Imithi kanye nokwelashwa kwe-MS Progressive MS

-Delile

• Imithi ye-PPMS
• I-Ocrelizumab (Ocrevus)
• Ukwelashwa kwama-stem
• Ukuhlolwa kwemitholampilo
• I-lipoic acid
• Umthamo ophezulu we-biotin
• I-Masitinib (AB1010)
• Ibudilast
• Izindlela zokwelapha zemvelo nezihambisanayo
• Ukwelashwa emsebenzini
• Ukwelashwa ngokomzimba
• I-pathology yolimi lwenkulumo (SLP)
• Ukuzivocavoca umzimba
• Izindlela zokwelapha ezihambisanayo nezinye (CAM)
• Ukwelapha izimpawu ze-PPMS
• Imithi
• Izinguquko zendlela yokuphila
• Ukuvuselelwa
• Ukudla okudlela endlini

I-primary progressive multiple sclerosis (PPMS) ingenye yezinhlobo ezine ze-multiple sclerosis (MS).

Ngokusho kweNational Multiple Sclerosis Society, cishe amaphesenti ayi-15 abantu abane-MS bathola ukuxilongwa kwe-PPMS.

Ngokungafani nezinye izinhlobo ze-MS, i-PPMS iqhubeka kusukela ekuqaleni ngaphandle kokubuyela emuva noma ukukhishwa okunamandla. Yize lesi sifo siqhubeka kancane kancane futhi kungathatha iminyaka ukusithola, siholela ezinkingeni ngokuhamba.

Asikho isizathu esaziwayo se-MS. Kodwa-ke, izindlela eziningi zokwelapha zingasiza ekunqandeni ukuqhubeka kwezimpawu ze-PPMS.

Imithi ye-PPMS

Izidakamizwa eziningi ezikhona ze-MS zenzelwe ukulawula ukuvuvukala futhi zinciphise inani lokuphindelela.

Kodwa-ke, i-PPMS ibangela ukuvuvukala okuncane kakhulu kunokuphindaphinda-ukubuyisela ama-multiple sclerosis (RRMS), uhlobo oluvame kakhulu lwe-MS.

Ngaphezu kwalokho, yize kungahle kube nezikhathi ezithile zokuthuthuka okuncane, i-PPMS ayinakho ukuthethelelwa.

Ngoba akunakwenzeka ukubikezela inkambo yenqubekela phambili ye-PPMS kunoma yimuphi umuntu onayo, kunzima kubaphenyi ukuthi bahlole ukusebenza komuthi lapho kuqhubeka lesi sifo. Kodwa-ke, kusukela ngo-2017, umuthi owodwa we-PPMS uthole imvume ku-Food and Drug Administration (FDA).

I-Ocrelizumab (Ocrevus)

I-Ocrelizumab (i-Ocrevus) ivunyiwe yi-FDA ukwelapha zombili i-PPMS ne-RRMS.

I-anti-monoclonal antibody ebulala amaseli athile we-B amasosha omzimba. Ucwaningo lubonisa ukuthi amangqamuzana e-B anesibopho sokulimaza ubuchopho kanye nezicubu zomgogodla zabantu abane-MS. Lo monakalo unikezwa amasosha omzimba uqobo.

I-Ocrelizumab ilawulwa ukumnika okufaka emithanjeni. Ama-infusions amabili okuqala afakwa ngaphandle kwamasonto amabili. Ama-infusions kamuva afakwa njalo ezinyangeni eziyisithupha.

Ukwelashwa kwama-stem

Inhloso yokusebenzisa ama-stem cells ukwelapha i-PPMS ukukhuthaza amasosha omzimba ukulungisa umonakalo nokunciphisa ukuvuvukala ohlelweni lwezinzwa oluphakathi (CNS).

Ngenqubo eyaziwa ngokuthi i-hematopoietic stem cell transplantation (HSCT), ama-stem cell aqoqwa ezicutshini zomuntu uqobo, njengomnkantsha wegazi noma ngegazi, bese ebuyiselwa emuva ngemuva kokucindezelwa kwamasosha omzimba. Lokhu kwenziwa esimweni sesibhedlela futhi njengamanje kuvunyelwe i-FDA.

Kodwa-ke, i-HSCT yinqubo enkulu enemiphumela emibi kakhulu.Ucwaningo olwengeziwe nemiphumela evela ekuhlolweni kwemitholampilo iyadingeka ngaphambi kokuba lokhu kube ukwelashwa okusetshenziswa kabanzi kwe-PPMS.

Ukuhlolwa kwemitholampilo

Izilingo eziningana zokwelashwa okwamanje ziyaqhubeka kubantu abane-PPMS. Ukuhlolwa kwemitholampilo kudlula ezigabeni eziningana ngaphambi kokuthola imvume ye-FDA.

Isigaba I sigxile ekutheni umuthi uphephe kangakanani futhi sibandakanya iqembu elincane labahlanganyeli.

Ngesikhathi sesigaba II, abacwaningi bahlose ukuthola ukuthi umuthi usebenza kangakanani ezimeni ezithile ezifana ne-MS.

Isigaba III uqobo sifaka iqembu elikhulu labahlanganyeli.

Abaphenyi baphinde babheke abanye abantu, imithamo, kanye nokuhlanganiswa kwezidakamizwa ukuthola kabanzi mayelana nokuthi umuthi uphephe kangakanani futhi usebenza kahle kangakanani.

I-lipoic acid

Ucwaningo lwesigaba II seminyaka emibili njengamanje luhlola i-oral antioxidant lipoic acid. Abaphenyi bacwaninga ukuthi ingakwazi yini ukugcina ukuhamba nokuvikela ubuchopho ngaphezu kwe-placebo engasebenzi ezinhlotsheni eziqhubekayo ze-MS.

Lolu cwaningo lwakhela ocwaningweni lwesigaba II lwangaphambilini olwalubheke abantu abangama-51 abane-MS yesibili eqhubekayo (SPMS). Abaphenyi bathole ukuthi i-lipoic acid ikwazile ukunciphisa izinga lokulahleka kwezicubu zobuchopho uma kuqhathaniswa ne-placebo.

Umthamo ophezulu we-biotin

I-Biotin iyingxenye yenkimbinkimbi kavithamini B futhi iyabandakanyeka ekukhuleni kwamaseli nasekuguqulweni komzimba kwamafutha nama-amino acid.

Ucwaningo lokubuka luqasha abantu abane-PPMS abathatha umthamo ophakeme we-biotin (300 milligrams) nsuku zonke. Abaphenyi bafuna ukubona ukuthi kuyasebenza yini futhi kuphephile ekunciphiseni ukuqhubeka kokukhubazeka kubantu abane-PPMS. Ezifundweni zokubheka, abacwaningi baqapha ababambiqhaza ngaphandle kokungenelela kule nqubo.

Olunye ucwaningo lwesigaba III luhlola ukwakheka komthamo ophezulu we-biotin owaziwa nge-MD1003 ukubona ukuthi lusebenza kangcono kune-placebo. Abaphenyi bafuna ukwazi ukuthi kunganciphisa yini ukukhubazeka kwabantu abane-MS eqhubekayo, ikakhulukazi labo abanokukhubazeka kwe-gait.

Isivivinyo esincane esinelebuli evulekile sibheke imiphumela ye-biotin yedosi ephezulu kubantu abane-PPMS noma i-SPMS. Imithamo isukela kuma-milligram ayi-100 kuye kwangama-300 ngosuku izinyanga ezimbili kuya kwezingama-36.

Abahlanganyeli kulolu cwaningo babonise ukuthuthuka kokukhubazeka okubukwayo okuhlobene nokulimala kwe-optic nerve nezinye izimpawu ze-MS, njengokusebenza kwezimoto nokukhathala.

Kodwa-ke, olunye ucwaningo luthole ukuthi i-biotin yedosi ephezulu icishe yaphindeka kathathu izinga lokubuyela emuva kwabahlanganyeli abane-PPMS.

Ubuye waxwayisa ukuthi imithamo ephezulu ye-biotin ingaholela emiphumeleni enganembile yelabhu kubantu abanezimo ezithile, kufaka phakathi i-MS.

I-Masitinib (AB1010)

I-Masitinib yisidakamizwa somlomo sokuzivikela emzimbeni esenziwe njengokwelashwa okungenzeka kwe-PPMS.

Ukwelashwa sekuvele kukhombisile ukuthembisa esivivinyweni sesigaba II. Njengamanje kusaphenywa ocwaningweni lwesigaba III kubantu abane-PPMS noma i-SPMS engabuyeli emuva.

Ibudilast

I-Ibudilast inqanda i-enzyme ebizwa nge-phosphodiesterase. Isetshenziswa njengomuthi wesifuba ikakhulukazi e-Asia, kukhonjisiwe futhi ukukhuthaza ukulungiswa kwe-myelin nokusiza ukuvikela amaseli ezinzwa ekulimaleni.

U-Ibudilast uklonyeliswe nge-FDA ukuqokwa kwethrekhi esheshayo. Lokhu kungasheshisa ukukhula kwayo kwesikhathi esizayo njengokwelashwa okungenzeka kwe-MS okuqhubekayo.

Imiphumela yesivivinyo sesigaba II ezigulini ezingama-255 ezine-MS eqhubekayo yashicilelwa kuThe New England Journal of Medicine.

Ocwaningweni, i-ibudilast yayihlotshaniswa nokuqhubeka kancane kwe-atrophy yobuchopho kune-placebo. Kodwa-ke, futhi kwaholela emazingeni aphezulu emiphumela emibi yohlelo lokugaya ukudla, ikhanda elibuhlungu nokudangala.

Izindlela zokwelapha zemvelo nezihambisanayo

Ezinye izindlela eziningi zokwelashwa, ngaphandle kwemithi, zingasiza ukwandisa ukusebenza nekhwalithi yempilo yize kunemiphumela yalesi sifo.

Ukwelashwa emsebenzini

Ukwelashwa emsebenzini kufundisa abantu amakhono asebenzayo abawadingayo ukuze bazinakekele ekhaya nasemsebenzini.

Ochwepheshe basemsebenzini bakhombisa abantu ukuthi bangawagcina kanjani amandla abo, ngoba i-PPMS imvamisa ibangela ukukhathala okukhulu. Basiza nabantu ukulungisa imisebenzi yabo yansuku zonke nemisebenzi yabo yasekhaya.

Abelaphi bangaphakamisa izindlela zokwenza ngcono noma ukuvuselela amakhaya nezindawo zokusebenza ukuze zenziwe zifinyeleleke kubantu abakhubazekile. Bangasiza futhi ekwelapheni inkumbulo nezinkinga zokuqonda.

Ukwelashwa ngokomzimba

Abahlinzeki bomzimba basebenzela ukudala izindlela ezithile zokuzivocavoca umzimba ukusiza abantu ukuthi bandise ukunyakaza kwabo, balondoloze ukuhamba kwabo, futhi banciphise ukuqina nokuzamazama.

Abahlinzeki bomzimba bangancoma imishini yokusiza abantu abane-PPMS ukuba bahambe kangcono, njenge:

• izihlalo ezinamasondo
• abahamba ngezinyawo
• izinduku
• izithuthuthu

I-pathology yolimi lwenkulumo (SLP)

Abanye abantu abane-PPMS banezinkinga ngolimi lwabo, ukukhuluma, noma ukugwinya. Ama-pathologists angafundisa abantu ukuthi:

• lungisa ukudla okulula ukukugwinya
• udle ngokuphepha
• sebenzisa amashubhu wokondla kahle

Bangancoma nezinsiza zocingo eziwusizo nezikhulisi zokukhuluma ukuze kwenziwe ukuxhumana kube lula.

Ukuzivocavoca umzimba

Ukuzivocavoca umzimba kungakusiza wehlise ukuqina futhi ugcine ukuhamba okuningana. Ungazama i-yoga, ukubhukuda, ukuzelula, nezinye izinhlobo zokuzivocavoca ezamukelekayo.

Vele, kuhlale kungumqondo omuhle ukuxoxa nganoma yisiphi isimiso esisha sokuzivocavoca nodokotela wakho.

Izindlela zokwelapha ezihambisanayo nezinye (CAM)

Imithi yokwelashwa ye-CAM ibhekwa njengezindlela ezingajwayelekile. Abantu abaningi bafaka uhlobo oluthile lokwelashwa kwe-CAM njengengxenye yokuphathwa kwabo kwe-MS.

Kunocwaningo olulinganiselwe oluhlola ukuphepha nokusebenza kwe-CAM ku-MS. Kodwa izindlela zokwelapha ezinjalo zihloselwe ukusiza ukuvimbela lesi sifo ekulimaleni isimiso sakho sezinzwa nokugcina impilo yakho ukuze umzimba wakho ungezwa kakhulu ngemiphumela yalesi sifo.

Ngokwesifundo esisodwa, izindlela zokwelashwa ze-CAM ezithembisa kakhulu ze-MS zifaka:

• ukudla okunamafutha amancane
• ama-omega-3 fatty acid anezela
• izithako ze-lipoic acid
• izengezo zikavithamini D

Khuluma nodokotela wakho ngaphambi kokungeza i-CAM ohlelweni lwakho lokwelashwa, futhi uqiniseke ukuthi uyaqhubeka nokulandela izindlela zakho zokwelashwa ezibekiwe.

Ukwelapha izimpawu ze-PPMS

Izimpawu ezijwayelekile ze-MS ongazithola zifaka:

• ukukhathala
• ukuba ndikindiki
• ubuthakathaka
• isiyezi
• ukukhubazeka kwengqondo
• ukuqina
• ubuhlungu
• ukungalingani
• izinkinga zomchamo
• ukuguquka kwemizwelo

Ingxenye enkulu yohlelo lwakho lonke lokwelashwa kuzoba ukuphatha izimpawu zakho. Ungadinga imishanguzo enhlobonhlobo, ushintsho endleleni ophila ngayo, kanye nokwelashwa okuhambisanayo ukwenza lokhu.

Imithi

Ngokuya ngezimpawu zakho, udokotela angakunikeza:

• ukuphumula kwemisipha
• imishanguzo
• imithi yokungasebenzi kahle kwesinye
• imithi yokwehlisa ukukhathala, njenge-modafinil (Provigil)
• imithi yezinhlungu
• izinsiza zokulala ezisiza ukuqwasha
• imithi yokusiza ekwelapheni ukungasebenzi kahle kwe-erectile (ED)

Izinguquko zendlela yokuphila

Lezi zinguquko zendlela yokuphila zingenza izimpawu zakho zilawuleke kakhulu:

• Yidla ukudla okunempilo okunothe ngamavithamini, amaminerali kanye nama-antioxidants.
• Yenza izivivinyo zokwakha amandla ukwakha imisipha futhi kukhulise amandla.
• Zama ukuzivocavoca ngobumnene nezinhlelo zokwelula njenge-tai chi ne-yoga ukusiza ngokulinganisela, ukuguquguquka, nokuxhumanisa.
• Gcina inqubo efanele yokulala.
• Phatha ukucindezelwa ngokubhucungwa, ukuzindla, noma ukutshopa.
• Sebenzisa amadivayisi okusiza ukuthuthukisa ikhwalithi yempilo.

Ukuvuselelwa

Umgomo wokuvuselelwa ukuthuthukisa nokugcina ukusebenza nokunciphisa ukukhathala. Lokhu kungafaka:

• ukwelashwa ngokomzimba
• ukwelashwa emsebenzini
• ukuvuselelwa kwengqondo
• izifo zolimi lokukhuluma
• ukuvuselelwa kwamakhono

Buza udokotela wakho ukuthi akudlulisele kochwepheshe kulezi zindawo.

Ukudla okudlela endlini

I-PPMS akuyona uhlobo olujwayelekile lwe-MS, kodwa abacwaningi abaningi basacwaninga izindlela zokwelapha lesi simo.

Ukuvunyelwa kuka-ocrelizumab ngo-2017 kumake isinyathelo esikhulu sokuya phambili ngoba kuvunyelwe ukukhonjiswa kwe-PPMS. Ezinye izindlela zokwelapha ezivelayo, ezinjenge-anti-inflammatories ne-biotin, zithole imiphumela exubile ku-PPMS kuze kube manje.

I-Ibudilast nayo ifundelwe imiphumela yayo ku-PPMS naku-SPMS. Imiphumela yakamuva evela esivivinyweni sesigaba II ikhombisa ukuthi ibangela imiphumela emibi ethile, kubandakanya ukucindezeleka. Kodwa-ke, yayihlotshaniswa nezinga eliphansi le-atrophy yobuchopho.

Khuluma nodokotela wakho uma ufuna ulwazi olusesikhathini kakhulu ngezindlela ezinhle zokuphatha i-PPMS yakho.