Multiple Sclerosis

Thola ulwazi oluthe xaxa ku-neurologist u-Oliver Tobin, M.B., B.Ch., B.A.O., Ph.D.

Asazi ukuthi yini ebangela i-MS, kodwa kunezinye izinto ezingase zikhulise ingozi noma zibangele ukuqala kwayo. Ngakho-ke, nakuba i-MS ingase ibonakale kunoma iyiphi iminyaka, ikakhulukazi ivela kubantu abaneminyaka ephakathi kuka-20 no-40. Amazinga aphansi e-vitamin D nokuvezwa okuncane ekukhanyeni kwelanga, okuvumela umzimba wethu ukuba wenze i-vitamin D, kuhambisana nengozi eyenyuka yokuthuthukisa i-MS. Njengoba abantu abane-MS abanamanani aphansi e-vitamin D bathambekele ekubeni nesifo esinzima. Ngakho-ke abantu abanesisindo esiningi banamathuba amaningi okuthuthukisa i-MS kanye nabantu abane-MS futhi banesisindo esiningi bathambekele ekubeni nesifo esinzima kanye nokuqala okusheshayo kokuthuthuka. Abantu abane-MS nabafuma bathambekele ekubeni nezinye izikhathi zokubuyela, isifo esibi esithuthukayo, kanye nezimpawu ezingathandeki. Abafazi banamathuba amathathu okuba ne-MS enqamula-nqamula kunamadoda. Ingozi ye-MS kubantu abavamile cishe i-0.5%. Uma umzali noma umfowabo noma udadewabo enesifo se-MS, ingozi yakho cishe iphindwe kabili noma cishe i-1%. Ukutheleleka okuthile kubalulekile. Izinhlobo ezihlukahlukene zama-virus ziye zahlanganiswa ne-MS, kufaka phakathi i-Epstein-Barr virus, ebangela i-mono. Ama-latitude aseNyakatho naseningizimu anamazinga aphezulu, kuhlanganise neCanada, i-US enyakatho, i-New Zealand, iningizimu-mpumalanga ye-Australia, neYurophu. Abantu abamhlophe, ikakhulukazi abavela enyakatho yeYurophu, banengozi enkulu. Abantu abavela e-Asia, e-Afrika, nase-Native America banengozi encane. Ingozi encane eyenyuka iyabonakala uma isiguli sesivele sinomdlavuza we-autoimmune thyroid, i-anemia pernicious, i-psoriasis, i-type 1 diabetes, noma isifo sokuvuvukala sezisu.

Okwamanje ayikho i-test eyodwa yokwenza ukuxilongwa kwe-MS. Noma kunjalo, kunezimpawu ezine eziyinhloko ezisiza ekuqinisekiseni ukuxilongwa. Okokuqala, ingabe kunezinhlobo zezimpawu ze-multiple sclerosis? Futhi, lezo zilahleko lombono elinye iso, ukulahleka kwamandla engalo noma umlenze, noma ukuhlupheka komuzwa engalweni noma umlenze okuhlala isikhathi esingaphezu kwamahora angu-24. Okwesibili, ingabe unezinye izinto ezitholakala ekuhlolweni komzimba ezihambisana ne-MS? Okulandelayo, ingabe i-MRI yobuchopho bakho noma umgogodla ihambisana ne-MS? Manje lapha kubalulekile ukuqaphela ukuthi i-95% yabantu abangaphezu kweminyaka engu-40 banesifo esingavamile se-MRI yobuchopho, njengoba nje abaningi bethu sinama-wrinkles olukhuni. Ekugcineni, ingabe imiphumela yokuhlaziywa kwe-spinal fluid ihambisana ne-MS? Udokotela wakho angase akukhuthaze ukuhlolwa kwegazi ukuhlola ezinye izifo ezinazo izimpawu ezifanayo. Bangase futhi bakhuthaze i-OCT test noma i-optical coherence tomography. Lokhu kuyiskena elifushane lobukhulu bezingqimba ngemuva kwamehlo akho.

Ngakho-ke into engcono kakhulu ongayenza uma uphila ne-MS ukufumana iqembu lezokwelapha elithenjiwe lezinhlangano ezingakusiza ukulandelela nokuphatha impilo yakho. Ukuba neqembu lezinhlangano eziningi kubalulekile ekubhekaneni nezimpawu zomuntu siqu ozibhekana nazo. Uma une-MS attack noma ukubuyela, udokotela wakho angase akubhalele ama-corticosteroids ukunciphisa noma ukuthuthukisa izimpawu zakho. Futhi uma izimpawu zakho zokuhlasela zingaphenduli kuma-steroids, enye indlela yi-plasmapheresis noma ukushintshwa kwe-plasma, okuyindlela yokwelapha efana ne-dialysis. Cishe i-50% yabantu abangaphenduli kuma-steroids banokuzuza okukhulu ngesikhathi esifushane sokushintshwa kwe-plasma. Kunezinye izidakamizwa ezingaphezu kuka-20 ezivunyelwe okwamanje zokuvimbela ukuhlaselwa kwe-MS nokuvimbela izifo ezintsha ze-MRI.

Ku-multiple sclerosis, ukumbozwa okuvikelayo ezintweni zezinzwa kulimala futhi kungase kugcinwe kubhujiswe. Lokhu kuboshwe okuvikelayo kubizwa ngokuthi i-myelin. Kuye ngokuthi ukubhujiswa kwezinzwa kwenzeka kuphi, i-MS ingathinta umbono, umuzwa, ukuxhumana, ukuhamba, kanye nokulawula kwesisu noma izisu.

Multiple sclerosis yisifo esibangela ukuphazamiseka kokumbozwa okuvikelayo kwezinzwa. Multiple sclerosis ingabangela ukungathandeki, ubuthakathaka, ukuhlupheka ekuhambeni, ukuguquka kombono nezinye izimpawu. Kuyaziwa nangokuthi yi-MS.

Ku-MS, uhlelo lokuphephakazi lomzimba luhlasele i-sheath evikela ehlanganisa ucingo lwezinzwa, oluaziwa ngokuthi yi-myelin. Lokhu kuphazamisa ukuxhumana phakathi kobuchopho nezinye izingxenye zomzimba. Ekugcineni, isifo singabangela umonakalo ophakade wezingqimba zezinzwa.

Izimpawu ze-MS ziyahlukahluka kuye ngumuntu, indawo yomonakalo ohlelweni lwezinzwa nokuthi umonakalo wezingqimba zezinzwa ukhulu kangakanani. Abanye abantu bayalahlekelwa ikhono lokuhamba bodwa noma ukuhamba nhlobo. Abanye bangaba nezikhathi ezinde phakathi kokuhlasela ngaphandle kwezimpawu ezintsha, okuthiwa yi-remission. Indlela yesifo iyahlukahluka kuye ngohlobo lwe-MS.

Asikho isilondolozi se-multiple sclerosis. Noma kunjalo, kunezinye izindlela zokwelapha ezisiza ekusizeni ukubuyela kokuhlasela, ukuguqula indlela yesifo nokuphatha izimpawu.

Ezinye izimo zihlelwa njengezigaba, kodwa i-multiple sclerosis ihlelwa njengezinhlobo. Izinhlobo ze-MS ziyahlukahluka kuye ngokuthuthuka kwezimpawu kanye nokuqina kokubuyela. Izinhlobo ze-MS zihlanganisa:

Abantu abaningi abane-multiple sclerosis banohlobo oluqamula-nqamula. Bayahlangabezana nezikhathi zezimpawu ezintsha noma ukubuyela okuthuthukayo ezinsukwini noma emaviki futhi ngokuvamile kuyaqina ngokuphelele noma ngokuphelele. Lokhu kubuyela kulandelelwa yizikhathi ezolile zokuthuthukiswa kwesifo ezingase zihlale izinyanga noma iminyaka.

Okungenani i-20% kuya ku-40% yabantu abane-multiple sclerosis enqamula-nqamula ekugcineni bangathuthukisa ukuqhubeka okuzinzile kwezimpawu. Lokhu kuqhubeka kungase kube khona noma kungabi khona izikhathi zokuthuthukiswa futhi kwenzeka phakathi kweminyaka engu-10 kuya kwengu-40 yokuqala kwesifo. Lokhu kuwaziwa ngokuthi yi-secondary-progressive MS.

Ukuwohloka kwezimpawu ngokuvamile kuhlanganisa inkinga yokunyakaza nokuhamba. Izinga lokuqhubeka kwesifo liyahlukahluka kakhulu phakathi kwabantu abane-secondary-progressive MS.

Abanye abantu abane-multiple sclerosis bayahlangabezana nokuqala okuqhubekayo nokuqhubeka okuzinzile kwezimpawu ngaphandle kokubuyela. Lolu hlobo lwe-MS luwaziwa ngokuthi yi-primary-progressive MS.

I-clinically isolated syndrome ibhekisela esigabeni sokuqala sesimo esithinta i-myelin. Ngemva kokuhlolwa okwengeziwe, i-clinically isolated syndrome ingase ixilongwe njenge-MS noma isimo esihlukile.

I-radiologically isolated syndrome ibhekisela ezintweni ezitholakala kwi-MRI yobuchopho nomgogodla obukela njenge-MS kumuntu ongenazo izimpawu ezivamile ze-MS.

Kwisifoqele esiningi, ukumbozwa okuvikelayo emithanjeni yezinzwa, okwaziwa ngokuthi i-myelin, ohlelweni lwezinzwa oluphakathi kulimale. Ngokuya ngendawo yomonakalo ohlelweni lwezinzwa oluphakathi, izimpawu zingase zenzeke, kufaka phakathi ukungabi namuzwa, ukukhahlela, ubuthakathaka, ukushintsha kokubona, izinkinga zesibindi nezamathumbu, izinkinga zokuqonda, noma ukushintsha kwesimo sengqondo, ngokwesibonelo.

Izimpawu zesifoqele esiningi zihlukahluka kuye ngumuntu. Izimpawu zingashintsha phakathi nohambo lwesifo kuye ngokuthi yimiphi imithanjeni yezinzwa eithintekayo.

Izimpawu ezivamile zihlanganisa:

• Ukungabi namuzwa noma ukukhahlela.
• Imizwa efana nokushaywa umbani okwenzeka ngezinye izinyathelo zentanyel, ikakhulukazi ukugoba intanyel phambili. Le mizwa ibizwa ngokuthi i-Lhermitte sign.
• Ukungabi namandla okuhambisana.
• Ukuphazamiseka ekuhambeni noma ukungakwazi ukuhamba nhlobo.
• Ubuthakathaka.
• Ukulahleka okuphelele noma okuphelele kokubona, ngokuvamile elinye iso ngesikhathi sinye. Ukulahleka kokubona ngokuvamile kwenzeka ngebuhlungu ngesikhathi sokuhamba kwamehlo.
• Ukubona okubili.
• Ukubona okuphazamisekile.
• Ukukhungatheka nomuzwa oqondile wokuthi wena noma izindawo zakho zihamba, okwaziwa ngokuthi i-vertigo.
• Ukuphazamiseka kokusebenza kobulili, kwamathumbu nangesibindi.
• Ukukhathala.
• Inkulumo ephazamisekile.
• Izinkinga zokuqonda, ukucabanga nokuqonda ulwazi.
• Ukushintsha kwesimo sengqondo.

Ukuqhubeka okuncane kokushisa komzimba kungalimaza izimpawu ze-MS isikhashana. Lezi azibhekwa njengokubuya kwezifo ezithile kodwa yi-pseudorelapses.

Yenza i-aphoyintimenti nodokotela wakho noma omunye ochwepheshe wezempilo uma unezinkinga ezikukhathazayo.

Imbangela ye-multiple sclerosis ayaziwa. Kubhekwa njengesiifo esibangelwa yisistimu yomzimba lapho isistimu yomzimba yokulwa nezifo ihlasela izicubu zayo. Ku-MS, isistimu yomzimba yokulwa nezifo ihlasela futhi ibhubhise izinto ezinhlanzi ezihlanganisa futhi zivikele imicu yezinzwa ebuchosheni nasemgogweni wasemuqolo. Le nto ehlanganisa amafutha ibizwa ngokuthi i-myelin.

I-myelin ingafaniswa nokumbozwa kokukhahlela kweentambo zombane. Uma i-myelin eyivikelo yonakele futhi umthambo wezinzwa ukhombile, imiyalezo ehamba kulelo thambo lezinzwa ingase ibe buthakathaka noma ivinjelwe.

Akucace ukuthi kungani i-MS ithuthukela kwabanye abantu hhayi kwabanye. Ukuhlanganiswa kwezinto zofuzo nezinto ezingaphandle kungase kukhulise ingozi ye-MS.

Izici ezandisa ingozi ye-multiple sclerosis zifaka phakathi:

• Ubudala. I-MS ingahle ibe khona kunoma yiliphi iminyaka. Kodwa-ke, ukuqala kwenzeka kakhulu phakathi kweminyaka engama-20 nama-40.
• Ubulili. Abafazi banethuba elingaphezulu kabili noma kathathu kunamadoda lokuba ne-MS ephindaphindayo-ehlala isikhathi esithile.
• Umlando womndeni. Uma omunye wabazali bakho noma abazalwane bakho ube ne-MS, unesangozi elikhulu lokukhula lesifo.
• Ukutheleleka okuthile. Izinhlobo ezahlukahlukene zezifo ezibangelwa yi-virus ziye zahlanganiswa ne-MS, kufaka phakathi i-Epstein-Barr. I-Epstein-Barr iwumkhuhlane obangela i-infectious mononucleosis.
• Uhlanga. Abantu abanezinwele ezimhlophe, ikakhulukazi labo abavela eYurophu eNyakatho, banegozi elikhulu lokukhula kwe-MS. Abantu abavela e-Asia, e-Afrika noma e-Native American banegozi elincane. Ucwaningo lwakamuva luphakamisa ukuthi inani labadala abancane abamnyama nabangamaHispanic abane-multiple sclerosis lingaba likhulu kunalokho okwakucatshangelwa ngaphambili.
• Isimo sezulu. I-MS ivame kakhulu ezindaweni ezinosimo sezulu esifudumele. Lokhu kufaka phakathi iCanada, i-United States enyakatho, i-New Zealand, i-southeastern Australia neYurophu.
• I-Vitamin D. Ukuba namanqanaba aphansi e-vitamin D nokubhekana nelanga okuncane kuhlotshaniswa nengozi enkulu ye-MS. Inyanga ozalwe ngayo ingase futhi ithonye amathuba okukhula kwe-MS. Lokhu kuhlobene namanqanaba okubhekana nelanga uma umama ekhulelwe.
• Ukukhuluphala. Abantu abakhuluphala noma ababekhuluphala ebuntwaneni banegozi elikhulu le-multiple sclerosis.
• Ezinye izifo zokuzipheka ngokweqile. Unegozi elincane lokukhula kwe-MS uma unezinye izimo zokuzipheka ngokweqile. Lokhu kungafaka phakathi isifo se-thyroid, i-pernicious anemia, i-psoriasis, i-type 1 diabetes noma isifo sokuvuvukala esibilisini.
• Ukubhema. Abantu ababhema banegozi elikhulu le-MS ephindaphindayo-ehlala isikhathi esithile kunabantu abangabhemi.
• I-gut microbiome. Abantu abane-MS bangaba ne-gut microbiome ehlukile kunabantu abangenayo i-MS. Kuyadingeka ucwaningo olwengeziwe ukuqonda lobuxhulumene.

Izinkinga ze-multiple sclerosis zingafaka:

• Ukuqina kwemisipha noma ukuqina.
• Ukubamba, nakuba kunqabile kakhulu.
• Ubuthakathaka obukhulu noma ukungakwazi ukuhamba, ngokuvamile ezingalweni noma emilenzeni.
• Ukuphazamiseka kokusebenza kwesisu, amathumbu noma ubulili.
• Ukuphazamiseka kokucinga nokukhumbula.

Ukuhlolwa okuphelele kwesistimu yezinzwa kanye nomlando wezokwelapha kuyadingeka ukuze kuhlonishwa i-MS.

Udokotela wezinzwa u-Oliver Tobin, uM.B., uB.Ch., uB.A.O., uPh.D., uyaphendula imibuzo ebuzwa kakhulu mayelana ne-sclerosis ephindaphindayo.

Ngakho-ke abantu abanesisindo esiningi banesilinganiso esiphezulu sokuthuthukisa i-MS kanye nabantu abane-MS abanesisindo esiningi bathambekele ekubeni nesifo esisebenzayo kakhulu kanye nokuqala okusheshayo kokuthuthuka. Ukudla okukhulu okuye kwabonakala kuvikelayo izinzwa yikudla kweMediterranean. Lokhu kudla kuphezulu ezinhlanzini, imifino, namantongomane, futhi kuphansi enyameni ebomvu.

Ngakho-ke lo mbuzo uvela kakhulu ngoba iziguli ezinale sclerosis ephindaphindayo ngezinye izikhathi zingaba nokuwohloka okwesikhashana kwezinkinga zazo ekushiseni noma uma zenza umsebenzi onzima. Into ebalulekile okumele iphawulwe ukuthi ukushisa akubangeli ukuhlaselwa yi-MS noma ukuphindaphinda kwe-MS. Futhi ngakho-ke akubi. Awukwenzi noma yiluphi uhlobo lokulimala oluhlala njalo uma lokhu kwenzeka. Ukuzivocavoca kunconywa kakhulu futhi kuvikelekile ebuchosheni nasemgogweni wamathambo.

Ososayensi abakaqondi ukuthi yiziphi izicubu ze-stem ezilusizo ku-MS, iyiphi indlela yokuzinika noma iyiphi inani lokubapha noma iyiphi isikhathi. Ngakho-ke okwamanje, ukwelashwa kwezicubu ze-stem akuconyiwe ngaphandle kokuba kuvivinywe okungokwelapha.

I-Neuromyelitis optica spectrum disorder noma i-NMOSD ne-MOG-associated disorder zingabangela izici ezifana ne-sclerosis ephindaphindayo. Lezi ziyavame kakhulu kubantu base-Asia noma base-Afrika-Amerika. Futhi udokotela wakho angakuncoma ukuhlolwa kwegazi ukuze kuvinjwe lezi zifo.

Kahle, into ebaluleke kakhulu ngokuba nokuxilongwa kwe-sclerosis ephindaphindayo ukuthi ungumuntu ophakathi kweqembu lakho lezokwelapha. Isikhungo esiphelele se-MS yindawo engcono kakhulu yokuphathwa kwe-sclerosis ephindaphindayo, futhi lokhu ngokuvamile kuhlanganisa odokotela abanolwazi olukhulu e-sclerosis ephindaphindayo, odokotela bezinzwa, kodwa futhi odokotela bezitho zokukhulula, abaphathi bezokwelapha bomzimba kanye nokulungiswa, izazi zengqondo, nabanye abaninzi abahlinzeki abanesithakazelo ekhethekile e-sclerosis ephindaphindayo. Ukuhlanganisa leli qembu elizungezile wena nezidingo zakho ezithile kuzokuthuthukisa imiphumela yakho ngokuhamba kwesikhathi.

Awekho amavivinyo athile e-MS. Ukuxilongwa kunikezwa ngokuhlanganiswa komlando wezokwelapha, ukuhlolwa komzimba, i-MRI kanye nemiphumela yokuphuma komgogodla. Ukuxilongwa kwe-sclerosis ephindaphindayo kuhlanganisa nokukhipha ezinye izimo ezingase ziveze izimpawu ezifanayo. Lokhu kuyaziwa njengokuxilongwa okuhlukile.

Isithombe se-MRI sobuchopho esibonisa izigxobo ezimhlophe ezihlotshaniswa ne-sclerosis ephindaphindayo.

Phakathi nokuphuma komgogodla, okwaziwa nangokuthi i-spinal tap, ngokuvamile ulela eceleni ngamadolo akho aphakanyisiwe esifubeni sakho. Khona-ke inhlanzi ifakwa emgodini womgogodla ngemuva kwakho ophansi ukuze iqoqe i-cerebrospinal fluid ukuze ihlolwe.

Amavivinyo asetshenziswa ukuze kuhlonishwa i-MS angafaka:

• i-MRI, engabonisa izindawo ze-MS ebuchosheni nasemgogweni wamathambo. Lezi zindawo zibizwa ngokuthi izigxobo. I-dye contrast inganikezwa nge-IV ukuze ibonise izigxobo ezibonisa ukuthi isifo sisesigabeni esisebenzayo.
• Ukuphuma komgogodla, okwaziwa nangokuthi i-spinal tap, lapho isampula encane ye-cerebrospinal fluid ikhishwa emgodini womgogodla ukuze ihlolwe elabhoratri. Lesi sampula singabonisa ukushintsha kuma-antibodies ahlotshaniswa ne-MS. Ukuphuma komgogodla kungasiza futhi ekukhipeni ukutheleleka nezinye izimo ezinezimpawu ezifanayo ne-MS. Ukuhlolwa kwe-antibody olufuna i-kappa free light chains kungase kube ngokushesha futhi kubize kancane kunokuvivinyo lwangaphambili lwe-spinal fluid ye-MS.
• Optical coherence tomography, esebenzisa amaza okukhanya ukuze iveze izithombe zeso. Ku-MS, isimo esibizwa ngokuthi i-optic neuritis sibangela ukushintsha kwel retina. I-Optical coherence tomography ingasetshenziswa ukuze ilinganise ubukhulu bel retina. Ingabonisa futhi ukulimala kwe-retinal nerve fiber.
• Amavivinyo e-evoked potential, aqopha izibonakaliso zamandla ezidalwa yisistimu yakho yezinzwa njengokuphendula ekukhuthazeni. Ukuhlolwa kwe-evoked potential kungasebenzisa ukukhuthazwa kokubona noma ukukhuthazwa kwamandla. Kule mihlola, ubuka iphethini ehambayo yokubona, njengoba ama-impulses amancane amandla afakwa ezicubu zakho ezinyaweni noma ezingalweni. Ama-electrodes alinganisa ukuthi ulwazi luhamba ngokushesha kangakanani emizileni yakho yezinzwa.
• Ukuhlolwa kwegazi, okungasiza ekukhipeni ezinye izifo ezinezimpawu ezifanayo ne-MS. Ukuhlolwa kokuhlola ama-biomarkers athile ahlotshaniswa ne-MS kukhonjiswa. Le mihlola ingasiza ekuxilongweni lesifo.
• Ukuhlolwa kwe-neuropsychological. Ukuhlolwa kwe-neuropsychological kuhlanganisa ukubuka ukuthi ubuchopho bakho busebenza kanjani. Ukuhlolwa kuhlola ukucabanga kwakho, ukukhumbula, ulimi kanye namakhono omphakathi. Kuhlola futhi ubuntu bakho kanye nendlela ozizwa ngayo. Izazi zengqondo ezinobuchwepheshe obukhulu, ezibizwa ngokuthi i-neuropsychologist, yenza lo mkhuba. Ukuhlolwa kwe-neuropsychological kubalulekile ku-MS ngoba abantu abaningi abanesifo banokuwohloka kokwazi. Lokhu kungafaka ukulahleka kwemikhumbulo nobunzima ngolimi kanye namakhono okucabanga athonya imisebenzi yansuku zonke. Ochwepheshe bakho bezempilo bangakunika ukuhlolwa okuyisisekelo ngokushesha nje uma uxilongwe. Khona-ke ungahlolwa kabusha ngokuhamba kwesikhathi.

Kubantu abaningi abane-relapsing-remitting MS, ukuxilongwa kulula. Ukuxilongwa kusekelwe ephenini lezimpawu ezihlotshaniswa ne-MS futhi kuqinisekiswe yimiphumela yokuhlolwa.

Ukuxilongwa kwe-MS kungaba nzima kubantu abanezinkinga ezingavamile noma isifo esithuthukayo. Ukuhlolwa okwengeziwe kungadingeka.

i-Brain MRI ivame ukusetshenziswa ukuze kusize ekuxilongweni kwe-sclerosis ephindaphindayo.