I-ERNA: I-biomarker entsha ye-neurophysiological yokwenza ngokuzenzekelayo inkqubo ye-DBS

Ungugqirha wezifo zengqondo kwiCandelo le-Neuroscience laseFlorey kwiYunivesithi yaseMelbourne e-Australia kwaye ungumfundi wePhD. Wamkelekile, Gqirha Nagao. 

UDkt. Kanae J. Nagao: Enkosi ngokuba nam. 

UGqr. Mitra Afshari: Siyavuya kakhulu ukuba nawe kwaye namhlanje, sifuna ukuxoxa ngenqaku olipapashe kutshanje elibizwa ngokuba yi-"Automating Subthalamic Deep Brain Stimulation Programming with Evoked Resonant Neural Activity, ERNA in Parkinson's Disease."

Kwaye oku kupapashwe nje ngo-Epreli ophelileyo, kwijenali ethi "Movement Disorder", i-PI ephezulu malunga nomsebenzi nguWesley [00:01:00] Thevathasan umcebisi wakho wePhD. Ngoko ke Gqirha Nagao, ungaqala ngokunika nje imvelaphi encinci ngawe kunye nomsebenzi owenze kutshanje?

UDkt. Kanae J. Nagao: Ngoko ke ndingugqirha wezifo zengqondo osebenza eMelbourne e-Australia, kwaye okwangoku ndenza iPhD. Kwaye umsebenzi wam ugxile kakhulu ekujongeni indlela esinokuyiguqulela ngayo le biomarker intsha, i-ERNA, okanye umsebenzi we-neural ovuselelayo, kwaye ngethemba lokuba sizame ukuphucula inkqubo ye-DBS kwaye mhlawumbi njengendawo yokubeka phambili.

UGqr. Mitra Afshari: Kuhle kakhulu oko. Ngoko ke Dr. Nagao, kukho intetho eninzi kwihlabathi le-neuromodulation malunga ne-beta oscillations. Oko kukujikeleza kwe-hertz eyi-13 ukuya kwe-30. Bakwabiza ngokuba yi-beta band local field potentials, i-beta power. Ngoko ke amandla e-beta luphawu lwe-neurophysiological lwe-bradykinesia kunye ne-pathology engaphantsi kwesifo sikaParkinson.

[00:02:00] Kwaye eneneni, amandla e-beta sisiseko senkqubo yethu ye-DBS evaliweyo ekhoyo ngoku kurhwebo, apho sinokuziva sobabini ngexesha langempela xa kukho ukungasebenzi kakuhle size sivuselele ngexesha langempela kuphela xa oko kungasebenzi kakuhle kwenzeka. Kodwa ukongeza kuloo mvuselelo we-closed-loop yexesha langempela, ezi mpawu ze-neurophysiological ozifundayo zinokusinceda nazo kukulungelelanisa inkqubo ye-DBS njengoko ububhekisa ekuncedeni ngokwenene abaqulunqi beenkqubo ukuba bamisele apho kufanelekileyo ukuvuselela izigulane, kuba kukho iindlela ezininzi ezikhokelayo. Ubuncinane e-United States, sisanda kukhululeka ngakumbi ngokusebenzisa ii-leads ezinee-contacts ezili-16 ezikwanolwalathiso. Kwaye njengoko ukhankanyile ephepheni, inkqubo yendabuko esekwe kwiklinikhi ikakhulu iyinto ehambelanayo. Ngoko ke bekungayi kuba kuhle ukuba nento ethile enenjongo ngakumbi?

Umbuzo wam wokuqala kuwe, Gqirha Nagao, ngaphambi kokuba singene nzulu [00:03:00] kwisicatshulwa osipapashileyo ngulo, ungasixelela okungakumbi nge-ERNA kwaye zeziphi izibonelelo ezinokubakho xa kuthelekiswa namandla e-beta njengophawu lwe-neurophysiological lwe-neuromodulation kwi-PD?

UDkt. Kanae J. Nagao: Ewe. Ngoko ke i-ERNA sisignali enkulu ye-amplitude neural ekhutshwa ngokusebenzisa i-stimulation kwiindawo ezithile zobuchopho, njenge-STN kunye ne-GPi. Kwaye yi-oscillatory waveform, ngoko ke ijongeka njenge-sinusoidal, kwaye ukuba ufaka i-burst kwaye uyeke ukuyivuselela, iyabola ngokuhamba kwexesha. Kwaye kukho amaqela aliqela ajonga iindlela ze-neurobiological ze-ERNA.

Kodwa ukuqonda kukuba mhlawumbi kubonisa ukubandakanyeka kwenethiwekhi ezinokuba zibandakanyeka kwisifo sikaParkinson kunye nezinye iimeko ezifana ne-dystonia. Ngoko ke amanye amaqela asebenzisa imodeli yokubala kunye neemodeli zeempuku acebise ukuba mhlawumbi ibonisa umsebenzi ohambelanayo phakathi kwe-STN kunye ne-[00:04:00] GPe.

Kwaye amanye amaqela afumanise ukuba mhlawumbi kukusebenza ngakumbi kwe-STN yi-cortex ngendlela ethe ngqo. Kwaye bekukho umsebenzi omninzi othembisayo ngaphambi koku onokuthi ubonise ukuba i-ERNA inokuba yi-biomarker entle yokucwangcisa. Ngoko ke i-amplitude ye-ERNA ibonakala inkulu kwi-dorsal STN.

Kwaye xa kusetyenziswa iilead ezingangqalanga, kubekho izifundo ezibonise unxibelelwano phakathi kwendawo apho i-amplitude ye-ERNA inkulu khona kwaye ihambelana kakuhle nendawo apho ugqirha akhethe khona njengonxibelelwano olufanelekileyo lwenkqubo. Ukongeza, unxibelelwano apho i-amplitude ye-ERNA yayinkulu khona yayifana nonxibelelwano olunezibonelelo eziphezulu zeklinikhi kwisigulana ngokwezonyango. Kodwa ezi yayingezizo izifundo eziza kwenzeka ngokwazo. Kodwa siyazi ukuba i-ERNA ifumaneka kwi-dorsolateral kwaye inonxibelelwano oluhle namandla e-beta. Kwaye ndicinga ukuba apho [00:05:00] inokuba nenzuzo ngaphezu kwe-local field potentials kukuba inkulu kangakanani i-amplitude Ngoko ke ngamakhulu aliqela e-microvolts, kwaye oko kuthetha ukuba umlinganiselo wesignali-kwingxolo ungcono kakhulu.

Nangona incitshiswa, umzekelo, yi-anesthesia jikelele, ngenxa yobukhulu bayo obukhulu, inamandla ngakumbi kwimiphumo yayo, ngoko ke sisenokuyirekhoda ngokulula. Kwaye oko sikufumeneyo kukuba ukusasazwa kwendawo kwe-ERNA kwi-lead, ngoko ke ubukhulu bayo obuhambelanayo kwi-electrode nganye buhlala bugcinwe phantsi kwe-anesthesia jikelele.

Ngoko ke oko kuluncedo kakhulu. Kwaye ndicinga ukuba okulungileyo kukuba kunokurekhodwa ngokukhawuleza ngaphambi kotyando, nto leyo ebaluleke kakhulu xa sifuna ukuzama ukunciphisa impembelelo kwindlela yokusebenza kotyando.

UGqr. Mitra Afshari: Ngokuqinisekileyo. Ngoko ke into endiyivayo njengesishwankathelo kukuba i-ERNA ivuselelwa kukukhuthazwa, kwaye i-ERNA inokuba yeyona nto ibalulekileyo kutyando lwe-DBS oluleleyo apho kusetyenziswa i-anesthesia jikelele, kwaye, ezi ziintlobo zotyando ezikhethwa zizigulane [00:06:00], akunjalo? Ngokwengqiqo. kwaye ndicinga ukuba ukhankanye oku, kwingcaciso yakho, kukuba ngo-2022, iqela lakho lapapasha umsebenzi, apho urekhode khona zombini i-beta oscillations kunye ne-ERNA ngaphakathi kotyando, kwaye ujonge ukuba yeyiphi kwezi zintathu, i-beta vs ERNA vs anatomy, eya kuqikelela ngcono oonxibelelwano ekugqibeleni abakhethwe ukukhuthazwa okungapheliyo kwizigulane ezingama-47 ezine-STN DBS ezine-PD.

Kwaye njengoko utshilo, olu phononongo lukhethekileyo yayiluphononongo olujonga emva. Kwaye kwezo zintathu, ufumanise ukuba i-ERNA yayikwi-80%, i-anatomy yayikwi-67%, kwaye i-beta yayikwi-50%. Ngoko ke kubonakala ngathi, olu phando lwangaphambili lolona hlobo lokukhuthaza amanyathelo akho alandelayo kunye nophando esiluxoxayo namhlanje.

UDkt. Kanae J. Nagao: Ewe, kulungile oko. Nangona olo phononongo lwalukwiqela elikhokelayo elingakhethi cala, kwaye ngoku njengoko [00:07:00] sinala maqhosha amangalisayo anolawulo lwamandla ahlukeneyo azimeleyo. Ngoko ke sinalo olu buchule bokwahlulahlula amandla angoku ngesisombululo esikhulu sendawo. Kwaye ndicinga ukuba kulapho i-ERNA inendima khona ngenxa yobukhulu bayo obukhulu, sinokubonelela ngesisombululo sendawo sendlela yokwahlulahlula amandla angoku. Oko kuya kuba lula kakhulu kunakwii-local field potentials apho zincinci kakhulu. Kwaye ke ndicinga ukuba ingongoma kukuba asizami ukuthi i-ERNA ingcono okanye iza kuthatha indawo yee-local field potentials. Sizama ukujonga ukongeza isixhobo se-DBS programming esinokuba luncedo kwicala elahlukileyo ngakumbi ukuzama ukuphucula ukusebenza kakuhle kwelo xesha lokuqala le-DBS programming, elinzima kakhulu kwizigulane.

UGqr. Mitra Afshari: Ngokuqinisekileyo. Oko kunceda ngokwenene ukubeka izinto ngendlela eyiyo. Ngoko ke kolu phononongo esithetha ngalo namhlanje, uGqr. Nagao, injongo yayikukubona kuqala ukuba ungasebenzisa i-ERNA yangaphakathi kotyando ukuvelisa ulungiselelo lwenkqubo [00:08:00] ye-STN DBS, kwaye okwesibini, ukubona ukuba, olo lungiselelo luthelekiswa njani nohlelo lweklinikhi lwendabuko olusekelwe-- oluqhutywa ziingcali kwikliniki nakwinkqubo ekhokelwa yimifanekiso.

Ngoko ke ndiza kushwankathela oko ndikuqondayo njengeendlela zophando lwakho, kwaye, ngokucacileyo undilungise ukuba ndiphosisile okanye kukho inkcukacha endiyiphosileyo. Ngoko ke uphando lwenziwe kwizigulane ezili-12 ze-STN DBS PD. Ezi zizigulane eziqeshwe kumaziko amathathu eMelbourne.

Zonke izigulana zafakelwa ngugqirha ofanayo we-neurosurgeon. Olu tyando lwenziwe phantsi komsebenzi oqhelekileyo wotyando olusekelwe kwisakhelo se-stereotactic kunye notyando olukhokelwa yi-MER. Ezinye iintlobo zotyando zenziwe phantsi kwe-anesthesia eqhelekileyo, ezinye zenziwa zivukile. Ii-Boston Scientific Cartesia leads ezidibeneyo ezisibhozo zasetyenziswa apho iitiye ezimbini eziphakathi ziyi-leads ezihlukanisiweyo kwaye inkqubo isebenza kulawulo lwangoku oluzimeleyo oluninzi [00:09:00], yiyo leyo i-MICC, evumela ukuhlukaniswa okuthetha ngako.

I-dorsolateral STN yayijoliswe kuyo, kwaye xa wawuhlalutya ngokucwangcisiweyo ukuba ingaba iileads zibekwe kakuhle ngokujonga ukuba zikude kangakanani na kwiindawo ezithandekayo, zazibekwe kakuhle ngaphakathi kwe-1 milimitha ezimbini ukusuka kwiindawo ezithandekayo eziqikelelweyo. Inkqubo ekhokelwa ngumfanekiso yenziwe nge-Guide XT, esebenzisa iBrainLab, kwaye ujonge iziphumo zenkqubo ezivela kwiiparadigms ezintathu ezahlukeneyo zenkqubo ukusuka kwelinye icala, i-hemibody echaphazeleke kakhulu, malunga neenyanga ezine ukuya kwezintandathu ukusuka ekufakweni kwe-DBS.

Ingaba konke oko kuchanekile?

UDkt. Kanae J. Nagao: Konke oko kuchanekile, ewe. Kwaye ndicinga ukuba isitshixo kukuba aba baguli, njengoko ubutshilo, babekwindawo entle. Ngoko ke, kungekuphela nje ngokwe-anatomiki, kodwa xa sijonga iziphumo zabo emva kotyando lweenyanga ezine, amanqaku abo okukhuthaza ukuba basebenzise amayeza ngaphandle kokusebenzisa amayeza [00:10:00] aphantse afane namanqaku abo okusebenzisa amayeza ngaphambi kotyando. Ngoko ke basebenze kakuhle.

Ngoko ke kukho into ekufuneka iqwalaselwe

UGqr. Mitra Afshari: Yingongoma entle leyo. Ngoko ke ndiyazi ukuba iziphumo zithini malunga neziphumo zokunyakaza xa kuthelekiswa amaqela amathathu ahlukeneyo. Kodwa ndingathanda ukuva, kwaye ndicinga ukuba abaphulaphuli bethu bangathanda ukuva iziphumo zolu phando ngamazwi akho njengomphandi okhokelayo.

UDkt. Kanae J. Nagao: Ewe. Ngoko ke into esayenzayo kukuba aba baguli babecwangciswe ngokwemigangatho yonyango ngugqirha. Ngoko ke sasinenkqubo yabo yonyango ephuculiweyo esinokuyithelekisa nayo, kwaye njengoko ubutshilo, sasinenkqubo eyenziwe yiGuideXT okanye ekhokelwa yiGuideXT esinokuyithelekisa nayo. Kodwa aba bantu bavavanywa ngokukhawuleza emva kweenyanga ezine ukuya kwezintandathu emva kokuhlinzwa.

Ngoko ke ngenye imini, bathelekisa ezi nkqubo zintathu, ngoko ke yayilixesha elinzima kakhulu leeyure ezine ukuya kwezintlanu. Babene-stimulation washout. Iinkqubo zabo zasetyenziswa kwi-counterbalanced [00:11:00] order kunye ne-washout phakathi, ukuze kuncitshiswe naluphi na ukudideka kwiziphumo ze-order. Kwaye into esasinomdla kuyo yayikukuthelekisa amanqaku abo omzimba kwi-DBS MDS-UPDRS III kwiprogram nganye xa kuthelekiswa namanqaku abo e-OFF stimulation ngaloo mini, saza sajonga nolo phuculo lwepesenti. Kwaye okuvuyisayo kukuba, sifumanise ukuba okokuqala, zonke iinkqubo zintathu zisebenze ngcono kwi-stim xa kuthelekiswa ne-OFF stim, nto leyo ehlala iqinisekisa. Kodwa ukuba inkqubo ye-ERNA kwi-stimulation scores yayifana ne-clinician kunye ne-imaging, kwaye olo phuculo lwepesenti olwalumalunga namashumi asixhenxe anesithandathu ekhulwini, lwalufana nenkqubo yeclinician, eyayingamashumi amathandathu anesithoba ekhulwini, kunye ne-imaging, eyayingamashumi asibhozo anesibini ekhulwini.

Kwaye besifuna nokuqwalasela ukuba impendulo yabo ye-levodopa ngaphambi kotyando yahluke kangakanani kuba oko kubalulekile. Ngoko ke sibale umlinganiselo wempendulo ye-motor, othelekisa ngokusisiseko loo pesenti ye-MDS-UPDRS [00:12:00] III kwimpendulo yabo ye-levodopa ngaphambi kotyando. Oko kuthetha ukuba ukuba babenomlinganiselo omnye okanye ngaphezulu, ngokusisiseko bafanisa impendulo ye-levodopa okanye bayidlule, oko kuthetha isiphumo esihle. Kwaye kwakhona, sifumanise ukuba i-ERNA isebenze kakuhle, ngoko ke umlinganiselo wabo wempendulo ye-motor wawumnye, kwaye babengahlukanga kwisikhokelo se-i-imaging, esasiyinqaku elinye lokuqala, kunye nogqirha, esasiyinqaku lesithoba. Okubalulekileyo, besifuna ukuqinisekisa ukuba yinkqubo enokunyamezeleka, kwaye imida yabo yempembelelo ecaleni, kwakhona, yayifana kakhulu. Kwaye imida yabo yezonyango nayo yayifana. Ngoku, loo mida yezonyango yahlukile kancinci kwinto abanye abantu abanokuyiqonda njengomlinganiselo wezonyango. Ngoko ke umda wezonyango uhlala ungowona mzuzu uphantsi apho abantu baqala ukufumana inzuzo ebalulekileyo yeklinikhi. Kodwa lo mgangatho wonyango ungaphezulu kowangoku apho isigulane sasinamanqaku angcono kakhulu e-MDS-UPDRS III kwaye sasizinzile kuloo manqaku.

Ngoko ke amanani abonakala ephezulu kancinci kunokuba ubuya kulindela kumlinganiselo oqhelekileyo wonyango [00:13:00]. Kodwa ingongoma kukuba la manani ayefana kakhulu.

UGqr. Mitra Afshari: Ngoko ke ngamafutshane, ufumanise ukuba i-ERNA yindlela elungileyo yokuqikelela ukwenziwa kwenkqubo.

UDkt. Kanae J. Nagao: Ewe. Besifuna nokuthelekisa, ngaba kukho umahluko ngokwenkqubo apho sicwangcisa khona i-ERNA xa kuthelekiswa nogqirha kunye nemifanekiso? Ngoko ke siye sabonisa nganye yezi nkqubo njenge-midpoint elinganisiweyo apho umsinga wahlulwahlulwa khona.

Kwaye okunomdla kukuba, sifumanise ukuba inkqubo ye-ERNA ibonakala ivuselela malunga ne-millimeter enye ngaphakathi kwesisu ukuya kwi-imaging-guided-guide kunye malunga ne-0.8 millimeter ngaphezulu ngaphakathi kwesisu ukuya kwi-clinic-guided-guide.

UGqr. Mitra Afshari: Ndiyifundile loo nto kwaye bendinomdla kakhulu ngayo loo nto. Ngoko ke i-ERNA ngokomyinge yayimalunga ne-millimeter enye ye-ventral kwaye yayimalunga ne-0.3 millimeters emva. Ingaba kunjalo? I-clinical programming paradigm.

UDkt. Kanae J. Nagao: Ewe, uxolo. Ndithethe kakubi [00:14:00] ngaphambili. Yayingaphezulu ngemilimitha enye kuneyeklinikhi.

UGqr. Mitra Afshari: Ungakhathazeki. Kwaye ufumanise ukuba loo nto iyinto eqhelekileyo. Oko kunomdla kakhulu. Ngoko ke kusenokwenzeka ukuba kukho into ethile koku. Kwaye ucinga ntoni ngaloo nto? Ithini ingcamango yakho apho? 

UDkt. Kanae J. Nagao: Ndicinga ukuba sisiphumo esinomdla kakhulu kuba, kuphakamisa amathuba okuba mhlawumbi i-ERNA ifumaneka kwindawo eyahlukileyo kwindawo esicinga ukuba yindawo ephambili yeklinikhi. Kwaye, ngaba oko kungenxa yokuba ikufutshane neendlela ezithile okanye imicu ethile? Akucaci.

Asizange senze naluphi na udweliso lwe-DTI ukuze sihlolisise loo nto ngakumbi, kodwa loo nto ingaba yindlela enomdla yokuyihlola. Ngokuqinisekileyo, iphakanyiswe ngamanye amaqela. Umzekelo, enye ichaze indawo ethe tyaba ye-ERNA, kwaye loo nto yayikufutshane kancinci nomda phakathi konxibelelwano kunye nee-subdomains ze-motor ze-STN.

Ngoko ke iphakamisa ingongoma enomdla. Kodwa ndicinga ukuba sinqunyelwe kukuba asinakuyithatha lula ngokupheleleyo le yindlela yokurekhoda i-ERNA [00:15:00] ukuba siyifumene le nto inokwenzeka. Ngoko ke kufuneka sihlolisise ukuba kukho na ukungqubana kwiprotokholi yethu yokurekhoda okunokubangela oku.

UGqr. Mitra Afshari: Ndiyaqonda. Kuyamangalisa ngokwenene oko ukukhankanyileyo malunga nokuba mhlawumbi kusenokufakwa i-DTI. Ndingakubona ngokuqinisekileyo oko, njengenyathelo elilandelayo. Kwiphepha, uGqr. Nagao, unomfanekiso, umzekelo wokuqhekezwa kwangoku usebenzisa i-ERNA komnye wabathathi-nxaxheba bakho. Kwaye into endiyibonayo kweli nani kukuba kukho inani elikhulu lokuqhekezwa.

Ngoko ke ukushwankathela, kukho i-22% kwenye yeefowuni, enye yeefowuni ezidityanisiweyo. Ifowuni ekufutshane ine-8%, kwaye ngaphezulu kwayo, kukho i-52% kwifowuni enye kwaye ifowuni ekufutshane enefayile ine-18%. Asinalo uluhlu lwazo zonke ii-amplitudes zokugqibela zokukhuthaza izigulane ezili-12 kwi-paradigms nganye yeenkqubo ezintathu zokucwangcisa, kodwa ukhankanya [00:16:00] ukuba ukuvuselela kwicala kwakhethwa kuphela kwesinye sezigulane ezili-12 xa, benza iinkqubo zeklinikhi, oko kuthetha ukuba phantse zonke izicwangciso zeklinikhi zezigulane zibonelela ngokuvuselela kwicala ngalinye xa kuthelekiswa nezicwangciso ezicwangcisiweyo ze-ERNA ezili-9 zezo zigulane zazicwangcisiwe, kwaye kwiisetingi zenkqubo ezikhokelwa ngumfanekiso, ezili-9 zezo zigulane zazicwangcisiwe.

Ngoko ke oku bekunomdla kakhulu kum. Ngoko ke umbuzo wam ubuya kuba, ukuba akukho mahluko kwisiphumo sokunyakaza sokuvuselela phakathi kwezi paradigms zintathu zeprogram, ngaba kunokwenzeka ukuba, ukuvuselela ngesisombululo esiphezulu kangaka kunye nokuhlukaniswa okuntsonkothileyo akubalulekanga kangako, kwaye okubalulekileyo kukuba uvuselela nje kwi-dorsolateral STN entle [00:17:00] kwaye mhlawumbi ezi ziphumo zingabonakalisa iileads ezifakwe kakuhle kakhulu?

Ucinga ntoni ngaloo nto?

UDkt. Kanae J. Nagao: Ndicinga ukuba yingongoma entle leyo kwaye ibuyela kwinyani yokuba kuluntu lwethu, besinazo izikhokelo ezifanelekileyo. Nangona oko kulungile kuluntu lwethu, kukwangumda wokuba ezi ziphumo zingaba njani ngokubanzi. Kwaye kwingongoma yakho malunga nendlela esiya ngayo kunye nokuba kubaluleke kangakanani kwaye yintoni isisombululo sendlela esibalulekileyo, andicingi ukuba oko akwaziwa okwangoku.

Ngokuqinisekileyo nangona kukho isoftware entsha ekhokelwa yimifanekiso efana ne-Illumina enika ukwahlulwahlulwa okungaqhelekanga kunye nokudibanisa, ingakanani umahluko weklinikhi oyenzayo? Asikaqiniseki. Okunomdla kukuba, xa sijonga iziphumo zethu, isoftware ekhokelwa yimifanekiso ekhokelwa yimifanekiso isebenze ngcono kuneenkqubo zonyango nangona zikwindawo efanayo nendawo ezazikhuthaza kuyo.[00:18:00] 

Mhlawumbi oko kuphakamisa amathuba okuba kuba umahluko omkhulu phakathi kwezi yayikukuba zibhekisa kwicala elinjani. Kuphakamisa amathuba okuba kusebalulekile nangaphakathi kwabantu abakwindawo efanelekileyo. Kodwa ngokuqinisekileyo, sinabemi abancinci kakhulu. Sinabo abantu abakwindawo efanelekileyo.

Kufuneka sandise uphando lwethu kwiindawo ezinkulu apho kukho ulungelelwaniso olungakumbi kwindawo efanelekileyo yokukhuthaza kwaye sibone ukuba indlela esiya kuyo inika na inzuzo ethile esingayiboniyo apha. Kodwa ndicinga ukuba omnye umda kukuba senze i-hemibody enye saza savavanya ukuphucuka kwe-hemibody yabo echaphazeleke kakhulu.

Ngoko ke kukho imida kuloo nto.

UGqr. Mitra Afshari: Ngoko ke kukho izifundo ezininzi zexesha elizayo ezinokwenziwa apha, akunjalo? Ngoko ke ukwandisa iqela lakho, ukwenza amacala omabini, ukujonga ukuvuselela okungapheliyo, akunjalo? Kwaye nokuba i-ERNA iyatshintsha ngokuhamba kwexesha. Ngoko ke ndibone zonke ezo zinto zenziwa [00:19:00]. Esinye isiphumo esibalulekileyo othethe ngaso ngaphambili kukuba, ipesenti yokuphuculwa kwe-motor UPDRS ayizange yahluke phakathi kwezigulana ezazicwangciswe kusetyenziswa ulungelelwaniso lwe-ERNA, nokuba i-ERNA yabanjwa kwimeko yokuvuka xa kuthelekiswa nokuba yabanjwa phantsi kwe-anesthesia eqhelekileyo.

 Ngamanye amazwi, uqikelelo lwe-ERNA beluchanekile nokuba luthathwe luvukile okanye lulele. Kwaye zithini iziphumo zalo nto? Oko mhlawumbi kwahluka njani ngamandla e-beta, ukuba ufuna ukuphinda amanqaku owawathetha ngaphambili kwingxoxo yethu?

UDkt. Kanae J. Nagao: Ndicinga ukuba le yenye yezona nzuzo ziphambili ze-ERNA, kukuba inamandla kangakanani xa iphantsi kwe-anesthesia eqhelekileyo. Amaziko ahlukeneyo asebenzisa iindlela ezahlukeneyo zotyando, kodwa sifuna oku kufumaneke kubantu abaninzi. Sifuna iziphumo ezilungileyo zifumaneke kubo bonke abantu be-DBS. Asifuni ukuba kuthintelwe kwizigulana ezivukileyo.

Ngoko ke inyani yokuba ukuba phantsi kwe-anesthesia ngokubanzi akunampembelelo [00:20:00] le yinzuzo enkulu kakhulu ye-ERNA.

UGqr. Mitra Afshari: Ngokuqinisekileyo. Ndicinga ukuba le yingongoma entle kakhulu, kukuba ukwahluka kwendlela abantu abatyalwa ngayo kule mihla kukhulu kakhulu. Ngoko ke oku kungaba, ithuba lokusebenzisa i-ERNA kwiindawo ezininzi. Kwaye ke ungasichazela, Gqr. Nagao, kwaye lo ngumbuzo wam wokugqibela. Ndiyazi ukuba ndikubuze imibuzo enzima. Zithini iziphumo ezinokwenzeka zokuba ukurekhodwa kwe-ERNA kwi-OR kufuna imizuzwana engama-45 kuphela ngomntu ngamnye? Ndicinga ukuba ukhankanyile ngaphambili ukuba oko kukwaluncedo kakhulu kwi-ERNA.

UDkt. Kanae J. Nagao: Ewe. Ngoko ke ithetha nje ngendlela i-ERNA enokufakwa ngayo ngaphandle komthungo kumsebenzi wotyando. Ukuze kucaciswe, irekhodwe kwi-DBS lead ngokwayo, ngoko ke asikokuba kufuneka songeze enye i-electrode ukuze siyirekhode. Ngoko ke inempembelelo encinci kumngcipheko wotyando kunye nexesha lotyando, kwaye [00:21:00] ingatolikwa emva kotyando.

Njengoko besitshilo, ayikhethi cala xa ujonga nje ubukhulu besignali. Ngoko ke ndicinga ukuba le yenye inzuzo ebalulekileyo kuba akufuneki nje ukwazi ukuba i-ERNA ilungile kangakanani njenge-biomarker, kodwa kufuneka ibe luncedo ukuze ibe luncedo kwezonyango.

UGqr. Mitra Afshari: Kuhle kakhulu. Ngoko ke ndifuna ukukubulela, Gqirha Nagao. Le yayiyingxoxo etyebileyo ngokwenene. Ezi yayizizihloko ezinzima kakhulu. Kunzima ukuzidlulisela kwi-podcast, kodwa wenze umsebenzi omhle kakhulu wokuhlalutya yonke into, kwaye ndifuna ukukubulela ngomsebenzi owenzayo kunye neqela lakho eliwenzayo ekugqibeleni ukuphucula i-DBS kuzo zonke izigulana zethu, kwaye ngokwenene, ukwenza lula ezi nkqubo kubaboneleli bethu. Ngoko ke ndilangazelela umsebenzi wakho wexesha elizayo, kunye neqela lakho elimangalisayo. Ngoko ke enkosi ngokuthatha ixesha lokuba nathi kule podcast namhlanje, kwaye sala kakuhle.

UDkt. Kanae J. Nagao: Enkosi. [00:22:00] [00:23:00]