Tesis

Uji Diagnostik Ice Pack Test dan Repetitive Nerve Stimulation serta Kombinasi Keduanya pada Diagnosis Miastenia Gravis = Diagnostic Test of Ice Pack Test, Repetitive Nerve Stimulation, and Combination of Both in the Diagnosis of MG.

Latar belakang : Penegakan miastenia gravis (MG) didasarkan pada gejala klinis, pemeriksaan fisik dan pemeriksaan penunjang, sampai saat ini belum ada pemeriksaan yang menjadi standar utama dalam penegakan MG. Pemeriksaaan dalam penegakan MG yang hasilnya cepat, tidak invasif dan mudah dilakukan serta biayanya murah yaitu ice pack test (IPT) dan Repetitive Nerve Stimulation (RNS). Metode: Disain penelitian potong lintang menggunakan data primer dan rekam medis pasien yang dicuriga MG dengan ptosis di Poliklinik Saraf, Instalasi Gawat Darurat (IGD), dan Ruang Rawat Inap di RSUPN Cipto Mangunkusumo (RSCM) sejak Juli 2019 – November 2019. Hasil: Dari 38 subjek penelitian dengan ptosis, didapatkan 35 subjek terkonfirmasi MG (SF-EMG/Achr antibodi/respon terapi), 19 di antaranya (54,29%) MG jenis okular dan 16 (45,71%) MG jenis general. Hasil ice pack test positif pada 29 subjek (76,3%). Hasil uji diagnostik pemeriksaan ice pack test diperoleh sensitivitas 80%, spesifisitas 66,67%, nilai AUC 73,3%; Hasil uji diagnostik pemeriksaan RNS diperoleh sensitivitas 60%, spesifisitas 100%, nilai AUC 80%; Sedangkan uji diagnostik kombinasi pemeriksaan diperoleh sensitivitas 94,28%, spesifisitas 66,67%, nilai AUC 80,5%. Kesimpulan: Kombinasi pemeriksaan Ice Pack Test dan Repetitive Nerve Stimulation (RNS) memiliki nilai diagnostik yang baik, sehingga dapat digunakan sebagai pemeriksaan penunjang untuk menegakkan diagnosis MG di RSUPN Cipto Mangunkusumo.
Kata kunci: uji diagnostik, ptosis, ice pack test, RNS, miastenia gravis


Background: Diagnosis of myasthenia gravis (MG) is based on clinical symptoms, physical examination and supporting examination, so far there has been no examination that has become the main standard in the enforcement of MGSupporting examination of MG that are fast, non-invasive and easy to do are ice pack test (IPT) and Repetitive Nerve Stimulation (RNS). Methods: This study was conducted with cross-sectional design using primary data and medical records of suspicious MG patients with ptosis in Cipto Mangunkusumo General Hospital between july-november 2019. Results: Of the 38 subjects with ptosis, 35 subjects were confirmed MG with SFEMG/AChR antibodies/respon therapy, 19 (54,29 %) ocular type and 16 (45,71%) general type. The ice pack test was positive in 29 subjects (76,3 %). The diagnostic test results of the ice pack test has sensitivity 80%, Specificity 66,67%, AUC(area under the curve) value 73,3%; the RNS has sensitivity 60%, Specificity 100%, AUC value 80%; while the combination test has sensitivity 94,28%, Specificity 66,67% and AUC(area under the curve) value 80,5% Conclusions: The combination of IPT and RNS has good diagnostic value, so that it can be used as a supporting examination to diagnosis of MG in Cipto mangunkusumo general hospital.
Keywords: diagnostic test, ptosis, ice pack test, RNS, myasthenia gravis