannot. Thus, each VEP laboratory needs its own set of normative values. A normal VEP response to a stimulus is a positive occipital peak that occurs at a mean latency of 100ms. Most of the published normal value originated from abroad where demographical and environment condition are considered less appropriate with Indonesian population.Aims: To established normal value of adult VEP latency and amplitude in Clinical Naeurophysiology Laboratori- um, Neurology Clinic Dr. Cipto Mangunkusumo Hospital, Jakarta.Method: A cross-sectional study on healthy subject between 18 to 55 years old. The anthropometric parameters including age, height, weight, body mass index and head circumference were recorded in all the subjects. VEP was record- ed with a Caldwell Sierra Summit machine and standard silver-silver chloride disc electrodes. A VEP monitor displaying checker board was used to give the pattern reversal stimulus. The VEP parameters recorded were latencies to P100 waves.Results: P100 latencies on 110 subjects, 55 male, and 55 female upon recording at  32’ check size were 117ms in male and 119 ms in female. Upper normal limit of interocular latency difference values in recording at the same size were 10,96ms in male and 10,2ms in female. No significant differences of P100 latencies between male and female were found, but there were significant differences in amplitudes.Discussion: In our population, gender is an important factor affecting P100 amplitudes but not P100 latencies.Keywords: Amplitude, latency, P100, visual evoked potentialABSTRAKPendahuluan: Visual evoked potentials (VEP) digunakan untuk menilai jaras visual dari nervus optikus hingga korteks visual. Gelombang VEP dapat dipengaruhi oleh berbagai faktor fisiologis dan non-fisiologis yang tidak semua dapat dikontrol, sehingga diperlukan referensi nilai normal latensi dan amplitudo gelombang VEP untuk di setiap laborato- rium. Sejauh ini mayoritas referensi berasal dari studi di luar negeri yang secara demografi maupun kondisi setempat dapat kurang sesuai dengan populasi di Indonesia.Tujuan: Mengetahui  nilai normal latensi dan amplitudo gelombang VEP pada subjek dewasa di Laboratorium Neurofisiologi Klinik, Poliklinik Saraf RSUPN Dr. Cipto Mangunkusumo, Jakarta, sebagai referensi pemeriksaan VEP di kemudian hari.Metode: Studi potong lintang pada subjek sehat berusia antara 18 hingga 55 tahun. Subjek diukur antropometri, seperti usia, tinggi badan, berat badan, indeks massa tubuh, dan lingkar kepala. Perekaman VEP menggunakan alat Cald- well Sierra Summit, dan elektroda elektroensefalografi (EEG) standar. Stimulus VEP menggunakan layar berpola dan metode transient pattern reversal. Parameter VEP yang direkam adalah latensi dan amplitudo P100.Hasil: Pada perekaman terhadap 110 subjek yang terdiri dari 55 subjek laki-laki dan 55 subjek perempuan dengan ukuran kotak 32’, nilai batas atas latensi gelombang P100 adalah 117ms pada laki-laki dan 119ms pada perempuan. Nilai batas atas perbedaan latensi interokular pada perekaman dengan ukuran kotak yang sama adalah 10,96ms untuk laki-laki dan 10,2ms untuk perempuan. Tidak ada perbedaan bermakna antara latensi gelombang P100 pada kelompok laki-laki dan perempuan, tetapi terdapat perbedaan amplitudo P100 yang bermakna antara kelompok laki-laki dan perempuan.Diskusi: Terdapat perbedaan yang bermakna pada rerata amplitudo P100 antara subjek laki-laki dan perempuan pada perekaman dengan ukuran kotak 16’ maupun 32’.Kata kunci: Amplitudo, latensi, P100, visual evoked potentials
ANALISIS KORELASI SKOR GEJALA TOTAL, NYERI, DAN KUALITAS HIDUP SETELAH PENGOBATAN VITAMIN B1, B6, DAN B12 DOSIS TINGGI PADA NEUROPATI PERIFER Hakim, Manfaluthy; Kurniani, Nani; Pinzon, Rizaldy; Tugasworo, Dodik; Basuki, Mudjiani; Haddani, Hasnawi; Pambudi, Pagan; Fithrie, Aida; Wuysang, Audry Devisanty
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 35 No 2 (2018)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v35i2.3

Abstract

CORRELATION ANALYSIS OF TOTAL SYMPTOM SCORE, PAIN, AND QUALITY OF LIFE POST HIGH DOSE VITAMIN B1, B6, DAN B12 TREATMENT IN PERIPHERAL NEUROPATHYABSTRACTIntroduction: Peripheral neuropathy (PN) is a clinical condition in which nerves of the peripheral nervous system are damaged and is associated with various symptoms affecting the patients’ quality of life (QoL).Aims: To understand the  effect of Vitamin B1, B6, and B12 combination in mild to moderate PN.Methods: This is a prospective, open label, multicenter, single arm observational study involved 399 subjects with PN of different etiology. Subjects received the vitamin B1, B6, and B12 combination tablet orally once daily and were observed for 3 months. Total symptom score (TSS), visual analog score (VAS) and QoL were assessed, and the correlation between these parameters was analyzed.Results: Clinically significant reductions were observed from baseline to subsequent visits for TSS and VAS. Positive correlation  was observed between TSS and components of VAS. The study treatment was associated with a significant improvement in QoL parameters. Inverse correlation was observed between QoL and TSS as well as QoL and components of VAS. The study treatment was found to be well tolerated.Discussion: The correlation  analysis between different outcome measures demonstrated the beneficial effect of combination of vitamin B1, B6, and B12 in relief from symptoms and improvement in QoL of PN.Keyword: Correlation analysis, peripheral neuropathy, SF-8, TSS, VAS, vitamin B1, B6, and B12ABSTRAKPendahuluan: Neuropati perifer (NP) merupakan kondisi klinis akibat kerusakan pada sistem saraf tepi yang memengaruhi kualitas hidup (quality of life/QoL) pasien.Tujuan: Mengetahui efek pemberian kombinasi vitamin B1, B6, and B12 pada NP ringan hingga sedang.Metode: Penelitian observasional dan prospektif secara open label, multisenter, dan single arm, yang melibatkan 399 subjek penderita neuropati perifer dengan etiologi yang berbeda-beda. Subjek mengonsumsi tablet kombinasi vitamin B1, B6, and B12 secara oral satu kali sehari dan diamati selama 3 bulan. Dilakukan penilaian skor gejala total (total symptom score/TSS), visual analog scale (VAS), dan QoL, serta korelasi antara parameter-parameter tersebut.Hasil: Terdapat penurunan TSS dan VAS yang bermakna secara klinis antara baseline (awal) dengan kunjungan berikutnya. Terdapat korelasi yang positif antara TSS dengan komponen-komponen VAS. Pemberian perlakuan dalam penelitian berkorelasi secara bermakna dengan perbaikan parameter dalam QoL. Teramati juga adanya hubungan terbalik antara QoL dengan TSS serta QoL dan komponen VAS. Pengobatan pada penelitian ini juga terbukti dapat ditoleransi dengan baik.Diskusi: Analisis korelasi antara berbagai macam metode pengukuran yang berbeda menunjukkan manfaat dari pemberian kombinasi vitamin B1, B6, and B12 dalam mengurangi gejala dan perbaikan QoL pada pasien PN.Kata kunci: Analisis korelasi, neuropati perifer, kualitas hidup, SF-8, TSS, VAS, vitamin B1, B6, and B12
FENOMENA OTOT POSITIF PADA KELAINAN NEUROMUSKULAR Angelita, Michelle Cancera; Indrawati, Luh Ari; Hakim, Manfaluthy; Octaviana, Fitri; Budikayanti, Astri; Safri, Ahmad Yanuar; Wiratman, Winnugroho; Fadli, Nurul; Harsono, Adrian Ridski
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 40 No 2 (2024): Vol 40 No 2 (2024): Volume 40, No 2 - Maret 2024
Publisher : PERDOSNI

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Abstract

Positive muscle phenomena arise due to various forms of spontaneous muscle hyperactivity originating from motor neurons or the muscle itself. The presence of this phenomenon can constringe the possible diagnosis to be more specific, so if presence it is necessary to be identified in patients with potential neuromuscular disease. However, the presence of positive muscle phenomena is often overlooked. This gap in our knowledge regarding definitions, clinical findings, electrodiagnostic findings, and pathophysiological mechanisms hampers effective diagnosis and treatment. In this article, we review the clinical characteristics approach to diagnosis of various positive muscle phenomena originating from the lower motor neuron (LMN) and muscle, including tetany, cramps, fasciculations, myokymia, neuromyotonia, rippling muscle, percussion induced rapid contractions (PIRCs), myoedema, and contractures. Keywords: fasciculation, muscle phenomena, hyperactivity, myotonia, rippling muscle
Korelasi Stenosis Penyakit Arteri Perifer di Bawah Lutut dengan Kecepatan Hantar Saraf pada Penyandang Neuropati Perifer Diabetes Melitus Tipe 2 Antono, Akbarbudhi; Antono, Dono; Karim, Birry; Hakim, Manfaluthy; Harimurti, Kuntjoro; Sulistianingsih, Dyah Purnamasari; Ginanjar, Eka; Nelwan, Erni Juwita; Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Abstract

Introduction. One consequence of DM is the emergence of peripheral artery disease (PAD) and diabetic peripheral neuropathy (DPN). Diabetic peripheral neuropathy is a complication of diabetes that presents signs and symptoms of motor and sensory disturbances, while PAD is an atherosclerosis condition that gradually develops in the arterial vessels. This study aimed to determine correlation of arterial obstruction assessed using arteriography and the nerve impairment assessed using nerve conduction velocity (NCV) in DM patients with PAD and DPN. Methods. This is a cross-sectional study that takes secondary data from previous research conducted from July 2018 to June 2021 in Cipto Mangunkusumo hospital. Subjects were people with DM type 2 who had NPD and PAP who met the inclusion criteria and did not meet the exclusion criteria. Subjects underwent an arteriography examination to assess the stenosis in the peroneal artery, anterior tibial artery, and posterior tibial artery. Subjects also underwent nerve conduction velocity (NCV) examinations in the peroneal N. communis, N. peroneal superficialis, N. tibialis, and N. suralis. The correlation between the two variables was then tested using the Spearman correlation test. Results. The peroneal artery stenosis had a moderate negative correlation (r = - 0.420) with the sensory NCV of the superficial peroneal nerve which was statistically significant (p = 0.023). Meanwhile, the correlation of stenosis and NCV disorders in the peroneal nerve with the common peroneal nerve, anterior tibial nerve with tibialis nerve and posterior tibial nerve with sural nerve was not statistically significant. This can be explained by the possibility of collaterals appearing in people with PAD, the structure of vasculature on the nerves, and the small number of samples. Conclusions. There is a moderate negative correlation between the stenosis of the peroneal nerve and the sensory NCV of the peroneal superficialis. However, insignificant results were found in the correlation between peroneal artery with common peroneal nerve, anterior tibialis artery with tibial nerve, and posterior tibial artery with sural nerve.
The Effectiveness of Plasmapheresis Compared to Intravenous Immunoglobulin in Guillain-Barre Syndrome Patients Mustika, Alyssa Putri; Hakim, Manfaluthy; Sari, Waode Satriana; Octaviana, Fitri; Budikayanti, Astri; Safri, Ahmad Yanuar; Wiratman, Winnugroho; Indrawati, Luh Ari; Fadli, Nurul; Harsono, Adrian Ridski; Savitri, Irma
Acta Neurologica Indonesia Vol. 2 No. 02 (2024): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v2i02.24

Abstract

Introduction : Guillain-Barré syndrome (GBS) is the second most common cause of acute and subacute general paralysis. The management is symptom-adjusting, but plasmapheresis (plasma exchange/PE) and intravenous immunoglobulin immunotherapy (IVIG) can be administered to accelerate the return of neurological function. This study aim to determine PE's effectiveness compared to IVIG in GBS patients and the side effects or complications that may arise. Method : The literature study is carried out on four databases. Selection is carried out using inclusion and exclusion criteria. The articles were screened and extracted independently by two investigators. Results : The literature study obtained three systematic review studies. In the first study, shows the outcomes in the form of improved Hughes Score (OR 1.9; 95% CI 1.11-3.28) and mortality (OR 0.8; 95% CI 0.31-2.29) against IVIG. The second study, outcomes shown in the form of improved disability scores (WMD -0.02, p: 0.83), and secondary outcomes such as mortality or relapse (p >0.05, respectively). The third study showed that IVIG had higher efficacy (OR 1.6, p: 0.067, 95% CI 0.972-2.587), shorter duration of hospitalization, 38 days, compared to 49-day PE therapy (SMD -3.389, 95% CI -11.601-4.824; p: 0.419), however, had higher side effect (OR 0.8, p: 0.430, 95% CI 0.389-1.495). Conclusion : PE efficacy is generally lower than IVIG, as indicated by disability scores/motor ability scores in various studies, as well as the duration of hospitalization. The safety of therapy is assessed by the side effects that appear and appear-more-often in IVIG therapy rather than PE.
ATTRv MIMICKING CIDP: INSIGHTS FROM TWO GENETICALLY CONFIRMED PATIENTS IN A NATIONAL TOP REFERRAL HOSPITAL Indrawati, Luh Ari; Hadiweijaya, Antonia; Wiguna, Fikry Ichsan; Parindra, Cakra; Safri, Ahmad Yanuar; Wiratman, Winnugroho; Fadli, Nurul; Harsono, Adrian Ridski; Hakim, Manfaluthy; Octaviana, Fitri
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 42 No 1 (2025): Volume 42, No 1 - Desember 2025
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v42i1.803

Abstract

ATTRv is a treatable autosomal dominant hereditary devastating disease caused by pathogenic variants in TTR gene leading to amyloid deposition in peripheral nerves. TTR stabilizer or gene silencing drugs are able to reduce amyloid formation. It can mimic chronic inflammatory demyelinating polyneuropathy (CIDP) but does not respond to immunotherapy, highlighting the importance of accurate diagnosis. We present two Indonesian male patients initially misdiagnosed with CIDP. The first case developed progressive distal weakness, sensory loss, profound autonomic dysfunction including orthostatic hypotension, erectile dysfunction and significant weight loss. Nerve conduction studies revealed demyelinating sensory neuropathy with mixed motor involvement and autonomic testing showed absent SSR and abnormal HRV. The patient received supportive care, including fludrocortisone for orthostatic hypotension. The second case experienced distal sensory-motor neuropathy with additional features of erectile dysfunction, urinary and fecal incontinence and recurrent painless heel blisters. Nerve conduction studies showed axonal sensorimotor polyneuropathy, and autonomic testing along with SSEP confirmed widespread autonomic and sensory pathway involvement. Serum protein electrophoresis in both cases revealed elevated gamma globulin without monoclonal spikes. Whole exome sequencing in both cases revealed the same pathogenic TTR variant (c.148G>A, p.Val50Met), confirming the diagnosis of ATTRv. CIDP lacks specific biomarkers and can mimic various neuropathies. In this case, distal predominant weakness and profound autonomic dysfunction were red flags for alternative diagnosis, such as ATTRv. Progressive sensory-motor neuropathy, atypical CIDP with autonomic involvement and unexplained weight loss warrant suspicion of ATTRv. Differential diagnoses should include diabetic neuropathy, autoimmune nodopathy, MAG neuropathy and monoclonal gammopathy-associated neuropathies.
Validity and reliability of the Indonesian version of the Douleur Neuropathique 4 for neuropathic pain Sofyan, Henry Riyanto; Hartono, Chandra; Savitri, Irma; Alvonsius, Raymond Aris Nimrod; Hakim, Manfaluthy; Aninditha, Tiara
Medical Journal of Indonesia Vol. 34 No. 4 (2025): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.257725

Abstract

BACKGROUND The Douleur Neuropathique 4 (DN4) is a widely used questionnaire for assessing neuropathic pain, demonstrating good sensitivity and specificity across various languages. Originally developed in France, cultural and linguistic differences necessitate its translation, validation, and reliability testing before use in Indonesia. This study aimed to translate, culturally adapt, and evaluate the validity and reliability of the Indonesian version of the DN4 questionnaire (DN4-Ina) for use in clinical and research settings. METHODS Translation and cross-cultural adaptation were conducted following World Health Organization guidelines in Indonesian. A cross-sectional study was conducted in the Neurology Clinic, Cipto Mangunkusumo Hospital, to assess the validity and reliability of the DN4-Ina. The study subjects were selected through consecutive sampling of adult patients with chronic pain visiting the clinic from June to December 2023. Validity and reliability were assessed using SPSS software version 25. Validity testing utilized adjusted item-total correlation analysis, while reliability testing was evaluated using the test-retest method, intraclass correlation coefficient (ICC), and Cronbach’s alpha for internal consistency. RESULTS Of 40 participants, 65% were female, with a mean age of 51.85 (13–92) years, moderate pain intensity (mean numeric rating scale of 4.25 [2.99]), and pain duration of 7.95 (4.41) months. All DN4-Ina questions showed a correlation coefficient (r) greater than the table’s value (0.312). The reliability test showed an ICC of 0.99 and a Cronbach’s alpha of 0.746. CONCLUSIONS The DN4-Ina score is a valid and reliable questionnaire for assessing neuropathic pain in the Indonesian population.
Co-Authors Alvonsius, Raymond Aris Nimrod Angelita, Michelle Cancera Aninditha, Tiara Antono, Akbarbudhi Astri Budikayanti Basuki, Mudjiani Birry Karim Dodik Tugasworo Dono Antono Eka Ginanjar Erni Juwita Nelwan, Erni Juwita Fadli, Nurul Fithrie, Aida Fitri Octaviana Hadiweijaya, Antonia Harsono, Adrian Ridski Hartono, Chandra Indrawati, Luh Ari Joedo Prihartono Kuntjoro Harimurti Muhammad Hasnawi Haddani Mustika, Alyssa Putri Nani Kurniani Nurhadi Ibrahim Pagan Pambudi Parindra, Cakra Pringgodigdo Nugroho, Pringgodigdo Rizaldy Pinzon Safri, Ahmad Yanuar Sari, Waode Satriana Savitri, Irma Sofyan, Henry Riyanto Sulistianingsih, Dyah Purnamasari Wiguna, Fikry Ichsan Wijaya, Ade Wiratman, Winnugroho Wuysang, Audry Devisanty