I-DBS: Inqubo Eshintsha Impilo

Ziningi iziyaluyalu zezinzwa ezifana isithuthwane kanye nokuquleka, unhlangothi, isifo i-Alzheimer's, ukuwohloka komqondo, nesifo sikaParkinson. Ukwelashwa kwazo zonke kuncike ebukhulwini benkinga. Inqubo eyodwa enjalo yokusiza iziguli ezinenkinga yemizwa njengesifo sikaParkinson yaziwa ngokuthi i-DBS. Ake sikuqonde.

Yini i-DBS?

I-DBS imele i-Deep Brain Stimulation. 
Umshini ufakwa ebuchosheni ukuze ulethe imisinga kagesi ezindaweni zobuchopho ngokuqondile. Isetshenziselwa ukwelapha isifo sikaParkinson, i-dystonia, ukuthuthumela okubalulekile, nezinye izimo zemizwa. Izimpawu zikagesi ezingahlelekile ezindaweni zokunyakaza okulawula ubuchopho kubangela izimo zemizwa njenge-PD. 

Uma imithi yehluleka ukusebenza kahle ezimeni ze-neuropsychiatric kanye nokuphazamiseka kokunyakaza, odokotela bangaphendukela ku-DBS. Nakuba kungase kungazixazululi ngokuphelele izimpawu ze-Parkinson's Disease (PD), ukuncika kwesiguli emithini kungancipha futhi nezinga lempilo yaso libe ngcono.

Uma inqubo ye-DBS seyenziwe ngempumelelo, imisa amasignali angavamile abangela ukundindizela nezinye izimpawu ezihlobene nokunyakaza njengobunzima bokuhamba, ukunyakaza okuhamba kancane, ukuqina, njll.  

Obani abangazuza kukho?

Iziguli ezinezimo zokwelapha ezilandelayo nezifo zingazuza ku-DBS:

Isifo sikaParkinson

• Iziguli ezisabela kahle lapho zisebenzisa imithi kodwa lapho imithi iphela, ziba nama-dyskinesias kanye nokungaqini kahle kwemoto. Ngisho noma imithi ilungiswa, iyehluleka ukunikeza imiphumela. 
• Labo abanokundindizela okungalawuleki nalabo imithi eye yabonakala ingasebenzi kubo. 
• Iziguli ezisabela kahle kumithamo ephakeme noma ephindaphindiwe yomuthi kodwa ngenxa yemiphumela engemihle azikwazi ukunikezwa izidakamizwa. 

I-Dystonia

Uma imithi ingasizi futhi imbangela eyinhloko ye-dystonia kungakhathaliseki ukuthi ibangelwa izidakamizwa, izakhi zofuzo, noma esinye isici siphakamisa ukuthi isimo singathuthuka ngenqubo ye-DBS. I-Dystonia kuwukuphazamiseka kokuhamba okungajwayelekile. Idala ukunyakaza okusontekile kanye nokuma okungajwayelekile. 

I-Essential Tremor

Iziguli ezinalesi sifo zinokuvevezela kwezwi, ikhanda, izandla, umboko noma imilenze okunesigqi. I-DBS ingaba usizo olukhulu uma kunokuzamazama okukhulu. Imisebenzi yansuku zonke njengokushefa, ukugqoka, ukudla, nokuphuza iyathinteka njengoba benenkinga yokunyakaza. Iziguli zingathuthuka ngenqubo ye-DBS.

Yiziphi izifo abantu abangazicabangela nge-DBS?

Akuzona zonke iziguli ezingaba amakhandidethi akhethwayo e-DBS. Izifo ezichazwe ngenhla kufanele zelapheke futhi zikwazi ukwenza ngcono isimo sesiguli samanje njengombono wodokotela bezinzwa. Ngaphezulu kwezimo ezichazwe ngenhla i-DBS ingaba usizo nakwezinye izimo zemizwa. I-DBS ingaba usizo ezigulini ezinokukhathazeka, i-obsessive-compulsive disorder, ukucindezeleka, noma i-Tourette disorder futhi. Ngisho ne-multiple sclerosis kanye nobuhlungu obungalawuleki bungelashwa nge-DBS. 

Ukuhlolwa Kokuhlola Ukufaneleka Kwesiguli Kwe-DBS

Isikhathi esiningi sitshalwa ekubonisaneni, ekuhloleni, nasezinkambisweni zokufinyelela esinqumweni esivumela i-DBS. Isiguli kufanele sivakashe njalo futhi inqubo nayo iyabiza. Iziguli ezinekhava yomshwalense zingase zikuthole kuzuzisa. 
Isiguli sichazelwa ukuthi isimo sizoba ngcono futhi ukuncika emithini kuzoncipha kodwa ngeke kukwazi ukwelapha lesi simo futhi kubuyisele isiguli ekuphileni okujwayelekile okunempilo. 

1. Ithimba elihlanganisa udokotela wezinzwa, udokotela ohlinzayo, kanye nodokotela wezifo zengqondo lihlola isimo sesiguli nokuthi sikulungele yini ukuhlinzwa noma cha. 
2. Ukunyakaza okuhlukile njengokuthinta iminwe, ukuhamba, ukusukuma esihlalweni, njll. kuyarekhodwa ngenkathi imithi ivuliwe futhi ivaliwe. Ukuhlolwa kwengqondo, ukwelashwa komsebenzi, njll. kwenziwa ukukala ikhono lesiguli lokubamba iqhaza kunqubo. Imisebenzi yokukhuluma nokugwinya igadwa. Amakhono nezimpawu zikalwa ngokusebenzisa Isikali Sesilinganiso Sezifo Se-Parkinson Ehlangene. 
3. Udokotela wengqondo uhlola isiguli ukuthi kungenzeka yini ukuba nokucindezeleka nokukhathazeka njengoba sidinga ukwelashwa ngaphambi kokuthatha inqubo ye-DBS.
4. Ungabuza mayelana nesikhathi esidingekayo ukuze uthole ukwelashwa kanye nokuthi noma yimiphi imikhawulo yokudla kanye neminye imithi okufanele ilandelwe noma cha. 
5. Icala lixoxwa nalo lonke ithimba labahlinzayo, abahlengikazi, nodokotela. Uma isiguli sisungulwa njengekhandidethi elihle le-DBS, i-aphoyintimenti nodokotela ohlinzayo iyalungiswa.  

Inqubo

Kunezinhlobo ezimbili zokuhlinzwa kwe-DBS

• I-Stereotactic futhi 
• Kuqondiswe isithombe

 Enqubweni ye-Stereotactic, isiguli sinikezwa i-anesthesia yendawo futhi umthofu uzinzile ngosizo lwezixhumanisi endaweni efanele ebuchosheni ngudokotela ohlinzayo. 

Ukuhlinzwa kwe-DBS okuqondiswa isithombe kwenziwa nge-MRI noma i-CT scan. Isiguli sinikezwa i-anesthesia jikelele. Zombili izinhlobo zezinqubo cishe zizosetshenziswa ekuhlinzeni. Labo abanezimpawu ezeqisayo noma labo abanovalo noma abakhathazekile bangaphakanyiswa ngenqubo eqondiswa isithombe. Kuphinde kuphakanyiswe izingane neziguli ingxenye yazo ethile yobuchopho ezosimamiswa ngosizo lomthofu. 

Inqubo yesinyathelo ngesinyathelo yokuhlinzwa kwe-DBS ichazwe lapha:

1. Ukufakwa komthofu 

• Isiguli kufanele silandele yonke imiyalelo edingekayo ngaphambi kokungena enqubweni efana nokukhipha izingubo, ubucwebe, nezinye izinto ezingase ziphazamise inqubo. 
• Inani elincane lezinwele liyagundwa ukuze kujovwe i-anesthesia yendawo ukuze ndikindiki ekhanda.
• Uhlaka lwekhanda luxhunywe kugebhezi ngezikulufo, ukugcina ikhanda lisendaweni efanele ngesikhathi senqubo. 
• I-CT scan noma i-MRI isetshenziselwa ukuthola indawo eqondiwe ebuchosheni.
• Kubhojwa imbobo encane ogebhezini ukuze kufakwe umthofu.
• Inqubo irekhodwa ithimba ukuze lazi ukubekwa ngqo komthofu. Ubuso, ingalo noma umlenze wesiguli unganyakaziswa ngenkathi uqopha inqubo. 
• Umthofu ubekwe futhi unamathiselwe ku-neurostimulator yangaphandle. Izimo zikagesi zinikezwa ngokuhola isikhashana. Odokotela bahlola izimpawu ukuze zibe ngcono. Kungase kube nemiphumela engemihle efana nokufinyela kwemisipha. Imbobo eyenziwe ogebhezini ivalwa ngekepisi lepulasitiki nemithungo. 

2. Ukuqoshwa kwe-Microelectrode

Ukurekhoda kwe-Microelectrode kukhomba indawo yokuhlinzwa ukuze kufakwe isikhuthazi sobuchopho obujulile kusetshenziswa amandla kagesi ngefrikhwensi ephezulu kakhulu. Kubalulekile ukwazi okuhlosiwe okunembile kokubekwa kwe-DBS yokugcina esimweni sesiguli ngasinye njengoba ukwakheka kobuchopho kwehlukile kumuntu nomuntu. Isiguli sigcinwa siphapheme ukuze i-MER inikeze ulwazi oluseqophelweni eliphezulu. Ithimba elihlinzayo lingabona futhi lizwe umsebenzi wezinzwa. Intambo eyodwa noma ngaphezulu zifakwa ezaziwa ngokuthi umkhondo noma ama-electrode phakathi nenqubo. Ijeneretha encane yokushaya kwenhliziyo ifakwa esifubeni bese umthofu uthola ukukhuthazwa kagesi okuthambile kusuka lapho. 

3. Ukubekwa kwe-Neurostimulator

I-neurostimulator ifakwa ngenkathi isiguli silele ngaphansi kwe-anesthesia ejwayelekile. Ifakwa ngaphansi kwezingqimba zangaphandle zesikhumba, ngokuvamile ngaphansi kwe-collarbone. Kwesinye isikhathi ifakwa esifubeni ngisho nasesiswini imbala. Intambo yokwandisa ixhunywe ku-neurostimulator kusukela ekuholeni. 

Ukuphumelela kwalokhu kuhlinzwa kuncike ekukhethweni kwesiguli, ukubekwa okufanele kwama-electrode kanye nokuhlelwa kwe-pulse generator. Imithi nayo inqunywa ngokwezidingo zayo.

Ukubuyiselwa Nokunakekelwa Ngemva Kwenqubo

Isiguli kudingeka sihlale esibhedlela amahora angu-24 ngemva kokuhlinzwa kwe-DBS. Kungathatha isikhathi eside kunalokhu kuye ngokuthi isimo sokululama sesiguli ngasinye. Uma kunezinkinga, isiguli singase sihlale isikhathi eside ngaphansi kokubhekwa. Udokotela uvakashela isiguli ngaphambi kokuba isiguli siphume esibhedlela futhi kunikezwa imiyalelo ephelele yokuthi ukunakekelwa kufanele kuthathwe ekhaya. 

Ukunakekelwa kwangemva kokuhlinzwa kubalulekile njengoba kubaluleke kakhulu ukugcina izimbobo zihlanzekile futhi zomile. Udokotela uqondisa isiguli ngendlela yokugeza njengoba indawo okuhlinzelwa kuyo idinga ukuphola kahle. Imithungo iyasuswa ngesikhathi sokuvakasha okulandelayo. Imicu yokunamathisela evala izitishi kufanele igcinwe yomile futhi ivamise ukuwa ngokwazo ngemva kwezinsuku ezimbalwa. 

I-neurostimulator iyithuluzi elihleliwe. Isiguli kufanele sisebenzise uzibuthe ukuze sivule/Sivale isikhuthazi. Ukuhlelwa kwenzeka ngemva kokwenziwa kwenqubo ye-DBS. Kungase kuthathe amasonto ambalwa ukuze uhlelo luqale. Ngokuphambene nalokhu, ngezinye izikhathi odokotela abambalwa bayayivula ngaphambi kokuba isiguli sikhishwe esibhedlela. 

Iziguli ezine-a I-DBS neurostimulator kufanele uphathe ikhadi likamazisi futhi ugqoke isongo sezokwelapha ukukhombisa isimo. Amabhethri e-stimulator angashintshwa odokotela uma kudingeka. Ngokuvamile, zisebenza iminyaka engu-3-5. Imithi iyalungiswa ngemuva kokuthi i-neurostimulator isiqalile ukusebenza. 

Kungase kuthathe isikhathi ngaphambi kokuthi ukuhlela okuphelele kuqedwe. Isiguli kufanele sivakashele udokotela ukuze sihlolwe njalo ngezikhathi ezithile. Udokotela unquma izikhathi zokuvakasha kuye ngokuthi isimo sesiguli.