update paper fixed

8/18/2019 Update Paper Fixed

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THE EFFICACY OF TRANSCRANIAL MAGNETIC

STIMULATION ON IMPROVING

MOTORIC FUNCTIONAL IMPAIRMENT

OF POST ISCHEMIC STROKE PATIENTS

Iin Tammasse1, Nadya Sumolang1, Khumaira Santa1

1 Faculty of Medicine Hasanuddin University

Introduction


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Stroke is the 1st leading cause of death in Indonesia (15,4%) In !""#, $realence of

Stroke &as '! $er 1""" $o$ulation on $roinces in Indonesia (Indonesia asic *ealth

+esearch !""#) Stroke accounted for -1"" """ age.gender.standardi/ed death rate and

0'5-1"" """ age.gender.standardi/ed disaility.ad2usted life years lost (Karyana et al !"14,

Kusuma et al !"") Thus, further inestigation into treatments to decrease the numer of $ost

stroke disaility are critical to undertake

Stroke is defined y the 3orld *ealth rgani/ation as a clinical syndrome consisting of

ra$idly deelo$ing clinical signs of focal (or gloal in case of coma) disturance of cereral

function lasting more than !4 hours or leading to death &ith no a$$arent cause other than a

ascular origin (*atano, 1#0) lassification ased on the T6ST system identifies the

mechanism that leads to fie categories7 (1) 8arge.artery atherosclerosis, (!) ardioemolism

() Small.artery occlusion (lacune) (4) 6cute stroke of other determined etiology (5) Stroke of

undetermined etiology (*arold et al 1)

6$$ro9imately t&o thirds of stroke suriors hae residual neurological deficits that

im$air function and a$$ro9imately 5"% are left &ith disailities making them de$endent on

others for actiities of daily liing (:reshan :; et al 1#5)


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6uthor Study >esign uratio

n

utcome

(8ee et al

!"14)

ase.control

study

! $atients

&ith

suacute

stroke

rT?S &as

a$$lied to

the hand

motor corte9

for 1"

minutes &ith

1" */

freAuency

! &eeks uring4

&eeks.

4

months

after

stroke

Im$roed thekinematics

of finger and

gras$

moements

in the

affected

hand

3


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(Trom$etto

et al !""")

ase.control

study

!1

$atients

affected y

stroke (1!

male,

femaleC

aged

D"

years)

Stimulation

of the motor

corte9 &as

$erformed

&ith a

?agstim !""

stimulator

5 days Sugrou$

617 the hand

motor score

&as "C nly

t&o $atients

of grou$

sho&ed

$legic hand

muscles at

T1Conly one

of the

$atients of

grou$ had

some degree

of hand

moement at

(T1)

(3eiduscha

t et al

!"1")

+andomi/ed,

controlled,

linded study

1" rght.

handed

$atients

1.*/

re$etitie

transcranial

magnetic

stimulation

oer right.

hemis$heric

roca

months

etter

clinical

im$roement

Matrial# and Mt(od

Study population

The study $o$ulation consisted 1!4 $ost.ischemic stroke $atients, &ho &ere undergoing

T?S interention in a clinic in Indonesia and follo&ed u$ during Eanuary !"15 to Se$temer

!"15 Inclusion criteria for this study are $atients &ith $ost non.hemorrhagic stroke that has

motoric functional im$airment 6ll $atients had to receied ?+I scan efore undergoing T?S

interention Finally, all $atients that $assed the inclusion criteria &ere taken as total sam$le

4


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Clinical outcome

The $rimary outcome measures the thera$eutic efficacy of T?S interention, using the

;uro$ean Stroke Scale (;SS) The ;uro$ean Stroke scale can e used as an instrument for

matching of treatment grou$s as &ell as for ealuation of the $atients@ leel of im$airment The

scale consists of 14 items selected on the asis of their s$ecificity and their $rognostic alue

The 14 items are leel of consciousness, com$rehension, s$eech, isual field, ga/e, facial

moement, maintenance of arm $osition, arm raising, &rist e9tension, finger strength,

maintenance of leg $osition, leg fle9ing, foot dorsifle9ion, and gait (8 *antson et al 14) 6ll

$atients &ere ealuated y one consultant neurologist &ho runs a neurology clinic utcome

data &ere retrieed from the ;lectronic


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R#ult#

Clinical c(aractri#tic o% t( #tud) 'o'ulation

The clinical characteristics of the study $o$ulation are sho&n in Tale 1 The mean age

&as 5005 years old Seenty seen su2ects (0!1%) &ere males and forty seen of su2ects

(#%) &ere females There &ere 1!4 su2ects &ho suffered motoric functional im$airment

due to stroke attack

C(aractri#tic Total Nu$br *+, Man -./ S0

6ge 5005 H-. 114'

S1?ale ## (0!1)

Female 4# (#)

Si2ni%icant $otoric i$'ro3$nt 'o#t/TMS intr3ntion

6 $arametric $aired t.test analysis &as $erformed as descrie in the method to com$are

$re. and $ost. the ;SS score The mean of $re. score &as #",1 and the mean of $ost.score &as

'5,0' &ith res$ectiely standard deiation of 1',!04 and 1,#! Thus, there &as an aerage

im$roement score of 15,4' using ;SS score (".1"") &ith a standard deiation of 11,"

($G","5)

Pre PostT.

test resulted in a t alue of .15,0 and &ith t&o tail critical alue of 1,' &ith a confidence

interal of 5% Thus, there is a significant oerall im$roement as a result of T?S

interention The gra$h elo& indicates an association in com$arison of $re. and $ost. score of

;SS There is a clear im$roement in ;SS score

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From this study, &e can conclude that T?S is a technology that can e used to treat $atients

&ith $ost.ischaemic stroke motoric im$airment and $reent further disaility in the future T?S

interention has een $roen to e effectie to im$roe $atients@ clinical condition

3e suggested for dee$er inestigation and analysis to e conducted on T?S regarding the

treatment of other suty$es of stroke 3e also see that there is a $ossiility of T?S to e used

as solution for other motoric related disorder

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