Ukugqugquzela ubuchopho obujulile

Ukugqugquzela ubuchopho obujulile (i-DBS) isebenzisa idivaysi ebizwa nge-neurostimulator ukuletha amasiginali kagesi ezindaweni zobuchopho ezilawula ukunyakaza, ubuhlungu, imizwa, isisindo, imicabango ephoqelela ngamandla, nokuvuka ku-coma.

Uhlelo lwe-DBS luqukethe izingxenye ezine:

• Eyodwa noma ngaphezulu, izintambo ezibandisiwe ezibizwa ngokuthi imikhondo, noma ama-electrode, afakwa ebuchosheni
• Amahange ukulungisa imikhondo ogebhezini
  
• I-neurostimulator, ebeka amandla kagesi. Isikhuthazi siyefana nesenzi senhliziyo. Imvamisa ibekwa ngaphansi kwesikhumba eduze kokhololo, kepha ingabekwa kwenye indawo emzimbeni
• Kwabanye abantu kufakwa enye intambo ezacile, efakwe ngocingo ebizwa ngokuthi isandiso ukuxhuma ukuhola ku-neurostimulator

Kuhlinzwa ukwenziwa ukubeka ingxenye ngayinye yohlelo lwe-neurostimulator. Kubantu abadala, lonke uhlelo lungabekwa ezigabeni ezi-1 noma ezi-2 (ukuhlinza okubili okuhlukile).

Isigaba 1 kuvame ukwenziwa ngaphansi kwe-anesthesia yendawo, okusho ukuthi uvukile, kodwa awunazinhlungu. (Ezinganeni, kunikezwa i-anesthesia ejwayelekile.)

• Izinwele ezincane ekhanda lakho kungenzeka zigundiwe.
• Ikhanda lakho libekwe kuhlaka olukhethekile kusetshenziswa izikulufo ezincane ukuligcina linganyakazi ngesikhathi senqubo. Umuthi wokugunyaza usetshenziswa lapho izikulufu zixhumana khona nesikhumba. Kwesinye isikhathi, inqubo yenziwa emshinini we-MRI futhi ifreyimu iphezulu kwekhanda lakho kunokuba izungeze ikhanda lakho.
• Umuthi we-numbing ufakwa esikhunjeni sakho ekhanda lapho udokotela ohlinzayo azovula khona isikhumba, bese ebhoboza imbobo encane kugebhezi bese ebeka ukuhola endaweni ethile yobuchopho.
• Uma zombili izinhlangothi zobuchopho bakho zelashwa, udokotela ohlinzayo uvula imbobo ohlangothini ngalunye logebhezi, bese kufakwa imikhondo emibili.
• Imikhuba kagesi ingadinga ukuthunyelwa ngokuhola ukuqinisekisa ukuthi ixhunywe endaweni yobuchopho obhekene nezimpawu zakho.
• Ungabuzwa imibuzo, ufunde amakhadi, noma uchaze izithombe. Ungacelwa futhi ukuthi uhambise imilenze noma izingalo zakho. Lokhu kwenzelwa ukuqinisekisa ukuthi ama-electrode asezikhundleni ezifanele futhi umphumela olindelwe uyafinyelelwa.
  

Isigaba 2 senziwa ngaphansi kwe-anesthesia ejwayelekile, okusho ukuthi ulele futhi awunazinhlungu. Isikhathi salesi sigaba sokuhlinzwa sincike ekutheni ubuchopho buyobekwa kuphi ebuchosheni.

• Udokotela ohlinzayo uvula imbotshana encane, imvamisa ingaphansi nje kwekhola futhi afake i-neurostimulator. (Kwesinye isikhathi ibekwa ngaphansi kwesikhumba esifubeni esiphansi noma endaweni yesisu.)
• Intambo yokwelulwa ihanjiswe ngaphansi kwesikhumba sekhanda, intamo, nehlombe futhi ixhunywe kwi-neurostimulator.
• Imbobo ivaliwe. Idivayisi nezintambo azibonakali ngaphandle komzimba.

Uma sekuxhunyiwe, ama-pulses kagesi ahamba esuka ku-neurostimulator, eceleni kocingo lokunweba, kuya ekuholeni, nakubuchopho. Lezi zinhlayiya ezincane ziphazamisa futhi zivimbele izimpawu zikagesi ezidala izimpawu zezifo ezithile.

I-DBS ivame ukwenzelwa abantu abanesifo i-Parkinson lapho izimpawu zingalawulwa yimithi. I-DBS ayilaphi isifo seParkinson, kepha ingasiza ekwehliseni izimpawu ezifana nalezi:

• Ukuthuthumela
• Ukuqina
• Ukuqina
• Ukuhamba kancane
• Izinkinga zokuhamba

I-DBS nayo ingasetshenziselwa ukwelapha lezi zimo ezilandelayo:

• Ukudangala okukhulu okungaphenduli kahle emithini
• Ukuphazamiseka okubangelwa ukucindezela
• Ubuhlungu obungapheli (ubuhlungu obungapheli)
• Ukukhuluphala ngokweqile
• Ukunyakazisa ukunyakaza okungalawulwa futhi imbangela ayaziwa (ukuthuthumela okubalulekile)
• I-Tourette syndrome (ezimweni ezingavamile)
• Ukuhamba okungalawulwa noma okuhamba kancane (i-dystonia)

I-DBS ithathwa njengephephile futhi esebenza kahle uma yenziwa kubantu abafanele.

Izingozi zokubekwa kwe-DBS zingafaka:

• Ukusabela okweqile kuzingxenye ze-DBS
• Inkinga yokugxila
• Isiyezi
• Ukutheleleka
• Ukuvuza koketshezi lwe-cerebrospinal, okungaholela ekhanda noma kwi-meningitis
• Ukulahleka kokulinganisela, ukunciphisa ukuxhumana, noma ukulahleka okuncane kokuhamba
• Ukuzwa okufana nokwethuka
• Izinkinga zokukhuluma noma zokubona
• Ubuhlungu besikhashana noma ukuvuvukala kusayithi lapho kufakwe khona idivayisi
• Ukudlikizela okwesikhashana ebusweni, ezingalweni, noma emilenzeni
• Ukopha ebuchosheni

Izinkinga zingenzeka futhi uma izingxenye zohlelo lwe-DBS ziphuka noma zihamba. Lokhu kufaka phakathi:

• Idivayisi, ukuhola, noma izintambo ziyagqashuka, okungaholela kokunye ukuhlinzwa ukuze kuthathe indawo yengxenye ephukile
• Ibhethri lehluleka, okungadala ukuthi idivayisi iyeke ukusebenza kahle (ibhethri elijwayelekile livame ukuhlala iminyaka emi-3 kuye kwemi-5, ngenkathi ibhethri elishajekayo lihlala cishe iminyaka eyi-9)
• Intambo exhumanisa isikhuthazi nomthofu ebuchosheni idabula esikhunjeni
• Ingxenye yedivayisi efakwe ebuchosheni ingahle inqamuke noma iye endaweni ehlukile ebuchosheni (lokhu akuvamile)

Izingozi ezingaba khona zokuhlinzwa kobuchopho yilezi:

• Ukuqina kwegazi noma ukopha ebuchosheni
• Ukuvuvukala kobuchopho
• I-Coma
• Ukudideka, imvamisa kuhlala izinsuku noma amasonto kuphela
• Ukutheleleka ebuchosheni, enxebeni, noma kugebhezi
• Izinkinga ngenkulumo, inkumbulo, ubuthakathaka bemisipha, ibhalansi, umbono, ukuxhumana, neminye imisebenzi, engaba yesikhashana noma ehlala unomphela
• Ukuquleka
• Unhlangothi

Izingozi ze-anesthesia ejwayelekile yilezi:

• Ukusabela emithini
• Izinkinga ukuphefumula

Uzoba nokuhlolwa okuphelele ngokomzimba.

Udokotela wakho uzo-oda izivivinyo eziningi zaselebhu nezokucabanga, kufaka phakathi ukuskena kwe-CT noma kwe-MRI. Lokhu kuhlolwa kwe-imaging kwenziwa ukusiza udokotela ohlinzayo akhombe ingxenye ngqo yobuchopho obhekene nezimpawu. Izithombe zisetshenziselwa ukusiza udokotela ohlinzayo abeke phambili ebuchosheni ngesikhathi sokuhlinzwa.

Kungadingeka ukuthi ubone ochwepheshe abangaphezu koyedwa, njenge-neurologist, i-neurosurgeon, noma isazi sokusebenza kwengqondo, ukuze uqiniseke ukuthi inqubo ikulungele futhi inethuba elihle kakhulu lokuphumelela.

Ngaphambi kokuhlinzwa, tshela udokotela ohlinzayo:

• Uma ungakhulelwa
• Yimiphi imithi oyiphuzayo, kufaka phakathi amakhambi, izithasiselo, noma amavithamini owathengile ngaphandle kwekhawunta ngaphandle kwencwadi kadokotela
• Uma ngabe uphuze kakhulu utshwala

Phakathi nezinsuku ngaphambi kokuhlinzwa:

• Umhlinzeki wakho wezokunakekelwa kwempilo angakutshela ukuthi uyeke ukuthatha okwesikhashana izinciphisi zegazi. Lokhu kufaka phakathi i-warfarin (i-Coumadin, i-Jantoven), i-dabigatran (i-Pradaxa), i-rivaroxaban powder (i-Xarelto), i-apixaban (i-Eliquis), i-clopidogrel (i-Plavix), i-aspirin, ibuprofen, i-naproxen, namanye ama-NSAID.
• Uma uthatha eminye imithi, buza umhlinzeki wakho ukuthi kulungile yini ukuyiphuza ngosuku noma ezinsukwini ngaphambi kokuhlinzwa.
• Uma ubhema, zama ukuyeka. Cela usizo kumhlinzeki wakho.

Ngobusuku bangaphambi nangosuku lokuhlinzwa, landela imiyalo mayelana:

• Ukungaphuzi noma ukungadli lutho amahora ayi-8 kuya kwayi-12 ngaphambi kokuhlinzwa.
• Ukugeza izinwele zakho nge-shampoo ekhethekile.
• Thatha imithi umhlinzeki wakho akutshele ukuthi uyiphuze ngesiphuzo esincane samanzi.
• Ukufika esibhedlela ngesikhathi.

Ungadinga ukuhlala esibhedlela cishe izinsuku ezintathu.

Udokotela anganikeza ama-antibiotic ukuvikela ukutheleleka.

Uzobuyela ehhovisi likadokotela wakho ngosuku oluthile ngemuva kokuhlinzwa. Phakathi nalokhu kuvakasha, i-stimulator ivuliwe futhi nenani lokuvuselela liyalungiswa. Ukuhlinzwa akudingeki. Le nqubo ibizwa nangokuthi uhlelo.

Xhumana nodokotela wakho uma uthuthukisa noma yikuphi okulandelayo ngemuva kokuhlinzwa kwe-DBS:

• Imfiva
• Ubuhlungu bekhanda
• Ukulunywa noma isifuba
• Ubuthakathaka bemisipha
• Isicanucanu nokuhlanza
• Ukuba ndikindiki noma ukuncinza kolunye uhlangothi lomzimba
• Ubuhlungu
• Ukubomvu, ukuvuvukala, noma ukucasuka kunoma yiziphi izindawo zokuhlinzwa
• Inkinga yokukhuluma
• Izinkinga zombono

Abantu abane-DBS bavame ukwenza kahle ngesikhathi sokuhlinzwa. Abantu abaningi banokuthuthuka okukhulu ezimpawu zabo kanye nekhwalithi yempilo. Iningi labantu lisadinga ukuthatha umuthi, kepha ngomthamo ophansi.

Lokhu kuhlinzwa, nokuhlinzwa ngokujwayelekile, kuyingozi kubantu abaneminyaka engaphezu kwengama-70 nalabo abanezimo zezempilo ezifana nomfutho wegazi ophakeme nezifo ezithinta imithambo yegazi ebuchosheni. Wena nodokotela wakho kufanele nilinganise ngokucophelela izinzuzo zalokhu kuhlinzeka ngobungozi.

Inqubo ye-DBS ingaguqulwa, uma kudingeka.

Ukugqugquzela kobuchopho okujulile kwe-Globus pallidus; Ukuvuselelwa kobuchopho obujulile; Ukugqugquzela ubuchopho obujulile beThalamic; I-DBS; I-Brain neurostimulation

UJohnson LA, uVitek JL. Ukukhuthaza ubuchopho obujulile: izindlela zokwenza. Ku: Winn HR, ed. Ukuhlinzwa Kwe-Youmans neWinn Neurological. Umhla wesi-7. IPhiladelphia, PA: Elsevier; 2017: isahluko 91.

ULozano AM, uLipsman N, uBergman H, et al. Ukukhuthaza ubuchopho obujulile: izinselelo zamanje nezinkomba zesikhathi esizayo. UNat Rev Neurol. 2019; 15 (3): 148-160. I-PMID: 30683913 pubmed.ncbi.nlm.nih.gov/30683913/.

URundle-Gonzalez V, Peng-Chen Z, Kumar A, Okun MS. Ukugqugquzela ubuchopho obujulile. Ku: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, ama-eds. I-Neurology kaBradley ekwenziweni kwemitholampilo. Umhla wesi-7. IPhiladelphia, PA: Elsevier; 2016: isahluko 37.