Kushungurudzika, Epilepsy Uye Chiropractic

El Paso, TX. Chiropractor, Dr. Alexander Jimenez anotarisa kugunun'una, kushaya dutu uye kurapa.
Kugumburwa zvinotsanangurwa se, kushambadzira kusina kujairika kana mufambiro kubva kumabasa asingagoneki emagetsi muuropi. Kugumburwa chiratidzo chekufa pfuti asi havazi vese vane pfari vane pfari. Sezvo paine boka rehukama hwakanangana nehunhu hunoonekwa nekugwinha kunoitikapfari iri boka rematambudziko anowirirana uye anozivikanwa nekugumburwa kunowanzoitika. Kune marudzi akasiyana-siyana ekuputika uye kugumburwa. Kune mishonga yekurapa iyo inorayirwa kuti itadze kudzivirira, uye chirwere hachiwanzodikanwa kana mishonga isingabatsiri.

Kufenda & pfari

• Kukanganisika kunoitika kana pane kuparara kwemavara uye kushandiswa kwechikwata chemapoka e-neuron, kazhinji mukupindura kune chinokonzera sekusagadzikana kwemagetsi
• chero ubongo inogona kubatwa kana mamiriro acho akanaka
• Chirwere chekurwadziwa kana kugunun'una, ndiko kuwedzera kwehutachiona hwehutachiona hunoitika mukati mevanhu ubongo

Seizure Categories

• General / Global inotanga kubatwa

• Kubata motokari yemagetsi (Grand mal)

• Kusabatwa kwekutora (Petite mal)

• Focal allt seizures

• Kunyoresa kusarura zvishoma

• Motor cortex (Jacksonian)
• Sensory cortex
• Somatosensory
• Auditory-vestibular
• zvekuona nemeso
• Olfactory-gustatory (uncinate)

• Kushanda kwechikamu chakakwana (libmbic)

• Kuenderera mberi / kuenderera mberi kwekukurira

• Generalized (status epilepticus)
• Focal (epilepticus partialis continua)

Generalized Motor Seizure

• Kurapa kwemagetsi kweeuroni muhutachiona hwose hwekthete panguva imwe chete
• Trigger inofungidzirwa kuva kunze kwe cerebral cortex, yakadai se thalamus kana brainstem
• Zvikamu zvinotanga nekurasika kwekuziva zvakatevedzerwa ne tonic contraction (extension)
• Kufema kunomiswa, uye vhudzi rinodzingwa kupfuura glottis yakavharwa ( cry )
• Yakawedzera kuwedzerwa kweropa, vadzidzi vakaputika
• Kurwisana kwepakati nepanozorodza (clonic basa)
• Kazhinji inopedza maminetsi mashomanana, asi kune vamwe varwere vanogona kupedza maawa kana mazuva (status epilepticus)
• Kazhinji inotanga muhuduku

Tonic Clonic Seizure

nanfoundation.org/neurologic-disorders/epilepsy/what-is-epilepsy

My Tonic Clonic / Grand Mal Seizure

Seizure Inotyisa

• Ionic kusagadzikana (Na, K, Ca, Mg, BUN, pH)
• Kunyengedza kuzvidzora muropa (alcohol, barbiturates, benzodiazepines)
• Hypoglycemia
• Hypoxia
• Hyperthermia (kunyanya varwere vari pasi pemakore anopfuura 4)
• Toxin inosangana
• Genetic kusanzwisisika kusanzwisisika kweeuroni (kazhinji)

EEG Yakukuru Makuhwa

• Tonic phase
• Clonic phase
• Postictal phase

Swenson, R. Epilepsy. 2010

Kutadza (Petit Mal) Kugumburwa

• Kazhinji kazhinji inowanikwa kuvana
• Kubva mumusoro we brain brain
• Kazhinji zvinoratidzika sekurasikirwa nechitima chepfungwa kana kutarisa munzvimbo
• Idzi vana vanogona kuramba vachikudziridza kukanganisa kwakapera muupenyu
• Kuregererwa kwepachivande kunogona kuitika sezvo neuroni yakakura

Kusina Kuchengetedzwa Kwakaitwa paKamera

EEG Ya Petit Mal Seizure

• 3 spike-mawimbi / wechipiri
• Inogona kupiwa ne hyperventilation
• Spike = kufarira
• Wave = inhibition

Swenson, R. Epilepsy. 2010

Simple Focal / Partial Seizures

• Unogona kunge uri kana usina wechipiri
• Murwere anowanzochengetedza pfungwa
• Tanga munharaunda inonyanya kushanda nzvimbo ye cortex
• Zviratidzo zvakasiyana uye zvikamu zvichienderana nepo uri muuropi basa rekuchirapa rinobva
• Nharaunda dzinonyanya kugadzirwa dzinowanzoita chiitiko chakanaka (kuona magetsi, kunhuhwira chimwe chinhu, nezvimwe, kunze kwekushaikwa kwekunzwa)
• Nzvimbo dzemotokari dzinogona kubudisa zviratidzo zvakanaka kana zvisina kunaka
• Basa remunzvimbo yekubatanidza rinogona kuderedzwa panguva yechikamu chekuita
• Kana iyo yekutanga motokari inobatanidzwa = "Todd paralysis"

Partial (Focal Seizure) 12 Yr Old Boy

Kuchengetedza Kusarura MuInjini Cortex

• Inogona kutanga sekukanda kwomuviri mumwechete, pamubatanidzwa wechipatara kune basa rekudzivirira, asi rinogona kupararira kuburikidza nemuviri muitiro wevanhu (Jacksonian seizure / march)

www.maxplanckflorida.org/fitzpatricklab/homunculus/science/

Kusarura Kunosarura MuSomatosensory Cortex

Inobereka paresthesia pamativi akasiyana-siyana kumabasa epileptiform uye inogonawo kupararira mumhando yeumambo (maraka) yakafanana neya motokari

en.wikipedia.org/wiki/Cortical_homunculus

Kusarura Kusarura MuNyaya yeApriitory - Vestibular Area

• Posterior temporal region involvement
• Inogona kubudisa tinnitus uye / kana vertigo
• Audiometry ichave yakajairika

Kusarura Kusarura MuItual Cortex

• Inogona kubudisa mazano munzvimbo inotaridzika
• Visual cortex (calcarine cortex) yakabudisa kupenya, mavara, uye / kana zig-zags chiedza
• Kubatana kwekuona mahara cortex inobatanidza kukwana kwakakwana kwakadai sekanyorera mabhaloni, nyeredzi, uye mapurogoni

Kusarura Chikamu MuOffactory - Gustatory Cortex

• Inogona kubudisa mafungiro emagetsi
• Zvichida nzvimbo yekupararira kune mamwe maitiro akawanda

Zvikamu Zvikamu Zvikamu Zvokuda

• Inosanganisira sangano rekubatana kwepamberi, nguva dzemazuva kana parietal lobes
• Kufanana nekudzivirira kusarura zvishoma asi kunogona kuve nokuwedzerwa kwakawanda / kuderedza pfungwa
• Limbic Cortex (hippocampus, parahippocampal temporal cortex, retro-splenial-cingulate-subcallosal cortex, orbito- frontal cortex, uye insula) ndiyo inonyanya kukuvara

• Nokudaro iyi ndiyo inowanzove yakawanda yechipfupa

• Zvinogona kubudisa zviratidzo zvekuona uye zvinokonzera (zvinowanzoitika), zvinoshamisa uye zvisingafadzi zvinonhuwira uye zvinonakidza, zvinoshamisa zvisingaiti zvemuviri, kutya, kuzvidya mwoyo, kazhinji kushatirwa, uye kuda zvepabonde zvakanyanya, visceral uye zviitiko zvekuita zvakadai sekunyorova, kutsva, lip smacking, salivation, kudarika mvere, kuchema, penile erection, kudya, kana kumhanya

Zvikamu zveZvikanana zvakasiyana-siyana MuChimwe Checheche

Kuenderera mberi / Kuramba Kuchinge

• 2 Mitauro

• Generalized (status epilepticus)

• Focal (epilepticus partialis continua)

• Kuramba kunopfuurira kana kuti kunowanzoitika pane imwe nguva ye30 isina kudzokera kune yakanaka pane nguva
• Basa rekukurumidza kwenguva refu kana kuti kukanganisa kwakawanda kunoitika pedyo pamwe chete pasina kuzorora zvakakwana pakati
• Kazhinji kazhinji kuonekwa semugumisiro wekurwadziwa kwemaanti anticonvulsive nekuda kwekuderedza hyperexcitability
• Kuwedzererwa mupfungwa, fever, kana mamwe maitiro e hypermetabolic, hypoglycemia, hypocalcemia, hypomagnesemia, hypoxemia, hutu hwehutu (semuenzaniso, tetanus, uremia, unremia, zvinokonzera kushamwaridzana zvakadai samamphetamine, aminophyline, lidocaine, penicillin) uye kuregererwa kunogona kunotangirawo kukunda

Mamiriro Epilepticus

• Kuenderera mberi kwekukuvara kwekukuvara kwechirwere ndikokukurumidzira kwechirwere nokuti zvinogona kuita kuti uropi hukuvadzwa kana kufa kana kukanganisa kwenguva refu kusina kubviswa
• Kuwedzera kwekushisa pamusana pemabasa ekusimudzira musimba, hypoxia nekuda kwekushaya kwakakwana kwemavhenekeri uye yakaoma lactic acidosis inogona kukanganisa neurons
• Rufu runogona kukonzerwa nokushamiswa uye kudengenyeka kwema cardiopulmonary

Epilepsia Partialis Continua

• Kunotora hupenyu hunotyisidzira kupfuura chiremera chekufa, asi kubata basa kunofanira kupedzwa sezvo zvichigona kufambira mberi kune fomu yakagadziriswa kana yakabvumirwa kuramba ichienderera mberi kwenguva yakareba
• Ive nemugumisiro weweoplasm, ischemia-infarction, inokonzera kutyisa kana hyperglycemia

Kurapa Kwekugumburwa

• Kana kukanganisa kunokonzerwa nemamiriro ezvinhu akadai, soutachiona, kukanganiswa kwehuwandu hwemvura uye electrolyte kuenzanisa, zvinodhaka uye zvisingagumi zvekushaya simba, kana kusakundikana kwechirwere, kurapwa kwechikonzero chiripo kunofanira kusimbisa basa rekukunda
• Mazhinji antiepileptic mishonga inobata akawanda marudzi ekubatwa - asina kukwana zvakadaro
• Zvimwe zvinowanzobudirira (phenytoin, carbamazepine, valproic acid uye phenobarbital)
• Iko kune avo vane zvigaro zvishoma (gabapentin, lamotrigine uye topiramate)
• Imwe mishonga inobata chete chirwere chimwechete (sezvinonzi ethosuximide yekutadza kusagadzikana)

Sources

Alexander G. Reeves, A. & Swenson, R. Kukanganiswa kweNervous System. Dartmouth, 2004.
Swenson, R. Epilepsy. 2010.