Matenda ofanana a golide a Parkinson's Disease (PD) ndi mankhwala opatsirana . Pafupifupi mankhwala onse omwe alipo amachititsa kuti dopamine mukhale ubongo. Njira yomwe mankhwala omwe amaperekedwa amachitira zimenezi ndi zambiri zokhudzana ndi mphamvu zake komanso zotsatira zake.
Levodoopa Pogwiritsa Ntchito Zizindikiro za Magalimoto
Levodopa ndi mankhwala oyamba a maselo a ubongo a PD omwe amagwiritsa ntchito levodopa ngati malo omanga kupanga dopamine.
Levodopa imagwira ntchito mwazidzidzimoto zimayendera, zimakupangitsani kukhala omasuka, osasunthika, komanso osinthasintha. Tsoka ilo, silichiritsa PD ndipo silingalepheretse njira yowonongeka yowonongeka yokha.
Levodopa nayenso ali ndi zotsatira zake. Zotsatira zake, komabe, zimatha kuthetsedwa mwa kuphatikiza levodopa ndi mankhwala ena. Mwachitsanzo, zotsatira zina zazikulu za levodopa zikagwiritsidwa ntchito payekha ndizosautsa-chifukwa cha dopamine yochulukirapo m'magazi a thupi mmalo mwa ubongo. Pofuna kuteteza khunyu komanso kuonjezera kuchuluka kwa levodopa yomwe ikufika mu ubongo, levodopa imaperekedwa ndi mankhwala ena otchedwa dopa decarboxylase inhibitor (DDI). DDI imaletsa kutembenuka kwa levodopa ku dopamine m'magazi a thupi kotero kumalola kuti levodopa ifike pa ubongo ndi kupewa nthenda.
Mtundu wambiri wa DDI umene umagwiritsidwa ntchito m'mayiko ambiri ndi carbidopa. Kuphatikiza kwa levodopa ndi carbidopa kumadziwika ndi dzina la malonda la Sinemet.
M'mayiko ambiri carbidopa / levodopa mlingo wa mlingo amadziwika ngati chiwerengero-chiwerengero (chiwerengero cha pamwamba) ndi kuchuluka kwa carbidopa mu piritsi lililonse, ndipo nambala (pansi) nambala ya levodopa. Mwachitsanzo, kuphatikiza 25/100 kumapangidwa ndi milligrams 25 za carbidopa ndi milligrams 100 za levodopa.
Carbidopa / levodopa imapezekanso pomasuliridwa mwachindunji wotchedwa Sinemet CR. Kukonzekeretsa kutuluka kwa Sinemet kumathandiza kuti pang'onopang'ono nthawi yowonjezera ya levodopa ikhale m'magazi, zomwe zimathandiza kuthetsa kusinthasintha kwa mlingo, komanso kupsinjika kwa usiku.
Mankhwala Ena Osokoneza Bongo
Ngakhale kuti levodopa imachita bwino ndi zizindikiro za matenda a Parkinson , matendawa akuchulukirabe mpaka patapita nthawi. Matenda a Parkinson amawononga maselo a ubongo omwe amapanga dopamine kapena omwe amasintha levodopa kuti awononge dopamine. Pamene matendawa akufalikira, zimakhala zovuta kwambiri kuti ubongo ukhale ndi dopamine . Choncho, ife tikusowa njira zina zosungira ubongo wa dopamine mmwamba mokwanira kuti zithandize kugwira ntchito yogwira ntchito.
Popeza maselo opanga dopamine akuwonongeka ndi matendawa tiyenera kulumikiza maselo ena omwe sangathe kutulutsa dopamine koma amagwiritsa ntchito dopamine yomwe ilipo bwino kwambiri. Magulu awiri a mankhwala angathe kuchita izi:
- mankhwala omwe amachititsa kuti maselo azigwiritsa ntchito dopamine-"dopamine agonists"
- mankhwala omwe amaletsa kuwonongeka kwa dopamine m'thupi ndipo motero amachulukitsa zomwe zimapezeka ku ubongo-"COMT ndi MAO inhibitors"
Odwala a Dopamine mu Matenda a Parkinson
Pali ochepa agonist a dopamine monga:
- (Mirapex) Pulogalamu yamakono
- (Gwiritsani Ntchito) Ropinirole
- (Neupro) Rotigotine
Mankhwala onsewa amachititsa zotsatira za dopamine pamasewera omwe amasankhidwa a dopamine, omwe ndi maselo omwe amalimbikitsa zotsatira za dopamine mu ubongo.
Mankhwalawa akhoza kubweretsa mavuto monga chizungulire, kuthamanga kwa magazi, ndi kusokonezeka kwa maganizo kotero kuti ayenera kuyamba monga mlingo wochepa kwambiri, ndipo pang'onopang'ono anawonjezeka motsogoleredwa ndi katswiri wa m'maganizo a munthu.
Zizindikiro za COMT ndi MAO Inhibitors
Komiti ya COMT (catechol-O-methyltransferase) inhibitors ndi MAO-B (monoamine oxidase mtundu wa B) zimayesetsa kuletsa kuwonongeka ndi kusokoneza dopamine mu thupi ndi ubongo.
Ngati COMT imatsekedwa kapena yoletsedwa, mwachitsanzo, levodopa yambiri ikhoza kufika pamagalimoto a kayendedwe ka ubongo. Zowonongeka kwambiri za COMT ndi (Tasmar) tolcapone ndi (Comtan) entacapone. COMT inhibitors ndi othandiza makamaka kwa anthu okhala ndi kusintha kwa magalimoto.
Koma monga mankhwala ambiri, ziwalo za COMT ndi MAOI zimakhala ndi zotsatirapo. Mwachitsanzo, odwala asanu kapena khumi pa 100 aliwonse omwe amatenga kachilombo ka COMT amayambitsa kutsegula m'mimba. Izi nthawi zambiri zimatanthauza mankhwalawa ayenera kuimitsidwa. Anthu awiri kapena atatu mwa anthu 100 aliwonse amene amagwiritsa ntchito tolcapone amakhala ndi vuto lalikulu la chiwindi lomwe limafuna kuyang'anitsitsa chiwindi kugwira ntchito mosamala kapena kumwa mankhwala osokoneza bongo. Entacapone alibe vuto la chiwindi cha chiwindi.
Mankhwala a MAO-B, monga (Eldepryl) selegiline ndi (Azilect) rasagiline, amachititsa kuti maOY-B asamathetse dopamine mu ubongo.
Selegiline imagwiritsidwa ntchito makamaka pofuna kuteteza kapena kutsegula mapeto amtundu wamoto. Zotsatira zake ndi zofatsa kwambiri. Kale Selegiline ankakhulupirira kuti ndi mankhwala osokoneza bongo omwe amaletsa kuwonongeka kwa dopamine neurons mu ubongo. Zikuwoneka kuti zotsatira zokhudzana ndi ubongo wa selegiline ndizochepa kapena siziripo.
Rasagiline, kumbali inayo, akuwoneka kuti akulonjeza kwambiri potsata zotsatira zake zomwe zingakhale zovuta kwambiri pokhapokha jury akadali pa zotsatira zofunikira za mankhwalawa. Rasagiline imagwiritsidwa ntchito popinsinsanti yoyamba komanso yochepetsetsa pofuna kuchepetsa kusintha kwa magalimoto. Pali umboni wochuluka wa momwe rasagiline amathandizira ndi chitetezo chofunikira.
Pansi
Ngakhale levodopa ndi mankhwala abwino kwambiri ochizira matenda a Parkinson, nthawizina mankhwala ena monga dopamine agonists kapena MAO inhibitors akhoza kuyamba poyamba, makamaka ngati zizindikiro za munthu zili zochepa. Mankhwalawa amatha kuwonjezeredwa ku levodopa mankhwala kuti asamayende bwino.
Uthenga wabwino ndi wakuti ngakhale matenda a Parkinson sachiritsidwa, pali njira zothetsera matendawa ndikuthandizani kuti tsiku ndi tsiku wanu azigwira bwino ntchito komanso moyo wanu.
Zotsatira:
Amishonale a American Society of Health-System, Levodopa ndi Carbidopa
Connolly, BS, Lang, AE (2014). Chithandizo chamankhwala cha Parkinson matenda: ndemanga. JAMA , Apr 23-30; 311 (16): 1670-83.
R. Pahwa ndi KE Lyons (Okonza), Buku la Matenda a Parkinson ; Magazini ya 4, New York, Informa Healthcare Publishers, 2007.