Umbuzo omdala, iteknoloji entsha: Ukususwa kwamalungu amabini kwisifo sikaParkinson 

---

Utyando olusebenzisa i-ablative lunelifa elinzima kwicandelo lethu. I-Pallidotomy, i-thalamotomy, kunye ne-subthalamotomy zinembali ende kunyango lweengxaki zokuhamba, kodwa xa ukuvuselelwa kwengqondo okunzulu kwafika ngeminyaka yoo-1990, iinkqubo zokulimala kwe-radiofrequency zayekiswa kakhulu kwiindawo ezininzi. Ukususwa kwe-Bilateral kunebali elinzima ngakumbi; i-radiofrequency bilateral pallidotomy, umzekelo, yayinxulunyaniswa namazinga angamkelekanga eengxaki zentetho kunye nokuhamba. I-MR-guided focused ultrasound (MRgFUS) ivule kwakhona umbuzo: incisionless, image-guided, kunye ne-real-time thermometry kunye nokuhanjiswa kwamandla stepwise okuvumela uvavanyo olungaphantsi komgca ngaphambi kwesilonda esiqinisekileyo. NgoJulayi 2025, i-FDA yavuma i-bilateral pallidothalamic tractotomy ehleliweyo yesifo sikaParkinson esine-motor fluctuations okanye i-dyskinesia. Uvavanyo olungasemva kwaloo mvume, ngoku olupapashwe kwi-The Lancet Neurology, lususa ingxoxo ukusuka ekubeni omabini amacala anokunyangwa na ukuya kwindlela esichonga ngayo izigulane ezifanelwe licala lesibini. 

Izifundo zangaphambili ze-MRgFUS ablations kwisifo sikaParkinson zihlolisise ikakhulu izilonda ezikwicala elinye. I-Unilateral thalamotomy ivunyiwe kwisifo sikaParkinson esixhaphakileyo kwi-thrombosis ukusukela ngo-2018 kunye ne-unilateral pallidotomy kwiingxaki ze-motor ukusukela ngo-2021. I-Unilateral subthalamotomy, evavanyiweyo kuvavanyo olucwangcisiweyo kwaye yalandelwa kwangaphambili ngenzuzo eqhubekayo kulandelelwano lwexesha elide, iphucula zonke iimpawu eziphambili ze-parkinsonism (ukungcangcazela, i-bradykinesia kunye nokuqina) kwicala elinyangiweyo, kwaye ihlala ilukhetho oluxabisekileyo kwizigulane ezineempawu ezingafaniyo. I-Pallidothalamic tractotomy yandisa ingqiqo efanayo: i-tract ivela kwi-internal pallidum, kwaye indlela yayo ivumela izilonda ezincinci, ezinamandla aphantsi kune-pallidotomy. 

Olu phononongo olucwangcisiweyo, oluvulelekileyo, olusebenzisa ingalo enye lubhalise izigulane kwiindawo ezisithoba kumazwekazi amathathu. Izigulane ezingamashumi amahlanu anesine zenze i-lateral pallidothalamic tractotomy kwicala elinophawu oluphezulu; ezingama-40 zaqhubeka zaya kwicala elingasemva ubuncinane kwiinyanga ezintandathu kamva, emva kokuhlangabezana nemigangatho yokhuseleko ebekiweyo. Isiphelo esiphambili yayikukutshintsha kwepesenti kwi-MDS-UPDRS inxalenye yesi-3 ngaphandle kweyeza kwinqanaba eliphezulu nelisezantsi (ULE) kwiinyanga ezintathu emva kwenkqubo yesibini. 

Emva konyango oluhambelanayo, amanqaku e-ULE aphuculwe ngomyinge we-53% kwiinyanga ezintathu kwaye amanqaku ewonke enxalenye yesi-3 ngaphandle konyango aphuculwe ngama-30%, kunye nenzuzo eqhubekekayo kwiinyanga ezili-12. Iziganeko ezimbi ezinxulumene nonyango zenzeke kwi-39% yezigulane, phantse zonke zincinci, kwaye isigulane esinye kuphela (2%) safumana isiganeko esibalulekileyo seklinikhi kwiinyanga ezintandathu. 

Emva kwenkqubo yesibini, amanqaku e-ULE adibeneyo ayengcono ngama-32% kune-baseline, inani eliquka yonke into eyayiphucukile kwicala lokuqala. Ixesha lokungasebenzisi amayeza nalo liphucukile kakhulu emva konyango lokuqala: inani lezigulana ezixela ukuba liye lehla ukusuka kwi-80% ekuqaleni ukuya kwi-33% emva kwecala lokuqala, emva koko laya kwi-32% emva kwelesibini. I-Dyskinesia ilandele indlela eyahlukileyo kancinci: ibikwe yi-50% ekuqaleni, i-18% emva konyango oluzimeleyo, kunye ne-0% emva konyango oluhlangeneyo, kunye namanqaku e-MDS-UPDRS inxalenye yesine ephucuka ngama-67% ukusuka ekuqaleni. 

Iziganeko ezimbi ezinxulumene nonyango zilandele inkqubo yesibini kwi-55% yezigulane; i-25% yayineziganeko eziqhubekayo eziphakathi (n=9) okanye ezinzima (n=1) kwiinyanga ezili-12, ezichaphazela kakhulu intetho, ukuhamba, kunye nokulinganisela, kuquka isigulane esinye esine-anarthria engapheliyo. La manani afanele umxholo: uvavanyo olusetyenzisiweyo intetho ezimeleyo, intsimi yokubona, kunye nokujonga i-neuropsychological, inqanaba lovavanyo uninzi lweenkqubo zotyando aluziboni, ngoko ke iziganeko ezincinci ezinokungabhalwanga kwenye indawo ziboniswe apha. Ngokwembono, uvavanyo lwe-Veterans Affairs cooperative trial lubike iingxaki zokuthetha eziphakathi ukuya kwezinzima kwiinyanga ezingama-24 kwi-28% yezigulane ze-pallidal kunye ne-35% yezigulane ze-DBS ezingaphantsi kwethala, kunye nokuphazamiseka kwebhalansi malunga ne-30% nganye, nangona uthelekiso kufuneka lwenziwe ngononophelo, kuba i-DBS iyakwazi ukutshintshwa kwaye ukuhlanjwa akukwazi. 

Ukuze sitolike ezi ziphumo, kufuneka siqwalasele ezinye izithintelo. Olu phononongo beluvulelekile kwaye alulawulwa yinkohliso, kwaye akukho siseko siphindaphindwayo esifunyenweyo ngaphambi kwenkqubo yesibini, ngoko ke ukuqhubela phambili ngexesha lekhefu akunakuhlukaniswa nesiphumo sesilonda sesibini. Kwakhona, ijika lokufunda liyabonakala: amaziko amathathu anyanga i-70% yezigulane ngelixa amathathu anyanga enye kuphela nganye, kwaye amava okuqala amaziko amaninzi adla ngokuthatha indlela engekavuthwa ngokupheleleyo kwaye ilungisiwe. 

Indlela ye-pallidothalamic ayilodwa ukhetho oluphantsi kophando. I-subthalamotomy ehleliweyo ihlolwe kuthotho oluncinci oluza kwenzeka, kunye nokuphuculwa okukhulu kwemisipha kunye neziganeko ezimbi ezazincinci kwaye zidlula ngokukhawuleza, nangona intetho nayo ichaphazelekile kwezinye izigulana. Ukukhetha injongo, ubungakanani besilonda, kunye neprotokholi yamandla ngokunokwenzeka zenza iprofayili yentetho kunye nokuhamba. 

Oko kufunwayo ngoku bubungqina obungcono kwicala lesibini. Ukuba ngaba izigulane zinyamezela unyango oluhambelanayo akukacaciswa: nokuba ukusebenza kwe-axial kunye nokusebenza kwentetho kuqikelela umngcipheko, nokuba ixesha eliphakathi kweenkqubo libalulekile na, nokuba ukujolisa okuqinileyo kunye nezilonda ezincinci zigcina inzuzo ngelixa zigcina i-corticobulbar kunye neendlela ze-corticospinal, kunye nendlela ezi ziganeko eziguquka ngayo ngaphaya kweenyanga ezili-12. Iirejista ezithatha amava ahleliweyo, kunye nezifundo ezilindelekileyo eziyilwe ngokukodwa malunga nokukhethwa kwecala lesibini, zinokuphendula imibuzo engenakukwazi ukuvavanywa yingcali yengalo enye yezigulane ezingama-40. 

Okwangoku, i-tractotomy ye-pallidothalamic tractotomy engasebenziyo yindlela esebenzayo yokukhetha izigulane ezikhethiweyo ngokufanelekileyo. Unyango lwesibini kufuneka luqwalaselwe kwizigulane ezineempawu ezingasebenziyo zecala elingasemva ezihlala zikhululekile ukuthetha kunye nokuphazamiseka kokuhamba emva kwenkqubo yokuqala, zilulekwe ngokunyanisekileyo malunga nomngcipheko oqokelelweyo: umda wokukhetha ngononophelo, kungekhona isizathu sokuyishiya ingahlolwanga.