Kev sib sib zog nqus ntawm lub hlwb

Lub hlwb sib sib zog nqus (DBS) siv cov khoom siv hu ua neurostimulator xa cov hluav taws xob xa mus rau thaj chaw ntawm lub hlwb uas tswj kev txav, mob, lub siab lub cev, qhov hnyav, tsis xav txog qhov kev xav, thiab tsim los ntawm lub cev tsis nco qab.

DBS system muaj plaub ntu:

• Ib lossis ntau dua, cov kab hluav taws xob hu ua cov hlau lead, lossis hluav taws xob, uas tau muab tso rau hauv lub hlwb
• Cov thauj tog rau nkoj txhawm rau kho qhov ua rau lub pob txha taub hau
  
• Neurostimulator, uas tso tawm ntawm lub roj hluav taws xob. Cov stimulator zoo ib yam li lub plawv dhia ceev ceev. Nws feem ntau yog muab tso rau hauv qab daim tawv nqaij nyob ze ntawm lub caj dab, tab sis tej zaum yuav muab tso rau lwm qhov ntawm lub cev
• Hauv qee tus neeg lwm tus nyias, insulated hlau hu ua kev txuas ntxiv tau ntxiv los txuas cov hlau lead rau lub neurostimulator

Kev phais mob tau ua tiav tso rau txhua ntu ntawm cov txheej txheem neurostimulator. Hauv cov laus, tag nrho cov kab ke tuaj yeem tso rau hauv 1 lossis 2 theem (ob qho kev phais cais).

Theem 1 ib txwm ua nyob rau hauv tshuaj loog hauv zos, txhais tau tias koj tsaug zog, tab sis tsis muaj mob. (Hauv cov menyuam yaus, kev muab tshuaj loog yog muab rau.)

• Ib ntsis plaub hau ntawm koj lub taub hau yuav zoo li chais.
• Koj lub taub hau tau muab tso rau hauv cov ntawv tshwj xeeb uas siv ntsia hlau me me kom nws tseem nyob thaum txoj kev ua haujlwm. Numbing tshuaj tau thov nyob rau qhov twg cov screws hu rau saum tawv taub hau. Qee zaum, tus txheej txheem tau ua tiav hauv MRI lub tshuab thiab thav duab yog sab saum koj lub taub hau dua li ncig koj lub taub hau.
• Cov tshuaj numbing tau thov rau koj cov tawv taub hau ntawm thaj chaw uas tus kws phais yuav qhib daim tawv, tom qab ntawd tho qhov qhib me me rau hauv pob txha taub hau thiab muab cov hmoov txhuas coj mus rau hauv thaj chaw tshwj xeeb ntawm lub hlwb.
• Yog hais tias ob sab ntawm koj lub hlwb tau txais kev kho mob, tus kws phais mob ua rau qhib ib sab ntawm txhua lub pob txha taub hau, thiab ob txoj hau kev tau ntxig.
• Kev siv hluav taws xob tuaj yeem xa mus los ntawm cov ntawv txhuas kom paub tseeb tias nws txuas nrog thaj tsam ntawm lub hlwb lub luag haujlwm rau koj cov tsos mob.
• Koj yuav raug nug cov lus nug, nyeem cov ntawv teev lus, lossis piav qhia cov duab. Lawv tseem yuav kom koj txav koj ob sab ceg lossis caj npab. Cov no yog ua kom cov electrodes muaj nyob rau hauv txoj haujlwm txoj haujlwm thiab cov nyhuv xav pom tiav.
  

Theem 2 yog ua tiav los ntawm kev siv tshuaj loog, txhais tau tias koj tsaug zog thiab tsis hnov ​​mob. Lub sijhawm ntawm qib theem ntawm kev phais mob no yog nyob ntawm qhov twg hauv lub hlwb qhov txhawb kom ua haujlwm.

• Tus kws phais mob ua kom qhib me me (phais), feem ntau tsuas yog hauv qab ntawm lub caj dab thiab qog ntawm neurostimulator. (Qee zaum nws muab tso rau hauv qab daim tawv nqaij hauv qab hauv siab lossis lub plab hauv plab.)
• Cov xov hlau txuas ntxiv tau tho nyob rau hauv daim tawv nqaij ntawm lub taub hau, caj dab, thiab xub pwg thiab txuas nrog lub neurostimulator.
• Qhov phais ntawd tau kaw. Cov cuab yeej thiab cov xov hlau tsis tuaj yeem pom sab nraud lub cev.

Thaum sib txuas, hluav taws xob pulses mus los ntawm lub neurostimulator, nrog cov txuas hlau txuas ntxiv, mus rau cov hlau lead, thiab nkag mus rau lub hlwb. Cov xaim me me no cuam tshuam nrog thiab thaiv cov teeb liab hluav taws xob uas ua rau cov tsos mob ntawm qee yam kab mob.

DBS ib txwm muaj rau cov neeg muaj tus mob Parkinson thaum cov tsos mob tswj tsis tau los ntawm tshuaj. DBS tsis kho cov mob Parkinson, tab sis tuaj yeem pab txo cov tsos mob xws li:

• Tus tsim hluav taws xob
• Txhav Dab Tsi
• Lub cev txhav
• Qeeb qeeb
• Taug kev teeb meem

DBS kuj tseem siv tau los kho cov mob hauv qab no:

• Kev nyuaj siab loj uas tsis teb zoo rau cov tshuaj
• Obsessive-compulsive tsis meej
• Qhov mob tsis ploj mus (mob mob)
• Kev rog nyhav
• Tsoo zog uas tsis tuaj yeem tswj tau thiab qhov ua rau tsis paub (lub tshee tshee)
• Tourette Syndrome (muaj qee zaus)
• Kev tswj tsis tau lossis qeeb zog (dystonia)

DBS tau pom tias muaj kev nyab xeeb thiab muaj txiaj ntsig thaum ua tiav cov neeg.

Kev phom sij ntawm qhov muab nkag rau DBS yuav suav nrog:

• Ua xua rau DBS ntu
• Qhov teeb meem kom pom tseeb
• Kiv taub hau
• Kab mob
• To ntawm cerebrospinal kua, uas tuaj yeem ua rau mob taub hau lossis mob caj dab
• Kev ploj ntawm kev tshuav, txo kev sib koom tes, lossis me ntsis poob ntawm lub zog
• Poob siab-xws li ncus
• Hais lus lossis teeb meem tsis pom kev
• Kev mob ib ntus lossis o ntawm qhov chaw uas lub khoom cog khoom
• Tingling ib ntus hauv lub ntsej muag, caj npab, lossis ceg
• Los ntshav nyob rau hauv lub hlwb

Cov teeb meem tseem yuav tshwm sim yog tias ib feem ntawm DBS system tawg lossis tsiv mus. Cov no suav nrog:

• Ntaus ntawv, txhuas, lossis cov xov hluav taws xob tawg, uas tuaj yeem ua rau lwm qhov kev phais los hloov qhov tawg
• Lub roj teeb tsis ua haujlwm, uas yuav ua rau lub xov tooj tsum tsis ua haujlwm zoo (lub roj teeb ib txwm siv sijhawm ntev li 3 txog 5 xyoos, thaum lub roj teeb rov siv tau ntev txog 9 xyoo)
• Cov kav hlau uas txuas cov twj txhawb nqa mus rau cov txhuas hauv lub paj hlwb tawg los ntawm daim tawv nqaij
• Ib feem ntawm cov cuab yeej muab tso rau hauv lub hlwb yuav tawg tawm lossis txav mus rau qhov chaw sib txawv hauv lub hlwb (qhov no tsis tshua muaj)

Cov kev pheej hmoo txaus ntshai ntawm kev phais mob hlwb yog:

• Cov ntshav txhaws lossis ntshav tawm hauv lub hlwb
• Lub hlwb o
• Coma
• Tsis meej pem, feem ntau tsuas kav rau hnub lossis lim tiam ntawm feem ntau
• Kab mob hauv lub hlwb, hauv qhov txhab lossis hauv pob txha taub hau
• Cov teeb meem hais lus, nco, ua rau cov leeg tsis muaj zog, tshuav nyiaj li cas, pom kev, sib koom tes, thiab lwm yam haujlwm, uas yuav ua tau luv luv lossis tas mus li
• Qaug dab peg
• Mob stroke

Kev phom sij ntawm cov tshuaj loog yog:

• Kev tshuaj tiv thaiv
• Teeb meem ua pa

Koj yuav muaj kev kuaj mob lub cev tag.

Koj tus kws kho mob yuav xaj ntau yam kev sim thiab ntsuas duab, suav nrog CT lossis MRI scan. Cov kev ntsuam xyuas keeb kwm no yog ua los pab tus kws phais neeg txheeb xyuas qhov tseeb ntawm lub hlwb tau lees paub rau cov tsos mob. Cov duab no tau siv los pab tus kws phais neeg tso tus thawj hauv lub hlwb thaum phais mob.

Tej zaum koj yuav tsum ntsib ntau tshaj ib tus kws tshaj lij, xws li tus kws kho mob hlwb, neurosurgeon, lossis tus kws kho hlwb, kom paub meej tias cov txheej txheem no yog rau koj thiab muaj txoj hauv kev zoo.

Ua ntej kev phais mob, qhia rau koj tus kws phais mob:

• Yog koj xeeb tub
• Cov tshuaj twg koj noj, nrog rau tshuaj ntsuab, tshuaj ntxiv, lossis vitamins koj yuav tom kiab khw yam tsis muaj daim ntawv yuav tshuaj
• Yog hais tias koj tau haus cawv ntau heev

Thaum lub hnub ua ntej kev phais mob:

• Koj tus kws kho mob yuav hais kom koj tsum tsis txhob noj cov ntshav thinner. Cov no suav nrog warfarin (Coumadin, Jantoven), dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), clopidogrel (Plavix), tshuaj aspirin, ibuprofen, naproxen, thiab lwm yam NSAIDs.
• Yog tias koj noj lwm yam tshuaj, nug koj tus kws kho mob yog tias lawv xav tshuaj rau hnub lawv lossis hnub ua ntej kev phais mob.
• Yog koj haus luam yeeb, sim nres. Nug koj tus kws khomob kom pab.

Hmo ua ntej thiab hnub phais mob, ua raws cov lus qhia txog:

• Tsis haus cawv los yog noj dab tsi rau 8 rau 12 teev ua ntej kev phais mob.
• Ntxuav koj cov plaub hau nrog tsuaj zawv plaub hau tshwj xeeb.
• Noj cov tshuaj uas koj tus kws kho mob hais kom koj nqa nrog lub pas dej me me.
• Mus txog tsev kho mob kom ncav sijhawm.

Tej zaum koj yuav tau nyob hauv tsev kho mob txog 3 hnub.

Tus kws kho mob yuav sau ntawv tawm tshuaj tua kab mob los tiv thaiv tus kab mob.

Koj yuav rov qab mus rau koj tus kws kho mob lub chaw ua haujlwm tom qab hnub tom qab phais mob. Thaum lub sijhawm mus saib xyuas no, lub stimulator tau muab hloov thiab qhov nyiaj ntawm lub stimulation raug kho. Tsis xav phais. Tus txheej txheem no tseem hu ua lub cajmeem.

Hu rau koj tus kws kho mob yog tias koj muaj qee yam hauv qab no tom qab kev phais DBS:

• Ua npaws
• Mob taub hau
• Khaus lossis khaus
• Nqaij tsis muaj zog
• Xeev siab thiab ntuav
• Xuas caj dab los yog tingling ntawm ib sab ntawm lub cev
• Mob
• Liab, o, los sis vau ntawm ib thaj chaw phais
• Teeb meem hais lus
• Cov teeb meem tsis pom kev

Cov neeg muaj DBS feem ntau ua tau zoo thaum phais mob. Coob tus neeg muaj kev txhim kho zoo rau lawv cov tsos mob thiab lub neej zoo. Cov neeg feem coob tseem yuav tsum tau noj tshuaj, tab sis ntawm kev noj tshuaj ntau dua.

Qhov kev phais mob no, thiab kev phais mob feem ntau, tau nce siab rau cov neeg muaj hnub nyoog 70 xyoo thiab cov neeg muaj mob xws li ntshav siab thiab kab mob uas cuam tshuam rau cov hlab ntshav hauv lub hlwb. Koj thiab koj tus kws kho mob yuav tsum ua tib zoo ntsuas cov txiaj ntsig ntawm kev phais mob no txhawm rau tiv thaiv kev pheej hmoo.

Tus txheej txheem DBS tuaj yeem hloov rov qab, yog tias xav tau.

Globus pallidus sib sib zog nqus lub hlwb txhawb nqa; Subthalamic sib sib zog nqus lub hlwb kev tsa; Thalamic sib sib zog nqus lub hlwb tsa; DBS; Lub hlwb neurostimulation

Johnson LA, Vitek JL. Kev sib sib zog nqus ntawm lub hlwb: cov txheej txheem ntawm kev txiav txim. Hauv: Winn HR, ed. Youmans thiab Winn Neurological phaisCov. 7 tus ed. Philadelphia, PA: Elsevier; 2017: cha 91.

Lozano AM, Lipsman N, Bergman H, li al. Kev sib sib zog nqus ntawm lub hlwb: kev cov nyom tam sim no thiab cov lus qhia yav tom ntej. Nat Rev NeurolCov. 2019; 15 (3): 148-160. PMID: 30683913 pubmed.ncbi.nlm.nih.gov/30683913/.

Pob-Gonzalez V, Peng-Chen Z, Kumar A, Okun MS. Kev sib sib zog nqus ntawm lub hlwb. Hauv: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology nyob rau hauv Kev Soj NtsuamCov. 7 tus ed. Philadelphia, PA: Elsevier; 2016: chap 37.