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All Journal Medicina Callosum Neurology Journal : Jurnal Berkala Neurologi Bali
Luh Kadek Trisna Lestari
Department Of Neurology, Bangli General Regional Hospital, Bangli, Bali, Indonesia
Health Professions Medicine & Pharmacology Neuroscience

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Terapi insulin menurunkan kejadian nyeri neuropati diabetik dibandingkan dengan oral anti-diabetes pada penderita diabetes melitus tipe 2 Lestari, Luh Kadek Trisna; Purwata, Thomas Eko; Putra, IGN Purna
Medicina Vol 47 No 1 (2016): Januari 2016
Publisher : Medicina

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (376.431 KB)

Abstract

Nyeri neuropati diabetik (NND) merupakan salah satu komplikasi yang sering terjadi pada penderita diabetes melitus (DM) tipe 2. Insulin merupakan salah satu terapi DM tipe 2. Insulin memperbaiki status metabolik dengan cepat terutama kadar glukosa darah sehingga kerusakan sel saraf dapat dicegah termasuk kejadian NND. Tujuan penelitian ini adalah untuk mengetahui apakah terapi insulin dapat menurunkan kejadian NND pada pasien DM tipe II dibandingkan dengan oral anti-diabetes (OAD). Subjek penelitian adalah 80 orang penderita DM tipe 2 yang menjalani pengobatan ke Poliklinik Endokrin dan Poliklinik Saraf RSUP Sanglah selama bulan Januari-Maret 2015. Subjek terdiri dari kelompok kasus 40 orang DM dengan NND dan kelompok kontrol 40 orang DM tanpa NND. Adanya NND ditentukan dengan alat bantu douleur neuropathique en 4 questions (DN4). Uji hipotesis menggunakan Chi-square, dan regresi logistik dengan tingkat kemaknaan P<0,05. Hasil penelitian mendapatkan bahwa terapi insulin pada penderita DM tipe 2 menurunkan risiko NND dibanding terapi OAD dengan RO=0,07 (IK95% 0,02 sampai 0,26), P<0,0001. Dari penelitian ini dapat disimpulkan bahwa terapi insulin pada penderita DM tipe 2 dapat menurunkan kejadian NND. Painful diabetic neuropathy (PDN) is one of the most common complications that often occur in diabetes mellitus (DM) patient. Insulin is one of the DM treatment can quickly improve metabolic status, especially blood glucose levels, so prevent damage to nerve cells include NND. The purpose of this study was to determine whether insulin therapy can reduce the risk of NND in patients with type II DM compared to oral anti-diabetic (OAD). Subject of study was 80 samples with type 2-DM underwent treatment to Endocrine and Neurology Outpatient Clinic at Sanglah Hospital from January until March 2015. Subjects consist of 40 subjects in case group with PDN and 40 subjects in control group without PDN. The existence of PDN was determined by douleur neuropathique en 4 questions (DN4) tools. This study found that insulin therapy reduce incidence of PDN on type 2-DM patients compared to OAD therapy with OR=0.07 (95%CI 0.02 to 0.26), P<0.0001. It was concluded that insulin therapy can reduce incidence of PDN in type 2-DM patient.
CASE REPORT: HEMICHOREA-HEMIBALLISMUS IN NON-KETOTIC HYPERGLYCEMIA AND NON-HEMORRHAGIC STROKE PATIENT WITH BASAL GANGLIA HYPERDENSITY Regina Caecilia Setiawan; William Septian Sonyo; Luh Kadek Trisna Lestari
Callosum Neurology Vol 2 No 2 (2019): Callosum Neurology Journal
Publisher : The Indonesia Neurological Association Branch of Denpasar

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (426.273 KB) | DOI: 10.29342/cnj.v2i2.78

Abstract

Background : Hemichorea-hemiballismus (HC-HB) is a hyperkinetic disorder characterized by uncontrolled movements, non patterned, occurring mostly in the proximal extremity on one side of the body. The etiology that most often causes HC-HB is acute cerebrovascular disorder. Non-ketotic hyperglycemia is another etiology that is very important because it is the second most common cause of HC-HB and can be manifested as an initial symptom or complication of diabetes mellitus. This case is rare and the prevalence is unknown. Case : A diabetic patient with non-ketotic hyperglycemia reported  with hemiballismus syndrome. A 60-year-old woman experiences involuntary, repetitive, and non-rhythmic movements in the left arm and leg. These patients have a history of uncontrolled diabetes mellitus and hypertension. Head CT scan images in patients showed hyperdensity lesions in the right basal ganglia which were thought to be caused by non-ketotic hyperglycemia and infarction in the right temporal lobe. Involuntary movements improve after blood glucose targets are achieved by administering basal and prandial insulin.  Clinical response in the case of hemiballismus above is reversible even though the appearance of hyperdensityt lesions can last for several months. Discussion : Hemichorea-Hemiballismus (HC-HB) is a rare disorder of involuntary movement, most often caused by focal lesions in the basal ganglia and the contralateral subthalamic nucleus. HC-HB is mainly caused by systemic processes both focal and diffuse. Nonketotic hyperglycemia is known to be a metabolic cause of HC-HB, especially in elderly patients with uncontrolled diabetes mellitus. Clinical manifestations and supporting patients support hyperglycemia and basal ganglia hyperdensity to be the etiology of hemiballismus experienced by patients. Conclusion : Many etiologies can cause this disorder, but vascular disorders and non-ketotic hyperglycemia are the most common etiologies. HC-HB in non-ketotic hyperglycemic is manifestation which is very rare in diabetes mellitus. The prognosis is quite good in most patients with or without treatment. This case report describes a successful treatment approach with positive results and a fairly short duration. Keywords: Hemichorea, Hemiballismus, Hyperglycemia, Basal Ganglia Hyperdensity
Co-Authors IGN Purna Putra, IGN Purna Regina Caecilia Setiawan Thomas Eko Purwata William Septian Sonyo