Peran memantine dalam perbaikan afasia akibat stroke akut: sebuah case series
https://doi.org/10.22146/bns.v20i2.105953 Mohamad Reza Hendratmoko(1*), Ken Wirastuti(2)
(1) Departemen Neurologi, Fakultas Kedokteran, Universitas Islam Sultan Agung, Semarang
(2) Departemen Neurologi, Fakultas Kedokteran, Universitas Islam Sultan Agung, Semarang
(*) Corresponding Author
Abstract
Background: Aphasia significantly contributes to disability, depression, and reduced quality of life among post-stroke patients. The current management approaches have yet to yield satisfactory outcomes. There are no official guidelines that recommend pharmacological therapy and the appropriate time to administer it. Cognitive stimulants such as memantine have been studied to improve language function. Memantine has neuroprotective effects and increases neuroplasticity in cases of acute to chronic phase of stroke and has efficacy in improving post-stroke aphasia with minimal side effects compared to other drugs. The administration of memantine for aphasia due to acute stroke has not been widely studied.
Case Presentation: We present a case series on three patients diagnosed with acute stroke, both hemorrhagic and infarction, with aphasic manifestations. The three patients were given stroke standard therapy (antiplatelet for infarct stroke and anti-cerebral edema for hemorrhagic stroke) and memantine 5 mg/day for the first 3 months. Language function was measured using the test of Aphasia for Diagnosis Information Rehabilitation (TADIR) score and global cognitive function using the Indonesian version of the Montreal Cognitive Assesment Score (MoCA-Ina). The results of periodically TADIR score showed that all patients were improved. The MoCA-Ina score and independence test in the three patients at 3 months led to a diagnosis of vascular dementia. There were no side effects of memantine that appeared in the 3 months of observation.
Conclusion: Giving memantine in the acute stroke phase may improve language function in patients with aphasia due to stroke. Randomized controlled trials are needed to assess the efficacy and side effects of therapy.
ABSTRAK
Latar Belakang: Afasia merupakan kondisi yang berkontribusi besar dalam disabilitas, depresi dan penurunan kualitas hidup pada pasien pascastroke. Tatalaksana yang diberikan hingga saat ini masih belum memuaskan. Belum ada guideline resmi yang merekomendasikan terapi farmakologi dan waktu yang tepat untuk diberikan. Stimulansia kognitif seperti memantine diteliti dapat memperbaiki fungsi bahasa. Memantine memiliki efek neuroprotektif dan meningkatkan neuroplastisitas pada kasus stroke akut hingga kronik dan memiliki efikasi dalam perbaikan afasia pascastroke dengan efek samping yang lebih minimal dibandingkan obat lain. Pemberian memantine pada afasia akibat stroke akut masih belum banyak diteliti.
Laporan Kasus: Kami sajikan laporan kasus serial pada tiga pasien yang terdiagnosis stroke akut baik hemoragik maupun infark dengan manifestasi afasia. Ketiga pasien tersebut diberikan terapi standar stroke (antiplatelet untuk stroke infark dan anti edema otak untuk stroke hemoragik) dan memantine 5 mg/hari selama 3 bulan pertama. Fungsi bahasa diukur menggunakan skor Tes Afasia untuk Diagnosis Informasi Rehabilitasi (TADIR) dan fungsi kognitif global menggunakan skor Montreal Cognitive Assesment versi Indonesia (MoCA-Ina). Hasil skor TADIR yang diperiksa secara berkala menunjukkan ketiga pasien mengalami perbaikan. Skor MoCA-Ina dan tes kemandirian pada ketiga pasien di bulan ke-3 mengarahkan diagnosis demensia vaskular. Tidak ada efek samping memantine yang muncul pada bulan-3 observasi.
Kesimpulan: Pemberian memantine pada fase stroke akut dapat dipertimbangkan untuk memperbaiki fungsi bahasa pada pasien afasia akibat stroke. Perlu dilakukan penelitian uji randomized controlled trial untuk menilai efikasi dan efek samping terapi.
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DOI: https://doi.org/10.22146/bns.v20i2.105953
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