PR Kasus 1 Migrain Non Aura (Tutorial A4)

ANATOMI

Batang otak terdiri dari otak tengah/midbrain/mesencephalon, pons, dan medulla oblongata.
Referensi: Buku Dasar-Dasar Anatomi Gray’s Edisi ke-9 dan Buku Fisiologi Lauralee
Sherwood Edisi ke-8.

PATOFISIOLOGI

A. PHOTOPHOBIA CIRCUITS
1. Ganglion cells project light-related signaling to the olivary pretectal nucleus (OPN;
light green). OPN projections activate superior salivatory nucleus (SSN; dark green),
which via pterygopalatine ganglion, causes ocular vasodilation and activation of
ocular trigeminal afferents (orange) which are heavily expressed on blood vessels.
These afferents, with cell bodies in the trigeminal ganglion, project to trigeminal
nucleus caudalis, thalamus and cortex.
 2. Intrinsically photosensitive retinal ganglion cells (IPRGCs) project directly to thalamic
neuron (blue) that also receive intracranial nociceptive afferent signal (yellow
neurons in trigeminal gangliong and trigeminal nucleus caudalis. Thalamic neurons
fire in response to light and pain stimuli. Their output projects diffusely to sensory and
association cortex.
3. Melanopsin-containing, intrinsically photosensitive ganglion-like cells have been
identified in rodent iris. These afferent may explain the fact that light can activate
trigeminal blink reflec even after the optic nerve (though which circuits 1 and 2 pass)
has been sectioned. Not that all three circuits may interact at different.

B. PHONOPHOBIA
Phonophobia develops when the autonomic nervous system and the limbic system
are over-excited (Baguley & McFerran, 2011), especially in the areas responsible for
emotions – in a situation of properly developed, healthy hearing aids. The specific sound
that appears on the average or low volume is selectively intolerable, causing discomfort.
In the phenomenon of misophonia and phonophobia, the effect of the amygdala, taking
part in fear conditioning, depression or tinnitus, is noticed (Baguley, 2014). In response to
the perception of sounds audible in everyday life (e.g. ticking of the clock, footsteps,
creaking doors, breathing, munching, snoring, sniffing), a person with phonophobia reacts
with excessive clarity losing control of behavior: he escapes in a panic, isolates himself
from the environment is distracted, irritated, scared and evil (Pienkowski et al., 2014)
The literature suggests that the majority of patients with misophonia have normal
hearing sensitivity (Schroder et al., 2014), while the limbic and autonomic nervous
systems are in a heightened state of excitation and thus react abnormally to normal
auditory input (Moller, 2011). A recent functional and structural MRI study has revealed
that trigger sounds elicited increased responses in the anterior insular cortex (AIC) and
abnormal functional connectivity between the AIC and medial frontal, medial parietal, and
medial temporal regions (Kumar et al., 2017). The findings of Kumar et al. (2017) implied
that there was abnormal myelination in the medial frontal cortex that shows abnormal
functional connectivity, and that the aberrant neural response mediates the emotional
coloring and physiological arousal that accompany misophonic experiences.
- Jaras Auditori -

Referensi:
Digre, K. B., & Brennan, K. C. (2012). Shedding light on photophobia. Journal of
neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology
Society, 32(1), 68–81. https://doi.org/10.1097/WNO.0b013e3182474548
Kokowaska, Mariola. (2018). Psychological Sensitivity to Sounds in Misophony and
Phonophobia. Open Journal for Psychological Research, 2018, 2(1), 1-12.
https://centerprode.com/ojpr/ojpr0201/coas.ojpr.0201.01001k.pdf
Palumbo, D. B., Alsalman, O., De Ridder, D., Song, J. J., & Vanneste, S. (2018). Misophonia
and Potential Underlying Mechanisms: A Perspective. Frontiers in psychology, 9, 953.
https://doi.org/10.3389/fpsyg.2018.00953
Wu, Y., & Hallett, M. (2017). Photophobia in neurologic disorders. Translational
neurodegeneration, 6, 26. https://doi.org/10.1186/s40035-017-0095-3