Perbandingan kerusakan saraf perifer melalui pemeriksaan elektroneuromiografi pada kusta tipe multibasiler

I Dewa Made Rendy Sanjaya; Luh Made Mas Rusyati; Ketut Kwartantaya Winaya; I Komang Arimbawa; I Gusti Ayu Agung Praharsini; Ni Made Dwi Puspawati

doi:10.15562/ism.v13i3.1523

Perbandingan kerusakan saraf perifer melalui pemeriksaan elektroneuromiografi pada kusta tipe multibasiler

I Dewa Made Rendy Sanjaya ,

Luh Made Mas Rusyati ,

Ketut Kwartantaya Winaya ,

I Komang Arimbawa ,

I Gusti Ayu Agung Praharsini ,

Ni Made Dwi Puspawati ,

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DOI: https://doi.org/10.15562/ism.v13i3.1523 |
Published: 2022-11-02

Abstract

Background: Leprosy is a bacterial infection that is still a neglected disease. This disease leads to peripheral neuropathy despite routine treatment. Moreover, early detection of peripheral neuropathy in leprosy patients is very important. ENMG is known to have fairly good sensitivity and specificity in detecting it. Therefore, this study aims to determine the relationship between type 2 leprosy reactions and the risk of peripheral neuropathy through ENMG examination.

Methods: The study design was a prospective, cross-sectional observational study. The research was conducted in July-September 2022 at Prof. dr. I G.N.G. Ngoerah General Hospital, Denpasar. The sample will be selected based on inclusion and exclusion criteria and then divided into two groups as a group with type 2 leprosy reaction and a group without type 2 leprosy reaction. The data were analyzed using SPSS version 25. The analysis was carried out in the form of descriptive and analytical analyses. The analytical analysis used is fisher's exact.

Results: This study obtained 20 samples with an average age of 36.2±13.3 years. There were 40% of patients with type 2 leprosy reactions. All patients had polyneuropathy with 30% axonal type polyneuropathy and 70% mixed type. Bivariate analysis showed that there was no significant relationship between type 2 leprosy reaction to the type of peripheral neuropathy and the number of nerves involved based on ENMG examination (p=0.64).

Conclusion: From this study, it can be concluded that there was no statistically significant relationship between the type 2 leprosy reaction to the type of peripheral neuropathy and the number of nerves involved based on the ENMG examination.

Latar belakang: Kusta merupakan infeksi bakteri yang masih menjadi penyakit terbengkalai. Penyakit ini dapat menimbulkan terjadinya neuropati perifer meskipun telah melakukan pengobatan yang rutin. Untuk itu deteksi dini neuropati perifer pada pasien kusta sangat penting. ENMG diketehui memiliki sensitivitas dan spesifisitas yang cukup baik dalam mendeteksi hal tersebut. Maka dari itu, penelitian ini bertujuan untuk mengetahui hubungan antara reaksi kusta tipe 2 dengan resiko neuropati perifer melalui pemeriksaan ENMG.

Metode: Disain penelitian ini merupakan observasional prospektif, potong lintang. Penelitian dilakukan pada bulan Juli-September 2022 di RSUP Prof. dr. I G.N.G. Ngoerah, Denpasar. Sampel akan diseleksi berdasarkan kriteria inklusi dan eksklusi kemudian di bagi menjadi dua kelompok yaitu, kelompok dengan reaksi kusta tipe 2 dan kelompok tanpa rekasi kusta tipe 2. Data dianalisis menggunakan SPSS versi 25. Analisis yang dilakukan berupa analisis deskriptif, dan analitik. Analisis analitik yang digunakan berupa fisher’s exact.

Hasil: Pada penelitian ini mendapatkan 20 sampel dengan rata-rata berusia 36,2±13,3 tahun. Terdapat 40% pasien dengan reaksi kusta tipe 2. Seluruh pasien mengalami polineuropati dengan 30% merupakan polineuropati tipe aksonal dan 70% tipe campuran. Analissi bivariat menunjukkan tidak ditemukannya hubungan yang signifikan antara rekasi kusta tipe 2 terhadap jenis nauropati perifer dan jumlah saraf yang terlibat berdasarkan pemeriksaan ENMG (p=0,64).

Simpulan: Dari penelitian ini dapat disimpulkan bahwa tidak ditemukannya hubungan yang signifikan secara statistik antara rekasi kusta tipe 2 terhadap jenis nauropati perifer dan jumlah saraf yang terlibat berdasarkan pemeriksaan ENMG.

References

WHO. Global leprosy update, 2018: moving towards a leprosy- free world. Weekly Epidemiol Rec. 2019;94(35/36):389–412.
Pusat Data dan Informasi Kementerian Kesehatan RI (InfoDATIN). Hapuskan Stigma dan Diskriminasi terhadap Kusta. Jakarta; 2018.
WHO. Towards zero leprosy Global Leprosy (Hansen’s disease) Strategy 2021-2030. Cooreman E, editor. India: World Health Organization. 2021:1–30.
Bilik L, Demir B, Cicek D. Leprosy Reaction. IntechOpen. 2017;82–91.
Fischer M. Leprosy – an overview of clinical features, diagnosis, and treatment. JDDG - J Ger Soc Dermatology. 2017;15(8):801–27.
Ebenezer GJ, Scollard DM. Treatment and Evaluation Advances in Leprosy Neuropathy. Neurotherapeutics. 2021;18(4):2337–50.
Nascimento OJM. Leprosy neuropathy: Clinical presentations. Arq Neuropsiquiatr. 2013;71(9 B):661–6.
Marahatta S, Bhattarai S, Paudel B. Electrophysiological profiles of leprosy neuropathy. Lepr Rev. 2017;88(3):373–80.
Nusartha P, Arimbawa I, Putra I, Widyadharma I, Pratiwi N. Characteristics of Enmg Examination in Morbus Hansen Patient in Neurology Polyclinic Sanglah General Hospital. Int J Med Rev Case Reports. 2020;1–5.
Rusyati LMM, Sasmita PA, Adiguna MS. Diagnostic test using monofilament compared to electroneuromyography (ENMG) for detection of peripheral neuropathy in leprosy at Sanglah General Hospital, Bali-Indonesia. Bali Med J. 2019;8(3):722–7.
Gunawan A, Argentina F, Subandrate S. Hubungan Faktor Risiko Dengan Kejadian Erythema Nodosum Leprosum (ENL) di RSUP Dr Mohammad Hoesin Palembang. Maj Kedokt Sriwij. 2019;51(2):53–62.
Herawan S, Sudrajat. Apakah Upaya Pencegahan, Faktor Penyakit, dan Faktor Individu Mempunyai Dampak Terhadap Cacat Tingkat II Kusta. J Ilm Indones. 2018;3(7):45–53.
Prakoeswa CRS, Lubis RS, Anum Q, Argentina F, Menaldi SL, Gunawan H, et al. Epidemiology of Leprosy in Indonesia: a Retrospective Study. Berk Ilmu Kesehat Kulit dan Kelamin. 2022;34(1):29–35.
Pagolori. Analisis Faktor Risiko Reaksi sesudah Pengobatan MDT pada Penderita Kusta di Kabupaten Gowa tahun 2002. FKM UNHAS. 2003;1–2.
Nakwan N, S T, Nakwan N. A case of erythema nodosum leprosum reaction with diffuse alveolar haemorrhage, successfully treated by pulsed methylprednisolone. Lepr Rev. 2010;81(2):129–36.
Prawoto. Faktor - Faktor Risiko Yang Berpengaruh Terhadap Terjadinya Reaksi Kusta (Studi di wilayah kerja Puskesmas Kabupaten Brebes) Semarang. Univ Diponegoro. 2008;1–15.
De Sousa Oliveira JS, Dos Reis ALM, Margalho LP, Lopes GL, Da Silva AR, De Moraes NS, et al. Leprosy in elderly people and the profile of a retrospective cohort in an endemic region of the Brazilian Amazon. PLoS Negl Trop Dis. 2019;13(9):1–12.
Verdy, Budianto A, Siswati A. Lepra Tipe Neural Murni (Pure Neural Leprosy). J Unair. 2015;27(1):70–6.
Yadav N, Kar S, Madke B, Dashatwar D, Signh N, Prasad K, et al. Leprosy elimination: A myth busted. J Neurosci Rural Pr. 2014;5(Suppl 1):S28–32.
Coster S, de Bruijin S, Tavy D. Diagnostic value of history, physical examination and needle electromyography in diagnosing lumbosacral radiculopathy. J Neurol. 2010;257(3):332–7.
Cho S. Utility of electrodiagnostic testing in evaluating patients with lumbosacral radiculopathy: An evidence-based review. Muscle Nerve. 2010;42(2):276–82.

[1] WHO. Global leprosy update, 2018: moving towards a leprosy- free world. Weekly Epidemiol Rec. 2019;94(35/36):389–412.

[2] Pusat Data dan Informasi Kementerian Kesehatan RI (InfoDATIN). Hapuskan Stigma dan Diskriminasi terhadap Kusta. Jakarta; 2018.

[3] WHO. Towards zero leprosy Global Leprosy (Hansen’s disease) Strategy 2021-2030. Cooreman E, editor. India: World Health Organization. 2021:1–30.

[4] Bilik L, Demir B, Cicek D. Leprosy Reaction. IntechOpen. 2017;82–91.

[5] Fischer M. Leprosy – an overview of clinical features, diagnosis, and treatment. JDDG - J Ger Soc Dermatology. 2017;15(8):801–27.

[6] Ebenezer GJ, Scollard DM. Treatment and Evaluation Advances in Leprosy Neuropathy. Neurotherapeutics. 2021;18(4):2337–50.

[7] Nascimento OJM. Leprosy neuropathy: Clinical presentations. Arq Neuropsiquiatr. 2013;71(9 B):661–6.

[8] Marahatta S, Bhattarai S, Paudel B. Electrophysiological profiles of leprosy neuropathy. Lepr Rev. 2017;88(3):373–80.

[9] Nusartha P, Arimbawa I, Putra I, Widyadharma I, Pratiwi N. Characteristics of Enmg Examination in Morbus Hansen Patient in Neurology Polyclinic Sanglah General Hospital. Int J Med Rev Case Reports. 2020;1–5.

[10] Rusyati LMM, Sasmita PA, Adiguna MS. Diagnostic test using monofilament compared to electroneuromyography (ENMG) for detection of peripheral neuropathy in leprosy at Sanglah General Hospital, Bali-Indonesia. Bali Med J. 2019;8(3):722–7.

[11] Gunawan A, Argentina F, Subandrate S. Hubungan Faktor Risiko Dengan Kejadian Erythema Nodosum Leprosum (ENL) di RSUP Dr Mohammad Hoesin Palembang. Maj Kedokt Sriwij. 2019;51(2):53–62.

[12] Herawan S, Sudrajat. Apakah Upaya Pencegahan, Faktor Penyakit, dan Faktor Individu Mempunyai Dampak Terhadap Cacat Tingkat II Kusta. J Ilm Indones. 2018;3(7):45–53.

[13] Prakoeswa CRS, Lubis RS, Anum Q, Argentina F, Menaldi SL, Gunawan H, et al. Epidemiology of Leprosy in Indonesia: a Retrospective Study. Berk Ilmu Kesehat Kulit dan Kelamin. 2022;34(1):29–35.

[14] Pagolori. Analisis Faktor Risiko Reaksi sesudah Pengobatan MDT pada Penderita Kusta di Kabupaten Gowa tahun 2002. FKM UNHAS. 2003;1–2.

[15] Nakwan N, S T, Nakwan N. A case of erythema nodosum leprosum reaction with diffuse alveolar haemorrhage, successfully treated by pulsed methylprednisolone. Lepr Rev. 2010;81(2):129–36.

[16] Prawoto. Faktor - Faktor Risiko Yang Berpengaruh Terhadap Terjadinya Reaksi Kusta (Studi di wilayah kerja Puskesmas Kabupaten Brebes) Semarang. Univ Diponegoro. 2008;1–15.

[17] De Sousa Oliveira JS, Dos Reis ALM, Margalho LP, Lopes GL, Da Silva AR, De Moraes NS, et al. Leprosy in elderly people and the profile of a retrospective cohort in an endemic region of the Brazilian Amazon. PLoS Negl Trop Dis. 2019;13(9):1–12.

[18] Verdy, Budianto A, Siswati A. Lepra Tipe Neural Murni (Pure Neural Leprosy). J Unair. 2015;27(1):70–6.

[19] Yadav N, Kar S, Madke B, Dashatwar D, Signh N, Prasad K, et al. Leprosy elimination: A myth busted. J Neurosci Rural Pr. 2014;5(Suppl 1):S28–32.

[20] Coster S, de Bruijin S, Tavy D. Diagnostic value of history, physical examination and needle electromyography in diagnosing lumbosacral radiculopathy. J Neurol. 2010;257(3):332–7.

[21] Cho S. Utility of electrodiagnostic testing in evaluating patients with lumbosacral radiculopathy: An evidence-based review. Muscle Nerve. 2010;42(2):276–82.

Perbandingan kerusakan saraf perifer melalui pemeriksaan elektroneuromiografi pada kusta tipe multibasiler

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References

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