ORIGINAL ARTICLE Bali Medical Journal (Bali Med J) 2019, Volume 8, Number 2: 449-453 P-ISSN.2089-1180, E-ISSN.2302-2914 449 Open access: www.balimedicaljournal.org and ojs.unud.ac.id/index.php/bmj CrossMark Published by DiscoverSys ABSTRACT Background: Stroke has always been a complicated disease which affects not only the patient quality of life but also the patient family. In ischemic stroke patients, one of the most complicated outcomes was the disruption of motor function. Increased motor function is a visible positive outcome of stroke patients. Aim: This study aims to measure the motor evoked potentials values which the results might give us more insights into how this disease affects the motor neuron pathway. Methods: This study was an experimental pre-posttest study involved 75 patients diagnosed with chronic ischemic stroke (onset of more than 30 days). The MEPs value was measured by adjusting the IAHF procedure in 2015. Results: There was no significant difference between motor evoked potential value (amplitude, latency, central motor conduction time) pre and post intraarterial heparin procedure (IAHF) (p>0.05). Occasionally, there was a significant difference in latency value in lacunar, subcortical, and cortical-subcortical area after IAHF (p<0.05). Conclusion: This study shows that the size and localization of the affected area might determine the results of IAHF. Keywords: IAHF, MEPs, amplitude, latency, CMCT, ischemic stroke Cite this Article: Putranto, T.A., Ratmono, T., Yusuf, I., Murtala, B., Wijaya, A. 2019. Intraarterial heparin flushing effect on motor evoked potentials in chronic ischemic stroke patients. Bali Medical Journal 8(2): 449-453. DOI:10.15562/bmj.v8i2.1493 Intraarterial heparin flushing effect on motor evoked potentials in chronic ischemic stroke patients Terawan Agus Putranto, 1,2* Tugas Ratmono, 1,2 Irawan Yusuf, 1 Bachtiar Murtala, 1 Andi Wijaya 1,3 INTRODUCTION Stroke is one of the leading cause of death and disability in adults. Unfortunately, until now the treatment for stroke is still limited to the narrow time window, distance factor between medi- cal facilities and required tools and skills that even limited to particular medical centers. Te limitation leads to afect much quality of life. Te narrow time window and another problem that prevent the patient from getting the appropriate treatment makes a new method of therapy is needed. IAHF (intraarterial heparin fushing) therapy is a modifed DSA procedure where continuous hepa- rin fushing is maintained via the directed catheter into the patient brain vasculature. Te usage of heparin either as a bolus or diluted with saline has been well-known in interventional radiology procedure. 1 Te safety of heparin usage has been proven which make it recommended as primary therapy in cerebral venous thrombosis case. 2 Tere is a method to measure the accomplishment by MEPs (motor evoked potentials) values as well as using TMS (transcranial magnetic stimulation) technique. In the frst time, an electrical stimulation used on muscles and nerve fbers in the late 18 th century by Galvani. 3 Te frst practical electromagnetic stimulation device for human use was designed and built by Barker. 4 TMS basic principles was to modulates brain electrical environment using magnetic felds, that will pass through the patient skull and scalp. Tese magnetic felds are produced by crossing a rapid alternating electrical current through a coil with a ferromagnetic core. TMS can be administrated in single pulses or as a brief series of pulses either for research, diagnostic, or thera- peutic purposes. When it used clinically, several thousand pulses are usually applied for minutes to hours. 5 TMS has been used as an investigation tool to investigate possible mechanisms underlying both spontaneous and therapy-induced post-stroke motor recovery. Besides, TMS basic principle was also to operate on the electrical current which directed through a hand-held copper-stimulating coil as the consequent production of a transient magnetic feld. When held over the scalp, the rapidly changing magnetic feld induces a small electrical current in underlying brain tissue which will produce depolarization processes of nerve cells which resulted in the stimulation or disruption of brain activity. 6 Central motor conduction time (CMCT) describes the conduction time from motor cortex to the spinal cord alpha-motoneurons. Tese include 1 Faculty of Medicine, Hasanuddin University 2 RSPAD Gatot Soebroto. Jl. Abdul Rahman Saleh, No.24, Central Jakarta 10410, Indonesia. Tel. 3 Prodia Clinical Laboratory, Prodia Tower, Jl. Kramat Raya No.150. Jakarta, Indonesia * Correspondence to: Terawan Agus Putranto, Faculty of Medicine, Hasanuddin University, 2RSPAD Gatot Soebroto. Jl. Abdul Rahman Saleh, No.24, Central Jakarta 10410, Indonesia. Tel. terawan@rspadgs.net Received: 2019-03-21 Accepted: 2019-05-02 Published: 2019-08-01