Izimpawu, i-MRI, ne-Lumbar Isikhathi sokuthola ukuxilongwa PML
I-leukoencephalopathy ye-multifocal leukoencephalopathy (i-PML) iyingozi eyingozi ebuchosheni obangelwa igciwane le- JC . Leli gciwane ngokuvamile aliboni izimpawu uma liphazamisa umuntu, ekugcineni lilele phansi emzimbeni wabo. Kodwa uma isimiso somzimba sokuzivikela somuntu sesinciphisa (njengengculazi, lupus, noma ezinye zegciwane), igciwane lingasetshenziswa kabusha, ukutheleleka amangqamuzana enza i-myelin (izembatho zakho zezinzwa) -kuyi-biology ngemuva kwe-PML.
Ukubaluleka kwe-PML ku-MS kungukuthi kungumphumela ongavamile wezinkinga ezithile zokwelapha izifo , ikakhulukazi, iTysabri (natalizumab).
Kukhona namacala ambalwa abikwa nge-PML kubantu abane-MS abathinte iGilenya (fingolimod), iTecfidera (dimethyl fumarate), noma i-Ocrevus (ocrelizumab).
Ukuxilongwa kwalesi sifo esibulalayo kudinga ukuhlolwa ngokucophelela futhi okusheshayo udokotela kuhlanganise nomlando oningiliziwe kanye nokuhlolwa ngokomzimba, i-MRI yobuchopho, nokukhishwa kwe-lumbar .
Ukuhlola i-JC Virus ku-Cerebrospinal Fluid
Ukuze uhlolisise i-PML, udokotela uzokwenzela i-lumbar puncture ukuze ahlaziye i- cerebrospinal fluid (CSF) yokutholakala kwegciwane le-JC. Lokhu kwenziwa ngokwenza ukuhlolwa kwe-polymerase chain reaction (PCR) ku-CSF ukubona ukuthi i-DNA yegciwane le-JC ikhona yini.
Imiphumela yokuhlolwa kwe-PCR ukubuka i-JC virus ku-fluid cerebrospinal iyohlanganiswa nokuthola okwelashwa (izimpawu ze-PML) kanye nemiphumela ye-MRI ukuze ifinyelele ekuxilongweni.
I-MRI ukuze ihlolwe i-PML
Ukuskena kwe-imagination (i-MRI) ye-resonance (MRI) yobuchopho iyobekwa. Ku-MRI, i-PML ivame ukukhombisa izilinganiso ezincane ezihlukene, ezihlukene T2 . Bangase bagcine ukujoyina ukwenza isilonda esisodwa esikhulu.
Izimpawu Zakho Zokuthola I-PML
Udokotela wakho uzofuna ukwazi kahle indlela owake wazizwa ngayo futhi lapho izimpawu zakho ezintsha ziqala.
Kubalulekile ukuba uqondile futhi ulandele incazelo yakho. Izimpawu ze-PML ziyashintsha kodwa zingabandakanya ushintsho ekucabangeni nasebuntwini, ekulahlekelweni kokubambisana, ezinkingeni zombono, ekukhuseni ubuhlungu bezingalo noma imilenze, ukuphathwa ikhanda noma ukuqubuka.
Ngezinye izikhathi kungaba yinselele ukuhlukanisa izimpawu ze-MS ebuyela emuva kwe-PML. Esinye isici, ngokucwaninga kuka-2009 ku- Archives of Neurology, ukuthi umuntu obenayo i- MS ubuyekezela ukuba nesifo esisodwa esiyinhloko, kuyilapho abantu abane-PML bevame ukuba nezimpawu eziningi.
Ubuchopho Bobuningi bokuthola i-PML
Uma umuntu e-Tysabri, izivivinyo ezitholela i-JC virus nge test PCR CSF, ibonisa izimpawu ze-PML, futhi inesisindo se-MRI ngokuthola okuhambisana ne-PML, kungenzeka ukuthi udokotela uzophatha i-PML. Nokho, ngezinye izikhathi, i-biopsy yobuchopho isenziwa.
I-biopsy yobuchopho ukukhipha izingcezu ezincane zezicubu zobuchopho ukuze zisetshenziswe ekuxilongweni kwe-PML. Izingcezu zezicubu zihlolwa ngegciwane le-JC.
I-biopsy yobuchopho yiyona "izinga legolide" lokuhlolwa kwe-PML. Noma kunjalo, ithwala izingozi, kuhlanganise nokufa. Ngaphezu kwalokho, izilonda ze-PML kungenzeka zingenakwenzeka ukufinyelela ukuthola isampula ye-biopsy. Akudingeki ukuthi, lokhu akuyona inqubo ethandwayo neziguli noma odokotela, noma okusetshenziselwa ngaphandle kwezimo ezimbi kakhulu, ukuze kulawulwe ezinye izifo.
Endabeni yomuntu ophethe i-MS e-Tysabri, lokhu akuyona inkinga kunomuntu onesandulela ngculazi nengculaza, njengoba inani lezifo ezingalingisa i-PML (i-toxoplasmosis, i-cryptococcal meningitis, noma i-complex dementia) cishe.
Izwi elivela
Uma uqala ukuba nezimpawu ezingavamile noma ezibi kakhulu kuyilapho ku-Tysabri (noma enye imithi yokwelashwa kwe-MS) thinta udokotela wakho ngokushesha. Ungacabangi ukuthi "i-MS kuphela ephindaphinda" noma izimpawu ze-paroxysmal. Thola ukuhlolwa ngokushesha ngangokunokwenzeka. Ngokushesha ukwelashwa kwe-PML kuqalile, kungcono amathuba akho okusinda.
> Imithombo:
> Boster A et al. I-leukoencephalopathy ye-multifocal i-protifressive and relapsing-remitting multiple sclerosis: isifundo sokuqhathanisa. Arch Neurol. 2009 Meyi; 66 (5): 593-9.
> Clifford DB et al. I-lealiencephaphapathy ehambisana ne-Natalizumab ehambisana ne-multipletifocal i-multipletifalal leukoencephapathy in iziguli ezine-multiple sclerosis: izifundo ezivela kumacala angu-28. I-Lancet Neurol . 2010 Ngo-Apr; 9 (4): 438-46.
> National MS Society (2015). Icala le-PML elibikiwe kumuntu othola uGilenya: UPDATED. futhi > Icala le-PML elibikwe kumuntu ukuthatha i-Tecfidera.
> National MS Society (2017). Icala le-PML ebikwe ku-Person ukuthola ama-Ocrevus ukuphatha i-MS.
> PML Consortium. Ochwepheshe bezeMpilo: Kuyini i-PML?