{"id":326,"date":"2020-09-13T20:53:08","date_gmt":"2020-09-13T13:53:08","guid":{"rendered":"https:\/\/koas2doctor.com\/?p=326"},"modified":"2020-09-13T20:53:11","modified_gmt":"2020-09-13T13:53:11","slug":"catatan-koas2doctor-guillain-barre-syndrome-update","status":"publish","type":"post","link":"https:\/\/koas2doctor.com\/id\/catatan-koas2doctor-guillain-barre-syndrome-update\/","title":{"rendered":"Catatan Koas2Doctor: Guillain Barre Syndrome Update"},"content":{"rendered":"<p><strong><span style=\"text-decoration: underline;\">DISCLAIMER:<\/span><\/strong><\/p>\n\n\n\n<p>Seluruh materi merupakan milik penyelenggara webinar. Koas2Doctor hanya membantu untuk menyediakan catatan tertulis berdasarkan webinar yang telah diupload ke youtube atau platform sosial lainnya secara terbuka. Anda sangat disarankan untuk menonton webinar secara full dan tidak memercayai apa yang kami catat 100%.<\/p>\n\n\n\n<p>Baca Juga: <a href=\"https:\/\/koas2doctor.com\/id\/catatan-koas2doctor-stroke-update\/\" target=\"_blank\" rel=\"noreferrer noopener\">Catatan Koas2Doctor: Stroke Update<\/a><\/p>\n\n\n\n<p>Link Webinarjam: <a href=\"https:\/\/event.webinarjam.com\/replay\/25\/09905f88aprbr2blm\">https:\/\/event.webinarjam.com\/replay\/25\/09905f88aprbr2blm<\/a><\/p>\n\n\n\n<p><span style=\"text-decoration: underline;\">Topik 1: Overview Guillain Barre Syndrome Update, What Should We Know? (<a href=\"https:\/\/www.alodokter.com\/cari-dokter\/dr-kiking-ritarwan-sps-k-mkt\" target=\"_blank\" rel=\"noreferrer noopener\">Dr. dr. Kiking Ritarwan, Sp.S(K),MKT<\/a>)<\/span><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Introduction<\/h2>\n\n\n\n<ul><li>An inflammatory disease of the PNS and is the most common cause of acute flaccid paralysis<\/li><li>Insidensi global sekitar 1-2 per 100,000 orang per tahun<\/li><li>Insidensinya meningkat sesuai usia, biasanya sekitar usia diatas 40 tahun<\/li><li>Lebih sering di laki-laki dibanding perempuan<\/li><li>Perjalanan penyakit monofasik dan berpotensi fatal<\/li><li>Biasanya dicetuskan oleh infeksi<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture1-1.png\" alt=\"Gambar 1. Tipe GBS dan Patofisiologinya\" class=\"wp-image-327\" width=\"382\" height=\"322\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture1-1.png 382w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture1-1-300x253.png 300w\" sizes=\"(max-width: 382px) 100vw, 382px\" \/><figcaption>Gambar 1. Tipe GBS dan Patofisiologinya<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"614\" height=\"302\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture2-3.png\" alt=\"Gambar 2. Patogenesis GBS\" class=\"wp-image-329\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture2-3.png 614w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture2-3-300x148.png 300w\" sizes=\"(max-width: 614px) 100vw, 614px\" \/><figcaption>Gambar 2. Patogenesis GBS<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Patogenesis Guillain Barre Syndrome<\/h2>\n\n\n\n<ul><li>Infiltrat inflamasi (Sel T dan aktivasi komlemen) = AIDP<\/li><li>Demyelinisasi segmental dengan gejala degenerasi akson 2<sup>nd<\/sup> order = AMAN<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Etiologi<\/h2>\n\n\n\n<ul><li>Molecular mimicry daripada antibodi terhadap Campylobacter jejuni<\/li><li>Lebih dari dua per tiga pasien denga GBS datang dengan gejala infeksi respirasi atau digestif dalam waktu 6 minggu sebelum onset.<\/li><li>Etiologi non-infeksi: administrasi gangliosida, vaksinasi (H1N1 influenza), imunosupresi (dengan terapi anti-TNF alfa), pembedahan<\/li><\/ul>\n\n\n\n<h2 class=\"has-normal-font-size wp-block-heading\">List Bakteria dan Virus Penyebab Pencetus Guillain Barre Syndrome<\/h2>\n\n\n\n<ul><li>Mycoplasma pneumonia<\/li><li>Haemophilus influenza<\/li><li>Salmonella species<\/li><li>Mycobacterium bovis<\/li><li>Brucella<\/li><li>Orientia tsutsugamushi<\/li><li>Legionella pneumophila<\/li><li>Baronella henselae<\/li><li>Helicobacter pylori<\/li><li>Francisella tularensis<\/li><li>Borrelia, cytomegalovirus<\/li><li>Epstein-Barr virus<\/li><li>Varicella-zoster virus<\/li><li>Influenza virus<\/li><li>Human immunodeficiency virus<\/li><li>Parainfluenza virus type 1<\/li><li>Adenovirus<\/li><li>Herpes simplex virus<\/li><li>Hepatitis (A,B, dan E)<\/li><li>Japanese encephalitis virus<\/li><li>West nile virus<\/li><li>Enterovirus<\/li><li>Hantavirus<\/li><li>Measles<\/li><li>Parvovirus<\/li><li>Norovirus<\/li><li>Parechovirus<\/li><li>Coxsackieviruses<\/li><li>Echovirus<\/li><li>Mumps<\/li><li>Rubella<\/li><li>Polio (wildtype 3)<\/li><li>Dengue<\/li><li>Chikunguya<\/li><li>Zika viruses<\/li><\/ul>\n\n\n\n<h2 class=\"has-medium-font-size wp-block-heading\">Hubungan Infeksi dengan Guillain-Barre Syndrome<\/h2>\n\n\n\n<ul><li>Kriteria yang perlu dipenuhi sebelum molecular mimicry dapat terpenuhi:<\/li><li>Bukti epidemiologi yang menghubungkan agen infeksius atau eksogen dengan penyakit autoimmun<\/li><li>Identifikasi dari response sel T atau antibodi spesifik terhadap target autoantigen<\/li><li>Identifikasi struktur homologi antara agen infeksius atau substansi eksogen dan target autoantigen<\/li><li>Reproduksi penyakit autoimun setelah imunisasi terhadap agen infeksius pada model hewan<\/li><li>GBS subtipe aksonal adalah satu-satunya penyakit autoimun yang memenuhi empat kriteria molecular mimicry.<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><em><u>Campylobacter jejuni<\/u><\/em><\/h2>\n\n\n\n<ul><li>Case Fatality Rate: 0.05 per 1000 infeksi dengan gejala penyakit gastrointestinal akut dengan demam, diare tanpa atau dengan darah dan abdominal cramps.<\/li><li>Onset diare dan terjadinya gejala neurologis adalah 10 hari dengan interval terpendek adalah 3 hari.<\/li><li>Pasien dengan GBS tipe AMAN akibat <em>C. jejuni<\/em> biasanya ada antibodi IgG terhadap GM1 dan GD1a.<\/li><li>Homologi struktural antara permukaan bakteri (lipooligosakarida) dan tetrasakarida terminal dari GM1 merupakan bukti kuat pertama dari molecular mimicry<\/li><li>SGD1a-like LOS juga ditemukan pada C.jejuni dengan strain yang sama.<\/li><li>Gangliosida adalah sialic acid containing subgroup of glycosphingolipids dengan asam N-asetilneuraminic yang terhubung dengan oligosaccharide core portion yang diekspresikan pada permukaan sel.<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"539\" height=\"385\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture3-2.png\" alt=\"Gambar 3. Serum Antibodi Terhadap Gangliosid Spesifik\" class=\"wp-image-330\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture3-2.png 539w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture3-2-300x214.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture3-2-390x280.png 390w\" sizes=\"(max-width: 539px) 100vw, 539px\" \/><figcaption>Gambar 3. Serum Antibodi Terhadap Gangliosid Spesifik<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"709\" height=\"535\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture4-2.png\" alt=\"Gambar 4. Spektrum Gangguan GBS dan Antibodinya\" class=\"wp-image-331\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture4-2.png 709w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture4-2-300x226.png 300w\" sizes=\"(max-width: 709px) 100vw, 709px\" \/><figcaption>Gambar 4. Spektrum Gangguan GBS dan Antibodinya<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"665\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture5-2.png\" alt=\"Gambar 5. Hubungan Antara C.jejuni dan GBS\" class=\"wp-image-332\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture5-2.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture5-2-300x212.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture5-2-768x543.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture5-2-795x562.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 5. Hubungan Antara C.jejuni dan GBS<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Perjalanan Penyakit GBS<\/h2>\n\n\n\n<p>Manifestasi klinis terlihat dalam 8 minggu pertama<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"502\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture6-2.png\" alt=\"Gambar 6. Hubungan Antara C.jejuni dan GBS\" class=\"wp-image-333\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture6-2.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture6-2-300x160.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture6-2-768x410.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture6-2-795x425.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 6. Hubungan Antara C.jejuni dan GBS<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Kerusakan Saraf pada GBS<\/h2>\n\n\n\n<ul><li>AIDP dikarakteristikkan dengan demielinisasi segmental dengan infiltrat sel inflamasi.<\/li><li>AMAN dikarakteristikkan dengan degenerasi syaraf motor aksonal tanpa adanya demielinisasi atau infiltrat inflamasi.<\/li><li>Untuk FS dan BBE, gambaran patologis masih belum jelas.<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"310\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture7-2.png\" alt=\"Gambar 7. Demielinisasi dari sel saraf\" class=\"wp-image-334\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture7-2.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture7-2-300x99.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture7-2-768x253.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture7-2-795x262.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 7. Demielinisasi dari sel saraf<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"448\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture8-2.png\" alt=\"Gambar 8. Subtipe GBS\" class=\"wp-image-335\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture8-2.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture8-2-300x143.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture8-2-768x366.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture8-2-795x379.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 8. Subtipe GBS<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"463\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture9-2.png\" alt=\"Gambar 9. Subfenotipe GBS\" class=\"wp-image-337\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture9-2.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture9-2-300x148.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture9-2-768x378.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture9-2-795x392.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 9. Subfenotipe GBS<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"344\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture10-2.png\" alt=\"Gambar 10. Manifestasi Gejala Varian GBS\" class=\"wp-image-336\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture10-2.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture10-2-300x110.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture10-2-768x281.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture10-2-795x291.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 10.. Manifestasi Gejala Varian GBS<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"540\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture11-2.png\" alt=\"Gambar 11. Varian GBS\" class=\"wp-image-340\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture11-2.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture11-2-300x172.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture11-2-768x441.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture11-2-795x457.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 11. Varian GBS<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"362\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture12-3.png\" alt=\"Gambar 12. Kriteria Diagnosis GBS\" class=\"wp-image-370\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture12-3.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture12-3-300x116.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture12-3-768x296.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture12-3-795x306.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 12. Kriteria Diagnosis GBS<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"554\" height=\"390\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture13-2.png\" alt=\"Gambar 13. Kriteria Yang Membuat Diagnosis GBS Meragukan\" class=\"wp-image-339\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture13-2.png 554w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture13-2-300x211.png 300w\" sizes=\"(max-width: 554px) 100vw, 554px\" \/><figcaption>Gambar 13. Kriteria Yang Membuat Diagnosis GBS Meragukan<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"475\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture14-3.png\" alt=\"Gambar 14. Manifestasi Klinis GBS, MFS, dan Subtipenya\" class=\"wp-image-371\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture14-3.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture14-3-300x152.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture14-3-768x388.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture14-3-795x402.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 14. Manifestasi Klinis GBS, MFS, dan Subtipenya<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Diagnosis Diferensial GBS<\/h2>\n\n\n\n<ul><li>Peripheral Neuropathy (Infection, Toxin, Tics paralysis, lyme disease, porphyria)<\/li><li>Neuromuscular junction disorders (MG, botulism, Lambert eaton myasthenic syndrome)<\/li><li>Spinal cord involvement<\/li><li>Anterior horn cell movement (poliomyelitis)<\/li><li>Muscle disorders (Acute myositis, periodic paralysis)<\/li><li>Brainstem stroke<\/li><li>Brainstem encephalitis<\/li><li>Wernicke encephalopathy<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"262\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture15-2.png\" alt=\"Gambar 15. 10 Step Approach For Diagnosis and Management of GBS (1)\" class=\"wp-image-341\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture15-2.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture15-2-300x84.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture15-2-768x214.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture15-2-795x222.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 15. 10 Step Approach For Diagnosis and Management of GBS (1)<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"494\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture16-4.png\" alt=\"Gambar 16. 10 Step Approach For Diagnosis and Management of GBS (2)\" class=\"wp-image-372\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture16-4.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture16-4-300x158.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture16-4-768x404.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture16-4-795x418.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 16. 10 Step Approach For Diagnosis and Management of GBS (2)<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"217\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture17-3.png\" alt=\"Gambar 17. 10 Step Approach For Diagnosis and Management of GBS (3)\" class=\"wp-image-373\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture17-3.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture17-3-300x69.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture17-3-768x177.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture17-3-795x184.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 17. 10 Step Approach For Diagnosis and Management of GBS (3)<\/figcaption><\/figure>\n\n\n\n<h2 class=\"has-medium-font-size wp-block-heading\">Erasmus GBS Respiratory Insufficiency Score (EGRIS)<\/h2>\n\n\n\n<ul><li>Memperkirakan perkembangan insufiensi pernafasan dalam1 minggu pada pasien dengan GBS<\/li><li>0-2: resiko rendah untuk intervensi mekanik (4%), skor 3-4: resiko menengah untuk intervensi mekanik (24%), skor \u22655 indikasi yang tinggi untuk intervensi mekanik (65%).<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"537\" height=\"486\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture18-3.png\" alt=\"Gambar 18. EGRIS Score\" class=\"wp-image-374\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture18-3.png 537w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture18-3-300x272.png 300w\" sizes=\"(max-width: 537px) 100vw, 537px\" \/><figcaption>Gambar 18. EGRIS Score<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"548\" height=\"525\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture19-3.png\" alt=\"Gambar 19. MEGRIS Score\" class=\"wp-image-375\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture19-3.png 548w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture19-3-300x287.png 300w\" sizes=\"(max-width: 548px) 100vw, 548px\" \/><figcaption>Gambar 19. MEGRIS Score<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"558\" height=\"325\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture20-3.png\" alt=\"Gambar 20. SGB Skoring Disabilitas\" class=\"wp-image-376\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture20-3.png 558w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture20-3-300x175.png 300w\" sizes=\"(max-width: 558px) 100vw, 558px\" \/><figcaption>Gambar 20. SGB Skoring Disabilitas<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"814\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture21-3.png\" alt=\"Gambar 21. Algoritma Tatalaksana GBS\" class=\"wp-image-377\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture21-3.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture21-3-300x260.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture21-3-768x665.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture21-3-795x688.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 21. Algoritma Tatalaksana GBS<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Tatalaksana GBS<\/h2>\n\n\n\n<ul><li>IVIG: Dosis anak 1-2 g\/kgBB IV, selama 2-3 hari; dosis dewasa 400 mg\/kgBB IV selama 5 hari berturut-turut dalam 14 hari sejak onset GBS<\/li><li>Plasma exchange dosis 4-6 kali exchange selang satu hari antar prosedur<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"303\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture22-3.png\" alt=\"Gambar 22. Perbandingan IVIG, Kortikosteroid, dan Plasma Exchange dalam GBS\" class=\"wp-image-378\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture22-3.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture22-3-300x97.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture22-3-768x248.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture22-3-795x256.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 22. Perbandingan IVIG, Kortikosteroid, dan Plasma Exchange dalam GBS<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Prognosis<\/h2>\n\n\n\n<ul><li>Setelah fase progresif inisial, pasien dengan GBS mencapai fase plateau yang dapat berlangsung dalam hitungan hari ke minggu atau bulan, dan setelah itu mereka berangsur-angsur pulih. Setelah itu,, 60-80% pasien dengan GBS dapat berjalan mandiri setelah 6 bulan dari onset pertama gejala, dengan atau tanpa pengobatan<\/li><li>GBS merupakan penyakit monofasik walaupun pasien dapat memburuk setelah tatalaksana \u2013 <em>Treatment related fluctuation<\/em> (TRF).<\/li><li>Treatement related failure adalah perbaikan skala disabilitas GBS sedikitnya 1 poin setelah pemberian imunoterapi diikuti oleh perburukan skala disabilitas GBS sedikitnya 1 poin dalam 2 bulan pertama setelah imunoterapi.<\/li><li>Fluktuasi TRF maksimal 3 episode.<\/li><li>Progresi penyakit dapat cepat dan maksimum disabilitas dalam 2 minggu. Sekitar 20% pasien dengan GBS akan lanjut ke gagal nafas dan membutuhkan ventilasi mekanik.<\/li><li>Aritmia dan instabilitas tekanan darah dapat terjadi akibat keterlibatan sistem autonom<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"653\" height=\"480\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture23-2.png\" alt=\"Gambar 23. Perjalanan Penyakit GBS\" class=\"wp-image-338\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture23-2.png 653w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture23-2-300x221.png 300w\" sizes=\"(max-width: 653px) 100vw, 653px\" \/><figcaption>Gambar 23. Perjalanan Penyakit GBS<\/figcaption><\/figure>\n\n\n\n<p><span style=\"text-decoration: underline;\">Topik 2: Intravena Immunoglobulin Treatment and Prognosis in Guillain-Barre Syndrome (dr. Manfaluthy Hakim, Sp.S(K))<\/span><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Introduction<\/h2>\n\n\n\n<ul><li>GBS merupakan penyakit akut yang dimediasi oleh imun, bersifat monofasik.<\/li><li>Poliradikuloneuropati yang disebabkan oleh demielinisasi akut atau kerusakan aksonal pada spinal roots dan nervus perifer<\/li><li>Dikarakteristikkan oleh gejala sensoris, motorik, dan autonomik, yang biasanya berbarengan dengan gejala paralisis progresif dan berkurangnya refleks tendon dalam<\/li><li>IVIG merupakan pengobatan efektif yang telah terbukti<\/li><li>GBS memiliki prognosis yang baik. Hampir 90% pasien sembuh total atau dengan defisit neurologis ringan dalam satu tahun.<\/li><li>Faktor klinis diasosiasikan dengan luaran jelek adalah usia, adanya diare sebelumnya dan beratnya disabilitas pada perjalanan penyakit pertama kali.<\/li><li>Pure motoric GBS memiliki prognosis yang lebih baik sedangkan AMSAN recoverynya lebih lama<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Imunobiologi GBS<\/h2>\n\n\n\n<ul><li>Antibodi anti-ganglioside<\/li><li>Serum antibodi terhadap beberapa ganglioside yang ada di nervus perifer termasuk GM1, GD1a, Ga1NAc-GD1a, dan GQ1b<\/li><li>Antibodi ini berhubungan dengan varian dari GBS seperti GD1a dan GQ1b pada Miller-Fisher Syndrome<\/li><li>Molecular mimicry dan cross-reactivity<\/li><li>Aktivasi komplemen<\/li><li>Komplemen yang teraktivasi mampu menembus blood-nerve barrier dan menyerang myelin<\/li><li>Efek neurotoxic ini dapat diinhibis oleh IVIG dan inhibitor komplemen eculizumab.<\/li><li>Faktor pejamu: 1:1000 pasien dengan infeksi C. jejuni akan berkembang menjadi GBS.<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"576\" height=\"436\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture24-3.png\" alt=\"Gambar 24. Komplikasi GBS\" class=\"wp-image-379\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture24-3.png 576w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture24-3-300x227.png 300w\" sizes=\"(max-width: 576px) 100vw, 576px\" \/><figcaption>Gambar 24. Komplikasi GBS<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Management GBS<\/h2>\n\n\n\n<ul><li>Mempercepat pemulihan, mengurangi komplikasi selama penyakit akut, dan mengurangi defisit neurologis residual.<\/li><li>3 komponen manajemen GBS adalah:<\/li><li>Monitoring, supportif, dan bantuan kritis<\/li><li>Terapi spesifik seperti plasma exchange, imunoglobulin, dan kortikosteroid (tidak digunakan dalam GBS)<\/li><li>Rehabilitasi<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"485\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture25-3.png\" alt=\"Gambar 25. Prinsip Plasma Exchange\" class=\"wp-image-380\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture25-3.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture25-3-300x155.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture25-3-768x396.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture25-3-795x410.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 25. Prinsip Plasma Exchange<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"570\" height=\"423\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture26-3.png\" alt=\"Gambar 26. Plasma Exchange Pada Penyakit Neuroimunologi\" class=\"wp-image-381\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture26-3.png 570w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture26-3-300x223.png 300w\" sizes=\"(max-width: 570px) 100vw, 570px\" \/><figcaption>Gambar 26. Plasma Exchange Pada Penyakit Neuroimunologi<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"549\" height=\"579\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture27-2.png\" alt=\"Gambar 27. Cara Kerja Immunomodulatori dan Anti-inflamasi IVIG (1)\" class=\"wp-image-342\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture27-2.png 549w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture27-2-284x300.png 284w\" sizes=\"(max-width: 549px) 100vw, 549px\" \/><figcaption>Gambar 27. Cara Kerja Immunomodulatori dan Anti-inflamasi IVIG (1)<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"615\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture28-3.png\" alt=\"Gambar 28. Cara Kerja Immunomodulatori dan Anti-inflamasi IVIG (2)\" class=\"wp-image-382\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture28-3.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture28-3-300x196.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture28-3-768x502.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture28-3-795x520.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 28. Cara Kerja Immunomodulatori dan Anti-inflamasi IVIG (2)<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"511\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture29-3.png\" alt=\"Gambar 29. Guillain Barre Syndrome Treatment Related Failure\" class=\"wp-image-383\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture29-3.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture29-3-300x163.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture29-3-768x417.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture29-3-795x432.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 29. Guillain Barre Syndrome Treatment Related Failure<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"700\" src=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture30-3.png\" alt=\"Gambar 30. Terapi Imun untuk Penyakit Neuromuskular Autoimun\" class=\"wp-image-384\" srcset=\"https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture30-3.png 940w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture30-3-300x223.png 300w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture30-3-768x572.png 768w, https:\/\/koas2doctor.com\/wp-content\/uploads\/2020\/09\/Picture30-3-795x592.png 795w\" sizes=\"(max-width: 940px) 100vw, 940px\" \/><figcaption>Gambar 30. Terapi Imun untuk Penyakit Neuromuskular Autoimun<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Efek Samping IVIG pada GBS<\/h2>\n\n\n\n<ul><li>Pallor, chills dan sweating<\/li><li>Mual dan muntah<\/li><li>Demam ringan<\/li><li>Nyeri punggung dan otot<\/li><li>Takikardia dan rasa kencang di dada<\/li><li>Perubahan tekanan darah<\/li><li>Mengi<\/li><li>Ruam<\/li><li>Takipnea<\/li><li>Malaise general<\/li><li>Sindrom meningitis aseptik<\/li><li>Gagal ginjal akut<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Interaksi IVIG<\/h2>\n\n\n\n<ul><li>IVIG dapat menganggu respons terhadap vaksin virus yang hidup dilemahkan seperti virus measles, virus mumps, dan virus rubella<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Kontraindikasi IVIG<\/h2>\n\n\n\n<ul><li>Pasien dengan riwayat anafilaksis terhadap IVIG atau IMIG<\/li><li>Alergi terhadap bahan IVIG<\/li><li>Defisiensi selektif IgA<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Prognosis<\/h2>\n\n\n\n<ul><li>Angka kematian di Taiwan 1.61% sedangkan di Amerika Utara dan Eropa 3-7%<\/li><li>Dua puluh persen pasien tidak dapat berjalan tanpa bantuan dalam 6 bulan setelah onset<\/li><li>Rekurensi GBS dapat terjadi pada 6% kasus<\/li><li>Prognosis pasien yang tidak dapat berjalan diprediksi dengan modified Erasmus GBS Outcome Score (mEGOS) dinilai pada waktu masuk perawatan dan hari ke-7.<\/li><li>Secara umum prognosis lebih buruk pada kasus berikut:<\/li><li>Usia &gt;40 tahun<\/li><li>Riwayat diare sebagai infeksi pendahulu<\/li><li>Adanya infeksi C.jejuni<\/li><li>Progresifitas penyakit yang cepat dan berat<\/li><li>Disabilitas yang berat pada titik nadir perjalanan penyakit<\/li><li>Tipe aksonal terutama AMSAN<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Questions &amp; Answers:<\/h2>\n\n\n\n<ol type=\"1\"><li>Q: Hari keberapa post-onset paling jelas terlihat disosiasi albumin? Bagaimana membedakan periodic paralysis dengan GBS?<br>A: Untuk disosiasi albumin tidak jelas tapi titik nadir akut onset paralysis dari AIDP sekitar 3-6 minggu. GBS itu bersifat monofasik dan merupakan suatu infeksi, 70% disebabkan oleh C.jejuni dan melibatkan motorik, sensorik, dan autonom. Periodic paralysis disebabkan oleh motor pump. Gambaran disosiasi sitoalbumin baru ditemukan pada minggu ke-2 sedangkan elektrodiagnosis yang abnormal bisa ditemukan pada akhir minggu pertama.<\/li><li>Q: Pada varian Bickerstaff Brainstem Encephalitis (BBE) apakah ada tempat untuk elektrodiagnostik penunjang?<br>A: Diagnostiknya adalah klinis (gangguan n. kranialis dan lesi UMN) dan elektrodiagnostik yang didapatkan gejala LMN pada ekstremitas atas dan nervus kranialis. Tidak ada kriteria elektrodiagnostik BBE. Pemeriksaan imaging penting dilakukan dengan MRI kontras untuk melihat enhanced di daerah brainstemnya. Analisa LCS kadang-kadang menemukan peningkatan sel tapi tidak setinggi infeksi.<\/li><li>Q: Jika karena alasan biaya pasien hanya dapat membeli IVIG dengan dosis 0.4 mg\/kg\/BB selama 2-3 hari, apakah ada manfaatnya?<br>A: IVIG itu dose-dependant, kalau GBS disability scorenya 2-3 mungkin dapat membantu tapi kalau sudah dalam keadaan skornya 5 mungkin perlu berhati-hati.<\/li><li>Q: Hari keberapa di onset GBS untuk pemberian IVIG masih efektif?<br>A: Sampai 2 minggu dengan prinsip lebih cepat lebih baik.<\/li><li>Q: Terapi efektif plasma exchange dan IVIG atau salah satunya yang lebih baik dan kenapa kortikosteroid tidak bermanfaat?<br>A: Sebaiknya memilih satu modal terapi, PE atau IVIG. Dari AAN, plasmaferesis direkomendasikan pada pasien dengan immobilisasi karena lebih cepat terutama pada pasien dengan cepat mengalami kelumpuhan (dalam 1 hari plegia contohnya) yang artinya terjadi reaksi antibodi yang dahsyat. Kortikosteroid untuk mencapai efek imunosupresan membutuhkan dosis yang besar dan yang kedua ada bukti-bukti penelitian bahwa kortikosteroid menimbulkan debris di saraf tepi radiks di nodus\/paranodal of Splinter sehingga memperburuk outcome. Pada CIDP, pulse dose steroid justru dipakai.<\/li><li>Q: Bagaimana pengcoveran BPJS untuk PE atau IVIG? Apakah ada syarat tertentu pemakaian IVIG di RS tipe A,B,C?<br>A: Yang dicover adalah PE di faskes tingkat 3. Immunoglobulin boleh diberikan (dicover) bila ternyata PE tidak memperbaiki atau adanya kontraindikasi PE seperti gangguan kardiovaskular yang berat.<\/li><li>Q: Pada pasien usia tua, bila dia terkena GBS\/AIDP apakah pemberian oral\/parenteral pantoxyflline ada gunanya?<br>A: Tidak ada.<\/li><li>Q: Bagaimana perbedaan GBS bila di era COVID-19?<br>A: Ada laporan kasus bahwa pasien COVID-19 menderita GBS, bila dilihat dari patofisiologinya memang memungkinkan karena terjadi proses inflamasi dan sitokin storm dan memang ada laporan kasusnya. Pasien ini diberikan IVIG lalu ada perbaikan. Namun, masih kontroversial terutama IVIG pada pasien COVID-19. Secara teori, mekanisme kerja IVIG memang bisa namun belum dibuktikan secara klinis.<\/li><li>Q: Puskesmas terpencil, ada pasien GBS, apa yang harus dilakukan sebelum dirujuk?<br>A: Dilihat mEGOS apakah butuh hospitalized atau tidak, perhatikan dulu prognosisnya. Bila tahap awal (mEGOS 4-7) maka perhatikan bila mahal IVIG atau PE di puskesmas, mungkin bisa corticosteroid di puskesmas walau not recommended. Pastikan juga masalah ABC semua aman dan sudah berlangsung dari 2 minggu dan dia dalam fase plateau (sudah tidak perburukan), perawatan secara umum bila jauh kemana-mana, tunggu waktu saja untuk penyembuhan. Penting untuk dilakukan gerakan secara pasif untuk mencegah\/mempertahankan vaskularisasi perifer di kedua kaki dan tangan (mencegah DVT). Yang kedua, untuk menjaga tonus ototnya untuk bisa dipertahankan. GBS ini self-limiting, diintervensi karena kemungkinan gagal nafasnya tinggi. Tapi kalau pernafasannya baik, ditunggu saja.<\/li><li>Q: Gangguan jantung atau ginjal yang seperti apa yang menjadi kontraindikasi pemberian PE atau IVIG?<br>A: Tidak disarankan pemberian PE pada gangguan jantung berat sedangkan pada gangguan ginjal tidak ada kontraindikasi (prinsipnya sama seperti hemodialisa). Pada IVIG, kontraindikasinya adalah defisiensi imunoglobulin A karena akan menimbulkan reaksi anafilaktik.<\/li><li>Q: BB 50 kg dan pemberiannya 400 mg\/kgBB\/hari, pemberiannya di drip 24 jam atau bagaimana?<br>A: Berarti pemberiannya 2g, botol pertama untuk 5 menit pertama dengan kecepatan 3 ml\/menit untuk melihat toleransi pasien. Apabila mengeluh gatal sedikit, itu tidak masalah. Bila tidak masalah, lanjutkan dengan kecepatan 4-5 ml\/menit. Berarti 1 botol 10 menit (1 botol 50 mg).<\/li><li>Q: Kapan IVIG dikatakan gagal?<br>A: Waktu awal tentukan GBS disability scalenya. Bila 4, dikatakan gagal kalau GBS disability scalenya meningkat (dari 4 ke 5) tapi kita harus menunggu sampai 4 minggu untuk dikatakan gagal.<\/li><li>Q: Apakah pasien pasca SC terkena GBS ada tatalaksana khusus?<br>A: Perhatikan dulu apakah ada gagal nafas atau tidak? Tentu perlu ventilator bila ada gagal nafas selain pemberian IVIG. IVIG tidak dikontraindikasikan pada ibu hamil atau pasca menyusui tapi PE tidak disarankan karena resiko terjadinya disequilibrium kompartemen vaskular dengan ekstrakorporeal.<\/li><li>Q: Pada GBS tipe aksonal, bagaimana prognosisnya?<br>A: Sudah melibatkan akson, biasanya jelek. Bila diurutkan prognosisnya, AIDP prognosisnya paling baik (karena hanya demyelinisasi), kemudian AMAN (karena pure motor), barulah MFS dan AMSAN (paling buruk). AMSAN paling buruk karena sensoris dan propioceptive yang dibutuhkan untuk recovery motorik tidak berfungsi dengan baik sehingga ada ataxia sensorik.<\/li><\/ol>\n\n\n\n<p>Merasa catatan webinar ini bermanfaat? Ingin catatan webinar berikutnya? Komen ya untuk topik apa yang ingin dibuatkan catatannya!<\/p>\n\n\n\n<p>Oh iya, kalian bisa mendapatkan versi pdf catatan ini dengan cara mengklik tombol share di social media kalian serta mengkomen di post ini. Setelah itu, di tab <a href=\"https:\/\/koas2doctor.com\/id\/hubungi-kami-2\/\" target=\"_blank\" rel=\"noreferrer noopener\">hubungi kami<\/a>, kirimkan email kalian ke kami dan akan kami kirimkan pdfnya ke email kalian!<\/p>","protected":false},"excerpt":{"rendered":"<p>DISCLAIMER: Seluruh materi merupakan milik penyelenggara webinar. Koas2Doctor hanya membantu untuk menyediakan catatan tertulis berdasarkan webinar yang telah diupload ke youtube atau platform sosial lainnya secara terbuka. 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