Efektivitas repetitive transcranial magnetic stimulation terhadap perbaikan afasia nonfluent pasca stroke infark

Abstract

Aphasia is one of the most common consequences of stroke, approximately 21-38% of stroke patients have aphasia. The recovery of aphasia after stroke depends significantly on the level of neuroplasticity after brain damage. Transcranial magnetic stimulation (TMS) is a non-invasive and safe method used to induce or improve the neuroplasticity of brain cells. The aim of this study was to investigate the effectivity of 5Hz repetitive transcranial magnetic stimulation (rTMS) conducted 10 times over the Broca’s area for improving TADIR score in post-stroke patients with nonfluent aphasia.

This study was quasi-experimental with 24 patients with nonfluent aphasia (onset less than 6 months) after first-ever infarction stroke. They were divided into two groups. The rTMS group consisted of 12 subjects receiving 5Hz rTMS therapy (10 sessions, 5 consecutive days in 2 weeks), standard therapy, and cognitive stimulation. The control group with 12 subjects received standard therapy and cognitive stimulation. The outcome was assessed by TADIR score for the fluency, naming, comprehension, and repetitive component. Mann-Whitney analysis was performed to compare TADIR baseline score changes immediately at 2 and 6 weeks after experimental treatment both in rTMS and control groups.

The results of analysis, although both groups improved their fluency, naming, comprehension, and repetition abilities after treatment, there were significantly differences between the rTMS and control groups in comprehension and naming (p <0.05) abilities at 2 weeks afterf experimental treatment. Based on this study 5 Hz rTMS therapy of 10 sessions in Broca’s area are effective to nonfluent aphasia improvement particularly on short-term naming and comprehension components according to TADIR score.

ABSTRAK

Stroke dapat menyebabkan afasia, diperkirakan sekitar 21%-38% pasien stroke akut mengalami afasia. Pemulihan afasia setelah stroke tergantung secara signifikan pada tingkat neuroplastisitas setelah terjadinya kerusakan otak. Transcranial Magnetic Stimulation (TMS) merupakan metode non-invasif yang aman digunakan untuk menginduksi atau meningkatkan perubahan neuroplastisitas sel otak. Penelitian ini bertujuan untuk mengetahui efektivitas pemberian rTMS frekuensi 5Hz sebanyak 10 sesi di area Broca terhadap perbaikan afasia nonfluent pasca stroke infark yang dinilai dengan peningkatan skor TADIR.

Penelitian menggunakan rancangan kuasi eksperimental dengan subjek penelitian berjumlah 24 pasien dengan afasia pasca stroke infark pertama awitan kurang dari 6 bulan. Kelompok rTMS terdiri dari 12 subjek yang mendapat terapi repetitive TMS 5Hz (10 sesi, 5 hari berturut-turut selama 2 minggu), terapi standar, dan stimulasi kognitif. Kelompok kontrol dengan 12 subjek mendapat terapi standar dan stimulasi kognitif. Outcome penelitian dinilai dengan skor TADIR untuk komponen menyebut, menamai, pemahaman, dan meniru. Dilakukan analisis Mann-Whitney untuk membandingkan perubahan skor TADIR, setelah pemberian terapi pada minggu ke-2 dan ke-6 antara kelompok rTMS dan kontrol.

Dari hasil analisis pada kedua kelompok didapatkan peningkatan kemampuan menyebut, menamai, pemahaman, dan meniru setelah pemberian terapi. Namun demikian, perbedaan yang signifikan hanya pada kemampuan pemahaman dan menamai (p <0,05) setelah 2 minggu pemberian terapi. Berdasarkan penelitian ini, terapi rTMS frekuensi 5Hz sebanyak 10 sesi di area broca efektif untuk perbaikan afasia nonfluent terutama pada komponen fungsi penamaan dan pemahaman jangka pendek yang dinilai dari skor TADIR.