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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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Journal : Neurona

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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
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.
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