Inkqubo yeBongo idlalwa rhoqo ukuphatha izifo zika-Parkinson
Kuzwakala ngathi yinto evela kubenzi be Star Star, kodwa abaphandi babona amathuba okuphuma ngokusetyenziswa kobuchopho obujulileyo kubantu abane- Alzheimer's disease . Kwaye, kwihlabathi apho unyango lufumaneka khona kodwa iingenelo zilinganiselwe, kubalulekile ukuqhubeka nokuphuhlisa iindlela ezongezelelweyo zokwelapha nokukhusela i-Alzheimer's.
Ubunjani Ubunzima Bokubakhuthaza?
Ubungqingili beBrain Deep (DBS) yinkqubo apho i-electrode ifakwa ngaphakathi kwengqondo kwaye ihlelwe ukunika amancinci amancinci ombane ukuvuselela umsebenzi wengqondo.
I-DBS isetyenziselwe iminyaka emininzi kubantu abanesifo sikaParkinson benempumelelo enkulu ekunciphiseni ukuphazamiseka kwemisipha kunye nokuphuculwa kwemisipha, kunye nokuphucula ukuhamba. Kuphandwa kwakhona ukunyanga ezinye iimeko zonyango, ezifana nokudandatheka kunye nokukhathazeka okunyanzelekileyo .
I-Electrodes ifakwa njani kwiBrain?
Impendulo emfutshane: ukuhlinzwa kwengqondo. Ukuze i-DBS ibe yinto enokwenzeka, iintambo kufuneka zifakwe kwingqondo. Ukusebenzisa i- anesthesia yasendaweni , i-neurosurgeon iminyango ye-neurosurgeon ibe yintloko yegulane kunye neengcingo ngokucokisekileyo kwiindawo ezahlukeneyo zobuchopho. (I-anesthesia yendawo, xa isigulane siphakamisekile kodwa indawo yomzimba idibene, ingasetyenziswa kuba ingqondo ngokwayo ayikwazi ukuva intlungu.)
Umshini onjenge-pacemaker utshalwa phantsi kwe-anesthesia jikelele kwisigxina somntu apho ekugqibeleni ungakuhambisa iimpembelelo ezisisigxina ezingama-130 ngombane kwisibini kunye, ngoko ke, ingqondo. Xa uqala ukufakela, umvuseleli uyacinywa; iintsuku ezimbalwa okanye iiveki emva kokuhlinzwa, i-stimulator ivuliwe kwaye iqala ukuhambisa iimpembelelo zombane kwingqondo.
Xa zisetyenziselwa ukuphatha isifo se-Alzheimer, ezo zingo zixhomekeke kwi-fornix ebuchosheni. Ngokutsho kukaJohn Hopkins Medicine, "i-fornix yindlela yokwenza ubuchopho ekuhambiseni ulwazi kwi- hippocampus , inxalenye yengqondo apho kuqala khona ukufunda kunye neenkumbulo , kwaye apho kuvela khona iimpawu zokuqala ze -Alzheimer."
Umsebenzi woBucingca obunzulu obunjani?
Kukho iingcamango ezininzi malunga nokuba kutheni kusebenza, kodwa akukho mpendulo ecacileyo okwamanje. Kwi-Parkinson, kucingelwa ukuphazamisa nokuphazamisa ukudubula okuphosakeleyo kwengqondo.
Enyanisweni, ukuqonda abaphandi be-DBS kuncitshiswe ukuba amathuba okusebenzisa i-Alzheimer afunyanwe ngengozi xa i-DBS ivavanywa kwindoda eyayinyamezelayo njengendlela yokuzama ukulawula ukutya kwayo. Njengoko bevavanya ngokufakwa kwecingo kunye nempembelelo kagesi, wabika imemori ecacileyo. Xa bevale iimpembelelo, imemori yaphela, kwaye xa bajika umvuseleli, imemori yabuya. Oku kwakhokelela ekuqinisekiseni ukuba mhlawumbi kukho indlela yokuvuselela ingqondo kunye neengqondweni eziziphetheyo.
Ngaba Kukhuselekile?
I-DBS ibonakala ikhuselekile. Nangona ukucinga ngophenyo lweengqondo kubonakala kunengozi kakhulu, iingcali zithi le nkqubo ayinakwenzeka njengokuba ingenangqungquthela njengoko ityandile.
Kuhlala kukho ingozi ekusebenzeni kwengqondo; Nangona kunjalo, abantu abangaphezu kwe-100 000 kwihlabathi lonke ne-Parkinson yesifo baye bafumana i-DBS ngeengxaki ezincinci. Izingozi ziquka ukusulelwa, ukusetyenziswa kwezinto zokusebenza, ukubetha, ukuhluleka kwebhethri kunye nokuhamba kwentambo.
Uphando olusisiseko sokuQiniseka kweBongo kunye ne-Alzheimer's's disease
Isigaba soPhando
Ngo-2010, i-Annals ye-Neurology iphephancwadi ipapashwe uphando oluchaza isigaba se-I lonyango olwenziwe eCanada kunye nabantu abayisithupha abafumana ukuba bafumana isifo se-Alzheimer yokuqala. Bonke babenomkhuhlane wengqondo ejulile abafakela ngqondweni yabo kwaye bafumana iinyanga ezili-12 zokuvuselela ugesi.
Ukuvavanywa kokusebenza kwabo kwengqondo kwiinyanga ezili-6 kunye ne-12 kubonise ukuphuculwa, okanye ukuhla kwe-less-expected-expected in three in the six participants.
Ukongezelela, i-PET yokuhlola yayisetyenziselwa ukuvavanya i-cerebral glucose metabolism, leyo yikhono lobuchopho ukuba liphule iishukela zefuthe lobuchopho kwaye lingabonakalisa amanqanaba omsebenzi we-neurons kwingqondo. Abantu abane-Alzheimer babonisa ukuhla kwe-glucose metabolism ngokuhamba kwesikhathi, kodwa aba bathathi-nxaxheba abathandathu babonisa ukwanda okwenziwe kulo lonke uphando. Kuyathakazelisa ukuba amandla okwehla kwengqondo ekuhlaleni iswekile kwisifo se-Alzheimer iye yabangela abanye abaphandi ukuba babize " uhlobo lwesifo sikashukela se-Alzheimer" sika-Alzheimer.
ISigaba sePhando II
Kwisigaba sesi-II sifundo ngoJohn Hopkins, izigulane ezingama-42 ubudala ezingama-45 ukuya kuma-85 zathatha inxaxheba kwi-DBS ukujolisa isifo sabo se-Alzheimer. Bonke bafumana utyando lwe-DBS ukufakwa phakathi kuka-2012 no-2014. Isiqingatha sazo sabavuseleli babo emva kweveki ezimbini, kwaye isiqingatha sazo sasivule emva kweenyanga ezili-12. Oku kwakufundwa ngokuziimfama kabini, kuba akukho magqirha kunye nezigulane ezazi ukuba zivuselelwe.
Ukuqwalaselwa kwahlolwa kuhlolisiso ngezifundo ezininzi kubandakanya i- ADAS-Cog 13. I-cerebral glucose metabolism yayilinganiswa kwiindawo ezahlukeneyo zobuchopho.
Iziphumo zolu cwaningo zinomdla, kwaye akunjalo oko kwakulindelwe. Kwiinyanga ezili-6 emva kokumiselwa kwe-stimulator, i-cerebral glucose metabolism yanda kakhulu, kodwa ezo zizuzi zazingagcinwa kwiinyanga ezili-12. Ukongezelela, ukuhlukana okumalunga neminyaka kuphendulwa. Abo bathathi-nxaxheba abangaphezu kweminyaka engama-65 babonisa ukuphuculwa kwendlela yokusebenza kwengqondo kunye ne-cerebral glucose metabolism. Abo babengaphantsi kweminyaka engama-65 abazange babonise ukuphucula okukhulu kuyo nayiphi na indawo. Abaphandi bafundisa ukuba le ntembeko inokuthi ixhamle kwixesha elithile likhulu lobuchopho lwakonakala kubantu abancinci abane-Alzheimers ( ekuqaleni kwe-Alzheimer's ), xa kuthelekiswa nalabo baqala ukuhlaziya i-Alzheimer's.
Isishwankathelo seempembelelo zeDBS kwiBrain
Iziphumo ze-DBS kwi-Alzheimer ziye zafundwa ngolu hlobo lwesigaba se-I kunye nesigaba se-II, kodwa ulwazi malunga nendlela oluchaphazela ngayo ingqondo sele luqokelelwe ekusebenziseni kwezinye izicwangciso, kuquka ezinye izifundo zophando kunye nokunyanga kwesifo se-Parkinson. Ezi ziphumo zilandelayo zifunyenwe:
Ukuphuculwa kwengqondo jikelele: Uphando lwe-DBS kubantu abane-Alzheimers lubangele ukuqonda ukuphuculwa kwabanye abathathi-nxaxheba, njengoko kulinganiswa neemvavanyo ezininzi ze- neuropsychological tests . Ezi mvavanyo zilinganisa iinkalo ezininzi zobomi beengqondo, kubandakanywa imemori, ukuqhelaniswa , ukuqonda igama, nokunye.
Ukwandisa i-hippocampus ivolumu: Nangona i-hippocampus (inxalenye yengqondo ehambelana nememori) inrophies kunye nobukho bokuguga nangakumbi kwi-Alzheimer's disease, i-DBS ifunyenwe ukwandisa umthamo we-hippocampus kubantu abane-Alzheimer's. Umthamo weHippocampal uhambelana nokusebenza kwememori.
Ukwandisa i-cerebral glucose metabolism: Njengoko kucacisiwe ngasentla, ezinye izifundo ezifumene i-DBS zibonise ukuphucula i-glucose metabolism kwiindawo ezininzi zobuchopho.
Umthamo ophezulu we-fornix kunye nemizimba yamathambo: I-fornix kunye nemizimba yamathambo engqondweni (ezo zombini zihambelana nokusebenza kwememori) ziye zabonisa ivolumu ephezulu emva kwe-DBS kulabo abane-Alzheimer's.
Amanqanaba aphezulu ase-acetylcholine: I- DBS iye yaboniswa kuphando lokubangela ukukhululwa kwe-acetylcholine. I-Acetylcholine inceda ukudlulisela imilayezo esuka kwiseli enye yesigane ukuya kwesibini kwiibhokhwe zethu.
Inkumbulo yokwandisa yendawo: Emva kokukhupha kwengqondo ephakamileyo kwi-fornix yamagundane, babonisa imemori ephuculweyo yendawo yokukwazi ukuhamba ngendlela. Nangona iifundo zezilwanyana zihlala zingena kubantu, zihlala zisinikeza ulwazi malunga nokukhusela nokusebenza kweenkqubo zokulinga.
Ukunciphisa ukuthetha ngokucacileyo: Ukuvuselela ubuchopho obujulile sele kusetyenziswe iminyaka kubantu baseParkinson abaneempembelelo ezintle. Nangona kunjalo, uphando oluthile lufumene ukuba ukuthetha ngomlomo kuye kwehla kwabanye balaba bantu. Nangona abaninzi abaneParkinson bavakalelwa kukuba lo mngcipheko uzuze inzuzo yokuba uvuselelo lwengqondo lubabonelela. kusenokuba lula ukuba kuthathwe ingozi ebalulekileyo kulabo abane-Alzheimer's disease.
Imilinganiselo yokuziphatha
Nangona kukho izifundo ezininzi eziqhutywe kubantu, abanye abaphandi bacela ukuqhutyelwa izifundo kunye nokwandiswa kweeDBS kwizilwanyana ngaphambi kokuqhubela phambili uphando olungakumbi kubantu. Bachaza ukuba ngelixa kubekho abathathi-nxaxheba be-DBS abaye bafumana ukuphuculwa kwengqondo, kuye kwabakho nabanye abambalwa abaye balahla kwiindawo ezithile ezinengqiqo emva kokuvuselelwa kwengqondo.
Aba baphandi baphinde bagxininise ukuba kukho ukungabikho kwengqiqo malunga nendlela yokuvuselela ingqondo ejulile; Ngako oko, bancomela ukuba ulwazi oluninzi lufumaneke ngaphambi kokunyusa izilingo zekliniki nabantu.
ILizwi
Ukuvuselelwa kwengqondo ejulile kuye kwasekwa ngokufanelekileyo njengonyango olufanelekileyo lwesifo sikaParkinson; Nangona kunjalo, uphando olongezelelweyo lufunekayo ukuqonda izibonelelo zalo kwi-Alzheimer's disease. Ubungakanani be-DBS yokuphuculwa kwengqondo kuyaxhamla, ngakumbi njengoko siqhubeka silwela ukufumana unyango olufanelekileyo lwe-Alzheimer's.
> Imithombo:
> Fagundes, VDC, Rieder, CRM, Nunes da Cruz, A, et al, Ubuninzi bobuchopho Ukukhutshwa kobukhulu be-Subthalamic Nucleus kuthinta i-Phonemic and Action Fluency kwiSifo se-Parkinson. Izifo zikaPasinson. 2016.
> Hescham S, Temel Y, uSchipper S. et al, I-Fornix yokuvuselela ubuchopho obunzulu yenzelwe inkumbulo yendawo edeleyo ngaphandle kwe-hippocampal neurogenesis. Ukwakhiwa kweBrains kunye neMisebenzi. Ngo-2017 Mar; 222 (2): 1069-1075.
> Johns Hopkins Medicine. I-Johns Hopkins Abagqirha Bakha Ukuqala Kwengqondo 'I-Pacemaker' yeSifo se-Alzheimer eUnited States njengeNgxenyana yovavanyo lwezonyango olwenzelwe ukulahleka kweMemori yeLokhumbuzo. Disemba 2012.
> Laxton AW, i-Tang-Wai DF, i-McAndrews MP, kunye ne-al. Annals of Neurology. 2010 Oct; 68 (4): 521-34. Icandelo lilingo lwe-brain stimulation of circuits in the disease of Alzheimer's disease. Annals of Neurology. 2010 Oct; 68 (4): 521-34.
> Lozano AM, Fosdick L, Chakravarty MM, et al, A Isigaba II Isifundo se-Fornix Deep Brain Stimulation kwi-Alfheimer's Disease's disease. Ingxelo yeZifo ze-Alzheimer's. 2016 Sep 6; 54 (2): 777-87.
> Ovadia D, Bottini G .. Impembelelo ye-neuroethical yokuvuselela ingqondo ebudeni bokuphazamiseka kwesifo. Iingcamango zangoku kwi-Neurology. NgoDisemba ka-2015; 28 (6): 598-603
> Viana JNM, Vickers JC, Cook MJ, Gilbert F, Imirhumo yememori: inkqubela phambili yentsholongwane, imingeni yokuguqulela, kunye nemilinganiselo yokuziphatha kwi-fornix ezinzulu zokuvuselela izilingo zesifo se-Alzheimer. Neurobiology of Age. 2017 Aug; 56: 202-210.