A titun de ni ti kii-elegbogi awọn itọju fun şuga

A new milestone in non-pharmaceutical treatments for depression

 

Agbara nipasẹ Guardian.co.ukYi article ti akole “A titun de ni ti kii-elegbogi awọn itọju fun şuga” a ti kọ nipa Nick Davis, fun theguardian.com on Monday 18th Le 2015 06.00 UTC

Iṣesi ségesège bi şuga ti wa ni pupo to sufferers, ati ki o hugely olówó iyebíye lati toju. Awọn julọ àìdá fọọmu ti şuga, igba ti a npe isẹgun şuga tabi pataki depressive ẹjẹ (MDD), mu ki awọn eniyan o ṣeeṣe ti ara ati ki o takantakan significantly to kan eniyan ibajẹ-ni titunse aye years (DALYs), a odiwon ti didara ti aye mu sinu iroyin akoko ti omiran. Awọn ilera ẹrù ti MDD jẹ tobi ni julọ awọn orilẹ-ede, paapa nigbati awọn eniyan nilo a duro ni iwosan. O nri awọn okunfa jọ, o ni ko a nilo lati se agbekale munadoko itọju lati dojuko şuga.

Awọn sise ti depressive ségesège ko ba wa ni daradara yé, ati awọn ti o dabi seese wipe o wa ni ko si nikan fa. Julọ igbalode itọju ti o baramu lo oloro ti Àkọlé neurotransmitters - awọn kemikali ti o gbe awọn ifihan agbara laarin iṣan. Fun apere, awọn kilasi ti oloro mọ bi SSRIs, tabi yan serotonin reuptake inhibitors, se awọn neurotransmitter serotonin lati ni reabsorbed nipa a neuron; yi tumo si wipe diẹ serotonin ti o wa lati w ayika laarin awọn nafu ẹyin, ati ki o jẹ diẹ seese lati mu ẹyin ni ọpọlọ awọn nẹtiwọki ti agbegbe fowo ni MDD.

Ṣugbọn SSRIs ati awọn miiran oloro wa ni ko a pharmacological 'free ọsan'. Oògùn itọju fun şuga ni o wa doko fun opolopo awon eniyan, fa ẹgbẹ-igbelaruge, ati ki o le padanu won mba ipa lori akoko. Fun awọn wọnyi idi, ọpọlọpọ awọn oluwadi wa ni wiwa fun yiyan awọn itọju fun MDD ti o bori awon isoro, ati ki o wa siwaju sii munadoko tabi kere si unpleasant. Ọkan o pọju itọju je awọn lilo ti isọ ti se agbara lori ori lati Àkọlé awọn ọpọlọ ká idunnu iyika. yi ilana, ti a npe ni transcranial se irusoke (TMS), o le oyi koju diẹ ninu awọn ti awọn isoro ti elegbogi itọju, sugbon a si tun ma ko mọ pato bi o ti ṣiṣẹ, tabi bi o munadoko ti o yoo wa ni atọju MDD.

Diẹ ninu awọn ti awọn wọnyi fenu ni o le wa sunmo si a ojutu sibẹsibẹ, pẹlu ose ká iroyin ti a ile orisun ni West Wales a ti funni alakosile nipasẹ awọn US Ounje ati oògùn ipinfunni lati tẹ awọn USA oja fun ẹrọ-orisun itoju ti MDD. Awọn alakosile ti awọn Magstim Company ká Dekun2 stimulator tumo si wipe stimulator le ṣee lo bi a itọju aṣayan ni agbalagba sufferers ti MDD ti o ti ko dahun si awọn miiran ailera- tabi oògùn-orisun itọju. Magstim ká awọn ọja ti gun a ti lo ninu egbelegbe ati iwadi awọn ile-iṣẹ to ibere ati ki o modulate ọpọlọ iṣẹ, ati ìtẹwọgbà ti awọn wọnyi awọn ẹrọ fun isẹgun lilo iṣmiṣ ohun pataki de ni translational Neuroscience – awọn agutan ti mu omowe awari sinu iwosan.

TMS ṣiṣẹ nipa fifi isọ ti se agbara kọja awọn timole. Awọn wọnyi ni se aaye jeki ina sisan to ṣàn ni kekere abulẹ ti ọpọlọ ti ni ayika kan square centimeter, eyi ti o ni Tan fa awọn iṣan ni ti agbegbe lati mu – wọnyi iṣẹlẹ ya ibi lori ida kan ti a ti keji. Fun idi ti o ko ba wa ni daradara yé, aye jade reluwe ti awọn wọnyi se isọ nyorisi si diẹ ti o tọ ipa, pípẹ fun wakati kan tabi diẹ ẹ sii lẹhin ti awọn fọwọkan – yi ni a mọ bi ti atunwi TMS, tabi rTMS. Tun akoko ti rTMS, fi gbogbo ọjọ fun orisirisi awọn ọjọ, nilokulo awọn ọpọlọ ká plasticity lati yi ọpọlọ aṣayan iṣẹ-ṣiṣe fun ọpọlọpọ awọn osu. Eleyi yoo fun neuroscientists a ọna lati reorganize (kò 'rewire') kekere ọpọlọ iyika.

rTMS itoju fun MDD fojusi awọn prefrontal kotesi, maa ni a iranran kan diẹ centimeters loke awọn loke ti osi oju, ti a npe ni oju prefrontal kotesi (tabi DLPFC). Awọn ẹyin ni agbegbe yi sopọ si nẹtiwọki ti o agbese jakejado awọn ọpọlọ, ati rTMS ni o ni awọn mejeeji igbelaruge ati inhibiting ipa lori jina ọpọlọ awọn ẹkun ni. Awọn ni kikun iye ti awọn wọnyi hobu ati awọn nẹtiwọki wa ni ibi ti gbọye, ṣugbọn o dabi ko o pe modulating awọn aṣayan iṣẹ ti awọn prefrontal kotesi tu neurotransmitters jin ni atijọ ti ẹya ti awọn ọpọlọ, ni pato awọn caudate arin. Leteto, these structures regulate our basic motivations and emotions. So by indirectly stimulating these regions, rTMS seems to correct the low mood and listlessness of MDD in some people.

Is rTMS the future of depression treatment? The treatment certainly looks promising, with increased remittance rates and seemingly few side-effects. Baseline depression scores may be reduced by up to a third according to some studies, although other studies are more cautious. It seems that longer courses of treatment, lasting several weeks, have greater effectsthis suggests an additive effect of rTMS on the brain over time. However the uncertainties over the mechanisms of rTMS in MDD mean that neurologists will find it difficult to personalise treatment for an individual patient. The number of parameters involved in rTMS, such as the number of pulses to deliver, or the intensity of each pulse, make it difficult to specify precisely the dose required for a patient. Precision is also a problem in locating the exact target in prefrontal cortex for stimulationeach person’s brain folds in its own way, and missing the DLPFC even by a centimetre can mean the difference between a person being a ‘responder’ or a ‘non-responder’, in the stark language of psychiatry. Jubẹlọ, the physical sensation of rTMS, which can feel like a woodpecker tapping the head, makes it difficult to create a placebo condition for use in clinical trials.

rTMS is currently approved for use only in the USA, and only in a restricted group of patients. However it is likely that, with further research into improvements in efficacy and in understanding the mechanisms of the technique, we will see increasing use of rTMS as a treatment for this burdensome disorder. The entry of Magstim into this market offers clinicians a new avenue for people who may be running out of drug-based options, and marks an important milestone in taking knowledge gained in research and making use of it for the benefit of many.

Dr Nick Davis is a lecturer in psychology at Swansea University. You can find him on Twitter Nibi.

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