Journal Neuralgia Post-Herpetik
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Transcript of Journal Neuralgia Post-Herpetik
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8/16/2019 Journal Neuralgia Post-Herpetik
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Jurnal Praktis Klinis
Robert W. Johnson, M.B., B.S., M.D.,and Andrew S.C. Rice, M.B., B.S., M.D.
NEURALGIA ASCA!ERE"I#
n en$% & 'ed ()*+* ne&'.or$ october *, -*/
"he New En$%and Jo0rna% o1 Medicine
Down%oaded 1ro' ne&'.or$ on Dece'ber *,-*/. 2or 3ersona% 0se on%4. Co34ri$ht 5 -*/
#i6i N0r A7idahN0di4a A8i'ah
S0wanda !endrawan
e'bi'bin$ 9 dr. Wiwin S0ndawi4ani,
S3.S
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Kasus
•Seoran$ wanita )( thn den$an n4eri3ersisten dan $ata% 3ada der'ato'
"* 6anan dari atas thoraco%0'ba%
&0nction hin$$a 6e 0'bi%i60s se&a6 Ia'enderita her3es 8ooster 3ada re$io4an$ sa'a * tah0n sebe%0'n4a
•
Ia 'en$$a'bar6an n4erin4a 4an$hebat den$an sensasi terba6ar, dan%ebih hebat terasa &i6a disti'0%asi
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Masalah Klinis
•Ne0ra%$ia 3ost:her3eti6
6o'3%i6asi 6roni6a6ibat in1e6si ;ir0s her3es 8ooster
•!er3es 8ooster
• In1e6si ;ir0s ;arise%%a:8oster =? dor'an di$an$%ia sensori6 4an$ 'en4ebab6an'ani1estasi n4eri a60t 3ada r0a' ;esi60%ar3ada sat0 der'ato', a6an 'en$hi%an$
da%a' bebera3a 'in$$0•=>= 9 ;ir0s ne0rotro3i6 4an$ secara ti3i6a%da3at 'en$a6ses sara1 sensori6 3ada in1e6si4an$ ter&adi se%a'a 'asa 6ana6:6ana6
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Di A'eri6a Utara dan Ero3a•Seban4a6 @ dewasa '0da'e'i%i6i sero3ositi1 0nt06 =>=
risi6o her3es 8oster•#e&adian (./ 6as0s 3er * oran$3er ta0n
•
Menin$6at tin$$i '0%ai 0sia tah0n ** 6as0s 3er *
•An$6a 6e&adian ber0%an$
oran$ den$an i'0no6o'3eten
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Neuralgia Post-Herpetik
•N4eri ne0ro3ati6 6o'3%e6s a6ibat%an$s0n$ dari 6er0sa6an sara1 3eri1erse%a'a in1e6si her3es 8oster
•M0nc0% hari sete%ah r0a' a60ther3es 8oster ti'b0%
•Insiden dan 3re;a%ensi9 dari se%0r0h
3asien den$an her3es 8oster 'en$e%0hn4eri ( b0%an sete%ah onset $e&a%a dan* - tah0n.
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• 'e'i%i6i s6or intensitas n4eri
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•Data ana%isis %ain 'en4eb0t6an9
Insiden ne0ra%$ia 3ost:her3eti6
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J0$a 'eni'b0%6an 3enderitaan 'asa%ah 6esehatan tin$6at indi;id0
dan sosia%
en0r0nan 60a%itas hid03, 10n$si Hsi6
3si6o%o$is
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Strategi & Bukti Ilmiah
1. AsesmenAses'en 6%inis ne0ra%$ia 3as6a her3es'en$i60ti 3roto6o% 0'0' ases'en 0nt063asien den$an n4eri ne0ro3ati6 3eri1er
/ #ate$ori 0'0'9
-. N4eri s3ontan 4an$ se6aran$ dirasa6an
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•In1or'asi 3entin$ %ainn4a9
"i3e n4eri
Intensitas n4eriE1e6n4a terhada3 a6ti;itas
2%06t0asin4a setia3 wa6t0
• ada 3e'eri6saan Hsi69• erbandin$an 6ontra%atera% 10n$si
sensoris 4an$ ter6ait
#ehi%an$an sensai 3ada tes raba3anas:din$in dan ta&a':t0'30%
A'3%iH6asi sensor secara 3ato%o$i6
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Menggali Informasi
•In1or'asi s0b&e6ti1 'en$enai9*. Leta6 n4eri dan intensitasn4a
-. E1e6 n4eri terhada3 a6ti;itasn4a
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atalaksana
•Berdasar6an $e&a%a•#adan$ 'e'b0t0h6an 3eriode3en$obatan 4an$ %a'a
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erapi opikal
"era3i frst-line n4eri rin$an
• #adan$ di$0na6an seba$ai tera3i6o'binasi
•Kbat to3i6a% ber03a 6o4o 4an$ 'en$and0n$ Lidocain %ebih 'en$0ran$i n4eri
•#ri' Ca3saicin ,) (: 'enit sete%ah3e'berian anesthesi to3i6a% @ 6o4oca3saicin sa&a se%a'a *- 'in$$0
#e60ran$an9 3en$$0naan terbatas /*
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erapi Sistemik
•Seb0ah 'eta ana%isis 'e'b06ti6anbahwa "risi6%i6 antide3resan danantie3i%e3si Gaba3entin dan re$aba%inda3at 'en&adi 3i%ihan tera3i ne0ra%$ia3osther3eti6 ini
• "risi6%i6 antide3resan
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•Gaba3entin re$aba%in•Ni%ai (:F seba$ai tera3i
•Ni%ai ):(- 3en$$0naan 4an$
'e'baha4a6an• K3ioid %ini 6e:(
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er%0 di erhatia6an
•asien ne0ra%$ia 3osther3eti6@ Usiat0a 'e'i%i6i 3en4a6it %ain
•Diawa%i den$an dosis rendah da3at'en4es0ai6an 6eb0t0han
•Monitor 6etat 0nt06 ESK
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Pen!egahan
•Dosis rendah a'itri3ti%in inisiasi se$erasete%ah didia$nosis her3es 8oster dan
di%an&0t6an hin$$a hari 6ede3an•In&e6si e3id0ra% 'eti%3redniso%on danb0;i6ain
•Usia @ tah0n9 ;a6sin 'en0r0n6aninsiden her3es 8oster )
•Lido6iain to3i6a% ora%
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"iskusi
•Masih 3er%0 3e'b06tian %an&0t'en$enai eH6asi 'asin$- tera3i, bai6tera3i t0n$$a% 'a030n 6o'binasin4a
•en$$0naan K3ioid6ontro;ersia%•en$$0naan Gaba3entin
• "era3i 6o'binasi Lido6ain dan obat ora%
•enan$anan 4an$ %ebih %an&0t
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#ekomen$asi
•#o4o Lido6ain
•Lini 6ed0a9 re$ba%in Gaba3entin
•Se$era Hsiotera3i
• Ji6a 3en$obatan tida6 ade60at9 "risi6%i6antide3resan