Ukuvuselelwa kwengqondo enzulu

Ukukhuthaza ubuchopho obunzulu (i-DBS) isebenzisa isixhobo esibizwa ngokuba yi-neurostimulator ukuhambisa imiqondiso yombane kwiindawo zobuchopho ezilawula intshukumo, iintlungu, imood, ubunzima, iingcinga ezinyanzelekileyo, kunye nokuvuka kwi-coma.

Inkqubo ye-DBS inamalungu amane:

• Inye okanye ezingaphezulu, iingcingo ezifakiweyo ezibizwa ngokuba zikhokelela, okanye ii-electrode, ezibekwe kwingqondo
• Iiankile zokulungisa izikhokelo kukhakhayi
  
• I-neurostimulator, ebeka umbane ngoku. Isikhuthazi sifana nentliziyo pacemaker. Ihlala ibekwe phantsi kolusu kufutshane nekhola, kodwa inokubekwa kwenye indawo emzimbeni
• Kwabanye abantu enye intambo encinci, efakwe kwi-insulated ebizwa ngokuba yongezwa yongezwa ukudibanisa ukukhokelela kwi-neurostimulator

Utyando lwenziwa ukubeka icandelo ngalinye lenkqubo ye-neurostimulator. Kubantu abadala, yonke inkqubo inokufakwa kwinqanaba le-1 okanye le-2 (utyando ezimbini ezahlukeneyo).

Isigaba 1 sihlala senziwa phantsi kwe-anesthesia yendawo, okuthetha ukuba uvukile, kodwa awunazintlungu. (Kubantwana, i-anesthesia ngokubanzi inikwa.)

• Inwele encinci entlokweni yakho inokuchetywa.
• Intloko yakho ibekwe kwisakhelo esikhethekileyo usebenzisa izikrufu esincinci ukuyigcina izolile ngexesha lenkqubo. Iyeza lokufaka amanani lisetyenziswa apho izikrufu zinxibelelana nentloko. Ngamanye amaxesha, inkqubo yenziwa kumatshini we-MRI kwaye isakhelo siphezu kwentloko yakho kunokuba sijikeleze intloko yakho.
• Iyeza lokufaka amanani lisetyenziswa kulusu lwakho kwindawo apho ugqirha aya kuvula khona isikhumba, emva koko ubole imbobo encinci kukhakhayi kwaye ubeke indawo ekhokelela kwindawo ethile yobuchopho.
• Ukuba omabini amacala obuchopho bakho ayanyangwa, ugqirha wotyando wenza ukuvuleka kwicala ngalinye lekhakhayi, kwaye kufakwe izikhokelo ezimbini.
• Iimpembelelo zombane zingadinga ukuba zithunyelwe ngokukhokelela ekuqinisekiseni ukuba zixhunyiwe kwindawo yengqondo ejongene neempawu zakho.
• Unokubuzwa imibuzo, ufunde amakhadi, okanye uchaze imifanekiso. Unokucelwa ukuba uhambise imilenze okanye iingalo zakho. Oku kukuqinisekisa ukuba ii-electrode zikwindawo efanelekileyo kwaye iziphumo ezilindelekileyo ziyafezekiswa.
  

Isigaba sesi-2 senziwa phantsi kwe-anesthesia jikelele, oku kuthetha ukuba ulele kwaye awunazintlungu. Ixesha leli nqanaba lotyando luxhomekeke kwindawo apho isikhuthazi siza kubekwa khona.

• Ugqirha wenza uvulo oluncinci (ukusikwa), ihlala ingezantsi kwekhola kwaye afake i-neurostimulator. (Ngamanye amaxesha ibekwa phantsi kolusu kwisifuba esisezantsi okanye kwindawo yesisu.)
• Ucingo olwandisiweyo luthungelwe phantsi kolusu lwentloko, intamo, kunye negxalaba kwaye luqhagamshelwe kwi-neurostimulator.
• Incision ivaliwe. Isixhobo kunye neengcingo azibonakali ngaphandle komzimba.

Nje ukuba idityanisiwe, iimpompo zombane zihamba ukusuka kwi-neurostimulator, ecaleni kwetambo yolwandiso, ukuya phambili, nasezingqondweni. Ezi pulses zincinci ziyaphazamisa kwaye zivimbe imiqondiso yombane ebangela iimpawu zezifo ezithile.

I-DBS iqhele ukwenziwa kubantu abanesifo se-Parkinson xa iimpawu zingenakulawulwa ngamayeza. I-DBS ayisinyangi isifo se-Parkinson, kodwa inokunceda ukunciphisa iimpawu ezinje:

• Iinyikima
• Ubungqongqo
• Ukuqina
• Ukuhamba kancinci
• Iingxaki zokuhamba

I-DBS inokusetyenziselwa ukunyanga le miqathango ilandelayo:

• Uxinzelelo olukhulu olungaphenduliyo kumayeza
• Ubume obungalunganga obuphambanisayo
• Intlungu engapheliyo (iintlungu ezingapheliyo)
• Ukutyeba kakhulu
• Ukushukumisa intshukumo engenakulawulwa kwaye unobangela awaziwa (inyikima ebalulekileyo)
• I-Tourette syndrome (kwiimeko ezinqabileyo)
• Ukuhamba okungalawulekiyo okanye okucothayo (dystonia)

I-DBS ithathwa njengekhuselekileyo kwaye iyasebenza xa isenziwa kubantu abalungileyo.

Umngcipheko wokubekwa kwe-DBS unokubandakanya:

• Ukusabela okungafunekiyo kumalungu e-DBS
• Ingxaki ukugxila
• Ukuba nesiyezi
• Usulelo
• Ukuvuza kwe-cerebrospinal fluid, enokuthi ikhokelele kwintloko ebuhlungu okanye kwi-meningitis
• Ukuphulukana nokulingana, ukunciphisa ukulungelelanisa, okanye ilahleko encinci yokuhamba
• Iimvakalelo ezothusayo
• Iingxaki zentetho okanye umbono
• Intlungu yethutyana okanye ukudumba kwindawo apho kufakwe khona isixhobo
• Ukubetheka okwethutyana ebusweni, kwiingalo, okanye emilenzeni
• Ukopha kwingqondo

Iingxaki zinokwenzeka kwakhona ukuba iinxalenye zenkqubo ye-DBS ziyaphuka okanye zihamba. Oku kubandakanya:

• Isixhobo, isikhokelo, okanye ukuqhekeka kweengcingo, ezinokukhokelela kolunye utyando ukubuyisela indawo eyaphukileyo
• Ibhetri iyasilela, eya kuthi ibangele ukuba isixhobo siyeke ukusebenza ngokufanelekileyo (ibhetri eqhelekileyo ihlala ihlala iminyaka emi-3 ukuya kwemi-5, ngelixa ibhetri egcwalisekayo ihlala malunga neminyaka eli-9)
• Ucingo oludibanisa isikhuthazi kunye nesikhokelo kwingqondo luqhekeza ulusu
• Inxalenye yesixhobo esibekwe kwingqondo sinokuqhawuka okanye siye endaweni eyahlukileyo kwingqondo (oku kunqabile)

Umngcipheko onokubakho kulo naluphi na utyando lobuchopho zezi:

• Ukuqhaqha kwegazi okanye ukopha kwingqondo
• Ukudumba kobuchopho
• Coma
• Ukudideka, kuhlala kuphela iintsuku okanye iiveki ubuninzi
• Usulelo kwingqondo, enxebeni, okanye kwikakayi
• Iingxaki ngentetho, inkumbulo, ubuthathaka bemisipha, ibhalansi, umbono, ulungelelwaniso, kunye neminye imisebenzi, enokuba yeyethutyana okanye esisigxina
• Ukuxhuzula
• Ukubetha

Iingozi zeanesthesia ngokubanzi zezi:

• Impendulo kumayeza
• Iingxaki zokuphefumla

Uya kuba novavanyo olupheleleyo lomzimba.

Ugqirha wakho uya ku-odola iimvavanyo ezininzi zaselebhu kunye nokucinga, kubandakanya i-CT okanye iMRI scan. Olu vavanyo lokucinga lwenziwa ukunceda ugqirha ukuba abonise elona candelo lobuchopho linoxanduva lweempawu. Imifanekiso isetyenziselwa ukunceda ugqirha ukuba abeke phambili kwingqondo ngexesha lotyando.

Kuya kufuneka ubone iingcali ezingaphezu kwesinye, ezinje nge-neurologist, i-neurosurgeon, okanye isayikholojisti, ukuze uqiniseke ukuba inkqubo ikulungele kwaye inelona thuba liphumelelayo lokuphumelela.

Ngaphambi kokuhlinzwa, xelela ugqirha wakho:

• Ukuba unokukhulelwa
• Ngawaphi amayeza owathathayo, kubandakanya amayeza, izongezo, okanye iivithamini owathengileyo ngaphandle kwekhawuntari ngaphandle kommiselo
• Ukuba ubusele utywala kakhulu

Ngexesha leentsuku ngaphambi kotyando:

• Umboneleli wakho wokhathalelo lwempilo angakuxelela ukuba uyeke okwethutyana ukuthoba igazi. Oku kubandakanya warfarin (Coumadin, Jantoven), dabigatran (Pradaxa), rivaroxaban powder (Xarelto), apixaban (Eliquis), clopidogrel (Plavix), aspirin, ibuprofen, naproxen, kunye nezinye ii-NSAID.
• Ukuba uthatha amanye amayeza, cela umboneleli wakho ukuba kulungile ukuwathatha ngosuku okanye kwiintsuku eziphambi kotyando.
• Ukuba uyatshaya, zama ukuyeka. Cela uncedo kumboneleli wakho.

Ngobusuku bangaphambi nangomhla wotyando, landela imiyalelo malunga:

• Ukungaseli okanye ukutya nantoni na kangangeeyure eziyi-8 ukuya kwezi-12 ngaphambi kotyando.
• Ukuhlamba iinwele zakho ngeshampu ekhethekileyo.
• Thatha amayeza umboneleli wakho akuxelele ukuba uwathabathe ngesiphuzo esincinci samanzi.
• Ukufika esibhedlele ngexesha.

Kuya kufuneka uhlale esibhedlele malunga neentsuku ezintathu.

Ugqirha unokumisela amayeza okubulala iintsholongwane ukuthintela usulelo.

Uya kubuyela e-ofisini kagqirha wakho emva komhla wokuhlinzwa. Ngelixa lotyelelo, isikhuthazi ivuliwe kwaye isixa sokuvuselela sihlengahlengisiwe. Utyando aludingeki. Le nkqubo ikwabizwa ngokuba yinkqubo.

Nxibelelana nogqirha wakho ukuba uphuhlisa oku kulandelayo emva kotyando lwe-DBS:

• Ifiva
• Intloko ebuhlungu
• Ukurhawuzelela okanye urticies
• Ubuthathaka bemisipha
• Isicaphucaphu nokugabha
• Ubudenge okanye ukurhawuzelela kwelinye icala lomzimba
• Intlungu
• Ububomvu, ukudumba, okanye ukucaphuka nakweyiphi na indawo yotyando
• Ingxaki yokuthetha
• Iingxaki zombono

Abantu abane-DBS bahlala benza kakuhle ngexesha lotyando. Abantu abaninzi banokuphucuka okukhulu kwiimpawu zabo kunye nomgangatho wobomi. Uninzi lwabantu lusadinga ukuthatha amayeza, kodwa ngedosi esezantsi.

Olu tyando, kunye notyando ngokubanzi, luyingozi kubantu abangaphezulu kweminyaka engama-70 nakwabo baneemeko zempilo ezinje ngoxinzelelo lwegazi kunye nezifo ezichaphazela imithambo yegazi kwingqondo. Wena kunye nogqirha wakho kuya kufuneka nilinganise ngononophelo izibonelelo zolu tyando nxamnye neengozi.

Inkqubo ye-DBS inokubuyiselwa umva, ukuba iyafuneka.

I-Globus pallidus enzulu yokuvuselela ingqondo; Inkuthazo yobuchopho obunzulu; Ukhuthazo lobuchopho obunzulu beThalam; DBS; Ubuchopho be-neurostimulation

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ILozano AM, uLipsman N, uBergman H, et al. Ukuvuselelwa kwengqondo enzulu: imiceli mngeni yangoku kunye nezikhokelo zexesha elizayo Nat Rev Neurol. 2019; 15 (3): 148-160. IINKCUKACHA: 30683913 pubmed.ncbi.nlm.nih.gov/30683913/.

Rundle-Gonzalez V, Peng-Chen Z, Kumar A, Okun MS. Ukuvuselela ingqondo nzulu. Ku: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, ii-eds. I-Neurology kaBradley kwiKlinikhi yokuziqhelanisa. Umhla wesi-7. IPhiladelphia, PA: Elsevier; 2016: isahluko 37.