Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
Vol
.
4,
N
o
.
4
,
D
ecem
b
er 20
1
5
, pp
. 25
0~
25
5
I
S
SN
: 225
2-8
8
0
6
2
50
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Gabapentin and Amitriptilin Treat
ment toward Living Quality
of
Post I
s
chemi
c
Strok
e
P
a
tient
s
with Neu
r
ophat
y
P
a
in
Pinas
t
i Utami
1
, Z
u
llies Ika
w
a
t
i
2
, Set
y
ani
n
gsi
h
3
1
Department of Pharmacolog
y
and
Clinical
Phar
ma
cy
, Univ
ersitas Muhammadi
y
a
h Yog
y
akarta, I
ndonesia
2
Department of Pharmacolog
y
and
C
linical Phar
macy
, Faku
ltas
Farmasi,
Univer
sitas Gadjah Mada, Indon
esia
3
Neuro Outpatient Depar
t
ment
Jogja Hospital, In
donesia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Aug 3, 2015
Rev
i
sed
Sep
21
, 20
15
Accepted Oct 22, 2015
Stroke becomes a significan
t pro
b
lem
for dev
e
lo
ping countries. I
n
Indonesia
the data show its inciden
ces 23
4 per 100.000 p
e
ople, and
arou
nd 2 - 8 %
stroke
pati
ents experi
encing ce
rebr
ovascul
ar session will get
neuroph
a
t
y
pain. It happ
ens
becaus
e
of s
e
ns
oric devi
ation af
ter s
t
roke, s
o
the
brain does
not completely
s
e
nd information
to th
e bod
y
co
rr
ectly
. Patien
t
s experien
cing
neurophaty
pain
are able to face decr
easing liv
ing quality
as the effect of
long term painf
u
l disturban
c
e.
Therefor
e,
it is
important to maintain the
pati
ents’ liv
ing
qualit
y.
Th
e
aim
of the st
ud
y
is t
o
investig
ate
the
com
p
arison
of using gab
a
pe
ntin and
am
itr
ipt
ilin
toward
livin
g quali
t
y
of
isch
em
ic strok
e
patients with
neurophaty
p
a
in
in
the hos
pitals in
Jogja. Th
e method used in
this stud
y was
q
uas
i exp
er
iment
a
l
with
consequtive sampling
.
Th
e s
t
ud
y w
a
s
conducted on 2
2
nd
of April-31
st
of Juli 2013 b
y
invo
lving 23
patients in
gabapen
tin gro
up and 18 patientsin
amitrip
tilin group that would be
evalu
a
ted dur
in
g 1 month. Li
ving quality
wa
s a
sse
sse
d by
Brief Pa
in
Inventor
y
(BP
I) in week 0 and week 4. The res
u
lt of the s
t
ud
y
s
howed that
the use of gabapentin and
am
it
riptil
in in 4 we
eks showed the incre
a
se of
living quality
represented b
y
d
e
creas
ing th
e score based on BPI
questioner
1.67±0.78 and
1.37±0.80 with
p-valu
e
>0.05
m
eaning th
at
th
ere was
no
significant diff
erence. It can
be
concluded
the comparison of using
gabapen
tin and
am
itripti
lin in p
o
st is
chemic stroke patient with
neuropath
y
pain no
t signif
i
cantly
incr
ease th
e quality
of
in
th
e hospitals in
Jo
gja.
Keyword:
Am
i
t
rip
tilin
Gaba
pe
nt
i
n
Ischem
ic Stroke
Liv
i
ng
Qu
ality
Copyright ©
201
5 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Pin
a
sti Utam
i,
Depa
rt
m
e
nt
of
Pha
r
m
acol
ogy
and Clinical Pharm
acy,
Uni
v
ersitas M
uhamm
adiyah Yogyaka
r
ta,
So
ut
h R
i
ng
R
o
ad,
Kasi
han
,
T
a
m
a
nt
i
r
t
o
, B
a
n
t
ul
, I
n
do
nesi
a.
Em
a
il: p
i
n
a
sti.wicak
san
a
@gmail.co
m
,
p
i
p
i
n
_
a
lice@yah
o
o
.
co
m
1.
INTRODUCTION
Strok
e
b
eco
m
e
s a p
r
ob
lem
in
d
e
v
e
lop
i
ng co
un
tr
ies. Acco
rd
ing
to
WHO, th
ere are 1
5
m
illio
n
po
p
u
l
a
t
i
ons
ge
t
st
roke at
t
ack
ever
y year in the whole
of the world,
an
d t
h
e m
o
st
com
m
on pat
i
e
nt
s
ar
e
el
derl
i
e
s
wi
t
h
deat
h rat
e
e
v
er
y
10y
ea
rs bet
w
een 55
an
d
8
5
y
ear
ol
d
[
1
]
.
Based
on
a su
rv
ey in
Bogo
r, th
e d
a
ta i
n
th
e
devel
o
p
i
ng c
o
u
n
t
r
i
e
s
l
i
k
e In
do
nesi
a
sho
w
e
d
i
t
s
i
n
ci
denc
es o
f
23
4
per
10
0.
0
00
pe
opl
e.
Ac
cor
d
i
n
g t
o
t
h
e dat
a
o
f
R
i
skes
das De
p
k
es R
I
(2
00
7
)
i
n
i
t
s
nat
i
ona
l
repo
rt, it was
m
e
n
tio
n
e
d
that th
e
m
a
in
d
eath
cau
se
fo
r all ag
es w
a
s str
o
k
e
(
1
5
,
4%)
,
TB (7
,5
%)
,
and
hi
pe
rt
ensi
o
n
(
6
,8%
)
[2]
.
Med
i
cal tr
eat
men
t
fo
r
p
o
s
t stro
k
e
p
a
in
i
n
In
do
n
e
sia h
a
s
b
e
en
star
ted
t
o
u
s
e
m
e
d
i
cin
e
f
r
om th
e g
r
oup
o
f
tricyclic an
ti-d
e
presan
t li
k
e
am
irip
tilin
an
d
fro
m th
e
g
r
ou
p
of an
ti-co
nvu
lsan
lik
e
g
a
b
a
p
e
n
tin
. Patien
t
s’
r
e
spon
se th
at
u
s
ed
bo
th
m
e
d
i
cin
e
s w
a
s
g
ood
enou
gh
.
H
e
re th
ey ar
e so
me
Evidence B
a
sed Me
dicine
(EBM)
stu
d
i
es
of am
ir
ip
tilin
and
g
a
bap
e
n
tin m
e
d
i
ci
n
e
u
s
ed
as
p
a
in relief m
e
d
i
cin
e
:
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Gabape
ntin and
A
m
itrip
tilin
Treatment t
o
ward Living
Quality pf P
o
st Is
chemic
Str
o
ke .... (Pinasti
Utami)
25
1
1.
The researc
h
c
o
nducted
by L
a
m
phl
et al
(
2
0
0
2
)
s
h
o
w
e
d
t
h
e resul
t
i
n
pl
ac
ebo
g
r
o
u
p
ha
vi
ng
pai
n
l
e
vel
2
1
%
an
d
17
%
in
p
r
ofilak
s
is g
r
o
u
p
with
am
itrip
til
i
n
in 1 year after th
e d
i
ag
no
sis
o
f
p
o
st
st
r
o
ke
pai
n
[3]
.
2.
A
resear
ch
don
e
b
y
Ter Ong
et al
(2
0
0
3
)
m
e
nt
i
oned
t
h
at
bet
w
ee
n 1
9
9
8
an
d 20
0
1
wi
t
h
68
4 pat
i
e
nt
s,
i
n
whic
h
52 of t
h
em
were in the m
a
in age
of
58 years
old, pa
rticipated i
n
two
stages
reserach. T
h
e
first
stage, te
hrese
r
acher
exam
in
ed
th
e p
a
tien
t
s
with
ou
t an
y special treat
m
e
n
t
for
p
a
restesia. Th
e
p
a
tien
t
s
were
onl
y
gi
ven a
n
t
i
pl
at
el
et
orant
i
k
oag
u
l
a
n m
e
di
ci
ne d
u
ri
ng
6 m
ont
h.
Du
ri
n
g
t
h
e sec
o
n
d
st
ag
e, t
h
e pat
i
e
nt
s (
4
4
p
a
tien
t
s) go
t amitrip
til
in
th
erap
h
y
, a
n
d
t
h
e
r
e
sul
t
sh
o
w
e
d
t
h
at
14
pat
i
e
nt
s
(
3
1
.
8%
)
re
po
r
t
ed t
h
at
t
h
ey
d
i
d
n
o
t
exp
e
rien
ce p
a
restesia. Th
e d
a
ta shows th
at a
m
i
t
rip
tilin
can
b
e
u
s
ed
in
post stroke paresthe
sia
ma
n
age
me
nt
[4
].
3.
A research
don
e b
y
Attal N
et al
(1
9
9
8
)
m
e
nt
i
one
d t
h
at
t
h
e ef
fect
o
f
ga
bape
nt
i
n
wi
t
h
l
o
w
d
o
se, a
n
d i
f
i
t
was i
n
c
r
ease
d
fre
que
nt
l
y
unt
i
l
i
t
s
m
a
xim
u
m
2.
40
0 m
g
/
day
sho
w
i
n
g t
h
a
t
gaba
pent
i
n
h
a
d t
h
e ef
fect
o
f
antiallodiniaa
ndantihi
p
eral
ges
i
a. Alth
o
u
g
h
t
h
ere was si
de ef
fect
, i
t
was onl
y
t
h
e l
i
ght
one.
An
d i
t
does n
o
t
d
i
stu
r
b
t
h
e
p
a
tien
t
s’
d
a
ily activ
ities [5
].
Th
e ex
p
l
an
atio
n
abo
v
e
shows th
at g
a
b
a
pen
tin
and
a
m
itr
ip
tilin
co
u
l
d
b
e
u
s
ed
as p
a
i
n
k
iller for
neu
r
op
hat
y
pa
i
n
al
t
h
o
u
gh
b
o
t
h
of
t
h
e m
e
di
ci
nes
were
not
m
e
nt
i
one
d
i
n
t
h
e m
e
di
ci
ne i
n
di
cat
i
o
n
on t
h
e
m
e
di
ci
ne l
eaph
l
et
. The pat
i
e
nt
s havi
ng
post
s
t
ro
ke ne
ur
op
ha
t
y
pai
n
can cau
se t
h
e decrease
of pat
i
e
nt
s
’
l
i
v
i
n
g
quality because they expe
rienced long te
rm
pain
disturba
nce, so it had si
gni
ficant effe
ct to the patients’ m
ood
co
nd
itio
n, sleep
ing
qu
ality, an
d
d
a
ily activ
i
ties. Th
u
s
, it is
i
m
p
o
r
tan
t
to
measu
r
e th
e inten
c
ity, p
a
in
qu
ality,
an
d
abn
o
rm
al
sen
s
ation
.
Th
e
m
easu
r
em
en
t
o
f
liv
ing
q
u
a
lity b
eco
m
e
s a si
g
n
i
fican
t factor in
th
e ou
tcome o
f
stroke theraphy because based on j
a
r
aczk & kozubski (2003),
It is shown the research
result that the c
h
ange
o
f
liv
i
n
g
qu
ality is clearly see
n
to
th
e
p
a
tien
t
s after
g
e
ttin
g
strok
e
[6
], bu
t
th
ere are
still v
e
ry few
research
es
wh
ich
fo
cu
s
on
liv
ing
q
u
a
lity o
f
th
e
p
a
tien
t
s esp
ecially th
e p
a
i
n
of
p
o
st strok
e
and
o
n
bo
th
m
e
d
i
cin
e
s.
There
f
ore, m
easurem
ent is needed
w
h
et
her
bot
h m
e
di
ci
nes can gi
ve si
gni
fi
cant
i
n
fl
u
e
nce o
f
t
h
e p
a
t
i
e
nt
s’
liv
in
g
q
u
a
lity after stro
k
e
, so th
ere sh
ou
ld
be fu
ether re
search
inv
e
stig
ati
n
g
t
h
e p
a
tien
t
s’ liv
in
g
qu
ality after
st
ro
ke t
h
e
pe
ri
od
be
f
o
re a
n
d
aft
e
r
usi
n
g
b
o
t
h
m
e
di
ci
nes.
Choosing a
hospital in J
o
gja was
signific
ant because
th
is hospital
wa
s one
of t
h
e
gove
rnm
e
nt
h
o
s
p
itals typ
e
B wh
ich
h
a
d so
m
e
facilit
ies su
ch as
n
e
ur
o
ou
tp
atien
t
d
e
p
a
rt
m
e
n
t
with
p
a
ti
en
ts v
i
sit aroud
8
0
0
-
10
0
0
pat
i
e
nt
s p
e
r
m
ont
h.
St
r
o
ke pat
i
e
nt
s vi
si
t
a
t
i
on
wa
s
i
n
th
e fi
rst h
i
gh
est rate in
1
m
o
n
t
h
.
Jog
j
a Ho
sp
ital was
an
ed
u
cati
o
n
a
l
h
o
s
p
ital supp
ortin
g
th
e research
, so
it
was
ea
s
i
er for the
rese
arche
r
to tak
e
th
e
d
a
ta th
ere.
2.
R
E
SEARC
H M
ETHOD
The res
earc
h
is an expe
rim
e
ntal study wit
h
Q
u
asyEks
pe
ri
ment
al
Desi
g
n
fram
ework c
o
nducted t
o
i
s
chem
i
c
st
rok
e
pat
i
e
nt
s ha
vi
ng
po
st
strok
e
p
a
in
co
m
i
n
g
to
n
e
uro
-
p
ily in
th
e ho
sp
itals in
Jo
gj
a
du
ring
22
nd
of
April-31
st
of
Ju
l
y
20
13
.
2.
1.
Ma
terial
The
resea
r
ch uses prim
ary data in the
form
of qu
estioner a
s
the m
e
dia to
co
llect th
e
d
a
ta. Qu
estioner
u
s
ed
was in the fo
rm
o
f
Brief Pa
in In
ven
t
ory
i
n
E
n
gl
i
s
h t
r
ansl
at
ed
t
o
B
a
hasa
In
d
one
si
a. T
h
e
quest
i
o
n
e
r
h
a
d
b
een tested
for
its v
a
lid
ity an
d reliab
ility.
2.
2.
Rese
arch Pr
ocess
The researc
h
was
conducte
d w
ith
in
t
h
ese
follo
wing
step
s:
1.
P
r
ep
a
r
a
tion
s
t
ep
This step include
s finishi
n
g
etichal clearance
o
f
t
h
e rese
arch an
d pe
rm
i
ssi
on f
r
om
t
h
e hos
pi
t
a
l
s
as
t
h
e
places for the
researc
h
as
we
ll as the prepa
r
ation
of
re
port sheets of the
patie
nts’ m
e
dical record a
nd
que
st
i
one
rs.
2.
Research Steps
Th
e
research
was cond
u
c
ted
i
n
sev
e
ral
fo
rms of activ
ities,
su
ch
as:
a.
The pat
i
e
nt
s w
ho
were
di
ag
n
o
se
d by
t
h
e
do
ct
ors cl
i
n
i
cal
l
y
havi
ng
p
o
st
i
s
chem
i
c
st
roke i
n
t
h
e H
o
s
p
i
t
a
l
i
n
Jo
gja were gi
ve
n
in
fo
rmed co
n
s
en
t
. In
itial ex
amin
atio
n
was g
i
v
e
n
si
n
g
le a
m
i
t
rip
tilin
t
r
eatm
e
n
t
an
d
sin
g
l
e g
a
b
a
p
e
n
tin
, an
d
t
h
e p
a
tien
t
s’ liv
ing
qu
ality was assessed
b
y
u
s
ing
Brief Pa
in
In
ven
t
ory
q
u
e
stio
n
e
r.
In
th
e end
,
th
e patien
t
s go
t 1
m
o
n
t
h
treatm
e
n
t
, an
d th
er liv
ing
q
u
a
lity was re-assessed
again.
b.
Qu
esti
o
n
e
r filli
n
g
was
g
u
i
d
e
d
di
rect
l
y
by
t
h
e
researc
h
er
, s
o
t
h
e
resep
o
nde
nt
s co
ul
d
ask
so
m
e
quest
i
o
n
s
if th
ey d
i
d
no
t u
n
d
e
rstand
th
e materials. After th
at
, the resea
r
che
r
rec
h
ecke
d
after the que
s
tioners we
re
ret
u
r
n
e
d
by
t
h
e resp
o
nde
nt
s.
In t
h
e q
u
est
i
o
ner
of B
P
I, t
h
ere we
re 1
-
10
scal
es i
n
w
h
i
c
h sc
ore
1 wa
s
u
s
ed
for th
e d
e
fin
itio
n no
t to
d
i
stu
r
b
,
and
sco
r
e 10
for
d
i
stu
r
b
i
ng
d
e
fi
n
itio
n, so
t
h
e
q
u
e
stio
n
e
r h
a
s the
lo
west score
hav
i
ng
th
e b
e
st liv
in
g qu
ality.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJPHS Vol. 4, No. 4, D
ecem
ber 2015
:
250 – 255
25
2
3.
D
a
ta Pr
o
cessing
an
d D
a
ta
Analysis
The
dat
a
fr
om
t
h
e
pat
i
e
nt
s a
n
d
t
h
e
dat
a
f
r
o
m
t
h
e quest
i
o
n
e
rs
were
p
r
oce
ssed a
n
d a
n
al
y
zed
base
d
o
n
i
t
s
anal
y
s
i
s
m
e
t
hod use
d
.
2.
3.
Data Pr
occesi
n
g
and Analys
is
Research d
a
ta
were pro
c
essed with
in th
ese fo
llo
wi
n
g
step
s
as fo
llo
w:
1.
Descri
p
tiv
e analisys fro
m
th
e ch
aracteristic
of resea
r
ch s
u
bject (base
d
on
gende
r).
2.
Th
e
Test an
alysis o
f
Brief
Pain
Inv
e
n
t
ory qu
estion
e
r significance
wa
s
conducted by
using a
statistical
m
e
t
hod nam
e
ly
st
ude
nt
t
-
t
e
st
with
th
e rate
of tru
s
t
95
.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
The
researc
h
was c
o
nducted on 22
nd
o
f
April
u
n
til
31
st
of
Jul
y
2
0
1
3
by
usi
n
g
c
o
nsecut
i
ve sampling
.
The pat
i
e
nt
s
were pat
i
e
nt
s of i
s
chem
i
c
post
st
ro
ke 5
7
p
a
tien
t
s. Th
e
p
a
tien
t
s were
allo
cated
in
to
2
g
r
ou
ps:
g
a
b
a
p
e
n
tin
g
r
ou
p (n
=3
1)
and
a
m
itr
ip
til
in
gr
ou
p (n
=2
6)
.
D
u
ri
n
g
t
h
e
re
sear
ch,
t
h
ere
were
16
p
a
t
i
e
nt
s
wh
o
di
d
not
co
nt
i
n
ue/
s
t
o
p
p
ed
fr
om
the resea
r
ch c
onsi
s
t
i
n
g o
f
8
pat
i
e
nt
s fr
om
gaba
pent
i
n
a
nd
8 pat
i
e
nt
s
from
a
m
itriptilin because of
doubl
e
teraphy, side
effect of the medicine
and the
unclear a
d
dres
s and phone
num
b
er,
so it was diffic
u
lt to reach the
m
.
Here
they were the patie
nts’ cha
r
acteris
tics following
the
researc
h
until the
end
o
f
t
h
e
pr
oc
esst
hat
i
s
s
h
o
w
n i
n
Ta
bl
e 1
.
Table1.The Characteristic of
Patients Dem
ogra
p
hic Fo
llo
win
g
t
h
e Research
in th
e
Ho
sp
itals in
Jogj
a.
Respondent
Char
acteristic
Gabapentin
A
m
i
t
rip
t
ilin
Value
N % N %
Gender
Male
16
69.
6
8
44.
4
0.
105
Fe
m
a
le
7 30.
4
10
55.
6
Age
< 40 y
e
ar
s old
0 0
1
5.
6
0.
436
40 y
ear
s old – 60 year
s old
10
43.
5
9
50
>60 y
ear
s old
13
42.
5
8
44.
4
E
ducation
E
l
em
teary
School
7 30.
4
9
50
0.
283
Junior
High Schoo
l
4 17.
4
5 27.
8
Senior
High School
9 39.
1
3 16.
6
Diplo
m
a
3 13.
1
1
5.
6
Job
Unem
p
l
oy
m
e
nt
17
74
12
66.
7
0.
151
En
terp
ren
e
u
r
3 13
6
33.
3
Private Sec
t
or
3 13
0
0
The c
h
aracte
r
istic of the
rese
arch
subject was grouped i
n
to se
veral cate
g
ories s
u
c
h
as
gende
r, a
g
e
,
ed
u
cation b
a
ck
gro
und
, and jo
b. Th
e r
e
su
lt of
statistical an
alysis u
s
in
g
ch
i squ
a
re
test got t
h
e
result
respectively
p
val
u
e >
0
.
0
5 t
h
ey
we
re
0.
10
5;
0
.
4
3
6
;
0.
2
8
3
;
0
.
1
5
1
. It
s
h
ows
t
h
at
t
h
e
r
e
was
no
si
g
n
i
f
i
cant
d
i
fferen
ce in
ev
ery ch
aracteritis o
f
th
e research
subj
ect, so
it cou
l
d
b
e
co
n
c
l
u
d
e
d
t
h
at th
e su
bj
ects
o
f
t
h
e
researc
h
were
hom
oge
no
us
.
Neuro
p
h
a
ty p
a
in
can
cause the d
ecrease
o
f
liv
ing
qu
ality to
th
e p
a
tien
t
s, so
it is sig
n
i
fican
t to
h
a
v
e
a
research
to
investig
ate th
e i
m
ag
e of p
a
tien
t
s’ liv
in
g
q
u
a
lity after strok
e
syn
d
ro
m
e
. It is
si
m
ilar
to
wh
at was
written
b
y
NICE (201
0) m
e
n
tio
n
i
n
g
th
at liv
ing
q
u
a
lity
need
s to
b
e
m
easu
r
ed
b
ecau
s
e n
e
uro
p
h
a
tic pain
can
h
a
v
e
sign
ifican
t effect to p
e
o
p
l
e’s liv
ing qu
ality [7
]. Th
is research u
s
ed Brief
Pain
Inv
e
n
t
o
r
y
qu
estio
n
e
r, in
whic
h questioner
was able to re
prese
n
t: ge
neral activ
ities,
m
ood situati
o
n, wal
k
ing capability, usual chores
,
rel
a
t
i
ons
hi
p
wi
t
h
ot
he
r pe
opl
e, and t
h
e way
t
o
enj
o
y
l
i
f
e.
Thi
s
q
u
est
i
o
ne
r has l
o
west
s
c
ore
whi
c
h m
e
ans t
o
h
a
v
e
t
h
e b
e
st liv
ing
qu
ality. Th
e pro
c
essing
d
a
ta o
f
t
h
e qu
estio
n
e
r
resu
lt sco
r
e
u
s
ed
t-test
with
tru
s
t
rate 9
5
%
b
y
co
m
p
aring
t
h
e m
ean
rate
of
p
a
tien
t
s’ liv
i
n
g
q
u
a
lity.
Measu
r
m
e
n
t
o
f
liv
in
g
qu
ality v
a
lu
e
u
s
ed
score with
0-10
scales in
wh
ich
sco
r
e
0
m
ean
ing
th
at it d
i
d
n
o
t
d
i
sturb, and
sco
r
e 10
was v
e
ry d
i
st
u
r
b
i
n
g
, so
th
e less th
e sco
r
e, th
e b
e
tter liv
i
n
g
q
u
a
lity th
e
p
a
t
i
en
ts
h
a
v
e
.Th
e
resu
l
t
o
f
th
is research
also
sho
w
s th
at
b
o
t
h
g
a
bap
e
n
tin
group
an
d
am
itrip
tili
n
group
sh
ow
liv
in
g
q
u
a
lity d
ecrease if it was com
p
ared
b
e
fore an
d after t
h
e
t
h
eraph
y
. Th
e resu
lt of th
e analysis is p
r
esen
ted
i
n
Tabl
e 2.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Gabape
ntin and
A
m
itrip
tilin
Treatment t
o
ward Living
Quality pf P
o
st Is
chemic
Str
o
ke .... (Pinasti
Utami)
25
3
Tab
l
e 2
.
Mean
Score o
f
Liv
i
ng
Qu
ality
of
Patien
t
s
with
Pos
t
NyeriPain
i
n
t
h
e
In
itial Con
d
itio
n
Description
Gabapentin
Grou
p
(
m
ean±SD)
A
m
i
t
rip
t
ilin Gro
up
(
m
ean±SD)
Wee
k
O
Wee
k
4
p-value
Wee
k
O
Wee
k
4
p-value
Daily Activities
4.83
±
2.
19
3.
00
±
1.
76
*0.
00
4.
50
±
1.
98
2.
94
±
1.
69
0.
00
M
ood
Situation
3.
91±1.
99
2.
35±1.
27
0.
00
4.
22±2.
24
2.
44±1.
19
*0.
00
Walking Ability
5.22±2.09
3.17±1.59
0.00
3.11±2.35
2.
00±1.41 0.00
Daily
Chor
es
4.
78±2.
11
3.
13±1.
71
0.
00
4.
22±1.
96
2.
89±1.
75
*0.
00
Relationship with
Others
4.
43±2.
15
2.
91±1.
62
*0.
00
3.
06±1.
79
1.
89±0.
83
0.
00
Sleeping Quality
3.30±2.64
1.83±1.80
0.00
3.33±2.47
2.
06±1.66 0.00
E
n
joy
i
ng L
i
fe
4.
13
±
1.
91
2.
52
±
1.
41
*0.
00
3.
50
±
2.
04
2.
17
±
1.
25
*0.
00
Whole Living
Quality
26.
49±1
1
.
0
8
16.
39±8.
1
4
*0.
00
22.
44±9.
8
5
14.
22±6.
9
8
*0.
00
Mean Value of
Living Q
u
alit
y
4.
37±1.
82
2.
70±1.
34
*0.
00
3.
71±1.
64
2.
34±1.
14
*0.
00
*i
n
d
epe
n
dent
t
e
st
res
u
l
t
of
t-t
e
st
Based
o
n
th
e
Tab
l
e
2
,
it can
b
e
k
nown t
h
at th
e m
ean
sco
r
e of i
n
itial who
l
e liv
i
n
g qu
ality in
gaba
pe
nt
i
n
g
r
o
up
got
4
.
3
7
±
1
.
8
2
.
Aft
e
r get
t
i
ng
1 m
ont
h t
h
erap
hy
, t
h
ey
w
e
re re-m
easure
d
,a
nd t
h
e r
e
sul
t
was
2.
70
±
1
.
3
4
.
Sy
st
em
at
i
c
al
l
y
t
h
ere was dec
r
eas
e 1.6
7
st
re
ngt
h
e
ni
n
g
by
pa
ired
samp
le t-test
whi
c
h got
p-
va
lu
e
0
.
0
0
(p
<0.05
)
mean
in
g
th
at
it was stati
s
tically d
i
ffe
ren
t
(sign
i
fican
t
),
wh
ile amitrip
til
in
g
r
ou
p
go
t
3
.
7
1
±1
.6
4.After g
e
tting
th
e t
h
eraph
y
fo
r 1, th
e
p
a
tien
t
s
were re-ex
a
m
i
n
e
d, and
th
e resu
lt g
o
t
was
2
.
34
±1
.14.
Syste
m
atica
lly,
th
ere was
d
e
crease
1
.
37
st
reng
th
en
ing
by
p
a
i
red
samp
le
t-test
(n
or
m
a
l
dat
a
di
st
r
i
but
ed
)
get
t
i
ng
p
-
val
u
e
0.
0
0
(
p
<
0
.
0
5
)
.
It
m
eans t
h
at
i
t
was
st
at
i
s
t
i
cal
ly
di
ffe
re
nt
(si
g
ni
fi
cant
)
.
Th
e ex
p
l
an
ation
ab
ov
e sho
w
s th
at th
e
u
s
e
of g
a
b
a
p
e
n
t
i
n
an
d
a
m
itrip
tilin
can
in
crease t
h
e
p
a
tien
t
s’
liv
in
g
qu
ality
sh
own
b
y
th
e decrease o
f
BPI
score.Th
ere
is also
th
e
ex
am
in
atio
n
o
f
p
a
i
n
in
ten
c
ity, and
th
ere
was dec
r
ease
of
pai
n
scal
e
by
usi
n
g V
A
S scal
e 2
.
8
7
±
1
.
3
3 f
o
r
ga
bape
nt
i
n
gr
o
u
p
, a
nd
2.
44
±
0
.7
8 f
o
r
a
m
itriptil
in group in 1 m
onth. Pain
intencity
coul
d also affe
ct the patie
nts’ living quality because the pa
tients
do
not
ex
peri
e
n
ce l
o
n
g
t
e
rm
pai
n
di
st
ur
ban
ce, so t
h
e pat
i
e
nt
s wo
ul
d
feel
m
o
re co
m
f
ort
a
bl
e t
o
t
h
e di
sea
s
e t
h
ey
h
a
d. Th
e id
ea
is si
milar to
S
m
ith
(2
01
2) men
tio
n
i
n
g
th
at
p
a
tien
t
s with
n
e
uro
p
h
a
ty p
a
in
can
in
crease th
eir
liv
in
g
qu
ality i
f
th
ey h
a
v
e
g
o
o
d
liv
i
n
g
m
a
n
a
g
e
m
e
n
t
[8
]. Co
nno
r (20
09) also
m
e
n
tio
n
s
th
at th
e rep
a
i
r
men
t
o
f
liv
in
g
qu
ality is strong
ly correlated
to
t
h
e increase
o
f
liv
ing
q
u
a
lity [9
].
In
add
ition
,
th
e co
m
p
ariso
n
of u
s
in
g
am
itrip
ti
lin
an
d
g
a
b
a
p
e
n
tin
as a n
e
u
r
op
h
a
ty p
a
in
th
erap
y o
f
po
st
strok
e
is
n
o
t
inclu
d
e
d
in
t
h
e list o
f
m
e
d
i
cin
e
leap
h
e
t, so
t
h
e
u
s
e still b
e
co
mes off lab
e
l u
s
e b
ecau
s
e th
ere
were
not
e
n
ou
g
h
res
earches
t
h
at
s
u
pp
o
r
t
e
d t
h
e
ef
f
ect
i
v
i
t
y
of b
o
t
h
m
e
di
ci
nes i
n
pai
n
m
a
nage
m
e
nt
of
p
o
st
s
t
ro
ke
neu
r
op
hat
y
. S
o
far t
h
ere ar
e
t
w
o R
a
n
dom
i
zed C
o
nt
r
o
l
Tri
a
l
i
nvest
i
g
at
i
ng t
h
e com
p
ar
i
s
on
of t
h
e t
h
erap
hy
effect of g
a
b
a
pen
tin
and
am
i
t
r
ip
tilin
; th
o
s
e
are Diab
etic
Periph
eral Neu
r
o
p
h
a
ty Pain
(DPN) (M
o
r
ell
o
et. al.,
19
9
9
) a
nd S
p
i
n
al Cor
d
I
n
ju
r
y
(Rintala et.
al., 20
0
7
)
[1
0]
, [1
1]
. The
re
sult of M
o
rello’s
researc
h
(
1
9
9
9
)
rep
o
rt
e
d
t
h
at
5
2
% (
11 o
f
2
1
)
pat
i
e
nt
s got
ga
bape
nt
i
n
cu
re (
d
ai
l
y
dosage
1.
56
5 m
g
) and 6
7
% (
14 o
f
2
1
)
wi
t
h
a
m
itrip
til
in
(daily d
o
s
ag
e
5
9
m
g
). Th
e
research
sho
w
s t
h
at the cure of bot
h m
e
dicines candec
r
easa
s
e pain
in
ten
c
ity, bu
t it cou
l
d
no
t reflect th
e co
m
p
ariso
n
effectiv
ity between
g
a
b
a
pen
tin
an
d am
itri
p
tilin
.
In
th
is research
, th
e inv
e
stigatio
n
was seen fro
m
th
e d
i
fferen
ce
o
f
th
e in
i
tial an
d
th
e end
m
ean
sco
r
e
o
f
th
e
p
a
tien
t
s’ liv
in
g
q
u
a
lity, an
d
tho
s
e two
g
r
o
u
p
s
were co
m
p
ared
.
Th
e obj
ectiv
e was to
see from wh
ich
g
r
ou
p
t
h
at was
ab
le to
rep
a
ir t
h
e
p
a
tien
t
s’ livin
g
qu
ality
after stro
k
e
. Based on
th
e tab
l
e
3
it can
b
e
kno
wn
th
at
th
e wh
o
l
e liv
i
n
g
qu
ality o
f
th
e p
a
tien
t
s go
t Mean
re
su
lt±SD. System
a
t
i
cally,
g
a
b
a
p
e
ntin
g
r
ou
p
was b
e
tter
th
an
am
itrip
til
in
g
r
ou
p. Howev
e
r, after th
ey were test
ed
b
y
using
in
d
e
p
e
n
d
e
n
t
t-t
e
st sa
m
p
le (no
r
m
a
l
di
st
ri
b
u
t
i
o
n
)
,
s
i
gni
fi
ca
nce sc
ore
was
p>
0,
0
5
m
eani
ng t
h
a
t
i
n
t
h
i
s
resea
r
ch t
h
e c
h
a
nge
of l
i
v
i
n
g q
u
al
i
t
y
of
g
a
b
a
p
e
n
tin
g
r
o
u
p
an
d
am
i
t
rip
tilin
g
r
o
u
p
was n
o
t
sign
ifi
can
tly d
i
fferen
t
statisticall
y
(no
t
sign
ifican
t).The
resu
lt
o
f
th
e analysis is p
r
esented
in
Tab
l
e
3
.
Tab
l
e3.
Mean Score o
f
Liv
i
ng
Qu
ality
Diff
eren
ce of Po
st
Strok
e
Pai
n
Pati
en
ts
Explanat
ion
Gabapentin
Grou
p
(
m
ean±SD)
A
m
i
t
rip
t
ilin Gro
up
(
m
ean±SD)
p
-
value
Daily Activities
1.83
±
1.
23
1.
56
±
0.
98
0.
53
Mood Conditio
n
1.57
±
1.
16
1.
78
±1.35
0.
71
Walking Ability
2.04
±
1.
43
1.
11
±
1.
23
0.
03
Usual Chor
e
1.
65
±
1.
07
1.
33
±
0.
97
0.
34
Relationship with Othe
r
People
1.
52±1.
08
1.
17
±
1.
25
0.
18
Sleeping Quality
1.48
±
1.
38
1.
28
±
1.
23
0.
66
E
n
joy
i
ng L
i
fe
1.
61
±
0.
89
1.
33
±
1.
09
0.
15
Whole Living Q
u
alit
y*
10.
87±4.
9
0
8.
22±4.
81
0.
22
Mean Value of D
i
fferen
ce Living
Qu
ality 1.67±0.78
1.37±0.80 0.22
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJPHS Vol. 4, No. 4, D
ecem
ber 2015
:
250 – 255
25
4
St
ro
ke
pat
i
e
nt
s expe
ri
ence
d
b
r
ai
n se
ns
ori
c
d
a
m
a
ge, st
i
ff
jo
i
n
t
/
p
aral
y
s
e w
h
i
c
h ca
n cau
se
pai
n
a
n
d
strange sensation t
h
at is usually called as
cent
r
al
st
roke
pai
n orce
nt
ra
l
pai
n sy
n
d
ro
me (
CPS). CP
S wa
s
cause
d
by the
dam
a
ge of the
area in the
thal
a
m
us. T
h
e
pai
n
w
a
s t
h
e m
i
x
t
u
r
e of
t
h
e f
eeli
n
g of
ho
t, co
ld
, bu
rn
t,
p
a
infu
l, and
nu
m
b
. Th
at
k
i
nd
of
feelin
g can
influ
e
n
ce t
h
e
p
a
tien
t
s’ li
v
i
ng
q
u
a
lity. So
m
e
o
f
th
e
p
a
tien
t
s
co
m
p
lain
ed
that th
e feelin
g
wou
l
d
g
e
t worse with
th
e
m
o
vem
e
nt differe
nce and col
d
te
m
p
erature (be
f
ore the
daw
n
a
n
d t
w
i
l
i
ght
)
.
F
r
om
t
h
e resea
r
ch
res
u
l
t
,
t
h
e
r
e
was
di
ffe
re
nce aft
e
r c
o
n
d
u
ct
i
n
g
1
m
ont
h t
e
ra
ph
y
bo
t
h
fro
m
g
a
b
a
p
e
n
t
in
gro
u
p
and
fro
m
a
m
itrip
til
i
n
.
Th
e p
a
tien
t
s were cap
a
b
l
e to
d
o
th
eir daily activ
ities
b
e
tter,
h
a
v
i
n
g
m
o
re co
m
f
o
r
tab
l
e m
o
o
d
feeling
,
b
e
tter walk
in
g
activ
ity, ab
le t
o
h
a
v
e
o
u
t
d
oor cativ
ities, so
th
eir
relatio
n
s
h
i
p
wi
th
o
t
h
e
r p
e
op
le cou
l
d
b
e
m
a
in
tain
ed
.
Th
ey
were ab
le to
h
a
ve b
e
tter sleep
an
d enjo
y th
eir life
b
e
tter. Th
e
referen
ce of research
es ab
ou
t
liv
in
g
qu
a
lity o
f
p
o
st stro
k
e
p
a
tien
t
s u
s
ing
g
a
b
a
p
e
ntin
an
d
a
m
itrip
til
in
med
i
cin
e
s as p
a
in
th
erap
h
y
is v
e
ry li
m
ite
d
.
Th
is research is si
milar to
Nurwah
yun
i research
(199
9) en
titled
Liv
i
ng
Qu
ality o
f
Po
rt
Stroke Patien
t
s Ba
sed
o
n
Lesi and
Strok
e
Kind
. In
th
is research
, 39
.13
p
a
tien
t
s cao
u
l
d h
a
v
e
g
ood
liv
i
n
g qu
ality b
y
assessing
th
ei
r an
swr
u
s
ing
Euro
Qo
l
qu
estioner [12
]
.
In
th
is research
, th
e researcher also
in
v
e
sti
g
ated
th
e sid
e
effect of u
s
ing g
a
b
a
p
e
n
tin
and
amitrip
tilin
.
In
g
a
b
a
p
e
n
tin
grou
p, th
e h
i
g
h
e
st rate o
f
th
e si
de effect is sleep
in
ess
(16
.
1
%
), wh
ile fo
r am
i
t
rip
tilin
th
e h
i
g
h
e
st
rat
e
was sl
eep
i
n
ess (
1
9
.
2
%
),
weak
(1
1.
5%
), an
d
dry
m
out
h (
7
.
7
%
)
. T
h
e res
u
l
t
i
s
si
m
i
l
a
r t
o
a previ
o
us
researc
h
by Backonjaet. al.
(1998) re
p
o
rt
i
ng t
h
at
t
h
e m
a
i
n
si
de e
ffect
of
usi
ng
ga
b
a
pent
i
n
was
h
eadache
(24
%
) and
sleep
in
ess (23
%
) [13
]
,
wh
ile the sid
e
effect t
h
at is often rep
o
rted in
t
h
e
u
s
e
o
f
am
i
t
rip
tilin
is
sleep
in
ess and an
tico
lin
erg
i
c effect (dry mo
u
t
h
an
d
con
s
tip
atio
n).
Gab
a
p
e
n
tin group
an
d
am
itrip
tilin
g
r
ou
p
had
t
h
e
sam
e
num
ber
o
f
t
h
e
pat
i
e
nt
s
1
1
p
a
t
i
e
nt
s get
t
i
n
g
t
h
e si
de e
ffec
t
of
t
h
e
m
e
di
ci
ne,
b
u
t
aft
e
r
i
t
was
d
i
v
i
d
e
d
wit
h
th
e to
tal p
a
tients in
th
e g
r
o
up, th
ere was 42
.2
% to
th
e grou
p
o
f
am
itrip
ti
lin
an
d
3
5
.3
%
in
th
e
g
r
ou
p of
g
a
bap
e
n
tin. Fro
m
th
e ex
p
l
an
atio
n abov
e,
g
a
b
a
p
e
n
tin
h
a
d
g
ood
, secure
to
lerab
ility, and
less
in
teracted
with o
t
h
e
r m
e
d
i
cin
e
s co
m
p
ared to th
e
o
t
h
e
r
p
a
ink
illers [14
]
.
Based
o
n
t
h
e i
n
v
e
stig
atio
n and
research
d
a
ta go
t fro
m
g
a
b
a
p
e
n
tin and
am
i
t
rip
tilin
g
r
ou
p, it co
u
l
d
be
co
n
c
l
u
d
e
d th
at
th
ose m
e
d
i
cin
e
s h
a
v
e
simila
r influ
e
n
ce t
o
th
e
p
a
tien
t
s’ li
v
i
ng
qu
ality, so
it is exp
ected
that
b
o
t
h
m
e
d
i
cin
e
s can b
e
r
e
-
i
n
c
lu
d
e
d
as th
e Li
st and
Plaf
on
o
f
Med
i
cin
e
Price as
n
e
ur
on th
er
aph
y
,
o
r
in
2
014,
all In
don
esian
p
e
op
le can
g
e
t
h
ealth
in
su
ran
c
e, so
bo
th
m
e
dicines can
be included i
n
ins
u
ra
nce m
e
dicine list
.
It is no
t on
ly fo
r
p
a
tien
t
s
with
Di
ab
et
ec Pe
ri
peral
N
e
ur
op
at
hy
and
P
o
st
Herp
et
i
c
N
e
ur
al
gi
a
. B
e
si
des
,
l
i
v
i
ng
q
u
a
lity shou
ld b
e
co
m
e
a
m
a
i
n
co
n
s
i
d
eration
in th
e asp
ect
o
f
cost and
si
d
e
effect.
From
th
e asp
ect
of cost,
a
m
itrip
til
in
was ch
eap
er th
at g
a
b
a
p
e
n
tin
,
b
u
t th
e eficati
on and si
de effect
sho
u
l
d
be co
n
s
i
d
ere
d
t
o
o
.
I
n
t
h
e
literatu
re, t
h
e sid
e
effect of amitrip
til
in
m
e
d
i
cin
e
can
b
e
avo
i
d
e
d
to th
e el
d
e
rly,
bu
t b
a
sed
o
n
th
e
d
e
m
o
g
r
aph
i
c
d
a
ta p
a
tien
t
s with
>60
were q
u
ite h
i
gh
.In
th
e literatu
re, th
e sid
e
effect
o
f
am
i
t
rip
tilin
is av
o
i
d
e
d
in
eld
e
rly,
w
h
ich
is b
a
sed o
n
Mo
rello
’
s
r
e
sear
ch
(1
999)
, and
Lacy et. al. (
2
00
2)
r
e
po
r
t
ed
th
at it h
a
s sid
e
ef
f
ect r
i
sk
on
cardi
ovasc
ul
ar
sy
st
em
and ext
r
api
r
i
m
i
d
al
sy
st
em
[10]
,[
15]
,
ho
we
ver f
r
o
m
t
h
e dem
ogra
p
h
i
c dat
a
t
h
at
cou
l
d be
achi
e
ve
d,
pat
i
e
nt
s wi
t
h
t
h
e
ag
e >6
0
was
q
u
i
t
e
hi
g
h
.
4.
CO
NCL
USI
O
N
Bo
th
u
s
ing
g
a
bap
e
n
tin an
d amitrip
tilin
treat
men
t
dur
ing
4
week
s sho
w
ed
i
n
creasing
o
f
liv
in
g qu
ality
in
ev
ery
g
r
o
up, bu
t th
e co
m
p
arison
o
f
th
em was
no
t si
gni
f
icantly differe
n
t. T
h
at
m
eans the c
o
m
p
arison
of
u
s
ing
g
a
b
a
p
e
ntin
an
d
am
i
t
ri
p
tilin
in
po
st
isch
em
ic stro
k
e
p
a
tien
t
with n
e
uro
p
a
t
h
y pain
no
t sign
ifi
can
tly
in
crease t
h
e
quality o
f
in
t
h
e
ho
sp
itals in Jo
gja.
REFERE
NC
ES
[1]
G
o
lds
t
ein
LB.
,
A
d
am
s
R., A
l
be
rts
M
J
., A
ppe
l L
J
., Br
as
s
LM
.,
B
u
s
hnell CD
.
,
Cu
lebras
A
.
, D
e
G
r
aba
TJ
.,
G
o
rel
i
c
k
P
B
., G
u
yton J
R
.
,
H
a
rt
RG
., H
o
w
a
rd G
., K
e
ll
y-
H
a
yes
M
., N
i
xo
n J
V
I., S
a
c
c
o R
L
.,
“
G
uidelin
e f
r
om
the A
m
eric
an
Heart Associatio
n/American Stro
ke A
ssociation S
t
roke Council”,
Stroke, Ha
rrison
’
s Manual of Medicin
e
, 16th
ed,
McGraw-Hill,
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ng Divisi
on, New York, vol
. 37
,
pp. 1583—1633
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Riset Keseh
a
tan
Dasar, “La
poran Nasional 2007
”, B
a
dan
Penelitian d
a
n Pengem
b
anga
n Keseh
a
tan, Dep
a
rtemen
Keshatan RI
, 20
07.
[3]
Lam
p
l C.
, Y
azdi
K.,
Roper
C.
, “
A
m
itriptilin
in
t
h
e Proph
ylax
is
of Centr
a
l
Poststroke Pain
:
Preli
m
i
nar
y
Results
of
39 Patien
t
s in a Placebo-
Cont
rolled
,
Lo
ng-Term
Study
”,
AHA jou
r
nal
, 2002.
doi: 10.1161
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1
STR.0000037674.95338.86
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://stroke.ahajourn
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l.org
/
cont
ent/33
/
12/3030, diakses tgl 9
januari 20
13.
[4]
Ter-Ong C., Fen
g
Sung S., Shun
Wu C., Ning
Lo C., “An Op
en-label Stud
y
of A
m
itriptilin in
Central Poststroke
Pa
re
sthe
sia,
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,
vol. 12
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. 177
-180, 2003
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ses tgl 9
januari
2013.
[5]
Attal N., Br
asseurb, Parkerf
,
Ch
auvinm, Bouhas
s
irad., “E
ffects of the
anticonvuls
a
nt gab
a
pen
tin o
n
peripher
a
l
and
centr
al n
e
uropa
t
h
icpa
in :
a
pilo
t
stud
y
”
,
Eur. N
e
u
r
ol.
, vo
l. 40, pp.
191-200, 1998
.
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I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Gabape
ntin and
A
m
itrip
tilin
Treatment t
o
ward Living
Quality pf P
o
st Is
chemic
Str
o
ke .... (Pinasti
Utami)
25
5
[6]
J
a
raczk
, Kozubs
ki W
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BIOGRAP
HI
ES
OF AUTH
ORS
Pinasti Utami is
a
lecturer
of
p
h
armacolog
y
an
d
clinical phar
m
acy
scien
c
e at School of
pharmacy
,
Muhammadiy
a
h University
of
Yog
y
akarta. She was born on March
18
th
, 1985 in
Semarang, Cen
t
r
a
l Jav
a
. She got
graduation, ph
ar
macy
b
y
tr
aini
n
g
, and
m
a
s
t
er of
s
c
ien
ce
at
Gadjah Mad
a
U
n
iversity
, Yog
y
akarta, Indon
esia. Her hobb
y
is r
e
ading
and
travelling.
Zulli
es
Ikawati i
s
a profes
s
o
r of
pharm
acolog
y
a
nd clinic
al phar
m
ac
y
s
c
i
e
nce a
t
GadjahM
a
d
a
Univers
i
t
y
. S
h
e
was
born on Decem
ber 6
th
, 1968
in Purwokerto,
Central Java. She got Ph.D
graduat
i
on at Eh
im
e, Universit
y
School of Medi
cine Japan. As her hobb
y
is writin
g, she has
several scientif
ic books.
Sety
aningsih is
a neurologist at J
ogja hospital.
She was born o
n
July
1
t
h
, 1958
in Metro
Lampung, Sumatera. She got graduation on 1999
at GadjahMad
a
University
, Y
o
g
y
ak
arta,
Indonesia. Her
h
obb
y
is reading
and shopping.
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