Ulwazi olusha mayelana ne-biology ngemuva kokuhlaselwa kwe-migraine lisho izindlela zokwelapha ezithuthukisiwe
I-Migraine yisifo esiyinkimbinkimbi segazi esishiya ngisho ososayensi abakhazimulayo kanye nama-neurologists ngezinye izikhathi ekhanda amakhanda abo. Ngokungafani nezinye izimo eziningi zezokwelapha, i-biology ye-migraine ukuhlaselwa akukaze kutholakale konke okwamanje.
Izindaba ezinhle ukuthi ekugcineni abacwaningi basondela ekuqondeni ukuthi "kanjani" ngemuva kokuhlaselwa kwe-migraine-okusho ukuthi bayaphila, noma ukuthi babonisa kanjani.
Yilolu lwazi oluye lwavuselela imithi yokwelashwa, ukubeka iziqu zezifundo ezithembisayo kanye nezinqubo ezintsha eziphuthumayo.
Intuthuko enkulu emithathu ekuthathweni kwe-migraine ihlanganisa:
- Izindlela eziyingqayizivele zokuphatha ama-triptans, isidakamizwa esivele simisiwe sokulwa ne-migraine.
- Imishanguzo ye-anti-migraine inoveli yombili ukwelashwa okujulile nokuvimbela.
- Amadivayisi wezokwelapha ukuphatha nokuvimbela imithi.
I-Triptans ihanjiswe ngokukhethekile
I-Triptans ibophezela ku-serotonin receptors ebuchosheni futhi isetshenziselwa ukuphatha ukuhlaselwa kwe-migraine ngokulinganayo. Zibuye zisetshenziselwe ukuphatha imishanguzo enomusa kuya ekulinganiseni engaqedi nge- NSAID .
Ubuhle bama-triptan wukuthi banganikezwa ngezindlela ezahlukene-amaphilisi, amaphilisi omlomo ahlakazekayo (okuphephile), ukufiphaza emzimbeni, ukujola okungaphansi kwesikhumba (ngaphansi kwesikhumba), kanye ne-suppository.
Ngalokhu konke okukhethwa kukho, umuntu onemigraines nodokotela wakhe angakhetha i-triptan, ngokusekelwe kokuthandayo kanye nezidingo zakhe ezihlukile.
Lezi zingqinamba zingabandakanya:
- Okuqhamuka uma udla imishanguzo
- Ukuqala kwesenzo
- Ukudlulisela eminye imikhakha ye-migrauneurs-ngokwesibonelo, labo abanenkinga yokuhlanzeka nokuhlanza nge-migraines futhi abakwazi ukubekezelela imithi ngomlomo
- Izindleko
- Okuhle
Kuyathakazelisa nokufunda ukuthi ama-triptan angase alawulwe ngezindlela ezingavamile nakakhulu esikhathini esizayo.
Isibonelo, i-sumatriptan isichazamazwi solimi njengamanje ithuthukiswa, njengalokhu i-zolmitriptan inhaler nomlomo we-rizatriptan ukuqeda ifilimu.
Khumbula ukuthi ukwakheka okusha akusebenzi ngaso sonke isikhathi. Isibonelo, i-sumatriptan isetshenziselwa ukuba itholakale njengengxenye ye-transdermal enamandla ebhethri-ebizwa ngokuthi i-Zecuity) esetshenziselwa ingalo noma ithanga eliphezulu. Ingena esikhunjeni isebenzisa uhlelo lwe-gradient kagesi, lunikeza u-6.5mg we-sumatriptan esikhathini esingamahora amane. Kodwa-ke, okwamanje isuka emakethe ngenxa yemibiko yokushisa nezibazi ezihambisana nayo.
Isithombe esikhulu lapha ukuthi ngemithi emisha kanye nokwakhiwa kwezabelo kuza isethembiso, kodwa futhi abanye bayangabaza njengoba ama-nuances atholakala ngaphandle.
Khumbula futhi ukuthi ukwakheka okusebenza kumuntu oyedwa kungase kungasebenzi kwabanye-ngakho-ke khuluma nodokotela wakho ukuze ukhethe ama-pluses namaminithi wezinketho zakho zokwelashwa kwe-migraine.
Imizwa Yokulwa Ne-Anti-Migraine
Njengoba ososayensi beveza ukuthi i-biology ihlasela kanjani ekuhlaseleni kwe-migraine, bayakwazi ukukhomba imigwaqo emisha nama-receptors. Intuthuko emithathu emithini ye-migraine ihlanganisa:
- I-Lasmiditan: Imithi efana nezinye i-triptan kodwa ngokubambisana okukhulu kwamukeli othile we-serotonin.
- Imithi eqondisa i-Calcitonin Gene-Related Peptide (CGRP)
- Imithi eqondisa i-Glutamate
I-Lasmiditan: I-Serotonin 5-HT1F Agonist
I-Lasmiditan ithuthukiswa njengenye imithi yokwelapha i- triptans . Kungani enye edingekayo? Kunezizathu ezintathu:
- Ukucwaninga kubonisa ukuthi cishe amaphesenti angama-35 abantu abatholi usizo lwe-migraine emilonyeni ye-triptans.
- Inombolo eningi yabantu ayikwazi ukuthatha i-triptan ngoba ingabangela ukungena kwe-blood constriction (vasoconstriction) -njalo, ama-triptans aphikisana nalabo abanomlando wesifo senhliziyo, isifo sohlangothi, isifo se-vascular peripheral , ukucindezelwa kwegazi okungalawuleki, kanye / noma izinhlobo ezithile i-migraine njenge- hemiplegic noma i-basilar migraine.
- Abanye abantu abathandi nje ukuthi ama-triptan abenza bazizwe kanjani, ngoba angabangela imiphumela emibi njengemangcwabo, intamo, nesifuba, ukungafihli, nokushaya (ikakhulukazi ebusweni).
Izindaba ezithembisayo mayelana ne-lasmiditan wukuthi zibopha ngokukhethayo kuma-receptors ethize we-serotonin ebuchosheni, enokubambisana kakhulu kwamanye ama-receptors ase-serotonin ukuthi lapho eboshiwe, angaholela ekusenikeni okungafunwa.
Izindaba ezinhle ukuthi esifundweni sesigaba sesibili, izidakamizwa ezithathwe ngezidakamizwa ezihlukahlukene zitholakale zithuthukisa ubuhlungu obuvela emakhanda wekhanda lomsindo osencane (noma obumnene) emahoreni amabili. Ukuthuthukiswa kobuhlungu kwakuncike emthamo, okusho ukuphakama komthamo, ukukhululeka okukhulu kobuhlungu.
Imiphumela emibi kakhulu yinkimbinkimbi (okwenzeka ngamaphesenti angu-38 abahlanganyeli) alandelwa yi-vertigo nokukhathala.
Ngakho-ke, ngokungafani ne-triptans yamanje, ukugoqa okuqondile kwe-lasmiditan kungase kugweme imiphumela emibi ye-vasoconstrictive, kodwa kungaholela ekuthintekeni kwesistimu eyengeziwe, okungase ibe nomkhawulo kwabanye abantu. Ngokubanzi, izifundo ezinkulu kanye nesithombe esicacile se-mechanism ngemuva kwesidakamizwa kuyadingeka.
I-Peptide ehlobene ne-Calcitonin ye-Gene (CGRP)
I-peptide ehlobene negciwane le-Calcitonin (i-CGRP) idlala indima ebalulekile ku-migraine pathogenesis. Ngokuqondile, ucwaningo lubonisa ukuthi ngesikhathi sokuhlasela kwe-migraine, uhlelo lwe-trigeminal lusetshenziswe, okuholela ekukhululweni kwe-CGRP kusuka ekupheleni kwezintathu zokuhlala. I-CGRP isebenza ukuze ihlise imithwalo yegazi ezungeze ubuchopho futhi idale into ebizwa nge-inflammation ye-neurogenic, futhi yizinyathelo ezimbili ezenza kube khona ikhanda le-migraine.
Ngakho-ke, imishanguzo engavimbela i-CGRP ngokwayo noma i-receptors (isayithi lokuxoshwa ebuchosheni) le-CGRP njengamanje liyahlolwa. Ngeshwa, ezinye izifundo ezihlolisisa abaphikisi be-CGRP-receptor (imithi evimbela isenzo se-CGRP) ziye zavalwa ngaphambi kwezizathu eziningi, kuhlanganise nokukhathazeka ngokweqile kwesibindi. Kodwa imithi eyodwa, i-ubrogepant, yayibekezelele kahle futhi iphumelele esifundweni sesi-2.
Ama-antibodies amathathu e-anti-CGRP (izidakamizwa ezibopha iphrotheni CGRP futhi zivimbela noma azivimbele) nazo zenzelwe ukuvimbela imithi, nomqondo wokukhipha i-CGRP eyengeziwe ekhishwe yizintambo zokuhlala ezintathu ngesikhathi sokuhlasela kwe-migraine. Lezi zidakamizwa zikhombisa imiphumela ethembisayo ekuhlolweni kokuqala kwesigaba 1 no-2.
Okokugcina, i-erenumab i-anti-monoglonal antibody engahlanganisi ku-CGRP, kodwa e-receptor yayo, futhi inikezwa ngaphansi kwesikhumba (umjovo ongaphansi kwesikhumba). Ngokubophezela ku-receptor, i-erenumab iyayivimbela ekuboniseni. Kuye kwafundwa njengemithi yokuvimbela i-migraine futhi ibonakala ibekezelela kahle esifundweni sesi-2.
Ngokubanzi, ukukhomba izindlela ze-CGRP kubonakala sengathi kuyindlela yokwelapha ethembisayo kulabo abane-disisodic or chronic disorder disorder.
I-Glutamate Receptor Antagonists
I-Glutamate yi-neurotransmitter, noma amakhemikhali ebuchosheni, ukuthi ngokusho kokubili isilwane nezifundo zabantu, kubonakala sengathi idlala indima ebalulekile endleleni i-migraines ebonakala ngayo. Imithi eminingi ehlobene nokuvimbela noma ukushintsha ama-glutamate receptors kuye kwacutshungulwa, okunye ukuphatha ukuhlasela okujulile kokunye nokunye ukuvimbela i-migraines.
Ungase uthathe noma ujwayele imithi yokuvimbela efana ne-topamax (topiramate) ne-botulinum i-toxin A evimbela ukukhululwa kwe-glutamate, kanye namanye amakhemikhali.
Ngokuthakazelisayo, i-ketamine (isisindo somuthi esiphunduzayo), esivimbela i-glutamate ebuchosheni obubizwa ngokuthi i-NMDA receptor, itholakale ukuphatha i- migraine aura- mhlawumbe ngokucindezela ukucindezeleka kokusabalalisa kwe-cortical, i-wave of stress depress ubuchopho.
Esifundweni esincane, esiphambanweni esiphambanweni sabantu abane-migraine aura ende, i-25mg ye-intranasal ketamine (eyanikezwa ngekhala) yayifaniswa ne-intranasal (i-midazolam) ejulile, okuyi-sedative. Ucwaningo lwathola ukuthi i-ketamine inciphise ubukhulu kodwa hhayi isikhathi se-aura. Imiphumela emibi ifakiwe:
- Imizwa engokoqobo
- Euphoria
- I-giddiness emfushane yesikhashana
Le miphumela igxile emaminithini angu-30 kuya kwangu-45. Ngokubanzi, indima ye-glutamate kanye nendlela yayo ekuguleni okungapheli kanye ne-migraine aura iyaqhubeka ibe umthombo wocwaningo, futhi ngaleyo ndlela, ithemba lezokwelapha ezintsha.
Amadivaysi e-FDA-avunyelwe ama-Migraine Therapy
Ukwakhiwa kwamadivayisi ukuphatha nokuvimbela imigraine kuye kwashintsha ukuguqulwa kwe-migraine. La madivaysi ayingxenye enkulu elula ukuyisebenzisa, elula, futhi exhunywe nemiphumela emibi emincane. Ukuhlaselwa yizindleko futhi iqiniso lokuthi amanye amadivaysi awasebenzi kuwo wonke umuntu.
Noma kunjalo, ukutshala izimali kudivayisi kungase kube okukhethwa kukho okunengqondo kwabanye abathintekayo, ikakhulukazi uma imithi ingasebenzi, noma kubantu abajwayele ukuphuza imithi ngokweqile ikhanda .
Idivaysi eyodwa yokuvimbela i-migraine ebizwa ngokuthi i-Cefaly ihlose i-supraorbital nerve (tSNS) egcina ingxenyeni ebunzini, isikhumba sesifuba nesichotho esingaphezulu. Kuyinto idivayisi eqhutshwa ibhetri egqoke njengebhokisi elibhekiselwe isetshenziswe nsuku zonke imizuzu emaminithi amabili.
Idivayisi ephephile, ebekezelelwe kahle, futhi enomusa ngokusho kokutadisha okukhulu ku- Journal of Headache and Pain, engaphansi kwamaphesenti angamahlanu abantu ababika imiphumela emincane emibi. Kungaba yindlela enhle kubantu abangakwazi ukubekezelela noma abafuni ukuthatha imithi yokuvimbela imithi ye-migraine.
Enye idivaysi yinkimbinkimbi ye-vagus n stimulation (i-nVNS) (ebizwa nge-GammaCore) engasetshenziselwa kokubili ukuvimbela nokwelapha ukuhlaselwa okujulile kwe-migraine. Isebenza ngokuvuselela i-vagus nerve-ngakho-ke ibanjwe ngokumelene nhlangothi entanyeni cishe imizuzu emibili ngemuva kokusebenzisa i-gel ehamba phambili. Kukholakala ukuthi kusebenza ngokucindezela amazinga aphezulu e-glutamate ohlelweni lwezintathu.
Esicwaningweni se- Journal of Headache and Pain, imiphumela yabonisa ukuthuthukiswa kwenani lezinsizwa ngenyanga, kanye nobuhlungu obukhulu, kubahlanganyeli abane-disisodic noma engavamile yokugula kwengcindezi. Zimbalwa imiphumela emibi ezabikwa futhi akekho okwakungathí sina. Le miphumela emibi yayihlanganisa ukucasuka kwesikhumba nentambo yokudonsa.
Idivayisi yesithathu ebizwa ngokuthi i-Spring transcranial stimulator (sTMS) i-FDA-evunyelwe ukuphatha i-migraine nge-aura. It isetshenziswa ngokusebenzisa idivayisi ngemuva kwekhanda lakho bese ucindezela inkinobho, okuyinto ukukhulula amandla magnetic okuvuselelayo ebuchosheni. Ingasetshenziswa kuphela kanye namahora angu-24 njengokwelashwa. Kucatshangwa ukuthi kusebenza ngokucindezeleka kokusabalalisa kwe-Cortical, ukuqhuma komsebenzi kagesi owela kulo lonke ubuchopho.
Izwi elivela
Ngenkathi ukuphela kwezintambo ezintsha zokwelashwa nezidakamizwa kujabulisa futhi kuthembise, khumbula ukuthi ukuphatha nokuvimbela ukuhlasela kwakho kwe-migraine kungaba yinkinga enzima futhi engenakulungiswa-enye yezilingo nokuphutha okuzoshintsha njengoba imigraines yakho, indlela yokuphila, kanye / noma okuthandayo kuyashintsha.
Hlala usebenza ngokulandela i-neurologist yakho njalo futhi uhlale usesikhathini izindaba ze-migraine, ngaphandle kokugxila kakhulu emithethini yobuchwepheshe yezokwelapha ezivela phambili. Masibe nethemba ukuthi lesi sifo esilimazayo singase sikhululwe kancane kancane kuwe noma othandekayo wakho.
> Imithombo:
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