Psychogenic Nonepileptic Mipikisano Yowonekera Ngati Khunyu
Ndiloleni ndikupatseni nkhani yongopeka. Tina Gerald ndi mayi wa zaka 35 yemwe wakhala akudwala matendawa kuyambira ali ndi zaka 20. Kuyamba kwake kugwidwa kwakukulu kunali kugwidwa ndi matenda aakulu , komanso thupi lake lonse limagwedezeka. Iye sakumbukira zomwe zinachitika mu nthawi zigawozi, ndipo iye sanakhale ndi mtundu wotere wa kulanda kwa zaka zambiri.
Mofanana ndi anthu ambiri omwe ali ndi khunyu , Tina ali ndi mitundu ina ya kugwa .
Posakhalitsa, wakhala ndi zigawo kumene akugwedezeka. Pamene kugwidwa kwake kwakukulu kwapweteka kunayambitsa kutaya mtima ndipo kunali maseŵera ndi olingana, machitidwewa amawoneka ngati akuwoneka mopanda chiwonongeko kapena ndondomeko. Mosiyana ndi mtundu woyamba wa kulanda, Tina amakumbukira zonse zomwe zimachitika pozungulira iye.
Moyo wa Tina sunakhale wosavuta. Iye sangagwire ntchito chifukwa cha kugwa kwake, ndipo ali ndi mbiri yakuzunzidwa ndi chibwenzi chake chakale. Ayesera mankhwala 11 oletsa kutsutsa ndipo tsopano akutenga anayi. Posachedwapa iye anakangana ndi apolisi; Kuyambira nthawi imeneyo, wakhala akudandaula chifukwa chovuta kuyenda, kuwala kwa kuwala, kufooka ndi kunjenjemera m'manja mwake.
Panthawi ya kuyezetsa magazi, iye ankangokhalira kugwedeza mutu wake koma ankatha kukambirana. Ngakhale kuti ankasunthira, ankatha kumwa khofi popanda kuthira. Maso ake adawoneka osakhazikika, ngakhale kuti sanagwa.
Kodi Psychogenic Nonepileptic Ndi Chiyani?
Pamene Tina ali ndi mbiri yovuta ya kugwidwa ndi khunyu, nthawi yake yowonjezera zizindikiro pambuyo pochitika ndi apolisi, kuphatikizapo mbiri yake yamaganizo ndi zizindikiritso zina, akusonyeza kuti ali ndi vuto la matenda osokonezeka maganizo.
Akatswiri a zamaganizo akhala akutsutsana ngati angatchule zochitika zenizenizi, chifukwa ena amakonda kusunga mawu akuti "kugwidwa" chifukwa cha matenda a khunyu kokha, kutanthauza kuti pali magetsi ambiri mu ubongo.
Ena amakonda kuganizira kwambiri za zochitikazo, pogwiritsira ntchito mawu akuti "psychogenic" (PNES). Liwu lina, "pseudoseizure," limasiyanitsa ntchitoyo ndi kulanda kwenikweni, koma akatswiri ena amapeza kuti mawuwo amanyansidwa kwa anthu. Mosasamala kanthu za mawu omveka bwino, PNES kapena pseudoseizure limafotokoza zochitika zadzidzidzi zomwe zikufanana ndi matenda a khunyu koma zimakhala ndi maganizo, m'malo mwa thupi.
PNES ikhoza kuganiziridwa ngati mtundu wa kutembenuka kwa matenda. Ngakhale mphamvu zamagetsi mu ubongo sizili zofanana ndi kugwidwa khunyu, munthuyo samasintha zizindikiro zake. Kugonjetsa kumamva ngati chenicheni ngati khunyu.
Ndani Amalandira PNES?
Kugwidwa kwa maganizo kumayambira m'badwo uliwonse koma makamaka kumakhudza achinyamata. Ndiponso, 70 peresenti ya odwala ndi akazi. Zomwe zimakhalapo zomwe nthawi zambiri zimakhala ndi ziwalo zokhudzana ndi maganizo, monga fibromyalgia , ululu wosatha , ndi kutopa kwowonjezera, zimawonjezera mwayi wa PNES. Pali kawirikawiri mbiriyakale ya maganizo ndi nthawi zambiri mbiri ya nkhanza kapena zoopsa za kugonana. Mwachitsanzo, Tina ali ndi mbiri yakuvutika maganizo, nkhawa, ndi nkhanza. Monga zovuta zina zotembenuzidwa, kudandaula kwa ubongo (mukuchita izi kumagwira ntchito) kumabweranso pambuyo pochitika zoopsa (kumenyana ndi apolisi).
Kodi PNES Yadziwika Bwanji?
Kusiyanitsa pakati pa khunyu ndi PNES ndi vuto lalikulu kwa katswiri wa zamagulu. Pafupifupi oposa 20 mpaka 30 peresenti ya odwala omwe amatchulidwa kuti matenda a khunyu amatha kugwidwa amapezeka ndi PNES. Ndi chimodzi mwa zovuta kwambiri kuti anthu asadziŵe kuti ndi khunyu, zomwe zimapangitsa 90 peresenti ya kusadziŵa bwino. Kuvuta kumvetsa, 15 peresenti ya anthu omwe ali ndi vuto la maganizo amatha kugwidwa ndi khunyu. Izi zimapangitsa chifukwa chenicheni chogwira ntchito monga kugwira ntchito molimbika kwambiri.
Zinthu zingapo zingapangitse dokotala kuti apeze matenda okhudza matenda a maganizo m'malo mogwidwa ndi khunyu.
Kukaniza mankhwala opatsirana ndi khunyu kawirikawiri kumakhala chitsimikizo choyamba - 80 peresenti ya odwala omwe ali ndi PNES akhala akuchiritsidwa ndi anticonvulsants poyamba, kawirikawiri popanda kupambana. Komabe, pafupifupi 25 peresenti ya anthu odwala matenda a khunyu amathandizidwanso ndi mankhwala osokoneza bongo.
Tina anavutika ndi kayendetsedwe kosasinthasintha kwa mbali zonse ziwiri za thupi lake. Kaŵirikaŵiri, pamene mbali zonse ziwiri za thupi zimakhudzidwa ndi matenda a khunyu, munthuyo amatha kuzindikira, koma izi sizinachitike kwa Tina. Komanso, iye akugwedezeka bwino pamene adasokonezedwa (ndicho chifukwa chake sanathetse khofi yake). Mosiyana ndi odwala matenda a khunyu, anthu omwe ali ndi PNES sadzipweteketsa okha panthawi imene akugwa.
PNES imatsutsana ndi lingaliro la wina la kulanda kuposa chidziwitso chenicheni cha khunyu. Mwachitsanzo, kugunda pa TV nthawi zambiri kumaphatikizapo munthu kumangoyendayenda popanda dongosolo linalake, koma zoona zowumitsa khunyu nthawi zambiri zimakhala zongomveka komanso zobwerezabwereza. Kulira kapena kulankhula pa chifuwa chachikulu cha khunyu ndichilendo kwambiri, koma chofala kwambiri mu PNES.
Ngakhale pali njira zambiri zothandizira kusiyanitsa pakati pa psychogenic ndi kugwidwa khunyu, palibe imodzi mwazolakwika. Pozindikira kuti PNES mwa munthu yemwe ali ndi mbiri yokhutira ya khunyu, dokotala ayenera kusamala kwambiri ndi matenda ena omwe akuwoneka ngati PNES. Kugonjetsa kwenikweni komwe kumachokera ku lobe, kutsogolo, nthawi zambiri kumakumbutsa madokotala a PNES.
Njira yabwino yofotokozera psychogenic ku matenda a khunyu ndi kugwiritsa ntchito electroencephalogram yomwe imatchula ntchito yogwira ntchito. Kugwidwa khunyu kumabweretsa mavuto ena pa EEG yomwe sichikuwoneka panthawi ya kugwidwa kwa maganizo.
Kodi Maganizo a Psychogenic Akuchitika Motani?
Maphunziro ndi ofunikira, ngati kuphunzira za matendawa kutembenuka nthawi zambiri kumakhudza momwe anthu akuchira. Malingaliro ena, pafupifupi 50 mpaka 70 peresenti ya anthu omwe ali ndi PNES amakhala opanda zizindikiro pambuyo poti matendawa apangidwa. Muzochitikira kwanga, gawoli ndilokulingalira kwambiri, koma maphunziro akadalibe sitepe yoyamba yakuchiritsa.
Anthu ambiri amayamba kuganiza kuti ali ndi matenda aliwonse monga matenda a khunyu. Katswiri wa zamaganizo ayenera kufunsidwa kuti athetse nkhawa kapena kupanikizika. Ngakhale wodwala akugwiritsidwa ntchito chifukwa cha ziwalo zina za khunyu, pafupifupi 50 peresenti ya anthu odwala matenda a khunyu amavutika maganizo ndipo angapindule ndi maganizo a maganizo.
Kodi N'chiyani Chimapangitsa Kuti Anthu Asamangokhala Osangalala?
Anthu omwe ali aang'ono pamene matendawa akupangidwira, ndi madandaulo pang'ono ndi zigawo zoopsa, ali ndi mwayi wapamwamba wopambana. Chofunika kwambiri ndi nthawi ya matenda. Ngati wina atha zaka zambiri akuchiritsidwa khunyu, ngakhale atakhala ndi zizindikiro zonse za matenda osandulika, munthuyo sangathe kuchira.
Chifukwa chomwe anthu ali ndi vuto la kutembenuka sichikhoza kusintha ngati atapatsidwa chithandizo cha khunyu kwa nthawi yayitali mwina chimakhala ndi lingaliro la kulimbikitsa. Malingana ndi chiphunzitso ichi, piritsi iliyonse yotengedwa ndi matenda a khunyu, dokotala aliyense amene amachititsa kuti asamvetsetse bwino, ngakhale abwenzi omwe amuthandiza munthuyo amatsitsimutsa kukhulupirira kuti matendawa amayamba chifukwa cha khunyu. Chikhulupiliro cholimba chotero ndi chovuta kuchichotsa, ngakhale ndi chitsimikizo choona komanso cholondola.
Monga mitundu ina ya matenda osandulika, PNES ndi matenda a kusalidwa. Izi zikutanthauza kuti dokotala yemwe akufufuza izi ayenera kukhala ndi maganizo omveka bwino ndikuganiza kuti mwina kupatulapo kudandaula kwa matenda a maganizo ndikochititsa kuti ntchitoyo ichitike, ndipo yesetsani kuthetsa mwayi woterewu. Mofananamo, nkofunika kuti odwala azikhala ndi maganizo omveka bwino kuti vuto lawo ndilo lingaliro ndikupeza thandizo lomwe akusowa.
Zotsatira
AB Ettinger ndi AM Kanner, Okonza, Matenda a maganizo m'maganizo a khunyu: Buku lothandizira kupeza matenda ndi mankhwala, Lippincott, Philadelphia (2001).
Krumholz A, Hopp J. Psychogenic (nonepileptic) amagwidwa. Semin Neurol. 2006 Jul; 26 (3): 341-50.
Benbadis SR, Tatum WO: Kudandaula kwa EEGs ndi kusokonezeka kwa matenda a khunyu. J Clin Neurophysiol 2003 Feb; 20 (1): 42-4
LaFrance WC. Ndi odwala angati omwe amagwidwa ndi matenda osokonezeka maganizo omwe ali ndi matendawa? Neurology. 2002 Mar 26; 58 (6): 990;
Benbadis SR. Ndi odwala angati omwe ali ndi pseudoseizures omwe amalandira mankhwala osokoneza bongo asanafike? Eur Neurol 1999; 41: 114-15.
Benbadis SR: Njira zothandizira ziyenera kugwiritsidwa ntchito kuti zidziwitsidwe za kugwidwa ndi matenda osokonezeka maganizo. Arch Neurol 2001 Dec; 58 (12): 2063-5
Gates JR: Kuyesera kokakamiza sikuyenera kugwiritsidwa ntchito kuti zisawonongeke. Arch Neurol 2001 Dec; 58 (12): 2065-6
IA Awadalira ndi DL Barrow, Okonza, Cavernous Malformations, Komiti ya American of Neurological Surgeons Publications Committee, (1993). p55-56.
PW Kaplan ndi RS Fisher, Okonza, Otsanzira Matenda a Khunyu, edition lachiwiri. Demos Medical Publishing, 2005. Chaputala 20.