Isihloko Esishushu: Isifo sikaParkinson seProdromal

UDkt. Eva Schäffer: Molo. Enkosi kakhulu ngokundimema.

UGqr. Eduardo de Pablo Fernandez: Kuhle kakhulu. Masiqale kwasekuqaleni. Ngamanye amaxesha-- siyazi ukuba kukho amanqanaba ahlukeneyo kunye namanqanaba ahlukeneyo kwisifo sikaParkinson, kodwa ngamanye amaxesha iileyibhile kunye namagama zinokuba zidida kancinci. Ngoko ke yintoni isifo sikaParkinson esibizwa ngokuba yi-prodromal?

UGqr. Eva Schäffer: Okwangoku xa sixilonga isifo sikaParkinson ngokweempawu eziqhelekileyo zentshukumo esizibonayo, i-bradykinesia, ukuqina, okanye ukungcangcazela kokuphumla, sisele siphuze kakhulu ekuhambeni kwesi sifo kuba siyazi ukuba kwiminyaka ngaphambi kokuba sibone iimpawu zentshukumo ezibonakalayo, sinesigaba sokuwohloka kwemithambo-luvo okuqhubekayo apho i-alpha-synucleinopathy, oluphawu lwesifo sikaParkinson, isasazeka kuyo yonke inkqubo yemithambo-luvo ephakathi neye-peripheral kwisifo sikaParkinson.

Kwiminyaka yokuqala ngaphambi kokuba iimpawu eziqhelekileyo ze-manifest motor zichongwe kwaye zibonakale, kunokubakho iimpawu zokuqala ezibonisa ukuwohloka kwe-neurological okuqhubekayo kwangethuba. Kwaye ezi mpawu zokuqala ze-prodromal, umzekelo, zinokuba yi-REM sleep behavior disorder okanye i-hyposmia. Kwaye isigaba apho sine-neurodegeneration eqhubekayo, apho sineempawu zokuqala ezinokuba ziimpawu ezingezizo ze-motor okanye iimpawu ezincinci kakhulu [00:02:00] okanye ezingezizo ze-mot, sibizwa ngokuba sisigaba se-prodromal sesifo.

UGqr. Eduardo de Pablo Fernandez: Ngoko ke wenze ingongoma enomdla apho. Sinengcamango ngaphambili yokuba isigaba sokuqala sesifo sikaParkinson sasinxulumene kakhulu neempawu ezingezizo ezomzimba. Kodwa ngokucacileyo, ngaphambi kokuba sifikelele ekuxilongweni kunye nokuphazamiseka kwemisipha okubonakalayo kunye nomfanekiso opheleleyo we-parkinsonism kunokubakho iimpawu ezithile zeklinikhi ezingabonakaliyo kunye nokuphazamiseka okungabonakaliyo esinokukufumana ngoku ngezixhobo ze-elektroniki okanye ezinye iindlela.

Ngoko ke ndicinga ukuba kubalulekile ukugxininisa ukuba ukungasebenzi kakuhle kwemisipha kunye neempawu zemisipha ziyinxalenye yesigaba se-prodromal. Kulungile, singasibona njani isifo se-Parkinson se-prodromal, kokubini, kwindlela yokwelapha kunye nophando lweklinikhi?

UDkt. Eva Schäffer: Ewe. Akukabi lula kangako. Okokuqala, kufuneka sithi sineekhrayitheriya zesifo sikaParkinson esibizwa ngokuba yi-prodromal Parkinson's disease ezipapashwe yi-Movement Disorder Society, kodwa ziyikhrayitheriya zophando, ngoko ke azijoliswanga [00:03:00] ukuba zisetyenziswe kwiikliniki, nto leyo ebaluleke kakhulu. Ngoko ke kufuneka silumke kakhulu ukuba sizama ukuxilonga isifo sikaParkinson esibizwa ngokuba yi-prodromal Parkinson's disease kwaye silumke kakhulu nendlela esixelela ngayo oku kwizigulana zethu.

Okokuqala, sineempawu zeklinikhi ezinokuba luphawu lwesifo sikaParkinson esibizwa ngokuba yi-prodromal. Iimpawu zesifo sikaParkinson ezibaluleke kakhulu nezicacileyo ziseyingxaki yokuziphatha yokulala ye-REM. Ukuba unesifo sokulala, unethuba eliphezulu lokufumana isifo sikaParkinson okanye i-MSA, i-dementia enemizimba kaLewy.

Emva koko sineempawu ezingaqhelekanga ze-prodromal. Kwaye ngokukodwa, ukuba senza uvavanyo lweklinikhi kuphela, kufuneka silumke kakhulu kuba i-hyposmia, ukudakumba, ukuqhina ziimpawu ezingaqhelekanga ze-prodromal. Ngoko ke kuqheliselo lweklinikhi, i-isolated REM sleep behavior disorder yeyona nto ibalulekileyo kwi-prodromal marker, kwaye sinethemba, ewe, kwixesha elizayo ukuba singayidibanisa ne-biomarker ukuze sikwazi ngokwenene [00:04:00] ukufumanisa i-prodromal PD ngcono. 

UGqr. Eduardo de Pablo Fernandez: Kuhle kakhulu. Ngoko ke ukhankanye ezinye zeendlela ezichazwe ngokucacileyo kwiklinikhi, kodwa kusekhona ukudibana okuthile, kwaye oku kungaba yindlela yokubonakaliswa kwe-prodromal kwezinye izifo ze-synucleinopathies, uninzi lwazo ludla ngokuba yi-multiple system atrophy. Ngoko ke ndicinga ukuba oko kusenzima kakhulu kwisigaba se-prodromal okanye ngaphezulu kunesigaba seklinikhi.

Njengoko utshilo, ezinye zeemvavanyo zokuxilonga, kwaye ngokucacileyo le yintsimi eguquka ngokukhawuleza, kodwa ezinye zezophando ze-i zifakiwe kwiikhrayitheriya zokuxilonga ze-prodromal ozikhankanyileyo. Kodwa kubekho uphuhliso olutsha, ngakumbi ngovavanyo lwe-synuclein seeding.

Ucinga ukuba olu phando lutsha luza kunceda njani ekuchongweni kwangethuba kwesifo sikaParkinson esibizwa ngokuba yi-prodromal Parkinson's disease?

UDkt. Eva Schäffer: Mna ngokwam ndicinga ukuba oku kuya kunceda kakhulu. Sikwabona uvakalelo oluphezulu kakhulu kunye nokuchaneka kovavanyo lwembewu ye-alpha-synuclein, ngakumbi okwangoku kwi-CSF nakwi-biopsies yolusu. [00:05:00] Nangona kunjalo, sisoloko sifumana ulwazi olukhulayo. Kukho iimpapasho ezininzi zamva nje ezibonisa ukuba uvavanyo lwe-alpha-synuclein oluqinisekileyo lunokuba nakwezinye izifo.

Sikubona oku kwezinye iimeko zesifo sika-Alzheimer okanye ezinye izifo ezibangelwa yi-neurodegenerative. Ngoko ke kwixesha elizayo, mna ngokwam ndicinga ukuba kufuneka kube yindibaniselwano yembonakalo yeklinikhi kunye ne-biomarker. Kodwa ke ezi biomarkers ziya kusinceda kakhulu ekuxilongeni isifo sika-Parkinson esibangelwa yi-prodromal, kuba okwangoku, asinangxaki nje yokuba asinayo nje kuphela ingxaki yokuba iimpawu zeklinikhi zodwa kunzima ukuzitolika, kodwa ukongeza, ukuba sibona, umzekelo, i-isolated REM sleep behavior disorder, asazi okwangoku ukuba umntu uza kufumana nini isifo sikaParkinson.

Ngoko ke ixesha lokuguquka nalo liyingxaki, kwaye sinethemba lokuba ukuba sidibanisa ii-biomarkers kunye neempawu zeklinikhi, mhlawumbi singawuvala loo msantsa wolwazi.

UGqr. Eduardo de Pablo Fernandez: Ngoko ke ukhankanye ukuba amanqaku ambalwa [00:06:00] nawo ngokucacileyo ukuba olu phando luza nemingeni kwaye siza kuxoxa ngakumbi ngaloo nto kamva namhlanje. Kodwa inqaku elinye endifuna ukulixoxa nawe kukuba singalujonga njani uxilongo lwesifo sikaParkinson esibizwa ngokuba yi-prodromal?

Sithetha njani ngengozi yokuguquka ibe sisifo sikaParkinson?

UDkt. Eva Schäffer: Ngoko ke eyona nto ibalulekileyo yinkalo yokuziphatha, kuba okwangoku, ukuba sifumanisa isifo sikaParkinson esibangelwa yi-prodromal, oku akuthethi ukuba unyango oluguqula isifo se-pharmacological, oko kuthetha ukuba ufumanisa into enesifo esiqhubekayo se-neurodegenerative esiya kwenzeka kwixesha elizayo, kodwa awunakukwazi ukunika naluphi na unyango lwe-pharmacological.

Ngoko ke eyona nto ibalulekileyo kunyango kukuba uzame ukufumanisa ukuba isigulana sakho sifuna ngokwenene ukwazi ukuba sinomngcipheko omkhulu wokufumana isifo sikaParkinson. Eli linyathelo lokuqala. Kwaye kukho, ewe, [00:07:00] izigulane ezahlukeneyo kakhulu. Abanye sele befunde konke malunga nalo mba kwi-intanethi, kwaye bafuna ukwazi yonke into malunga nesifo sabo sokulala se-REM ukuba bafumana isifo sikaParkinson okanye akunjalo.

Kodwa sikwanazo nezigulana ezininzi ezithi, "Andifuni ukwazi nto." Ngoko ke eli linyathelo lokuqala elibalulekileyo ekufuneka ulithathe. Kwaye ke ukuba unabantu ocinga ukuba bane-REM sleep behavior disorder, kuya kufuneka uyixilonge nge-polysonography, ukuze ube ne-REM sleep behavior disorder eqinisekisiweyo ngokucacileyo.

Kwaye ke kwahlukile kakhulu kumazwe ahlukeneyo kuba ungongeza ezinye iindlela zokuxilongwa, kodwa akukacaciswa ngokweekhrayitheriya zamazwe ngamazwe okwangoku. Umzekelo, ungongeza iDaTscan, eya kwandisa amathuba okuba nesifo sikaParkinson.

Kwaye sinedatha ethile ebonisa ukuba ukuba uneDaTscan elungileyo, ixesha lokuguqula lisondele kancinci. Ungongeza nakwamanye amazwe uvavanyo lwe-[00:08:00] lwe-alpha-synuclein seeding, kodwa kwakhona, alukho kwimikhwa yemihla ngemihla yeklinikhi okwangoku. Ke okwangoku ukuba unesigulana esinesifo sokuziphatha kweREM esizimeleyo, ukuxilongwa kweklinikhi kunye nokulandelela isifo sokuziphatha kweREM sleep yeyona nto ibalulekileyo onokuyenza, uze uzame ukufumanisa ukuba ufuna ukwazi umngcipheko okhulayo.

Asikafiki apho, ndicinga, ukuze sifumane umntu okwisigaba sokukhula kwesifo kwiklinikhi yemihla ngemihla.

UGqr. Eduardo de Pablo Fernandez: Loo nto imele igxininiswe. Into enye oyikhankanyileyo kukuba singaqikelela umngcipheko wesifo sikaParkinson esibizwa ngokuba yi-prodromal, kodwa asikabi nobuchule ekumiseleni ixesha lokuqhubela phambili kwesi sifo. Ujongana njani noko xa uxoxa ngokutyhilwa komngcipheko nabantu abanesifo sikaParkinson esibizwa ngokuba yi-prodromal?

Ukungaqiniseki, njengabanye baba bantu, mhlawumbi akunakuze kubekho iimpawu ezikhubazayo okanye ezifuna naluphi na unyango oluneempawu ngamayeza e-[00:09:00] e-dopaminergic. Ngoko ke ujongana njani nale nto nezigulana?

UDkt. Eva Schäffer: Ngoko ke kukho amanyathelo ambalwa onokuwathatha nezigulana. Inyathelo lokuqala endilikhankanyileyo kukubuza ukuba bafuna ukwazi ntoni kunye nobunzulu bolwazi abafuna ukulwazi. Kwaye ukuba bafuna ukwazi ukuba banomngcipheko ozayo, kufuneka uchaze ngokucacileyo ukuba okwangoku asazi ukuba ixesha labo, ixesha labo lobuqu lokuguquka liza kuba nini, kodwa ungacela ukuba ulandelele emva koko.

Le yeyona ndlela ifanelekileyo yokuba unike uphononongo rhoqo. Kodwa ndingathetha nabo ngokukhululekileyo ukuba okwangoku asikazi ukuba baza kuguquka nini, mhlawumbi kwixesha elizayo. Kwaye yintoni ebaluleke kakhulu ekufuneka uyenze ukuba ufumanisa umntu okwisigaba sokukhula kwesisu, okanye umxelele ukuba unethuba eliphezulu okanye umngcipheko ophezulu wokuba kwisigaba sokukhula kwesisu, kufuneka umxelele ngokuzenzekelayo ukuba ngokwenene unokuzenzela into ethile size siqhubekele phambili kwisihloko sendlela yokuphila.

Kuba sinendlela yonyango yokuguqula izifo kwaye le yindlela yethu yokuphila, umthambo ophakathi, ukulala ngokwaneleyo [00:10:00], ukutya kwaseMedithera. Kwaye ukuba uzama ukufumanisa umntu okwisigaba sokukhulelwa, oku, ngokoluvo lwam, kufuneka umxelele ukuba unokuzenzela into ethile.

UGqr. Eduardo de Pablo Fernandez: Leyo yingongoma ebaluleke kakhulu kwaye omnye wabagxeki abanye abathi iyintoni ingongoma yokwenza uxilongo xa ungakwazi ukunika naluphi na ukhetho lwezonyango? Kodwa kusekho utshintsho oluninzi kwindlela yokuphila kunye nonyango olungelulo olwezonyango esinokulunika. Andazi ukuba ungandisa kancinci na kuloo nto?

UDkt. Eva Schäffer: Ewe, ewe. Ngoko ke kukho izinto ezilungileyo nezingalunganga zokuxilonga okanye ukuzama ukufumanisa umntu okwisigaba sokukhula kwesisu. Kwaye enye yezona zinto zibalulekileyo kukuba ungamxelela ukuba ungayitshintsha indlela ophila ngayo kwaye mhlawumbi unganciphisa isantya sesifo sakho kwisigaba sokukhula kwesisu. Kwaye ezona zinto zibalulekileyo esizaziyo kwizifundo ezininzi kukuzilolonga okuphakathi, nantoni na othanda ukuyenza.

Ukutya kweMeditera kunedatha engcono kakhulu yokukhusela imithambo-luvo kunye nokunciphisa ukudumba kwe-neuroinflammation [00:11:00], uxinzelelo lwe-oxidative, zonke iintlobo zeendlela ze-pathological ezibalulekileyo kwisifo sikaParkinson. Ukulala ngokwaneleyo kubaluleke kakhulu. Uqeqesho lokuqonda, ulawulo loxinzelelo, ezi ziindlela zokuphila ezibalulekileyo ezinokukwazi ukucothisa isifo kwisigaba se-prodromal.

Ngoko ke le yeyona nto ibalulekileyo onokubaxelela yona. Kukho ezinye iingenelo. Enye ingcali kukuba, umzekelo, unokunyamekela unyango oluneempawu. Sinabantu abaninzi abane-REM sleep behavior disorder abanengxaki enkulu yokulala, ngoko ke ungayinyanga loo nto. Unganyanga ukuqhinwa, uxinzelelo lwegazi oluphantsi, kunye nokudakumba.

Uninzi lwabo luneengxaki eziphezulu zesifo, nangona bekwisigaba sokukhula kwesisu kuphela, kodwa banomthwalo weempawu ezingezizo ezomzimba, ngoko ke ungayinyanga loo nto. Kwaye ewe, enye ingcebiso kukuba ukuba baguqukela kwisifo sikaParkinson, ungasixilonga ngokukhawuleza uze ubanyange ngokukhawuleza, ngoko ke oku kukwayi-pro [00:12:00].

UGqr. Eduardo de Pablo Fernandez: Uhlobo lonyango olutshintsha izifo, olungelulo olwezonyango lunokunikezelwa, ulawulo olukhawulezileyo lweempawu ezinxulumene nelo nqanaba lokukhula kwesisu. Kwaye ndingathanda nokuxoxa ngokubaluleka kokuba abantu abanesifo sikaParkinson esikhula ngokukhawuleza bathathe inxaxheba kuphando.

Ngokucacileyo oku kunika ithuba elihle lokuphuhlisa ii-biomarkers kumanqanaba okuqala kunye novavanyo lweklinikhi lokungenelela kwangoko. Ndicinga ukuba mhlawumbi njengombuzo wokugqibela owukhankanyileyo, siya siphucuka ekufumaneni ukuchonga nokuqonda umngcipheko wesifo sikaParkinson, kwezi zigulana.

Andazi nokuba wena-- ndingathanda ukufumana iingcinga zakho malunga nendlela izinto eziza kuhamba ngayo kweli candelo kwixesha elizayo, ukuba kukho into onokuyingeza?

UGqr. Eva Schäffer: Nditsho ukuthi, injongo yethu ephambili kukuba sichonge abantu abakwisigaba sokukhulelwa size emva koko sibanike unyango lokuguqula izifo ngokwezonyango. Kwaye kwangaxeshanye, asifumani unyango lwezonyango oluguqula izifo kuba sivavanya [00:13:00] zonke iindlela zethu zezonyango ngokwezonyango kwisigaba seklinikhi, kwaye kusenokuba sekwephuzile ukuba kube nemiphumo ebalulekileyo.

Ngoko ke ndicinga ukuba sisondele kakhulu ekuxilongeni abantu abakwisigaba sokukhula kwesifo kunye nokudibanisa ii-biomarkers zeklinikhi kunye nee-biomarkers, kwaye sisondele kakhulu ekubandakanyeni aba bantu kwizifundo ze-pharmacological eziguqula izifo. Sele sinezilingo eziqhubekayo zokungenelela ezingezizo eze-pharmacological nto leyo intle kakhulu.

Uqeqesho lokuqonda eJamani, sineendlela ezininzi zokungenelela kwindlela yokuphila kubantu abakhulelweyo, ngoko ke sele sinayo loo nto. Kwaye ndicinga ukuba kuza kuqala kungekudala ukuba sisebenzise nezifundo ze-pharmacological, kwaye eli linyathelo elilandelayo elisondeleyo kakhulu.

UDkt. Eduardo de Pablo Fernandez: Ndicinga ukuba kuyathembisa kakhulu ukuva ukuba kukho uvavanyo oluninzi ngakumbi kubantu abanesifo sikaParkinson esibizwa ngokuba yi-prodromal. Enkosi kakhulu Gqirha Eva Schäffer ngokujoyina nathi namhlanje, kwaye ndiyathemba ukuba bonke abaphulaphuli bayonwabele. Enkosi kakhulu. Sala kakuhle okwangoku.

UGqr. Eva Schäffer: Bye. Enkosi [00:14:00] wena.