Ukuguqulwa nokuxhatshazwa kwezifo zeNkqubo yeNervous

El Paso, TX. I-Chiropractor, uDkt. Alexander Jimenez ugxile kulo ukuguga kunye nokutshatyalaliswa kwezifo zesimiso senzwa, iimpawu zabo, izizathu kunye nokonyango.

Izifo eziDala iziQinisekiso kunye neDemyelinating

Neuron Izifo

• Ubuthathaka obuthathaka ngaphandle kweenguqulelo
• I-Amyotrophic lateral sclerosis (ALS)
• ALS
• Primary sclerosis
• Inkqubela yokuqhuma
• Iimeko ezizuzelelweyo ezibangelwa ukuhlaliswa kwecilongo yangaphondo
• Isifo sikaM Werdnig-Hoffmann kwiintsana
• Isifo se-Kugelberg-Welander kubantwana kunye nabantu abadala

I-Amyotrophic Lateral Sclerosis (ALS)

• Ichaphazela izigulane ze-40-60 ubudala ubudala
• Umonakalo:
• Iipilisi zophondo zangaphambili
• I-cranial motor ner nuclei
• I-Corticobulbar kunye namaphecana eprostospin
• Iziphumo zokufumana i-neuron (infrostity, hyperreflexia)
• Ukusinda ~ iminyaka emithathu
• Ukufa kubangelwa kukungabikho kobuthathaka kunye nomzimba wokuphefumula kunye nokusuleleka kwintsholongwane

ALS

• Ngokuqhelekileyo ekugqibeleni iguqukela kumzekelo we-ALS oqhelekileyo
• I-Primary Lateral Sclerosis
• Iimpawu ze-neuron ezisemgangathweni ziqala kuqala, kodwa izigulane zigcina zineempawu ezisezantsi ze-neuron
• Ukusinda kungaba yiminyaka elishumi okanye ngaphezulu
• Ukuguqulwa kweBarbar Palsy
• Ukhetho luquka intloko nentamo yentambo

Izimo zeMoto zeNoron

• Ulwaphulo lwepilisi yangaphambili
• Isifo sikaM Werdnig-Hoffmann
• Ichaphazela iintsana
• Isifo seKagelberg-Welander
• Ichaphazela abantwana nabaselula

Icawa, u-Archibald. Izifo Neengqondo. WB Saunders Co., 1923.

Izifo zeAlzheimer

• Echazwe zii-tangles ze-neurofibrillary (i-aggregates ye-protein ye-hyperphosphorylated tau) kunye ne-beta-amyloid plaques
• Ngokuqhelekileyo kwenzeka emva kweminyaka yobudala 65
• Imiba yobungozi
• Ukuguqulwa kwegazi kwi-beta amyloid gene
• Uhlobo lwe-Epsilon 4 lwe-apolipoprotein

Ukuqondwa

• Ukuxilongwa kwe-Pathologic yindlela ephela yokufumanisa ngokucacileyo imeko
• Ukucingwa kunokukwazi ukulawula ezinye izizathu zengqondo
• Izifundo zengcamango zokusebenza ziyakwazi ukuphuhliswa ukuze zifumaneke luncedo kwixesha elizayo
• Ucwaningo lwe-CSF ukuhlola iiprotheni ze-tau kunye ne-beta amyloid zinokuba luncedo njengeemvavanyo zokuxilonga kwixesha elizayo

Iiplaque zeAmyloid kunye neeTangles zeNeurofibrillary

sage.buckinstitute.org/wp-content/uploads/2015/01/plaque-tanglesRNO.jpg

IiNdawo zeBongo ezichaphazelekayo yi-Alzheimer's disease

• Hippocampus

• Ukulahleka kwememori yakutshanje

• Ummandla we-posterior temporo-parietal

• Ukungahambi kakuhle kunye nokwakhiwa kweapraxia

• I-Nucleus basalis yaseMeynert (i-neurons e-cholinergic)

• Utshintsho kwiimbono ezibonakalayo

Inkqubela

• Njengoko ezinye iinkalo zee-cortical zibandakanyeka, isigulane siza kuba neengxaki ezingenangqondo ezingqondweni, nangona kunjalo i-paresis, ukulahleka kwintliziyo, okanye iimpembelelo zentsimi ebonakalayo ziyimpawu.

Izinyango Zonyango

• Amachiza avimbela inkqubo ye-nervous acetylcholinesterase

• Donepezil
• Galantamine
• Rivastigmine

• I-Aerobic Exercise, imizuzu ye-30 imihla ngemihla

• I-PT / OT ilondoloze imisebenzi yokuphila kwansuku zonke

• Iipilisi ze-Antioxidant kunye ne-anti-inflammatory
• Kwizigaba eziphambili, kunokufuna ixesha elipheleleyo, ekunakekelwa ekhaya

IVascular Dementia

• I-cerebral arteriosclerosis ekhokelela ekubetheni
• Umonde uya kuba nembali yesiganeko sombhalo okanye iimpawu zesifo sokuqala (ukuxhamla, i-paresis, i-pseudobulbar palsies, aphasia)
• Inokuthi idibana ne-Alzheimer's disease ukuba ngenxa ye-angiopathy ye-amyloid

I-Frontotemporal Dementia (Isifo Sokukhetha)

• Uhlobo

• Ichaphazela i-lobes yangaphambili neyesikhashana

• Ngangabonwa kwi-imaging ukuba ukuguqulwa okuphambili kule mimandla

• iimpawu

• Ukunganakwa

• Ukuziphatha kakubi

• Ukutshitshiswa
• Ukuziphatha okungalunganga komphakathi
• Impulsivity

• Ubunzima beelwimi

• Ngokuqhelekileyo akukho memori okanye ubunzima bendawo

• I-Pathology ibonisa imizimba ye-Pick ngaphakathi kwe-neurons

• Iziphumo ekufeni kwi-2-10 iminyaka

Pick Bodies / Cytoplasmic Inclusions

slideplayer.com/9467158/29/images/57/Pick+bodies+Silver+stain+Immunohistochemistry+for+Tau+protein.jpg

impatho

• Ukuxhatshazwa

• Sertraline
• Citalopram

• Yeka imithi enokubangela ukukhubazeka kwememori okanye ukudideka

• Uhlobo
• Benzodiazepines

• Lolonga

• Indlela yokuphila yokuguqula
• Inkqubo yokuguqulwa kwamathambo

Izifo zePasinson

• Unokuthi lenzeke nangaliphi na iminyaka, kodwa inqabile ngaphambi kwe-30 yobudala, kwaye ukwandisa ukukhula kwandala kubantu abadala

• Ukutyekela kobuhlobo kodwa kungabikho kwimbali yosapho

• Unokubakhokelwa yizinto ezithile zendalo

• I-1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)
• Iimveliso ezivelisa i-radicals ekhululekile

• Ichaphazela i-substantia nigra pars compacta

• Neoponergic neurons

• Kwi-pathology, ubukho be-Lewy Bodies

• Ukuhlanganiswa kwe-alpha-synuclein

Amabhunga aseLeyyy

scienceofpd.files.wordpress.com/2017/05/9-lb2.jpg

Iimpawu zePasinsinism

• Ubungqina (zonke iindiza)

• ROM
• Ukunyakaza okusebenzayo
• Kwangathi ingaba yendalo ye-cogwheel ngenxa yeempawu zentshukumo

• I Bradykinesia

• Ukunyuka kokuhamba
• Ukungakwazi ukuqala ukuhamba
• Ukukhupha

• Ukungcangcazela kokuphumla (�ipilisi-iqengqeleka�)

• Yadalwa ngokutshatyalaliswa kwamaqela omzimba aphikisayo

• I ziphene

• Ukuguquka kwangaphambili (kugxininiswe)
• Ukungakwazi ukuhlawulela ukuphazamiseka, okubangelwa ukuphindaphinda

• Iimpawu ezinjengeMask

• Ukunyuka kwengqondo ngokuthe ngqo

• Kamva ekuqhubekeni, ngenxa yokuqokelela umzimba

KuPathology

• Ukusilela kwe-dopamine kwi-striatum (i-caudate ne-putamen) ye-basal ganglia

• I-Dopamine ivame ukuba nefuthe lokukhupha isiphaluka esithe ngqo kwi-basal ganglia, ngelixa livimbela indlela engathanga ngqo

Carbidopa / Levodopa

• Unyango oluqhelekileyo unyango luyinkampani

• Levodopa

• Umtshintshisi we-dopamine owela umqobo wegazi

• ICarbidopa

• I-Dopamine decarboxylase inhibitor engadluli iBBB
• Ama-amino acids aya kunciphisa ukusebenza (ukhuphiswano) kwaye ngoko amayeza kufuneka asuswe kwiiprotheni

Utyando olude kunye neCarbidopa / iLevodopa

• Umthamo wesigulana wokugcina i-dopamine uyehla ngokusetyenziswa kwamayeza kwaye ke uphuculo lwamayeza luya kuhlala ixesha elifutshane nelifutshane ukuba iyeza lisetyenziswa ixesha elide.

• Ngokuhamba kwexesha kunokubangela ukwanda kwee-receptors ze-dopamine

• I-dose-dyskinesia

• Ukusetyenziswa kwexesha elide kugxininisa kwisibindi

• Ezinye iziphumo ezichaphazelekayo zingabandakanywa izibilini, i-hypotension kunye ne-hallucinations

Ezinye iindlela zokonyango

• Mayeza

• Anticholinergics
• Dopamine agonists
• I-Dopanime breakdown inhibitors (i-Monoamine oxidase okanye i-catechol-O-methyl transfase inhibitors)
• I-glutathione ephezulu

• Ukulinganisa ubuchopho bokusebenza ngokusebenza kwe-neuro-rehab umzimba

• wentshukumo
• Ukuvuselela ngokutsha
• Ukuphindaphinda ukuvuselela
• I-CMT / OMT ejoliswe kuyo

Multirogram System Atrophy

• Izibonakaliso zePasinson Izifo zibambene kunye okanye ngaphezulu kwezi zilandelayo:

• Iimpawu zePyramidal (ukubola kwe-Striatonigral)
• Ukukhubazeka kwe-Autonomic (ShyDrager syndrome)
• Ukufumana iCerebellar (i-Olivopontocerebellar atrophy)

• Ngokuqhelekileyo ayiphenduli kwiinkqubo eziqhelekileyo zonyango lwe-Parkinson

Inkqubela yokuPhuphuma kweSunyukliya

• Ukuqhubeka ngokukhawuleza okuqhubekayo okubandakanya amaprotheni kwiindawo ezininzi kuquka ne-rostral midbrain

• Iimpawu zivame ukuqala malunga nobudala be-50-60

• Ukufumana ubunzima

• Dysarthria ebalulekileyo

• Inkathazo yokujonga ngokuzithandela

• I-Retrocollis (ukongezwa kwe-dystonic entanyeni)

• Dysphagia

• Ukunyamekela ngokomzwelo

• Utshintsho lwabantu

• Inkathazo engqondweni

• Ayiphenduli kakuhle kwiinkqubo eziphambili zePD

Ukusasaza i-Lewy Body's Disease

• Ukugula kwengqondo
• Iingcamango ezinzulu kunye nokukhohlisa okusemandleni
• Ukudideka
• Izimpawu zeParkinsonian

Isifo sokugubhuka

• Izilonda zamanqaku ezimhlophe amaninzi (iipliti zokutshatyalaliswa kwemimoya) kwi-CNS

• Utshintshi ngobukhulu
• I-circumscribed kakuhle
• Ibonakala kwiMRI

• Iilonda ze-Optic ziqhelekile

• Iimbulunga zomhlaba azibandakanyeki

• Ngokuqhelekileyo kubantwana abangaphantsi kwe10, kodwa ngokuqhelekileyo banikela phambi kwe-55 yobudala

• Ukusuleleka ngentsholongwane ka-Virus kungabangela ukuphendula okungalunganga kwamagciwane kunye neengqungquthela kwi-antiel virus-myelin antigen

• Izisombululo zokusasazeka kunye nokuzivikela

Iintlobo ze-MS

• I-MS eqhubekayo ephambili (PPMS)

• MS eqhubekayo yeSMS (SPMS)

• Ukubuyiselwa kwakhona kwi-multiple sclerasis (i-RRMS)

• Uhlobo oluqhelekileyo
• Unokukhula ngokukhawuleza, ngokukhawuleza kubonakala ukucombulula nokubuyela
• Ekugqibeleni iba njenge-SPMS

Ukubandakanywa kweNgulo yamaNyo

• Kwi-40% yeemeko ze-MS

• Ubuhlungu kunye nokuhamba kwamehlo

• Isalathisi sensimu yokubonakalayo (ephakathi okanye epacentral scotoma)

• Uviwo lweFunduscopic

• Ingabonakalisa i-papilledema ukuba i-plaque ibandakanya i-optic disk
• Kwangathi kungabonakali into engaqhelekanga ukuba iiplathi zingemva kwe-optic disk (retrobulbar neuritis)

I-Longitudinal Fasciculus Inxaxheba

• Ukuxhatshazwa kweMLF kudala kwi-ophthalmoplegia ye-nyukliya

• Ngethuba lombono wecala kukho i-paresis yecala eliphakathi kunye ne-nystagmus yeso linye

• Ukuguquka kuhlala kuqhelekileyo

Ezinye iindlela ezinokwenzeka ze-MS

• Myelopathy

• I-hemiparesis ye-Spastic
• Amaphecana anomzimba ongekho amandla (DC-ML)
• Pherehesias

• Ukubandakanyeka kweCerebellar

• Ataxia
• Dysarthria

• Ukubandakanya inkqubo yeVestibular

• Ukungalingani
• Vertigo
• Nystagmus

• I-tic douloureux (i-trigeminal neuralgia)

• Uphawu lukaLhermitte

• Ukutshitshiswa okanye ukutshitshiswa kwintsimbi ebhekiswe kwisiqu kunye neenyawo ngexesha le-neckxion
• Ukukhathala
• Ukuhlamba okufudumele kudla ngokugqithiseleyo iimpawu

Ezahlukeneyo Ukuqwalasela

• Iimboli ezininzi kunye ne-vasculitis

• Inokuthi ibonakale njengommandla omhlophe umonakalo eMRI

• Inkqubo yesantya ephakathi kwe-sarcoidosis

• Unokuvelisa i-optic neuritis kunye nezinye iimpawu ze-CNS

• Isifo esinesifo

• Izilonda ezivuthayo
• Ukunyuka kwamehlo

• Ukunqongophala kweVitamin B12

• Dementia
• Ukunyaniseka
• Ikholam yeDorsal

• Isifo se-meningovascular syphilis

• Umonakalo we-CNS we-Multifocal

• Isifo seCSS Lyme

• Isifo se-Multifocal

Ukuxilongwa okungafaniyo: Izifundo zokuxilonga

• Ukuhlolwa kwegazi kunokunceda ukuhlukanisa

• Gcwalisa inani legazi
• I-anti-nuclear antibodies (ANA)
• Uvavanyo lweSerum ye-syphilis (RPR, VDRL, njl.)
• Vavanyo lwe-treponemal antibody
• Isiqu seLyme
• ESR
• I-Angiotensin iguqula i-enzyme level (ukuya kwi-r / o sarcoidosis)

Izifundo zoxilongo ze-MS

• MRI kunye kwaye ngaphandle kokungafani

• I-90% yamatyala e-MS afunyenwe iziphumo ze-MRI

• Ziphumo ze CSF

• Ukuphakanyiswa kweeseli zamhlophe zegazi zamononuclear
• Iinqwelo ze-Oligoclonal IgG

• Ukwandisa i-globulin kwi-albumin ratio

• Oku kubonakala nakwi-90% yeemeko ze-MS

• Ukwandisa izinga lamaprotheni e-myelin

Prognosis

• Umlinganiselo wokuphila emva kokuxilongwa ngu ~ 15 kunyaka we-20
• Ukufa kudla ngokusuleleka kwintsholongwane ephezulu kwaye kungekhona ngenxa yeziphumo zesifo ngokwazo

imithombo

UAlexander G. Reeves, A. kunye noSwenson, R. Ukuphazamiseka kwenkqubo yeNervous. UDartmouth, 2004.
Swenson, R. Degenerative Izifo zeNystem System. 2010.