Ukukhushulwa kobuchopho obujulile

Ukwelashwa Kokuvuselela Ubuchopho Okujulile e-Hyderabad, e-India

I-Deep brain stimulation (DBS) inqubo yokuhlinzwa lapho ama-electrode efakwa kwezinye izingxenye ze Ubuchopho. Lawa ma-electrode ngokuvamile aziwa ngokuthi umkhondo akhiqiza ama-electrodes asiza ukulawula ukusebenza okungavamile kobuchopho. Lawa mathonya kagesi abuye enze izingxenye zamakhemikhali ezisebuchosheni zibe zijwayelekile ezingaholela ezimweni eziningana. 

Ukushukumisa ubuchopho kulawulwa ijeneretha ehleliwe ebekwe esikhumbeni ngaphezu kwendawo engenhla. isifuba. Odokotela bangasebenzisa i-deep brain stimulation i-neuropsychiatric izimo noma ukuphazamiseka kokunyakaza lapho imithi enqunyiwe ingasebenzi kahle noma ibangele imiphumela emibi futhi iphazamise i-physiology evamile yesiguli. 

Uhlelo lwe-DBS luqukethe izingxenye ezintathu ezahlukene. 

• I-Electrode/lead- Lucingo oluncane noluvalekile olufakwa embotsheni encane yogebhezi bese lubekwa ezindaweni ezithile zobuchopho. 

• I-Extension wire- Iphinde ibe i-insulating wire edluliswa ngaphansi kwesikhumba sentamo, ihlombe nekhanda. Ixhuma i-electrode kujeneretha ye-pulse yangaphakathi (IPG). 

• I-Internal Pulse Generator (IPG)- Iyingxenye yesithathu yohlelo futhi ibekwe ngaphansi kwe isikhumba esifubeni esiphezulu. 

Isebenza kanjani i-DBS? 

Iziyaluyalu ezihlobene nokunyakaza noma ukuhambahamba njenge Isifo sikaParkinson nezinye izimo zemizwa zenzeka ngenxa yezimpawu zikagesi ezingahlelekile ezindaweni ezithile zobuchopho ezilawula ukuhambahamba. Uma kuphumelele, ukushukunyiswa kobuchopho okujulile kuphazamisa izimpawu zikagesi ezingajwayelekile ezibangela ukundindizela nezinye izimpawu ezihlobene nokunyakaza. 

Ngesikhathi senqubo, i-neurosurgeons faka umkhondo owodwa noma ngaphezulu ngaphakathi kobuchopho. Le mikhondo iphinde ixhunywe ocingweni olunwetshiwe olusungula ukuxhumana phakathi komkhondo/ama-electrode kusixhumi senzwa esincane (ijeneretha yokushaya kwenhliziyo yangaphakathi). Ngemva kwamasonto ambalwa okufakwa kwe-neurostimulator, udokotela uyakuhlelela ukuletha izimpawu zikagesi. Le nqubo yokuhlela ingase idinge ukuvakasha okungaphezu kokukodwa evikini noma enyangeni ukuze kuqinisekiswe ukuthi i-neurostimulator ilungisa okwamanje ngendlela efanele futhi inikeza imiphumela ephumelelayo. Udokotela ukhumbula ukusungula ibhalansi efanele phakathi kokunciphisa imiphumela emibi kanye nokwenza ngcono izimpawu ngenkathi elungisa idivayisi.  

Ubani odinga i-Deep Brain Stimulation? 

I-DBS ihilela uchungechunge lwezinqubo, ukuhlola nokubonisana ngaphambi nangemva kokuhlinzwa ukuze iziguli ezizimisele ngokuthola lokhu kwelashwa zikwazi ukunikela isikhathi esanele kule nqubo. Izindleko zenqubo ye-DBS, ukulandelela kwangaphambi kokuhlinzwa kanye nangemuva kokusebenza kungahluka ngokuya ngomshwalense wesiguli. 

Inqubo ingathuthukisa izimpawu ezihlobene nokunyakaza zesifo sika-Parkinson nezinye izimo, kodwa ayiqinisekisi ukunikeza impilo ephelele esigulini. 

Isifo sikaParkinson 

I-DBS ingazuza izinhlobo ezintathu zeziguli ze-PD- 

• Iziguli ezinokundindizela okungalawuleki nemithi azinikezanga imiphumela efiselekayo. 

• Iziguli ezibhekana nokuguquguquka okukhulu kwezimoto kanye ne-dyskinesia ngemva kokuhoxiswa kwezidakamizwa. 

• Iziguli izimpawu zazo zokunyakaza zisabela emithini yemithi ephakeme nevamile, kodwa azikwazi ukwenza kanjalo ngenxa yemiphumela engemihle. 

I-Essential Tremor 

Ukundindizela okubalulekile kuyisifo esivame kakhulu sokuhamba ngezinyawo. I-DBS ingaba ukwelashwa okusebenzayo kwalesi simo ezimeni lapho ukuzamazama kukhawulela imisebenzi yansuku zonke njengokushefa, ukugqoka, njll.   

I-Dystonia 

I-Dystonia wukuphazamiseka kokunyakaza okungajwayelekile. Izimpawu zayo zihlanganisa ukunyakaza okusontekile kanye nokuma okungavamile. I-DBS ingasiza ekuthuthukiseni izimpawu. Kodwa-ke, impendulo yesiguli incike kumbangela yalesi simo, okungenzeka kube ufuzo noma izidakamizwa. 

Iyini inqubo yokuvuselela ubuchopho obujulile?   

Kunezindlela ezimbili zokwenza i-DBS. Kwezinye izimo, udokotela ufaka kokubili i-neurostimulator futhi ahole esigulini. Futhi kwezinye izimo, ukuhlinzwa okubili kuyadingeka ngokuhlukana, ukufaka umkhondo kanye ne-neurostimulator.   

I-stereotactic DBS kanye ne-DBS eqondiswa isithombe yokungenelela

Ekuhlinzweni kwe-DBS okuyi-stereotactic, isiguli sidinga ukuthi sizikhiphe emithini yaso. Phakathi nenqubo, uhlaka luqinisa ikhanda lesiguli futhi lunikeze izixhumanisi ukusiza udokotela ohlinzayo aqondise i-electrode ezindaweni ezifanele ebuchosheni. Isiguli sithola indawo i-anesthesia ukuze azigcine enethezekile phakathi nayo yonke inqubo kanye ne-sedative emnene ukuze amgcine ekhululekile. 

Ekuhlinzweni kwe-DBS okuqondiswa isithombe, isiguli sinikezwa i-anesthesia evamile futhi silala emshinini we-MRI noma we-CT scan. Udokotela ohlinzayo usebenzisa izithombe ze-MRI ne-CT ukuze aqondise ama-electrode ezindaweni ezifiselekayo ebuchosheni. Ngokuvamile, le ndlela inconywa ezinganeni, iziguli ezinezimpawu ezimbi kakhulu noma labo abakhathazekile futhi besaba. Okulandelayo inqubo evamile yokuhlinzwa kwe-DBS. 

Ukufakwa komthofu

• Ubucwebe besiguli, izingubo zokugqoka kanye nezinye izinto ziyakhishwa njengoba zingase zibangele ukuphazamiseka phakathi nenqubo.

• Ithimba lezokwelapha lizophuca ingxenye encane yekhanda bese lijova i-anesthesia esikhumbeni ukuze bakwazi ukubeka uhlaka lwekhanda.

• Ngosizo lwezikulufu, ifreyimu yekhanda ihlanganiswe nogebhezi.

• Ithimba labahlinzayo libe selisebenzisa i-MRI noma i-CT ukuze likhombe indawo eqondiwe ebuchosheni lapho kuzoxhunywa khona umthofu.

• Ngemva kokunikeza imithi ethile, odokotela abahlinzayo benza imbobo encane kugebhezi ukuze bafake umthofu.

• Lapho umthofu uhamba ebuchosheni, i i-neurosurgeons qopha inqubo ukuze uhlole indawo efanele yomthofu.

• Uma umthofu ususendaweni efanele, ube usuxhunywa kusixhumi semizwa. Ukugqugquzela ugesi okwenziwa kuzosiza odokotela bahlaziye ukuthi izimpawu zithuthukisiwe noma uma kukhona imiphumela emibi eyenzekile.

• Intambo yokwandisa ixhunywe kumthofu oxhuma i-neurostimulator. Lolu cingo lufakwa ngaphansi kwesikhumba.

• Imbobo eyenziwe ogebhezini ivalwe ngemithungo kanye nekepisi lepulasitiki.

Ukurekhoda kwe-Microelectrode (MER)

I-MER (ukurekhoda kwe-microelectrode) isebenzisa i-current of high frequency ukuze kutholwe indawo enembile yokuhlinza ukuze kufakwe i-DBS (i-deep brain stimulator). Njengoba ukwakheka komuntu ngamunye kwehlukile, ngakho-ke, i-MER inikeza ulwazi olunembile mayelana nendawo yokuhlinza yokubeka i-DBS. I-microelectrode ivumela odokotela abahlinzayo ukuthi bezwe futhi babone umsebenzi we-neuronal ovela ezingxenyeni ezahlukene zobuchopho.

Ukufakwa kwe-Neurostimulator

Ukufeza le nqubo ngokuphumelelayo, umuntu unikezwa i-anesthesia. Ngemuva kwalokhu, ithimba lezokwelapha lifaka i-neurostimulator ngaphansi kwesikhumba sangaphandle njenge-collarbone, isisu noma isifuba. Intambo yokwandisa ixhunywe kumthofu oxhunywe ku-neurostimulator.

Ngemva kokuhlinzwa kwe-DBS (Deep Brain Stimulation).

Ukuhlinzwa Kwe-Deep Brain Stimulation (DBS) e-Hyderabad cishe amahora angu-24 noma ngaphezulu kuye ngokuthi isiguli silulame. Odokotela bazovakashela iziguli ngezikhathi ezithile futhi banikeze imiyalelo nezeluleko zokunakekelwa kwasekhaya.

Ekhaya, isiguli kudingeka sigcine imisila yaso yomile futhi ihlanzekile. Odokotela bazonikeza imiyalelo yokuthi ungazinakekela kanjani ekhaya ngemva kokuhlinzwa kwe-DBS e-Hyderabad. Umazibuthe unikezwa isiguli esingasetshenziswa ukucisha noma i-neurostimulator ngaphansi kwezimo ezithile.

Izinyathelo Eziqondile Ngemva Kokuhlinzwa kwe-DBS (Deep Brain Stimulation).

Iziguli ezine-DBS kufanele zithathe izinyathelo zokuphepha ezilandelayo:

• Phatha ikhadi le-ID njalo elisho ukuthi une-neurostimulator. Ungakwazi futhi ukugqoka isongo esibonisa lolu lwazi.

• Tshela abezokuphepha esikhumulweni sezindiza ukuthi uphatha i-neurostimulator ngaphambi kokudlula kumtshina. Kufanele wazise abezokuphepha abanemitshina ephathwa ngesandla ukuthi bangalusebenzisi lolu cingo isikhathi eside njengoba amadivaysi angase aphazamise imisebenzi ye-neurostimulator.

• Xhumana nodokotela ngaphambi kokudlula kunoma yiluphi uhlobo lwenqubo ye-MRI. Futhi, akufanele uvakashele izindawo ezinamazibuthe amakhulu njengamagceke emoto noma izikhiqizi zikagesi ezisebenzisa omazibuthe abakhulu.

• Ungasebenzisi ukushisa ekwelapheni ngokomzimba ukuze welaphe izinkinga zabo zemisipha.

• Ungayisebenzisi i-radar noma imishini enamandla kagesi njengeziko lokuncibilikisa, ama-transmitters kamabonakude, ukufakwa kwe-radar noma izintambo ezinamandla kakhulu.

• Yazisa odokotela abahlinzayo nge-neurostimulator ngaphambi kokuyokwenza okunye ukuhlinzwa. Kufanele uthathe izinyathelo zokuphepha ngaphambi nangesikhathi sokuhlinzwa. 

• Vikela ama-pacemaker noma ama-neurostimulators ngenkathi wenza noma yimuphi umsebenzi womzimba.

Izinqubo Zangemva Kokusebenza Zokuvuselela Ubuchopho Okujulile

I-Deep Brain Stimulation (DBS) yindlela yokuhlinzwa esetshenziselwa ukwelapha izimo ezihlukahlukene zemizwa njenge Isifo sikaParkinson, ukuthuthumela okubalulekile, kanye ne-dystonia. Ukunakekelwa kwangemva kokuhlinzwa kubalulekile ukuze kuqinisekiswe impumelelo yenqubo kanye nokuphila kahle kwesiguli. Nazi izinqubo kanye nokucatshangelwa okubalulekile kwangemva kokuhlinzwa:

• Ukunakekela Ngokushesha Ngemva Kokuhlinzwa
  • Ukuhlala Esibhedlela: Iziguli zivame ukuhlala esibhedlela izinsuku ezimbalwa kulandela ukuhlinzwa ukuze ziqashwe. Lokhu kuhlanganisa ukuhlolwa kwezinzwa ukuqinisekisa ukuthi azikho izinkinga ezisheshayo ezifana nokopha noma ukutheleleka.
  • Ubuhlungu Ukuphatha: Ubuhlungu bangemva kokuhlinzwa kulawulwa ngemithi njengoba kunqunywe udokotela ohlinzayo. Iziguli zingase ziphathwe yikhanda noma zingaphatheki kahle ezindaweni zokusikwa.
• Ukunakekelwa Kwezimbobo
  • Ukuqapha Ukutheleleka: Izindawo zokuhlinza esikhunjeni sekhanda nalapho umshini wokudonsa umoya ufakwe khona (ngokuvamile esifubeni) kufanele zigcinwe zihlanzekile futhi zomile ukuze kuvinjelwe ukutheleleka. Noma yiziphi izimpawu zokubomvu, ukuvuvukala, noma ukukhishwa kufanele kubikwe kumhlinzeki wezempilo ngokushesha.
  • Ukususwa kwe-Suture: Ama-Sutures noma ama-staples asetshenziselwa ukuvala izimbobo ngokuvamile asuswa cishe izinsuku ezingu-10-14 ngemva kokuhlinzwa.
• I-DBS Device Programming
  • Ukuhlelwa Kokuqala: Idivayisi ye-DBS ivamise ukuvulwa futhi ihlelwe emasontweni ambalwa ngemva kokuhlinzwa lapho ubuchopho sebunesikhathi sokululama. Lokhu kwenziwa udokotela wezinzwa noma uchwepheshe olungisa izilungiselelo ukuze afinyelele ukulawulwa kwezimpawu okuphelele.
  • Ukulungiswa Kokulandelela: Ama-aphoyintimenti amaningi okulandelela ayadingeka ukuze ulungise izilungiselelo zedivayisi ye-DBS. Inqubo ihilela ukulungisa ama-impulses kagesi ukulinganisa ukukhululeka kwezimpawu nokunciphisa imiphumela emibi.
• Ukuphathwa Kwemithi
  • Ukulungiswa Kwemithi: Iziguli kungase kudingeke ukuthi zilungise uhlobo lwemithi yazo ngemva kokuhlinzwa. Lokhu kuvame ukwenziwa kancane kancane futhi ngaphansi kokuqondisa kukadokotela wezinzwa ukuze agcwalise imiphumela ye-DBS.
• Ukuvuselela kanye Nokubuyisela
  • Ukwelashwa Kwemvelo: Ezinye iziguli zingazuza ekwelapheni ngokomzimba ukuze zisize ukubuyisela amandla nokuhamba.
  • Ukwelashwa Kwasemsebenzini: Lokhu kungasiza iziguli ukuzivumelanisa nanoma yiziphi izinguquko emakhonweni azo futhi zithuthukise ukusebenza kwazo kwansuku zonke.
  • Ukwelapha Ngenkulumo: Uma izinkinga zenkulumo bezikhona ngaphambi kokuhlinzwa, ukwelapha ngenkulumo kungase kube usizo ngemva kokuhlinzwa.
• Ukuqapha Okuvamile Nokunakekelwa Kwesikhathi Eside
  • Ukuhlola Okujwayelekile: Ukuqokwa njalo nethimba lezokunakekelwa kwempilo kubalulekile ukuze kuqashwe inqubekelaphambili yesiguli nokwenza noma yiziphi izinguquko ezidingekayo kudivayisi ye-DBS.
  • Ukushintshwa Kwebhethri: Ibhethri le-pulse generator ekugcineni lizodinga ukushintshwa. Lokhu ngokuvamile kwenziwa ngokuhlinzwa okuncane njalo eminyakeni engu-3-5, kuye ngedivayisi nokusetshenziswa.
• Indlela yokuphila
  • Imikhawulo Yomsebenzi: Iziguli zelulekwa ukuthi zigweme imisebenzi ekhandlayo kanye nokuphakamisa izinto ezinzima amasonto ambalwa ngemva kokuhlinzwa ukuze kuvunyelwe ukuphulukiswa okufanele.
• Izinkinga kanye nokuxazulula izinkinga
  • Qaphela Izinkinga: Izinkinga ezingaba khona zihlanganisa ukutheleleka, ukungasebenzi kahle kwedivayisi, nemiphumela engemihle ehlobene nokuvuselela njengezinkinga zenkulumo noma zokulinganisela. Iziguli kufanele zifundiswe ngokuqaphela lezi zinkinga kanye nokufuna usizo lwezokwelapha ngokushesha.
  • Ukulungiswa Kwedivayisi: Ukuxhumana okuqhubekayo nomhlinzeki wokunakekelwa kwezempilo kubalulekile ukuze kubhekwane nanoma yiziphi izimpawu ezintsha noma eziphikelelayo ngokulungisa idivayisi.

Izingozi Zokukhuthazwa Kwengqondo Ejulile

Nakuba i-DBS ingasebenza kahle kakhulu ekulawuleni izimpawu zezinkinga ezihlukahlukene zemizwa, iphinde ibe nezingozi ezithile. Ezinye zezingozi ezihlobene ne-Deep Brain Stimulation zihlanganisa:

• Izingozi Zokuhlinzwa: Inqubo yokufakelwa ihlanganisa ukubeka ama-electrode ezindaweni ezithile zobuchopho, ezithwala izingozi ezifana nokopha, ukutheleleka, unhlangothi, noma ukulimala kwezicubu zobuchopho ezizungezile. Lezi zingozi zingokwemvelo kunoma iyiphi inqubo yokuhlinzwa futhi zingahluka kuye ngezici ezifana nempilo yesiguli iyonke kanye nekhono likadokotela ohlinzayo.
• Izinkinga ezihlobene nedivayisi: Idivayisi efakiwe, okuhlanganisa ama-electrode kanye ne-pulse generator, ingase ingasebenzi kahle ngokuhamba kwesikhathi, edinga ukubuyekezwa kokuhlinzwa noma ukushintshwa. Lokhu kungaholela ezinkingeni ezinjengokususwa kwedivayisi, ukuthuthwa kwe-electrode, ukuphela kwebhethri, noma ukwehluleka kwehadiwe, okudinga izinqubo zokuhlinzwa ezengeziwe.
• Imiphumela Yengqondo Nengqondo: Ezinye iziguli zingase zithole izinguquko ekusebenzeni kwengqondo, imizwa, noma ukuziphatha okulandela ukuhlinzwa kwe-DBS. Lezi zinguquko zingabandakanya ukuncipha kwengqondo, izinkinga zenkumbulo, ukucindezeleka, ukukhathazeka, noma ukuthatheka. Yize le miphumela ivame ukuba mnene futhi ibuyisele emuva, kwesinye isikhathi ingaba nzima kakhulu futhi ibe nomthelela eqophelweni lempilo.
• Imiphumela Emibi Yokugqugquzela: Ukugqugquzelwa okungalungile noma okweqile kwezifunda zobuchopho kungaholela emiphumeleni engathandeki efana nokufinyela kwemisipha, ukuphazamiseka kwenkulumo, ukuzwa ukuntweza, noma ukuphazamiseka okubukwayo. Ukulungisa kahle imingcele yokuvuselela ngokuvamile kuyadingeka ukuze unciphise le miphumela engemihle ngenkathi kuthuthukiswa ukulawula izimpawu.
• Ukutheleleka kanye Nezinkinga Ezihlobene Nedivayisi: Njenganoma iyiphi idivayisi etshaliwe, kunobungozi bokutheleleka endaweni yokuhlinzwa noma eduze kwezingxenyekazi zekhompyutha ezifakiwe. Ukutheleleka kungaholela ezinkingeni ezinkulu futhi kungadinga ukususwa kocingo.

Izibhedlela ze-CARE zingasiza kanjani?

Ezibhedlela ze-CARE, silandela izimiso zokwelapha zamazwe ngamazwe ukuze sinikeze ukunakekelwa okuphelele nokwelashwa kwezifo ezihlobene nobuchopho. Ithimba lethu lezokwelapha eliqeqeshwe kahle lihlinzeka ngosizo nokunakekelwa kokuphela ukuze lisize iziguli zibe nempilo enempilo ngemva kokuhlinzwa kwe-deep brain stimulation (DBS) e-Hyderabad. 

Ukuze uthole ulwazi olwengeziwe ngezindleko zalokhu kwelashwa, Chofoza lapha.