Neuromyelitis Optica

I-Neuromyelitis optica, eyaziwa nangokuthi yi-NMO, yisifo sesistimu ephakathi yethu esenza ukuvuvukala emithanjeni yamehlo kanye nomgogodla.

I-NMO ibizwa nangokuthi i-neuromyelitis optica spectrum disorder (NMOSD) kanye nesifo seDevic. Kwenzeka uma uhlelo lokulwa nezifo lungqubuzana namasosha omzimba. Lokhu kwenzeka ikakhulu emgogodleni nasemithanjeni yamehlo ehlanganisa i-retina yamehlo nobuchopho. Kodwa ngezinye izikhathi kwenzeka ebuchosheni.

Lesi simo singase siqale ngemva kokutheleleka, noma singahlotshaniswa nesinye isimo sokuhlupheka komzimba. Ama-antibodies ashintshile abopha amaprotheni esistimu ephakathi yethu futhi abangele ukulimala.

I-Neuromyelitis optica ivame ukuxilongwa kabi njenge-multiple sclerosis, eyaziwa nangokuthi yi-MS, noma ibonakala njohlobo lwe-MS. Kodwa i-NMO yisimo esihlukile.

I-Neuromyelitis optica ingabangela ubuthakathaka, ubuthakathaka ezinyaweni noma ezingalweni, kanye nokuqina okuhlungu. Ingabangela nokuntuleka kokuzwa, ukugabha nokuhlanza, kanye nezinkinga zesibindi noma zamathumbu.

Izimpawu zingase zibe ngcono bese zibe zimbi futhi, okuyaziwa ngokuthi yi-relapse. Ukwelashwa ukuvimbela i-relapses kubalulekile ukusiza ukuvimbela ukukhubazeka. I-NMO ingabangela ukulahleka okungapheli kombono nobunzima bokuhamba.

Izimpawu ze-neuromyelitis optica zihambisana nokuvuvukala okwenzeka emithanjeni yamehlo nasemizwa yomgogodla.

Ukushintsha kokubona okubangelwa yi-NMO kubizwa ngokuthi i-optic neuritis. Lokhu kungafaka phakathi:

• Ukubona okuphazamisekile noma ukulahlekelwa ukubona elinye noma womabili amehlo.
• Ukungaqondi imibala.
• Ubuhlungu lwamehlo.

Izimpawu ezihlobene nomgogodla zibizwa ngokuthi i-transverse myelitis. Lokhu kungafaka phakathi:

• Ukuqina, ubuthakathaka noma ukungabi namandla ezinyaweni, ngezinye izikhathi nasezandleni.
• Ukulahlekelwa ukuzwa ezandleni noma ezinyaweni.
• Ukungaqondi ukuthambisa ibladder noma ukuhlupheka ekuphatheni umsebenzi webladder noma wesisu.
• Ukuzwa okungathi kubhoboza noma ubuhlungu obukhulu entanyeni, emhlane noma esiswini.

Ezinye izimpawu ze-NMO zingafaka phakathi:

• Ukugabha.
• Ukuphefumula nomhlane.

Abantwana bangaba nokudideka, ukuhlushwa noma i-coma. Noma kunjalo, lezi zimpawu kubantwana ziyavame kakhulu esimweni esihlobene esaziwa ngokuthi yi-myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).

Izimpawu zingase zibe ngcono bese zibe zimbi futhi. Uma zibe zimbi, kuwaziwa njengokubuya. Ukubuya kungase kwenzeke ngemva kwamasonto, izinyanga noma iminyaka. Ngokuhamba kwesikhathi, ukubuya kungabangela ukubona okuphelele noma ukulahlekelwa ukuzwa, okuwaziwa ngokuthi yi-paralysis.

Odokotela abaziqondi ngokucacile ukuthi yini ebangela i-neuromyelitis optica. Kubantu abane lesi sifo, uhlelo lokukhulula umzimba luhlasela izicubu eziphilile ohlelweni oluphakathi lolwempilo. Uhlelo oluphakathi lolwempilo lufaka phakathi i-spinal cord, ubuchopho nezinzwa zobuso ezihlanganisa i-retina yamehlo nobuchopho. Ukuhlaselwa kwenzeka ngoba ama-antibodies ashintshile abopha kumaprotheni ohlelweni oluphakathi lolwempilo futhi abangele ukonakala.

Lokhu kuphendula kohlelo lokukhulula umzimba kubangela ukukhuluphala, okwaziwa njengokuvuvukala, futhi kuholela ekubhujisweni kwamaselula ezinzwa.

I-Neuromyelitis optica iyabaphucuka. Abanye abazali abangase bakhulise ingozi yokuthola i-NMO bahlanganisa:

• Ubulili obubekwe ngesikhathi sokuzalwa. Abesifazane bathola i-NMO kaningi kunamadoda.
• Ubudala. Ngokuvamile, i-NMO ithinta abantu abadala. Ubudala obuphakathi nendawo bokuthola ukuxilongwa yi-40. Noma kunjalo, abantwana nabantu abadala bangaba ne-neuromyelitis optica.
• Uhlanga noma ubuzwe. Abantu abavela eHispanic, e-Asia, noma e-Afrika noma e-Afro-Caribbean banesilinganiso esiphezulu se-NMO kunabantu abamhlophe.

Ucwaningo oluthile luphakamisa ukuthi ukungabi ne-vitamin D eyanele emzimbeni, ukubhema nokungabi nezifo eziningi ekuqaleni kokuphila kungase futhi kukhulise ingozi ye-neuromyelitis optica.

Ukuxilongwa kwe-neuromyelitis optica kuhilela ukuhlolwa komzimba kanye nezivivinyo. Ingxenye yendlela yokuxilonga iwukusususa ezinye izimo zesimiso sezinzwa ezinawo ama-symptom afanayo. Abachwepheshe bezempilo nabo bafuna ama-symptom kanye nemiphumela yokuhlola ehlotshaniswa ne-NMO. Izindinganiso zokuxilonga isifo se-neuromyelitis optica spectrum disorder (NMOSD) ziye zaphakanyiswa ngo-2015 yi-International Panel for NMO Diagnosis.

Uchwepheshe wezempilo ubuyekeza umlando wakho wezokwelapha kanye nama-symptom bese enza ukuhlolwa komzimba. Ezinye izivivinyo zihlanganisa:

• Ukuhlolwa kwezinzwa. I-neurologist ihlola ukunyakaza, amandla emisipha, ukuhlanganiswa, ukuzwa, inkumbulo, ukucabanga, ukubona nokukhuluma. Udokotela wamehlo naye angase ahileleke ekuhlolweni.
• MRI. Le nqubo yokwenza izithombe isebenzisa insimu yamagnethi namaza omsakazo ukudala umbono oqondile wengqondo, izinzwa zamehlo kanye nomgogodla. Imiphumela ingabonisa izilonda noma izindawo ezilimele ebuchosheni, izinzwani zamehlo noma umgogodla.
• Izivivinyo zegazi. Uchwepheshe wezempilo angase ahlole igazi le-autoantibody ehlanganisa amaprotheni futhi ibangele i-NMO. I-autoantibody ibizwa ngokuthi i-aquaporin-4-immunoglobulin G, eyaziwa nangokuthi i-AQP4-IgG. Ukuhlolwa kwale autoantibody kungasiza ochwepheshe bezempilo ukwahlukanisa phakathi kwe-NMO ne-MS futhi benze ukuxilongwa kwasekuqaleni kwe-NMO.

Amanye ama-biomarkers anjenge-serum glial fibrillary acidic protein, eyaziwa nangokuthi i-GFAP, kanye ne-serum neurofilament light chain asisiza ekutholeni ukubuyela emuva. Ukuhlolwa kwe-myelin oligodendrocyte glycoprotein immunoglobulin G antibody, okuthiwa futhi yi-MOG-IgG antibody test, kungase futhi kusetshenziswe ukufuna olunye uhlangothi oluvuvukayo olufanisa i-NMO.

• Ukugoqa komgogodla, okuthiwa futhi yi-spinal tap. Ngalesi sivivinyo, uchwepheshe wezempilo ufake unhlanzi emuva ukuze asuse inani elincane le-spinal fluid. Lesi sivivinyo sinquma amazinga amaseli e-immune, amaprotheni kanye nama-antibodies e-fluid. Lesi sivivinyo singase sihlukanise i-NMO ne-MS.

I-spinal fluid ingabonisa amazinga aphezulu kakhulu amaseli amhlophe egazi ngesikhathi se-NMO episodes. Lokhu kukhulu kunaleyo ebonakala ngokuvamile e-MS, nakuba lesi simo singahlali senzeka.

• Ukuhlolwa kokusabela kwesikhuthazo. Ukuze ufunde ukuthi ingqondo iphendula kangcono kanjani ezikhuthazweni ezifana nemisindo, ukubona noma ukuthinta, ungase ube nevivinyo elibizwa ngokuthi yi-evoked potentials test noma i-evoked response test.

Ucingo oluthiwa ama-electrodes lunamathele ekhanda, futhi ngezinye izikhathi, emakhanda, entanyeni, ezingalweni, emilenzeni nasemuva. Imishini ehlanganisiwe nama-electrodes ibhalisa izimpendulo zengqondo ezikhuthazweni. Lezi zivivinyo zisiza ukuthola izilonda noma izindawo ezilimele ezinzwini, umgogodla, izinzwa zamehlo, ingqondo noma i-brainstem.

• Optical coherence tomography. Lesi sivivinyo sibheka i-retinal nerve fiber layer kanye nobukhulu bayo. Abahlengikazi abanezinhlobo zezinzwa zamehlo ezivela e-NMO bane-vision loss enkulu kakhulu kanye nokuthambisa kwe-retinal nerve kunabantu abane-MS.

Izivivinyo zegazi. Uchwepheshe wezempilo angase ahlole igazi le-autoantibody ehlanganisa amaprotheni futhi ibangele i-NMO. I-autoantibody ibizwa ngokuthi i-aquaporin-4-immunoglobulin G, eyaziwa nangokuthi i-AQP4-IgG. Ukuhlolwa kwale autoantibody kungasiza ochwepheshe bezempilo ukwahlukanisa phakathi kwe-NMO ne-MS futhi benze ukuxilongwa kwasekuqaleni kwe-NMO.

Amanye ama-biomarkers anjenge-serum glial fibrillary acidic protein, eyaziwa nangokuthi i-GFAP, kanye ne-serum neurofilament light chain asisiza ekutholeni ukubuyela emuva. Ukuhlolwa kwe-myelin oligodendrocyte glycoprotein immunoglobulin G antibody, okuthiwa futhi yi-MOG-IgG antibody test, kungase futhi kusetshenziswe ukufuna olunye uhlangothi oluvuvukayo olufanisa i-NMO.

Ukugoqa komgogodla, okuthiwa futhi yi-spinal tap. Ngalesi sivivinyo, uchwepheshe wezempilo ufake unhlanzi emuva ukuze asuse inani elincane le-spinal fluid. Lesi sivivinyo sinquma amazinga amaseli e-immune, amaprotheni kanye nama-antibodies e-fluid. Lesi sivivinyo singase sihlukanise i-NMO ne-MS.

I-spinal fluid ingabonisa amazinga aphezulu kakhulu amaseli amhlophe egazi ngesikhathi se-NMO episodes. Lokhu kukhulu kunaleyo ebonakala ngokuvamile e-MS, nakuba lesi simo singahlali senzeka.

Ukuhlolwa kokusabela kwesikhuthazo. Ukuze ufunde ukuthi ingqondo iphendula kangcono kanjani ezikhuthazweni ezifana nemisindo, ukubona noma ukuthinta, ungase ube nevivinyo elibizwa ngokuthi yi-evoked potentials test noma i-evoked response test.

Ucingo oluthiwa ama-electrodes lunamathele ekhanda, futhi ngezinye izikhathi, emakhanda, entanyeni, ezingalweni, emilenzeni nasemuva. Imishini ehlanganisiwe nama-electrodes ibhalisa izimpendulo zengqondo ezikhuthazweni. Lezi zivivinyo zisiza ukuthola izilonda noma izindawo ezilimele ezinzwini, umgogodla, izinzwa zamehlo, ingqondo noma i-brainstem.