Idatha entsha yokutshintsha iingozi zotyando lwe-DBS kwizigulana nakubaboneleli ngeenkonzo

Wamkelekile, Delaram. Wamkelekile, Chen. Enkosi ngokundijoyina namhlanje.

UDkt. Delaram Safarpour: Enkosi ngokuba nathi.

UGqr. Chengyuan Wu: Ewe. Kuhle ukuba lapha.

UGqr. Mitra Afshari: Bendinomdla wokudibanisa ezi mbono zimbini ukuze ndixoxe ngento endiyibona njengengxaki ebalulekileyo kwiingxaki zokuhamba. Ngelishwa, enye eqhubeka ichaphazela ukhathalelo lwethu lwezigulane zethu, nto leyo ethetha iintsomi malunga neengozi zangaphakathi kotyando kunye nezo zasemva kotyando ezinxulumene notyando lwe-DBS. Ulwazi kunye nokungazi kakuhle ngale nto kusaphezulu, kwaye kuchaphazela zombini imbono yesigulana malunga ne-DBS kunye nembono yomboneleli, nto leyo ekugqibeleni echaphazela izinga lokudluliselwa kwe-DBS kunye nenani lezigulana ezinokungenelwa kolu nyango ekugqibeleni.

Amanqaku amabini esingathanda ukuxoxa ngawo namhlanje nguGqr. Safarpour, Consensus Expert Recommendations for Referral of Parkinson's Disease Patients for DBS Surgery. Oku kwapapashwa kwiNature Parkinson's Disease ngoJanuwari, 2026. Kunye noGqr. Wu, Reframing the Risk of DBS: A Comparison of 2.8 million Elective Surgeries from the [00:02:00] NSQIP Database. Oku kwapapashwa kwiAnnals of Neurology ngoDisemba ka-2025.

Ngoko ke sonke siyazi ukuba i-DBS, nangona ibonakalisiwe ukuba iyasebenza kakhulu kwiingxaki ezininzi zokunyakaza, ngokuqinisekileyo ayisetyenziswa ngokwaneleyo. Ngoko ke Delaram noChen, zeziphi izinto ezahlukeneyo ezenza kube njalo, ngokwembono yenu?

UDkt. Delaram Safarpour: Ndiza kuqala. Uchanekile ngokupheleleyo, nangona kukho ubungqina obucacileyo bokuba i-DBS iphucula kakhulu iimpawu zemisipha, umgangatho wobomi, kunye nezinye zeempawu zesifo sikaParkinson ezingezizo zemisipha, kodwa ayisetyenziswa kangako. Kwaye kukho izinto ezininzi ezinegalelo kule ngxaki, apha ngokwenene.

Enye yazo ingaba yimiqobo yolwazi kunye nokuqonda esinayo sonke. Kwaye izigulane ezininzi kunye nabanye oogqirha basabonwa njenge-DBS njengonyango lwe-quote unquote lokugqibela lwesifo sikaParkinson esiphambili [00:03:00] endaweni yokhetho olusekelwe kubungqina xa iingxaki zemoto okanye i-dyskinesia ziba yingxaki kwezi zigulana, nangona unyango oluphuculweyo lwamayeza.

Isivumelwano sigxininise ngokwenene ukuba inqanaba okanye ubude besifo akufuneki sisetyenziswe njengesiphelo esiqinileyo. Ezo ngcamango ziphosakeleyo akufuneki zikhokelele ekulibazisekeni okungeyomfuneko ekuthunyelweni. Kwaye siyaqhubeka nokubona indlela yokwahluka kwindlela yokudluliselwa phakathi kweengcali ze-neurologists malunga nokuba nini, kwaye ngubani omele athunyelwe kuvavanyo lwe-DBS. Kwaye ezinye zeendlela zokudluliselwa zixhomekeke kuphela ekuphenduleni kweLevodopa, inqanaba likaHoehn kunye neYahr kwaye ezinye azizixabisi iimpawu ezifana nokunganyamezelani namayeza, ngoko ke ukungcangcazela okungenakuphikiswa. Ezinye zezi zigulana azikwazi ukunyamezela amayeza ngenxa yeziphumo ebezingalindelekanga abanazo.

Kwaye iphaneli ifumanise ukuba iikhrayitheriya ezingahambelaniyo [00:04:00] zibangela ukuba amathuba ovavanyo angabikho ngexesha elifanelekileyo. Enye ingxaki kukufikelela kumaziko akhethekileyo e-DBS, izinto ezifana nomgama, ukugubungela i-inshurensi okulinganiselweyo. Uninzi lwethu luye lwakhanyelwa yi-inshurensi ngokusekelwe kwezo khrayitheriya ziqinileyo endizikhankanyileyo, kwaye ukungoneli kweziseko zophuhliso ezahlukeneyo kunokulibazisa ezinye zezi zikhokelo kunye nokulandelelana kwazo. Ngokuqinisekileyo sinenkxalabo yenqanaba lesigulana. Ukubekwa ibala kunye noloyiko malunga notyando lobuchopho, oko kusasele kungumda onamandla kwaye izigulane zihlala zinokuqonda okulinganiselweyo kokuba yintoni inkqubo kunye nokuba zeziphi iinjongo, iingozi, iingenelo ezilindelekileyo, kunye nemfundo malunga ne-DBS rhoqo, ngokubanzi, kwenzeka kade kakhulu kwisifo. Kwaye kusenokwenzeka nakwinqanaba lesifo [00:05:00] ukuba iimpawu zengqondo okanye zengqondo, izifo ezihambisana noko sele ziqalile ukwenzeka kwizigulane zethu. Kwaye oko kuya kususa amathuba amahle esinawo ngaphambili.

Ngoko ke ukusetyenziswa okungaphelelanga kwe-DBS akubonisi nje kuphela ukungabikho kokusebenza kakuhle, kodwa kukudibanisa nje umsantsa wolwazi kunye nokuguquguquka kokudluliselwa. Kwaye le miqobo yondla ngokwenene ingcamango engafanelekanga yokuba yintoni i-DBS kunye noko ikunika kona.

Esinye sezizathu ezibalulekileyo esinazo kukuba kufuneka kubekho iingxoxo zangaphambili. Kwaye izigulane kufuneka ziqaphele.

UGqr. Mitra Afshari: Ndicinga ukuba zonke ezo ziingongoma ezintle kakhulu, Delaram, kwaye ndicinga ukuba zikhokelela kakuhle ekuxoxeni ngephepha likaChen. Ngoko ke Chen, uphononongo olubuyela umva oluveze kweli phepha lujolise ekukhanyiseni loo mngcipheko wotyando lwe-DBS kunye nokunciphisa imfihlakalo yesi sihloko njengoko uDelaram wayebhekisa kuso.[00:06:00] 

Okokuqala, ndifuna ukukubuza, ngokumalunga nolunye utyando lwengqondo ngokukodwa, ungalubeka phi utyando lwe-DBS kuluhlu olupheleleyo lomngcipheko wotyando?

UGqr. Chengyuan Wu: Ewe, enkosi ngaloo nto. Ngokubanzi yonke into ihambelana. Ngoko ke ngokwezinto esizenzayo, i-DBS ayinabungozi bungako. Uninzi lwezinto esizenzayo kutyando lwemithambo-luvo alukhethi nokuba yinto yokuzikhethela. Senza utyando oluninzi, utyando lomqolo, utyando lwethumba, utyando lwe-aneurysm, kunye nokubetha. Ngoko ke uninzi lotyando lwemithambo-luvo alukhethi kwaye ngokwemvelo luza kuba yingozi enkulu.

Ngoko ke kwicandelo le-neurosurgical spectrum, i-DBS yinto eqhelekileyo. Loo nto kufuneka ndiyibeke ecaleni xa ndithetha nezigulana ngaloo nto, kwaye phantse yiyo ebangela oko sifuna ukukwenza apha. Enyanisweni, ukuba ujonga izinto kwi-neurosurgery, kukho iinkqubo ze-neurosurgical kweli phepha esizenzileyo.

[00:07:00] Kukho i-laminectomy, kunye ne-cervical decompression fusion kunye neenkqubo eziqhelekileyo zokukhetha. Ngoko ke umbuzo wakho ngulo, ithelekiswa njani naleyo? Ngoku sinamanani apha apho i-laminectomy kunye ne-CDF ziyingozi ngokuphindwe kabini ukuya kathathu kune-deep brain stimulator. 

UGqr. Mitra Afshari: Ngoko ke sixelele kancinci ngesiseko solu phando kunye nokunye okuninzi malunga nale database ye-NSQIP. Asiqhelananga nale database mhlawumbi njengoko uqhelene nayo.

UGqr. Chengyuan Wu: Ewe. Ewe. Ngoko ke i-NSQIP yinto esiyibiza ngokuba yiyo ngothando, okanye ngaphandle kothando, nokuba injani na indlela ovakalelwa ngayo. Kodwa yiNkqubo yoPhuculo loMgangatho wotyando yeKholeji yaseMelika yoSurgeons. Ngoko ke yirejista enkulu yeklinikhi yesizwe eyenzelwe ukulinganisa nokuphucula iziphumo zotyando.

Izibhedlele ziza kukhetha ukuthatha inxaxheba kwaye okwangoku kukho malunga nezibhedlele ezingama-600-700 ezithatha inxaxheba kwaye zinikela ngedatha esemgangathweni yangaphambi kotyando. Oko akusiyo idatha yamabango kuphela, kungekuphela nje [00:08:00] uphononongo lwetshathi, kodwa ukuze ube yinxalenye yale ntlangano, kufuneka ube nomvavanyi weklinikhi oqeqeshiweyo onokukwazi ukuqokelela amanqaku edatha afunekayo kweli phulo lokuphucula umgangatho.

Nangona injongo yokuqala yayikukuphucula umgangatho, abanye abafana nam baye bakujonga oku njengesixhobo sophando kuba kubonelela ngokucace ngakumbi ngolu hlobo lwedatha kunedatha yeMedicare, endisebenze kuyo. Kwaye oko kunokuba yinto engcolileyo kakhulu. Ngoko ke le seti yedatha esiyisebenzisileyo iqale ukususela ngo-2015 ukuya ku-2021.

Kutshanje. Ufumana ulwazi oluninzi kakhulu kunokuba ubuya kuba nalo ngezinye iiseti zedatha ezinkulu. Ufumana ulwazi lweenkcukacha-manani zezigulane, iimeko zonyango ezisisiseko, kunye nezinye izifo ezihambisana noko. Ufumana uhlobo lwenkqubo yexesha lotyando. Kwaye okona kubaluleke kakhulu, njengoko ubonile apha kwisifundo sethu, iziphumo zosuku lwesithathu emva kotyando kuquka iingxaki, ukuphinda utyando, utyando kwakhona. Ngoko ke idatha kunye neenguqu [00:09:00] esinokukwazi ukuzisebenzisa zinokwenzeka kuphela ngenxa yoko sele kumiselwe kwisiseko sedatha se-NSQIP.

UGqr. Mitra Afshari: Ngoko ke iziphumo zakho eziphambili, usandul’ ukuzikhankanya, yayikukuthelekisa kwiimeko zotyando lwe-DBS kunye nezinye iindlela ezininzi zotyando oluqhelekileyo ukusuka kwi-elective C-section ukuya kwi-hip and knee arthroscopy, yayingomnye wemingcipheko iyonke yeengxaki kwiintsuku ezingama-30 emva kotyando, umngcipheko wesibini wokubuyiselwa kwakhona kwiintsuku ezingama-30 emva kotyando.

Emva koko okwesithathu, umngcipheko wotyando kwakhona zingadlulanga iintsuku ezingama-30 emva kotyando. Zithini iziphumo zakho?

UGqr. Chengyuan Wu: Ngoko ke, kunjalo kanye. Kwaye ke kwakhona, ezi ziingxaki ezibukhali ezenzekileyo, kwaye kukho iindlela ezimbalwa esinokujonga ngazo oku. Ukuba sijonga amazinga eengxaki ze-DBS xa kuthelekiswa nayo yonke enye into, amazinga eengxaki ngokubanzi ayemalunga ne-1.3% kwiintsuku ezingama-30 zokuqala kunye ne-DBS xa kuthelekiswa nazo zonke ezinye iindidi, njengoko ukhankanyile, ziqala [00:10:00] ukusuka ekulungisweni kwe-hernia, ukususwa kwe-tonsill ukuya kwi-prostatectomy kunye nokususwa kwe-hysterectomy.

Ezo zidibeneyo zazimalunga ne-4.1%, ngoko ke ziphantsi kakhulu kwi-DBS. Amazinga okwamkelwa kwakhona ayefana xa uthelekisa i-DBS nayo yonke enye into. Kwaye amazinga okusebenza kwakhona ayephantsi nakwi-DBS. Kodwa ndicinga ukuba, ukuze ndifumane ulwazi oluthe kratya, esikwenzileyo kukujonga umlinganiselo we-OR weziphumo eziphambili nganye ngeenkqubo ezithile, kuba ndicinga ukuba oko kunceda kwingxoxo nezigulane ezinokuba ziye zadlula kwenye yezi nkqubo zokhetho okanye ezazi umntu othile.

Ngoko ke, nangona kunjalo, iphantsi kwi-DBS xa ithelekiswa nayo yonke enye into. Kwaye amazinga okubuyiselwa kwakhona ayafana. Xa ujonga idatha, ngoku sinedatha ebonisa ukuba umngcipheko opheleleyo weengxaki ze-DBS ufana nokususwa kwethonsi okanye ukulungiswa kwe-hernia, xa ujonga into efana nokususwa kwe-C-section okanye i-hip replacement, ujonge izinga leengxaki ze-5X [00:11:00].

Uya kwi-hysterectomy, oko kukuphindaphindwa ka-6. Emva koko, ukuphinda ukhulelwe kuya kuba phezulu kwi-prostatectomy bariatric surgery. Kwaye, kufana ngakumbi ne-thyroidectomy. Ngoko ke, njengokuba nemizekelo ethile ndicinga ukuba iyanceda kuloo ngxoxo.

UGqr. Mitra Afshari: Ngokufanelekileyo. Ndicinga ukuba into eboniswa leli phepha, njengoko ukhankanyile, yindlela engcono yokubhekisela kuyo, akunjalo? Kwizigulane kuba uthelekisa ezi nkqubo ziqhelekileyo abantu abaziyo kwaye mhlawumbi sele benamava azo, njengoko uninzi lwezigulane zethu luye lwenziwa i-arthroscopies ye-hip nedolo.

Kukho iziphumo zesibini ozijongileyo. Ezi yayiziingxaki ezithile emva kokuhlinzwa emva kweentsuku ezingama-30, ezinje ngosulelo lwamanxeba, i-pulmonary embolism, ukunqandwa kwentliziyo, okanye i-MI. Kwane-TIA/stroke, eyayiyi-variable yesiphumo eyayigubungela iziganeko ezithile ze-intracerebral okanye ubuchopho [00:12:00].

Ngaba ichanekile loo nto?

UGqr. Chengyuan Wu: Kulungile. Kulungile. Into endandiyiva, okanye xa sithetha ngale nto yayikukuba, kulungile, ewe, izinga leengxaki liyafana okanye liphantsi, kodwa yingqondo yam, akunjalo? Ngoko ke oko kuthetha ukuthini ngokwenene? ​​Ukuba ndineengxaki engqondweni yam ezahlukileyo kuneengxaki kwenye indawo? Yiyo kanye loo nto besifuna ukubona, singajonga iingxaki ezithile engqondweni?

kuba siyazi, njengecandelo lezonyango ukuba xa utshintsha amalungu, ukwimeko yokuxinana kwegazi kakhulu kwaye unokuba nesifo sohlangothi. Yiyo loo nto izigulane zifakwa kwiCoumadin okanye kwi-blood thinners okanye njalo njalo. Ngoko xa sijonga loo nto, ngoku amanani kunye nokwenzeka kwawo kuphantsi kakhulu, kodwa ujonge amazinga angama-0.05, 0.04% ezi ziganeko zengqondo kwi-DBS kunye nayo yonke enye into.

Ngoko ke, kweli siseko sedatha sikhulu, ngokwezibalo, akukho mahluko mkhulu xa ujonga i-[00:13:00] DBS xa ithelekiswa nayo yonke enye into.

UGqr. Mitra Afshari: Kwaye into endiyifumene inomdla kukuba izigulane ezikule database ezafumana i-DBS zifunyenwe zinomngcipheko ophezulu wotyando olusetyenziswa yi-American Society of Anesthesiology classification system. Ngoko ke ungasikhumbuza ukuba yintoni le nkqubo yokwahlulahlula, kwaye ekugqibeleni kuthetha ukuthini oku malunga nezigqibo zokugqibela zophando lwakho?

UGqr. Chengyuan Wu: Ewe, ngoko ke amanqaku e-ASA ngamanqaku empilo iyonke. Yiloo nto isetyenziswa kakhulu ziingcali ze-anesthesiologists ukufumanisa umngcipheko wokuba isigulana sifumane i-anesthesia. Kwaye akumangalisi kakhulu kuba izigulane zethu ezine-Parkinson's zihlala zikhulile. Elo liza kuba yinxalenye enkulu yezi zigulane. Kwaye nezigulane zethu ezinesifo sokungcangcazela, ngamanye amaxesha sizicinga ukuba zisencinci, zihlala zilibazisa i-DBS kude kube kamva.

Ngoko ke oku akunyanzelekanga ukuba kube luluntu olutsha. Kwaye sibonile ukuba izigulane bezikhulile. Kwaye kulapho ubuyela umva ukuze ucinge ngako akumangalisi ukuba [00:14:00] sijonga iinkqubo ezifana notyando lwe-tonsillectomy kunye notyando lwe-appendectomy kunye neqela elinye, akunjalo? Oko kuya kuyinciphisa loo minyaka iphakathi.

Ngoko ke ngokuqinisekileyo kukho umthwalo owahlukileyo we-comorbidity kwizigulane ze-DBS. Ngoku, besingafuni ukuba oko kube yinzuzo engafanelekanga, ngoko ke senze oku kuthelekisa umngcipheko kuhlalutyo lwethu. Kodwa okunomdla kukuba, nokuba ngaphandle kwayo, iingozi zisephantsi kwi-DBS kunayo yonke enye into. Kwaye ngoko ke besingayidingi loo nzuzo, kodwa sithe, kulungile, yindlela efanelekileyo yokuyijonga.

Ukuba ubunesigulana esineminyaka efanayo nesinesifo esifanayo kwaye sisengozini efanayo yempilo, sithatha nayiphi na enye yeenkqubo zokhetho, yintoni uthelekiso? Ngoko ke ekugqibeleni aluzange lutshintshe kangako, kodwa ukuze sithelekise ama-apile nama-apile kangangoko sinako, senze olu hlobo lomngcipheko.

UGqr. Mitra Afshari: Ewe, bendicinga ukuba yinto ebalulekileyo ngokwenene. 

UGqr. Chengyuan Wu: Ekugqibeleni, ndicinga ukuba kuyasomeleza isigqibo sokuba nokuba kukho okanye akukho olu vavanyo lomngcipheko, kwaye nangona izigulane zikhulile [00:15:00] kwaye zisenokuba zigula kakhulu, oko akuzange kutshintshe izinto esinokuzenza ngokukhuselekileyo ezi nkqubo kwizigulane ezindala.

UGqr. Mitra Afshari: Ngokufanelekileyo. Ndicinga ukuba umda omnye wolu phando, uChen, oxoxe ngawo kwiphepha, kukuba isiseko sedatha oqokelele kuso idatha sasingenalo ulwazi oluneenkcukacha malunga nendlela utyando lwe-DBS olwenziwe ngayo. Kulungile. Iingcali ze-DBS, mna kunye noDelaram siqhelene kakhulu nale nto.

Siyazi ukuba kukho iindlela ezingaphezu kwesinye zokwenza utyando lwe-DBS. Kukho utyando oluqhelekileyo lwe-awake micro electrode recording DBS apho izigulane zivukile. Kukho i-anesthesia encinci esetyenziswayo. Akufuneki i-intubation. Kwaye kukho utyando lokulala, olunokuthi lungabi rhoqo eMelika, kodwa lwenziwa ndicinga ukuba luqhutywa rhoqo phantsi kwesikhokelo se-MRI kunye ne-CT ngaphandle kweerekhodi ze-micro electric. Kwaye izigulane ziphantsi kwe-anesthesia eqhelekileyo.

Kwaye [00:16:00] ngelishwa ezo nkcukacha azizange zifakwe kwi-database. Ngaba ucinga ukuba ezo nkcukacha zendlela utyando olwenziwe ngayo zinokuchaza iinkqubo zotyando ze-DBS ezinomngcipheko ophezulu okanye ophantsi, kwaye yintoni ingcamango yakho enxulumene noko?

UGqr. Chengyuan Wu: Ewe inomdla kakhulu kwaye ichanekile ngokupheleleyo. Ayikho apho kuba yayingeyonto ithile ekhethiweyo. Ndikwahlekisa ngelithi ukuba uthetha noogqirha abali-10 abahlukeneyo be-DBS, baza kukuxelela iindlela ezili-15 ezahlukeneyo zokwenza le nkqubo. Ngoko ke kukho ezi ngxaki zicacileyo.

Kodwa ekugqibeleni, ukuba ndibeka ecaleni zonke iimbono zam malunga nendlela endikwenza ngayo, kuba kwakhona, nawuphi na ugqirha wezifo zengqondo uza kucinga ukuba indlela abenza ngayo iya kuba yeyona ndlela ilungileyo. Kodwa ukuba ususa zonke ezo mbono uze ujonge idatha echanekileyo. Kukho inqaku elihle kakhulu elenziwe yiCleveland Group, ekhokelwa nguSean Nagel elibonisa ukuba iDBS kwiminyaka elishumi edlulileyo ikhuselekile kakhulu kunokuba yayinjalo kwiminyaka elishumi edlulileyo, ngaphandle kobuchule.

Ukuba ujonga zonke izifundo ezininzi [00:17:00] xa uthelekisa ukulala nokuvuka, siyabona ukuba akukho mahluko mkhulu phakathi kweendlela ngokubhekiselele kwiziphumo zonyango kunye neziphumo ebezingalindelekanga. Iingxaki azikho kuloo nto. Kodwa ngokubanzi, idatha esinayo ibonisa ukuba abantu benza kakuhle, kwaye ndicinga ukuba ekugqibeleni oko kuxhomekeke kuko, kwaye oku kuye kwaba yingxoxo engeyiyo i-quote uncote kwicandelo lethu, kukuba ekugqibeleni ugqirha kufuneka akhululeke ngenkqubo.

Ndicinga ukuba into engabalulekanga kangako kunendlela yokwenyani kukuqhelana nendlela yobugcisa kunye nokuqhelana kweqela nendlela yobuchule. Ngoko ke uqala ukungena kwisignali engaphezulu ngokubhekiselele kumazinga obunzima kwiindawo zomthamo ophezulu xa kuthelekiswa neendawo zomthamo ophantsi. Ngoko ke akunamsebenzi ukuba ukwenza njani, lo gama nje kwenziwa ngendlela ephindaphindwayo nethembekileyo.

Ngoko ke ekugqibeleni, ixhomekeke kakhulu kumava otyando, ukuhambelana kweqela, njalo njalo kunokuba ibe yindlela yokwenza izinto ngokungqalileyo.

UGqr. Mitra Afshari: Kwaye ndicinga ukuba [00:18:00] ngenxa yoku, Delaram, nawe ungangenelela. Endikufundisiweyo kukuba ngaphambili, xa i-DBS yaqala abantu babesenza iipasi ezininzi nge-micro electrode, kwaye besenza imaphu yezinto nge-microelectrode. Kwaye ndicinga ukuba izinto zitshintshile ngokuhamba kwexesha kwaye sisiya kude kancinci nemaphu, akunjalo?

Ngoko ke loo mngcipheko onokuza nee-microelectrode passes okanye tracks ezininzi uza kutshintsha ngokuhamba kwexesha. 

UGqr. Chengyuan Wu: Ndicinga ukuba ekugqibeleni, njengemiba emininzi yotyando lwe-neurosurgery, siye saphucuka kakhulu ngokuphuculwa kwemifanekiso. Kwaye ke nge-MRI, oko kuye kwavumela oogxa bethu abanesimila ukuba benze ii-craniotomies ezincinci kwaye asisazenzi ezi zikhewu zinkulu. Kuvumele oogxa bethu abanesihlunu ukuba bachaze ngakumbi ngokweenkqubo ezenziwayo.

Kwaye kwi-functional, [00:19:00] iyafana ncamanye apho kubonwa khona iithagethi obuthetha ngazo nge-subthalamic nucleus, okanye i-pallidus? Ngokuqinisekileyo zichazwe ngcono kakhulu kunangemihla oyaziyo, i-ventriculography. Ukuba uyibona ngcono, uza kuxhomekeka kancinci okanye ufune imaphu encinci, kwaye kusenokwenzeka ukuba usebenzise ii-MERs ngakumbi ukulungisa ubunzulu okanye ukuqinisekisa indawo, ukuba ukuvuselelwa kwakho kwe-macro akuchanekanga ngokupheleleyo. Ngoko ke ewe, ndicinga ukuba ulungile ngokwenene njengoko sikubonile kulo lonke icandelo lethu.

UGqr. Mitra Afshari: Linqaku elihle kakhulu. Delaram, ubufuna ukungenelela?

UDkt. Delaram Safarpour: Ewe. Ndingathetha nje ngehlabathi lotyando lwe-neurosurgery olusebenzayo kuba kulapho ndisebenzisana khona kakhulu neengcali zethu zotyando lwe-neurosurgery. Kwaye ndicinga ukuba sikwixesha lokuchaneka kwaye ngokuqinisekileyo zonke ezi nkqubela phambili esizenzileyo zayenza yachaneka ngakumbi. Izilonda esizenzayo nge-focus ultrasound zingcono [00:20:00] kuneendlela zangaphambili zokubulala izilonda esasinazo.

Ukufakelwa kwee-lead ze-DBS kuchanekile ngakumbi kwaye ngokuqinisekileyo ukuba sincinci inani lee-lead okanye ii-pass esinazo ziya kuphucula iziphumo. Ndiyavumelana ngokupheleleyo noko.

UGqr. Mitra Afshari: Umbuzo wokugqibela endandinawo ngoChen, ndaza ndafuna ukujika ndibhekise kuDelaram ukuze ndithethe ngakumbi ngephepha lakhe lokuvumelana, malunga nokunika iingcebiso kwizigulana. Ngoko ke, zombini ezi phepha zinefuthe elikhulu kulwazi lwababoneleli malunga nomngcipheko wotyando lwe-DBS, kodwa kuthekani ngendlela esibanika ngayo iingcebiso ngokuchanekileyo izigulana?

Chen, ndicinga ukuba abaphulaphuli bethu bangathanda ukuva kuwe malunga nendlela onokuthi umcebise ngayo umguli omvavanyayo ukuba atyandwe nge-DBS, uthatha olu lwazi lutsha. Ingaba isampulu yeskripthi ingaba yintoni evela kuwe?

UGqr. Chengyuan Wu: Ndicinga ukuba kulula ukuvuya kakhulu ngale nto, kodwa kubalulekile ukuba [00:21:00] singayigqithisi into yokuba uhlobo lokulinganisela inzuzo yomngcipheko lufanelekile, kwaye yiloo nto kanye, akunjalo? Ndicinga ukuba kuqala ndithetha ngokubanzi, njengoko uGqr. Safapour wayetshilo, ukuba ihlazo lotyando lobuchopho oluthi quote unquote kunye nendlela olutshintsha ngayo indlela esibona ngayo izinto kunye nento esiyenzayo kutyando kukuba kufuneka sisoloko sivavanya inzuzo ngomngcipheko. Kwaye ukuba iingenelo ziyaziwa kwaye siyazi ukuba i-DBS ayilonyango, kodwa inokuba sisixhobo esisebenzayo kakhulu sokuphucula iimpawu, ukunciphisa umthwalo wamayeza, kwaye ekugqibeleni siphucule umgangatho wobomi. Kwaye elo nqaku ndilivayo rhoqo kukuba, izigulane zangaphambili zihlala zisithi, ndingathanda ukuba ndikwenze oku kwangoko. Ndizama ukususa izigulane kule ngcinga yokuba quote unquote, utyando lobuchopho luyingozi ngakumbi. Kwaye bayakhathazeka ngokuqondakalayo, kodwa baqala ukuthetha ngokuvela kwe-DBS njengoko sinayo apha. Ngokubanzi [00:22:00] ithi iteknoloji iyiphucule indlela esenza ngayo oku kwaye inciphise kakhulu umngcipheko.

Ngoku njengoko besihlanganisa eli phepha, ndithethe ngalo, kodwa ngoku ndingatsho ngokuzithemba ukuba silithelekise ngokuchanekileyo ngendlela yokuba, uyazi, wena okanye usapho lwakho ninokuqonda kwaye, iingxaki ngokubanzi ezivela kutyando ziphantsi kakhulu kunezo zibonwayo. Kwaye oko, ndingakunika amanani, ngokubhekiselele kumazinga okopha kwegazi kunye namazinga osulelo, kwaye ndikwenze oko ngalo lonke ixesha. Kodwa ndicinga ukuba okunempembelelo ngakumbi kukuthetha ngoko kuboniswa yidatha yethu kukuba i-DBS ilingana nomngcipheko wokususwa kwe-tonsillectomy okanye ukulungiswa kwe-hernia kwaye ayinabungozi kangako kunokutshintshwa kwesinqe okanye idolo.

UGqr. Mitra Afshari: Ngokufanelekileyo. Delaram, ndingathanda ukuva kuwe ngoku. Ndicinga ukuba kuhle kakhulu ukuba sibe nezi mbono zimbini kunye kule podcast namhlanje, sixoxa ngalo mba. Kuba njengoko nobabini nitshilo ngaphambili, asifane sibe nala mathuba nakwiinkomfa zethu zemfundo. Uyazi, sisandula [00:23:00] ukuva esi sishwankathelo sibalaseleyo esivela kuChen malunga nazo zonke ezi ziphumo zibalulekileyo ezivela kuphando lwakhe malunga nomngcipheko wotyando lwe-DBS.

Xa ucinga ngamaxesha owahlala phantsi nezigulane zakho kwezo ngxoxo zokuqala ze-DBS, ucinga ukuba olu lwazi lutsha luza kwenza lula okanye luqinise njani iincoko zakho?

UDkt. Delaram Safarpour: Ndicinga ukuba ezi datha zisinceda kakhulu ukuba nencoko elungeleleneyo nezigulana. Amandla ophando olwenziwe nguGqr. Wu kunye noogxa babo kukubonisa olu thelekiso. kuba njengoko ebetshilo ngaphambili, xa unika isigulana la manani, abanye babo baya kuthi, ah, ndiza kuba nethamsanqa eliyi-1%.

Yinto nje abanye abantu abaza kuyithetha. Kodwa ke xa unika loo ngongoma yokuthelekisa notyando lwe-tonsillectomy, uthelekisa nezinye iindlela zotyando, umngcipheko uphantsi kakhulu. Kwaye xa ndithetha nabo, ndiza kuthi, ndiyaqonda ukuba le yingqondo yakho [00:24:00] esithetha ngayo, kwaye sifuna ukuba neziphumo ezintle, kodwa nantsi into esiyaziyo kwi-big data kwaye ezi ngozi ziphantsi kakhulu kwaye ungaphucula umgangatho wobomi.

Ngoko ke oku kundinceda kakhulu ukuba ndenze isigqibo esihle kakhulu kubaguli, ndinolwazi oluthe kratya kwaye kulula kangangokuba iingozi zihlala zibonwa zinkulu kunokuba zinjalo ngokwenene. Kwaye ndicinga ukuba olu hlobo lokutshintsha inkxaso nolwazi kwangethuba kwizigulane luya kusinceda sibe nokudluliselwa kwangaphambili kwezigulane kwaye sisuse ihlazo malunga notyando, kwaye ekugqibeleni senze izigqibo ezabelwana ngazo ngcono.

UGqr. Mitra Afshari: Kuhle kakhulu. Ngoko ke ndicinga ukuba ndifuna ukubuza umbuzo wokugqibela kuni nobabini. Kwaye oko kungaba, singenza njani ngcono? Ngaba le ngxoxo yanamhlanje nani nobabini mhlawumbi inokubangela ezinye izimvo ezintsha malunga nendlela esinokuyongeza ngayo i-DBS referrals evela kubaboneleli [00:25:00] kunye nendlela esinokwenza ngayo izigulane zikhululeke kancinci.

Ngaba oku kuvusa nantoni na entsha mhlawumbi esifanele siyiqalise nezigulane zethu kunye nababoneleli bethu? Delaram, siza kuqala ngawe.

UDkt. Delaram Safarpour: Ndiyavuya kakhulu ukuba uthethe ngale nto. Oku kubonisa ukuba kufuneka sisebenzele ngokwenene kule mbono yokuba kufuneka ube nenkqubo enkulu kakhulu, eyakhiwe ngokupheleleyo, neyahlukeneyo ngaphambi kokuba ukwazi ukubonelela nge-DBS ngokukhuselekileyo. Okanye, le ngcamango ngokwayo inokuba ngumqobo ekwandiseni ukufikelela.

Into esizama ukuyigxininisa kwiphepha lethu kukuba nangona unyango olunezifundo ezininzi lubalulekile, akufuneki lubonakale lufana kuzo zonke iziko. Ngokuqinisekileyo kukho umahluko kwindlela iinkqubo ezakhiwe ngayo, kwaye kulungile oko nje izinto eziphambili zikhona. Kum, iqela eliphambili liquka ingcali yezifo zengqondo eziphazamisa ukuhamba, ingcali ye-[00:26:00] esebenza nge-neurosurgeon, kwaye ngokuqinisekileyo ingcali ye-neuropsychologist bonke abanamava e-DBS kwaye basebenza kunye.

Olu budlelwane lusisiseko sempumelelo kwaye lujikeleze oko ukuba ukufikelela kuvumela ukuba kubekho intsebenziswano nonyango lomzimba, unyango lokuthetha, unyango lwangaphambi kotyando, kunye nomsebenzi wentlalo. Oku kuya kuyenza ibe lelona qela lamaphupha lifanelekileyo. Kodwa ayizizo zonke iziko ezinokufikelela kuvavanyo oluneenkcukacha ezinjalo.

Kwaye kubalulekile ukuqala intsebenziswano uze emva koko ufumane ukuba ezinye zazo zinokuqhutywa na zisuka kumaziko angaphandle okanye malunga namasebe ahlukeneyo, mhlawumbi ngokusebenzisa i-telehealth. Zininzi iindlela ezahlukeneyo ezinokwakhiwa ngazo eli qela lezifundo ezahlukeneyo. Kwaye ngeendlela ezininzi oku kuhambelana nengxoxo yangaphambili yokuba sifuna nje ukunciphisa umda wokudluliselwa, kwaye sifuna ingcali ye-neurologist ebhekisayo iqonde ukuba awubhekiseli kwaye uzinikele kutyando [00:27:00].

Kodwa endaweni yoko uthumela isigulana sakho ukuba siye kuvavanywa okunokutshintsha umgangatho wobomi baso kwaye oku akufanele kube yindlela yokugqibela kubo.

UGqr. Mitra Afshari: Ndicinga ukuba le yingongoma ebaluleke kakhulu kuba ndikhuthaza kakhulu iingcali zethu ze-neurological disorder ukuba zithumele izigulane ukuba zize kuthetha nam nge-DBS. Ukuze sithethe ngayo, kungabi yimfuneko ukuba zihambe ngale ndlela ikhawulezayo apho ziza kutyandwa khona.

Ndicinga ukuba yiloo nto abantu abaxhalabela ngayo. Ngoko ke kuhle ukuthetha nomntu onolwazi olufana nawe. Kwaye ube neengxoxo zokuqala nathi kwaye mhlawumbi ube neengxoxo zokuqala ukuze ufudumale isigulana kwingcinga nogqirha wemithambo-luvo. Ucinga ntoni ngaloo nto, Chen?

UGqr. Chengyuan Wu: Ewe, ndiyavuma ngokupheleleyo. Ekugqibeleni ngumbandela wokuqala loo ncoko njengoko nobabini nitshilo, akunjalo? Ndicinga ukuba into enye esingathethanga ngayo yimeko embi kakhulu engqondweni yam kukuba sisayibiza ngokuba kukukhuthaza ingqondo ngokunzulu. Kwaye kwizigulana asizange sizincede ngokuthi ziyaweva loo mazwi kwaye zathi, wow, nzulu, oko kuvakala kubi.

Kwaye engqondweni yam, oko kuvakala kubi ngakumbi, akunjalo? Singawoyisa njani loo mqobo? Kwaye, ngolu lwazi, ndinethemba lokuba le yindlela elula yokuqala loo ncoko nokusasaza olu hlobo lolwazi kwizigulana ngokuthe ngqo, kwiingcali zemithambo-luvo, kubo bonke abantu abanemizamo efana nale kwaye ngoncedo lweMovement Disorder Society ukuzama ukukhupha elo lizwi ukuze ewe, sikwazi ukuqala loo ncoko sithi, kulungile, ngaba lo mntu ungumgqatswa?

kuba asinalo elo thuba, abo baguli abasayi kuze bakwazi nokuyicinga le ndlela yonyango.

UGqr. Mitra Afshari: Enkosi kuni nobabini. Le ibiyingxoxo entle kakhulu. Ndifuna ukubulela ooGqirha uSafapour noWu ngomsebenzi onzima eniwenzayo nangokuthatha ixesha kwishedyuli yenu exakekileyo ukuze nincokole nathi kule MDS Podcast. Bekumnandi kakhulu ukuva izimvo zenu nobabini.

Enkosi. Kude kube lixesha elizayo.

UGqr. Chengyuan Wu: Enkosi.