Tesis

Fenomena Wearing Off Pada Penyakit Parkinson Dan Faktor Yang Berhubungan di RSUPN Dr. Cipto Mangunkusumo = Wearing Off phenomenon on Parkinson Disease Patient and Related Factors at RSUPN Dr. Cipto Mangunkusumo.

Latar Belakang. Wearing off (WO) merupakan komplikasi terapi penyakit Parkinson (PP) yang prevalensinya dulunya dianggap rendah pada tahun awal namun tampak meningkat di studi terbaru. WO dapat berupa komplikasi motorik maupun non motorik dan secara signifikan mempengaruhi kualitas hidup pasien PP. Faktor seperti durasi penyakit yang lebih lama, komponen motorik Unified Parkinson’s Disease Rating Scale (UPDRS) yang lebih tinggi, tingginya dosis levodopa harian, usia onset lebih muda merupakan hal-hal yang dikaitkan dengan komplikasi motorik. Terdapat diskrepansi data Eropa dan Asia. Sehingga studi ini bertujuan untuk mendapatkan prevalensi WO pada PP dan faktor yang berhubungan pada pasien PP di RSUPN Dr. Cipto Mangunkusumo Metode. Studi potong lintang pada pasien kontrol di poli Neurologi dan Geriatri di RSUPN Dr. Cipto Mangunkusumo. Dilakukan evaluasi terjadap karakteristik demografis, klinis dan tatalaksana pada subyek. Hasil. Dari 64 pasien PP yang terinklusi, 59% diantaranya pria. WO ditemukan pada 65% subyek. Gejala motorik muncul lebih sering yaitu kaku 51%, lambatnya pergerakan 46,9% dan tremor 46,9%. Sedangkan gejala non motorik berupa gangguan keseimbangan 21%, pegal 18% dan berkeringat 14%. Rerata usia 62 tahun, median usia saat onset gejala 56 tahun dan median durasi gejala 5 tahun. Dari status nutrisi, BB rerata 57,9 kg dan median IMT 22,1. Mayoritas berada pada stadium Hoehn and Yahr 1-2 sebesar 62,5%. Median dari MDS UPDRS II skor sebesar 10 dan median MDS UPDRS 3 21. WO mayoritas ditemukan pada subyek dengan politerapi antiparkinson/ hanya 50% subyek mengkonsumsi terapi sesusai instruksi (60 menit sebelum makan atau 120 menit setelah makan, meskipun hampir seluruh subyek melaporkan telah konsumsi obat secara teratur. Pada kelompok WO median dari dosis levodopa harian 300 mg (5,3 mg/kgBB dan dosis levodopa ekuivalen harian 389,5 mg (6mg/kgBB), secara signifikan lebih tinggi dibandingkan kelompok tanpa WO (p=0,012). Faktor-faktor yang berhubungan secara independen terhadap kejadian WO pada PP di RSCM adalah waktu konsumsi obat (p=0,01) dan jumlah terapi antiparkinson yang dikonsumsi(p=0,001). Kesimpulan. Meskipun mayoritas subyek masih dalam stadium awal, prevalensi WO pada pasien PP di RSUPN Dr. Cipto Mangunkusumo didapatkan cukup tinggi. Faktor-faktor yang berhubungan secara independen terhadap kejadian WO pada PP di RSCM adalah waktu konsumsi obat dan jumlah terapi antiparkinson yang dikonsumsi.
Kata kunci: wearing off, penyakit Parkinson, levodopa


Background. Wearing off (WO) is a complication of Parkinson's disease (PD) therapy. Previously thought to be low in the early years, yet recent studies have found otherwise. WO can be seen as a motor or nonmotor complication and significantly affects the quality of life Factors such as longer disease duration, higher motor component of the Unified Parkinson's Disease Rating Scale (UPDRS), higher daily levodopa dose, and younger age of onset are associated with motor complications. There is a discrepancy between earlier European and Asian studies. This study aim to find the prevalence of Wearing Off (WO) and related factors in PD patients at Dr. Cipto Mangunkusumo National Hospital Method. Cross-sectional study on PD subjects at Dr. Cipto National General Hospital Mangunkusumo. Demographic, clinical, and management characteristics of the subjects were conducted as a registry study. Result. Of 64 PD subjects, 59% were men. WO was found in 65% of subjects. The motor symptoms appear more frequent, which are general stiffness (51%), slowness of movements (46.9%), and tremor (46.9%), while non-motor symptoms were imbalance (21%), aching (18%), and sweating (14%). The mean age was 62 years old, with median age at symptom onset was 56 years old, and median duration of symptoms was 5 years. From the nutritional status, the mean body weight was 57,9 kg and the median body mass index was 22,1. Most of them were in the Hoehn and Yahr stage 1-2 (62,5%), the median MDS UPDRS II score was 10 and the median MDS UPDRS III score was 21. WO was mostly found in subjects with polytherapy. Only 50% of subjects took their medication according to the instructions (60 minutes before meal or 120 minutes after), although all subjects admitted to having taken their medication on time. In the WO group, the median levodopa daily dose (LDD) was 300 mg (5,3 mg/kg bw) and the levodopa equivalent dose (LEDD) was 389,5 mg (6 mg/kg bw), significantly higher than the subjects without WO (p=0,012). Factors independently associated with the incidence of WO in PD at RSCM were the time of drug consumption (p=0,01) and the number of medications (p=0,001). Conclusion. Despite many subjects being in the early stages, the prevalence of WO in PD at Dr. Cipto Mangunkusumo National Hospital is considerably high. Time of drug consumption and number of medications were the independent factors associated with WO.
Keywords: wearing off, Parkinson disesase, levodopa