Uhlobo Oluthile Lokwaziswa Okungahle Kukumangele
Abantu abaningi bakholelwa ukuthi bayazi ukuthi ukuthumba kubonakala kanjani. Umuntu onokuthunjwa uqala ukuzamazama ngokungalawuleki, uwa phansi, futhi ulahlekelwe ukwazi. Kodwa lokhu akunjalo ngaso sonke isikhathi. Ukuzizwa kungabonisa ngezindlela ezingavamile, ngezinye izikhathi kuthinta ingxenye eyodwa yomzimba, futhi ngezinye izikhathi kuthinta ingxenye eyodwa yobuchopho ngaphandle kokudonshulwa kwe-stereotypical nhlobo.
Isimo sokuhlukunyezwa yisimo esibi kakhulu sokuthumba - kungukuqothulwa okungeke kume. Ngaphandle kokwenza ngokuphumelelayo isiguli singene ku- coma , isimo sesifo se-epilepticus singabulala futhi siholele ekulimazeni okungapheli kobuchopho. Isimo sokuhlukunyezwa kwesimiso yisimo esiphuthumayo sezokwelapha.
Cishe eminyakeni eyishumi eyedlule, abacwaningi abavela e-Columbia University eNew York badala inselele emphakathini wezokwelapha lapho behlola iziguli e-ICU nge- electroencephalography . Nakuba bekungekho ukusola ukuthi lezi ziguli zinezinkinga, yilokho abacwaningi abathola khona. Cishe amaphesenti ayishumi kweziguli ezingaphenduliyo e-ICU empeleni zisesimweni esingenakunyakazeka nesifo se-epilepticus, i-NCSE.
Kuyini Isimo Esingaxhunyiwe Isimo Epilepticus?
Esimweni esingenasimanga sokuphefumula, ubuchopho buhlala bamba, noma bamba ngokuphindaphindiwe kangangokuthi isiguli asinaso ithuba lokuphumula kusukela esikhathini sokudideka okukhulu okuvame ukulandela ukuthunjwa.
Lesi sikhathi sokutakula sisho isimo se- post-ictal .
Ngokuyinhloko, abantu abanesimo esingenasibindi sokuhlukunyezwa kubonakala sengathi kunezinye iziguli ze-ICU ezingaphenduli ngenxa ye-encephalopathy noma noma iyiphi enye yezinye izinkinga zokuqwashisa . Kodwa-ke, uma kuhlolwe nge-EEG, singabona ukuthi ngokoqobo, isiguli sisesimweni se-epilepticus.
Ukuhlukaniswa kubalulekile, ngoba isimo sesifo sofuba singaphendula ngemithi. Ngokuvamile, kungaba umqondo omubi ukunikeza isiguli se-encephalopathic i-benzodiazepine efana ne-Ativan (lorazepam), ngoba le mithi inciphisa umsebenzi wobuchopho. Esigulini esivele singacabangi kahle, i-benzodiazepines ingenza inkinga ibe nzima nakakhulu.
Ngakolunye uhlangothi, ukuhlukunyezwa kubangelwa umsebenzi ongavamile wobuchopho. Kulezi zimo, imishanguzo yokulwa nesifo sofuba, njenge-benzodiazepine, ingasisiza ngempela isiguli ukuba siphinde siqaphele ngemuva kokuphazamiseka kwesimo se-epilepticus.
Ukuxilongwa kwe-Nonconvulsive Status Epilepticus
Yiqiniso, ukuze uphathe isimo esingenasibindi sokuphefumula, kudingeka uqale ubone ukuthi isiguli siyithatha yini. Ngokuvamile, isimo esingaxhunyiwe nesifo se-epilepticus asihloliswanga, okusho ukuthi iziguli eziningi azihambi kahle. Esinye sezizathu ukuthi i-NCSE yiyona nto echazwe ngokuchazwayo, futhi ngesimo sayo, akuyona into ephawulekayo njengento eguquguqukayo yesifo se-epilepticus.
Esinye isizathu se-undersiagnosis ye-NCSE ukuthi singabonakala ngezindlela eziningi ezahlukene, eziningi zazo ezivame ukubangelwa into evamile. Isibonelo, cishe isigamu seziguli esibhedlela sibhekene ne- delirium , esingabonakala kufana ne-NCSE kodwa sivame kakhulu.
Kwezinye izikhungo ezinkulu zezifundo ze-neurology, kuba umkhuba ojwayelekile wokunamathisela i-EEG kuholela kuzo zonke iziguli ze-ICU. Kodwa-ke, ezibhedlela eziningi, udokotela udinga ukucabangela ngokucophelela ukuthi yisiphi isiguli esifanele sihlolisise ukuhlola okunzulu ne-EEG.
Ukwelashwa Kwesimo Esingaxhunyiwe Isimo Epilepticus
Indlela yokuphatha kangcono i-NCSE yindawo eguqukayo yemithi. Indlela engcono kakhulu ihluka ngokuguga kwesinye isikhathi, ezinye izifo, kanye nezici ezithile zokubanjwa. Isibonelo, i-NCSE ngezinye izikhathi ilandela isimo esicacile se-epilepticus. Kulezi zimo, kukhona ingozi ecacile ku-NCSE, futhi ukwelashwa okunonya kumuntu wokunakekelwa okujulile (i-ICU) kuyadingeka.
Kodwa-ke, kwezinye izimo lapho i-NCSE ingakaze ilandelwe ukuxubana, kungase kube ngcono ukuthi iziguli zingaboniswa i-ICU, ikakhulu uma iziguli zikhulile. Lokhu kungaba ngoba imithi ye-anticonvulsant nayo inezimo ezimbi, futhi ngenxa yezingozi ezengeziwe zokuhlala ku-ICU.
Ubudala bubalulekile futhi lapho ukwelapha i-NCSE esemncane kakhulu, njengoba izimbangela zokugubha ngokuvamile zihluke kakhulu kuneziguli ezindala. Izingane zivame ukuba nezinkinga ngenxa yokuphazamiseka kwezakhi zofuzo, kanti iziguli ezikhulile zingase zithatheke ngenxa yenkinga etholakalayo, njenge-stroke.
Ezimweni lapho isimo se-epilepticus sihambisana nezinye izinkinga zezokwelapha, enye yezindwangu zokwelapha ukubhekana nezinkinga eziyinhloko. Ukwehluleka kwenziwa kabi lapho umzimba ungalingani ngokutheleleka noma ezinye izinkinga zezokwelapha. Isibonelo, uma isiguli sinomonakalo omkhulu wezinso nesibindi, ukungeza ama-anticonvulsants kungenza isimo sibe sibi nakakhulu. Njengoba ngokuvamile kunjalo, ukwelashwa kwe-NCSE kufanele kufanelane nezidingo zesiguli ngasinye njengomuntu ngamunye.
Imithombo:
J Claassen, Mayer SA, uKowalski RG, Emerson RG, uHirsch LJ. Ukutholakala kokuqothulwa kwe-electrographic nokuqapha okuqhubekayo kwe-EEG kwiziguli ezigula kakhulu. I-Neurology. 2004 Meyi 25; 62 (10): 1743-8.
UFrank W. Drislane, Ukumiswa kwe-MD1, Ukuhlola, nokuPhathwa Kwezinga Elingaxhumani Ne-Epilepticus Ukuhlushwa Nokuziphatha 1, 301-314 (2000)
USimon Shorvon Kuyini isimo esingenasiphambano nesifo se-epilepticus, futhi yiziphi izingxenye zayo? I-Epilepsia, 48 (Isihlomelo 8): 35-38, 2007
Litt B, Wityk RJ, Hertz SH, Mullen PD, Weiss H, Ryan DD, Henry TR. Epilepsia. Isimo esingaxhumani nesifo esibhedlela esidala esikhulile. 1998 (Nov); 39 (11): 1194-202.