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KEJANG

Kejang otot rangka merupakan respon terhadap iritasi atau stimuli yang dapat terjadi
pada semua tingkat, mulai dari korteks serebri sampai serabut otot rangka

Kejang otot berdasarkan atas asal terjadinya kelainan


Tingkat kortikal
kejang tonik : korteks ekstrapiramidalis
kejang klonik : korteks piramidalis
Tingkat medula spinalis (reseptor nosiseptif ataupun muscle spindle)
Tingkat saraf perifer (Ion kalsium
natrium channel )
Tingkat motor end plate
Enzim kolin esterase
Kalsium di luar membran
nilai ambang rangsang
Tingkat serabut otot : ion Na, K, Ca
Miotonia

CERREBELLUM
Fungsi :
Memantau dan membuat penyesuaian korektif dalam kegiatan motorik yang
dibangkitkan oleh bagian otak yang lain.
Cara :
Bandingkan status fisik dari informasi sensorik. Bila lebih atau kurang kontraksi di
koreksi.
Ditujukan untuk :
Koordinasi otot-otot.
Belajar ketrampilan

Keseimbangan
Pengaturan saat gerakan dan ketepatan gerakan

Kelainan klinik pada cerebellum


Kerusakan pada :
Nukleus profunda cerrebellum
Kortek cerebellum
1. Dismetria / Past pointing
2. Ataksia
3. Vertigo
4. Didiadokokinesia
5. Disartria
6. Tremor
7. Nistagmus
8. Rebound
9. Hipotonia
Dismetria / Past pointing
Penderita tidak dapat memperkirakan jarak shg tak dpt meramal
gerakan kearah yang dituju
Ataksia
Penderita mengalami gerakan yang tak terkoordinasi
Vertigo
Penderita merasa dinding berputar
Disdiadokokinesia
Penderita tak dapat melakukan gerakan ulang dengan cepat
(membolak-balik tangan)
Disartria
Penderita mengalami gangguan bicara
Gangguan penekanan suara/kata yang tak karuan sehingga sukar dipahami
Tremor
Gerakan otot volunter yang tak lancar
(tangan gemetar)
Nistagmus
Pada mata penderita terlihat bergerak terus bolak-balik, karena
kegagalan peredaman pada cerebellum
Rebound
Karena kegagalan peredaman, pada waktu penderita disuruh menahan
tangan kemudian dilepaskan , tangan akan memukul diri sendiri.
Hipotonia
Otot menjadi lemah karena hilangnya fasilitasi kortek motorik

REFLEK
Busur reflek terdiri dari:
Reseptor
Saraf aferen

Nukleus (pusat saraf)


Saraf eferen
Efektor
Reflek penting untuk pengaturan gerakan tubuh, pertahanan diri dan pengaturan
fungsi vegetatif

REFLEK UNTUK SIKAP TUBUH


Reflek suportif positif
Reseptor pada telapak kaki
Arcus reflek lewat medula spinalis
Reaksi maknit
Reaksi searah dengan tekanan dorongan
Reflek melangkah berirama
Gerakan melangkah berirama
Reflek mencongklang
Gerakan berlari berirama
Reflek menggaruk
Sensasi posisi
Gerakan menggaruk
Spasme otot karena fraktur
Oleh karena nyeri
Spasme abdomen
Karena nyeri
Spasme karena kram otot
O.k iritasi bhn metabolik lokal
O.k iskhemia otot
Reflek menegakkan diri
Usaha menegakkan diri bila binatang dibaringkan
Reflek agar tak jatuh

Keseimbangan waktu berdiri


Keseimbangan waktu bergerak

REFLEK LAIN
Reflek saraf otonom/ medulla spinalis
Reflek berkeringat
Reflek gerakan usus
Reflek berkemih
Reflek defecasi
Reflek tonus vaskuler
Bila ada kerusakan spinal bisa sebabkan syok spinal

PENGATURAN SENTRAL FUNGSI VISCERA


Oleh hipothalamus & sistem limbik, juga berfungsi sebagai satu unit yang
mengatur perilaku emosi.
Medulla oblongata mengatur reflek otonom untuk peredaran darah, jantung
dan paru.
Pusat-pusat di medulla oblongata bertugas mengatur reflek otonom untuk
Peredaran darah,jantung,paru-paru
Reflek menelan, batuk bersin, tersedak, tercekik (cegukan).

HIPOTHALAMUS

Merupakan bagian ujung depan diencephalon yang terletak dibawah sulkus


hipothalamic dan di depan nukleus interpudenkular. Terdapat hubungan saraf
antara hipothalamus dan lobus posterior hipofisa serta hubungan vaskuler
antara hipothalamus dan lobus
Fungsi
Pengaturan suhu
Pengaturan kasdiovaskuler
Pengaturan endokrin
Pengaturan nafsu makan
Pengaturan air tubuh
Pengaturan endokrin

Kelenjar hipofisa anterior


Perangsangan timbulkan sekresi :
1. Tirotropin
2. Kortikotropin
3. Pemacu FSH
4. Pemacu LH
Kelenjar hipofisa posterior
Osmoreseptor
atur cairan
1.

2.

3.

Pengaturan suhu
Hipothalamus anterior
Pusat pengaturan panas.
Bila dipacu reseptor suhu
Vasodilatasi kulit
Terengah-engah
Menghambat menggigil (dilingkungan dingin)
Hipothalamus posterior
Pusat konservasi (penahan) dingin
Bila digiatkan oleh reseptor suhu:
Menggigil
Vasokonstriksi
Pilo ereksi
Pengaturan kasdiovaskuler
Rangsang pada talamus posterior & lateral
Tekanan arteri
Frekwensi jantung
Rangsang pada preoptik
Tekanan arteri
Frekwensi jantung
Pengaturan endokrin
Kelenjar hipofisa anterior
Perangsangan timbulkan sekresi :
Tirotropin
Kortikotropin
Pemacu FSH
Pemacu LH
Kelenjar hipofisa posterior
Osmoreseptor
atur cairan

SARAF OTONOM
Sistem saraf yang mengatur fungsi visceral tubuh.
Dipengaruhi oleh emosi
Sistem ini membantu mengatur :
Tekanan darah
Motilitas dan sekresi gastrointestinal
Output urine
Berkeringat
Suhu tubuh dan lain-lain
Saraf otonom dibagi 2 :
1. Saraf simpatis (thoraco lumbal)

2. Saraf parasimpatis (craniosacral)

Lintasan eferen saraf otonom


Aktivasi simpatis
Melebarkan pupil
Naikkan frek.jantung
Vasokonstriksi vasa kulit dan viscera
Vasodilatasi koroner
Hambatan pada

Peristaltik

Otot-otot detrusor
Aktivasi parasimpatis

Kecilkan pupil
Turunkan frek.jantung
Vasodilatasi vasa kulit dan viscera
Konstriksi bronchioli
Sekresi air liur&air mata
Memberi pacuan pada

Peristaltik

Otot-otot detrusor
Untuk memelihara keseimbangan reflek vegetatif (visceral)
Misal untuk perasaan :
Berdebar
Lapar
Haus
Penuh pada
Kandung kencing
Rectum
Seksual
Berkeringat

SARAF OTONOM
The AUTONOMIC NERVOUS SYSTEM consists of the Sympathetic and the
Parasympathetic Nervous Systems. Both the SNS and the PNS make their first
connections outside the CNS in specialized synapses called ganglia. Note that the
neurotransmitter in PNS and SNS ganglia is ACh which interacts with nicotinonic
receptors. Activity in autonomic ganglia is terminated by acetylcholinesterase
(AChE)-mediated breakdown of ACh. All cholinergic nerves in the Autonomic
Nervous System are labeled in red. In the PNS, post-ganglionic nerves release
ACh, which interacts primarily with muscarinic receptors in a variety of target
tissues. Here, as in the ganglia, the actions of ACh are terminated by AChE.
While sympathetic autonomic ganglia are cholinergic synapses, post-ganglionic
sympathetic nerves are adrenergic nerves: They release norepinephrine which
interacts with a (alpha) and b (beta) receptors All adrenergic nerves in the SNS
are labeled in blue. The Somatic (Voluntary) Nervous System is also a
cholinergic pathway, but unlike the SNS and PNS, it has no ganglia. Instead,
motor neurons arising in the spinal cord terminate at a specialized synapse in
skeletal muscle called the neuromuscular junction (NMJ). This is still a
cholinergic synapse because ACh is released by the motor neuron, interacts with
nicotinic receptors and is broken down by AChE

PARASYMPATHETIC (CHOLINERGIC) SYNAPS


1. synthesis of acetylcholine (ACh) from acetyl CoA and choline
2. storage of ACh in synaptic vesicles
3. release of ACh ( fusion of synaptic vesicle with presysnaptic membrane and
release of ACh into the synapse)
4. action of ACh by binding to and activating receptors (nicotinic in autonmic
ganglia and NMJ and muscarinic in many sites)
5. inactivation by enzymatic breakdown of ACh by acetylcholinesterase (AChE)
located in the synapse

PARASYMPATHETIC (CHOLINERGIC) DRUGS


Cholinergic agonists are subdivided into direct-acting and indirect-acting
agonists. Direct-acting agonists bind to and activate receptors (Fig 2, site 4) at
autonomic ganglia (nicotinic), the neuromuscular junction (nicotinic), and a
variety of tissues such as the GI tract, heart, exocrine glands (muscarinic).
Activation of ganglionic nicotinic receptors leads to activation of SNS pathways
following by PNS pathways. This is result of the greater number of postganglionic fibers in the SNS. Thus ganglionic agonists activate SNS pathways first
and antagonists block SNS responses first. Activation of nicotinic receptors at the
NMJ leads to skeletal muscle contraction. Thus agonists (depolarizing

neuromuscular blocking agents) lead to muscle contraction (followed by paralysis)


while antagonists (non-depolarizing neuromuscular blocking agents) prevent
muscle contraction and produce flaccid paralysis. Activation of muscarinic
receptors produce 4 responses we're interested in in this class: increased GI tone
and motility, increased urinary bladder tone and motility, increased salivation and
sweating and decreased heart rate and blood pressure. Thus muscarinic receptor
agonists produce all these responses and can be used to treat non-obstructive
constipation and urine retention. They also cause side effects such as diarrhea,
drooling and hyperhidrosis, bradycardia and hypotension. Antagonists produce
the opposite effects and can be used to treat diarrhea, to dry up glandular
secretions, and increase heart rate while producing side effects such as
constipation, dry mouth and tachycardia. Indirect-acting agonists produce AChlike effects by inhibiting the activity of AChE (Fig 2, site 5). Since AChE is the
primary way transmission is terminated at all cholinergic synapses . these drugs
act at virtually all synapses where ACh is the neurotransmitter (i.e. autonomic
ganglia (if they're relatively uncharged), NMJ, and muscarinic receptors

RECEP LOCATIO
TOR
N

AGONIST

ANTAGONIST

SUMMARY OF CHOLINERGIC RECEPTOR ACTION


nicotinic ganglia activatesSNSpostganglionicfibersthenPNS

post-ganglionicfibers
(uses?)

blocksactivationofSNSpos-tganglionic

fibersthenPNSfibers(treat
hypertension)

causesmuscle
neuromus
cular
skeletalmusclecontraction relaxation/paralysis
(usedtointensifymuscle
junction
contractionsinmyesthenia
gravis;asneuromuscular
blockingagents)

muscari urinary
bladder
nic
smooth
muscle

increasesurinarybladder
diarrhea
toneandmotility(treaturine
retention)
decreasesheartrate
decreaseurinarytoneand
motility

heart

decreasesbloodpressure

blood
vessels

increasessweating

increasesheartrate(treat
bradycardia)
increasesbloodpressure

sweat
glands

increasessalivation

decreasessweating
decreasessalivation

salivaryglands

SYMPATHETIC SYNAPS
1. synthesis of norepinephrine (NE - not pictured)
2. storage of NE in vesicles
3. release of NE: fusion of synaptic vesicles with presysnaptic membrane and
release of NE into the synapse
4. action of NE through binding to and activating receptors (a2 presynaptic and a
and b post synaptic)
5. inactivation by presynaptic re-uptake transporters (also presynaptic receptors
shut off further NE release)

SYMPATHETIC (ADRENERGIC) DRUGS


Adrenergic agonists are sub-divided into 3 classes; direct-acting, indirectacting and dual- acting agonists.
Direct-acting agonists bind to and activate a1, a2, b1 and b2 receptors.
Fig 3 indicates pre-synaptic a2 receptors and site 4 has a1, a2, b1 and
b2 receptors. Naturally -occurring molecules which bind to these
receptors include norepinephrine (NE; a neurotransmitter which binds
to a1,a2 and b1 receptors), epinephrine (EPI; a hormone produced in
and secreted from the adrenal medulla which binds to a1,a2,b1 and b2
receptors -- EPI is a non-selective adrenergic agonist) and dopamine
(DA; also a neurotransmitter which binds to DA receptors as well as
a1, a2 and b1 receptors ). In addition, the synthetic catecholamine

isoproterenol binds to b1 and b2 receptors (it is a non-selective b


agonist), but has virtually no effect on a receptors.
Indirect-acting adrenergic agonists (i.e. amphetamines and cocaine)
produce NE-like actions by stimulating NE release (Fig 3 site 3) and
preventing its re-uptake (Fig 3 site 5) and thus its inactivation . By
preventing NE inactivation, these drugs allow NE to linger in
adrenergic synpases. Notice that this is different from the way
indirect-acting cholinergic agonists work as they inhibit the activity of
AChE, preventing ACh breakdown and allowing it to linger at
cholinergic sysnapse.
Dual-acting adrenergic agonists (i.e. ephedrine) act as a direct- and an
indirect-adrenergic agonists (hence dual-acting) - they bind to
adrenergic receptors and stimulate NE release.

SUMMARY OF ADRENERGIC RECEPTOR ACTION


RECEP
TOR

LOCATION

AGONIST

ANTAGONIST

bloodvessels

vasoconstriction(treat
hypotension)

vasodilation(treathypertension)

bloodvessels
pre-synaptic
membranesin
adrenergicnerves

vasoconstriction(treat
hypotension)
inhibitsNErelease

heart

increasesheartrateand
force(treatheartfailure)

vasodilation(treat
hypertension)
vasodilatesandprevent
reflextachycardia(treat
hypertension)
slowsheartrate(treat
hypertentsion,angina,
arrhythmia)

bronchiolesmooth
muscle
skeletalmuscle
arterioles

brochioledilation(treat
asthmaetc...)
??

SIMPATIS
Simpatis sebagai fungsi alarm
Peningkatan kard. vask / tek.arteri
Peningkatan aliran darah ke otot
Peningkatan glukosa darah
Peningkatan glikolisis otot
Peningkatan kekuatan otot
Peningkatan kecepatan metabolisme
Peningkatan kegiatan mental/sukar tidur
Reaksi tubuh thd stress

??
??

PUSAT ASOSIASI
Daerah assosiasi
Daerah untuk analisa rangsang, kemudian di interpretasi dengan mencocokan
pada memori yang ada, agar rangsang dapat ditafsirkan dan dimengerti
Jenis :
Asosiasi motorik
Asosiasi sensorik/somatik
Asosiasi visual
Asosiasi pendengaran
Bila disatukan menjadi daerah penafsiran
umum

Kerusakan daerah asosiasi


Kerusakan daerah asosiasi motorik
Tak dapat melakukan dan mengartikan gerakan yang rumit
Sulit bicara dan menulis
Kerusakan asosiasi sensorik/somatik
Tak dapat artikan jenis rangsang rumit (mis baca Braille)
Kerusakan asosiasi visual
Bisa baca tapi tak tahu artinya (buta kata : Aleksia)
Kerusakan asosiasi pendengaran
Bisa mendengar tapi sulit mengerti apa yang didengar sehingga
komunikasi sulit.

INGATAN
Daerah Prefrontal untuk :
Ingatan jangka pendek
Merencanakan masa depan
Mempertimbangkan kegiatan motorik

Memecahkan masalah
Fungsi luhur
Berhubungan dengan moral
Pengembangan pikiran abstrak (imaginasi)

Daya ingatan dibagi :


1. Ingatan sensoris
Bersifat hanya sekejap
Informasinya banyak harus dipilih mana yang diperlukan
2. Ingatan primer/ jangka pendek
Berupa fakta, kata, kalimat
Harus mempunyai arti/ makna
3. Ingatan jangka panjang
Ingatan sekunder ( ingatan lemah yang dlm jangka panjang hilang)
Ingatan tertier (ingatan yang tertanam untuk seumur