Kudzokorora maitiro ekuongorora chirwere cheParkinson cheMDS chegore ra2015

Uye ndine vanyori vaviri nhasi. Tine Susan Fox wekuYunivhesiti yeToronto Western Hospital, naClaudia Trenkwalder wekuParacelsus-Elena Hospital muKassel neUniversity Medical Center muGoettingen, Germany. Tinotenda zvikuru Susan naClaudia nekubatana nesu nhasi.

Dr. Susan Fox: Ndafara kuva pano.[00:01:00] 

Purofesa Claudia Trenkwalder: Hongu.

Dr. Eduardo de Pablo-Fernández: Tisati tatanga kutaura zvakawanda nezvepepa iri, ngatitaurei nezve nzira dzekuongorora chirwere dzakaburitswa kubva kuMDS. Saka tendai kana kwete, kwapfuura makore anopfuura gumi kubva zvaburitswa uye vari kutsigira kuongororwa kwenyanzvi. Uye nekuda kweizvi, vanoda kuratidzwa kweParkinsonian syndrome pakuongororwa, uye kusanganiswa kwakasiyana kwenzira dzekubvisa chirwere, zviratidzo zvinokatyamadza, uye zvinhu zvinotsigira. Uye zvichienderana nekusanganiswa kwacho kune mapoka maviri anotsanangurwa mukiriniki uye chirwere cheParkinson chingangodaro chiripo. Pfungwa iyi yekudzokorora nzira dzekuongorora chirwere yakabva kupi? Unofunga kuti izvi zvinogona kuvandudzwa sei?

Kana kuti ndezvipi zvikanganiso zviri mumatanho ekuongorora ari kushandiswa pari zvino?

Purofesa Claudia Trenkwalder: Saka pamwe ndinogona kutanga neruzivo urwu nenhoroondo uye zvakatangwa panguva yangu yehutungamiriri kuMDS kuti takaona zvinodiwa izvi [00:02:00] zvatove zvisiri kushanda kwemakore akati wandei uye zvichishandiswa, asi vamwe vachiri kushandisa zvinodiwa zveUK Brain Bank. Uye pane chimwe chinhu chatinogona kugadzirisa pane zvinodiwa izvi pamwe. Uye ndinofunga, zvakanaka kwazvo, zvine ruzivo rwakadzama. Asi dzimwe nguva zvinotora nguva, zvakare kune vanachiremba vepfungwa uye kunyanya kune vanoongorora kliniki, kana ukatarisa zvinodiwa zvakawanda zvinotsigira, zvinodiwa zvekubvisa zvachose, zviratidzo zvekusaonekwa, uye sezvawataura, unofanirwa kuzvienzanisa. Kunyangwe zvisina kunyorwa chaizvo kuti unoenzanisa sei. Kune misanganiswa yakawanda inogona kuitika, saka takafunga neruzivo rutsva uye rwuri kuwedzera rwe biomarkers, majini, izvo zvisiri muzvinodiwa izvi, pamwe munhu anogona kuzvivandudza. Asi danho rekutanga re [00:03:00] pane zvese izvi kugara uchizvitarisa uye kuzvienzanisa nedata. Uye kudzokera shure zvishoma kuna Jean-Martin Charcot, Charcot ndiye akatanga kuongorora neuropathology nezviratidzo zvekiriniki uye akazvienzanisa kare muzana remakore rechi19.

Uye ndiye zvakare akaramba izwi rekuti paralysis agitans rechirwere cheParkinson nekuti varwere vaisafanira kuoma mitezo kana kuti vaisafanira kudedera kana vasina kudengenyeka, uye akatsanangurazve chirwere ichi ndokutsigira zita rekuti maladie de parkinson, zvinoreva chirwere cheParkinson chete. Saka ndinofunga ndiye aive wekutanga.

Iye [00:04:00] akatarisa varwere vazhinji veParkinson kuSalpêtrière, uye akatarisawo neuropathology, uye akabva atsanangura chirwere chacho uye anotsanangura zviratidzo zvatichiri kushandisa pazviratidzo zvikuru, kuomarara, bradykinesia, uye pamwe kudengenyeka. Uye akasiyanisawo kudengenyeka kubva kumultiple sclerosis tremor.

Saka ndinofunga kuti zvaibatsira zvikuru kutarisa neuropathology nezviratidzo zvekiriniki uye sezvinodiwa neMDS ipapo zvichibva pakubvumirana kwenyanzvi nekuongorora mabhuku, asi kwete neuropathology. Takafunga kuti danho rekutanga ringave rekutarisa zvinhu izvi zvakawanda, uye izvi zvinhu zvinopfuura zvitanhatu kubva mukutsigira nezve 10 ne 11 [00:05:00] kusabatanidzwa uye zviratidzo zvitsvuku. Zvinhu izvi zvinoshanda sei? Tinogona kuwana data rekuzviratidza here? Kana kuti pamwe kuzviramba kana kuzvigadzirisa. Saka pfungwa idzi dzakauya uye takakurukura izvi muMDS uye pakupedzisira takabvumirana kutanga komiti ye ad hoc yezvinodiwa neMDS zvechirwere cheParkinson. Uye chinangwa cheprojekiti iyi chaive chekugadzira chirevo chekutanga chekupa kutsoropodzwa kwezvinodiwa zviripo.

Rondedzera zvinodiwa nebazi iri, pamwe kusanganisira biology, majini muchikamu chinotevera, uye kuratidza kuti nzira yekufambira mberi ingaratidzika sei. Uye ndinofunga kuti iyi ndiyo yaive nhoroondo yepepa uye ipapo basa re [00:06:00] rakatanga ne neuropathology uye makomiti eMDS aigara achienderana nekuenzanisa kwedu pakati pevanhurume nevanhukadzi nejogirafi, uye ndinofunga kuti taiva nemusanganiswa wakanaka uye komiti chaiyo yenyanzvi saka taigona kuita basa racho, ndinofunga, mamiriro ekunze anoshanda zvakanaka.

Dr. Eduardo de Pablo-Fernández: Uye kusvika pari zvino waita basa guru. Saka muchinyorwa chino maongorora zvese zvidzidzo zvezvirwere zviripo, zvidzidzo zvekiriniki zvezvirwere zvine kuongororwa kwakasimbiswa kweParkinson's, kusanganisirawo varwere vane Parkinsonism isingawanzoitiki. Mune huwandu uhu hunoshamisa hwedata, munoedza kushandisa zvinodiwa neMDS neruzivo rwekiriniki rwuripo. Saka makawana sei kuti nekushandiswa kwezvinodiwa zvekare, zvaive zvakaoma here? Ndezvipi zvaive matambudziko enzira idzi uye zvinokanganisa sei kududzira kwenyu [00:07:00] mhedzisiro?

Kana uchikwanisa kuwedzera zvishoma nezvenzira dzacho.

Dr. Susan Fox: Ehe. Pamwe ndinogona, nditore izvozvo. Ehe. Ndinofunga kuti chataive tichiedza kuita kwaive kutarisa chimwe nechimwe chezviyero sezvawataura, zviyero zvinotsigira, zviyero zvekusabvisa zvachose, uye zviratidzo zvisinganzwisisike chimwe nechimwe. Uye kungosimbisa kana izvi zvakaramba zviripo pataive nekusimbisa chirwere, tinoziva kuti zvidzidzo zvekare, kusanganisira zvidzidzo zvawakanyora zviri pachena kuti zvakatarisa zviyero zvese. Asi chataive tichiedza kubvisa chaive zviyero zvemunhu uye kuti izvi zvaive zvinobatsira sei. Uye ndinofunga ndipo patakasangana nematambudziko, matambudziko ekushandisa mazwi akaomarara ezviyero nemapepa ataive tatora.

Uye ndinofunga kuti mamwe ematambudziko makuru aive mamwe emashoko chaiwo. Semuenzaniso, nguva yaive chaiyo [00:08:00] mukati mechiratidzo chekurambidzwa. Saka semuenzaniso kufambira mberi nekukurumidza kwekutadza kufamba kwewheelchair mukati memakore mashanu ekutanga kwechirwere, BP yakanyanya mukati memakore mashanu ekutanga.

Uye kwaive neakawanda eizvi apo paive nenguva yakatarwa uye kazhinji yaisanyorwa mukati medata rekiriniki. Saka izvozvo zvakaita kuti zviome kutaura zvakananga. Rimwe dambudziko raive mukati memipimo yekutsigira, ndingati apo tsananguro yacho inotaura mhinduro yakajeka uye inoshamisa inobatsira pakurapa dopaminergic.

Saka tinorevei kana tichiti zvakajeka uye zvine drama? Ndinofunga kuti pane matambudziko pano. Ini sevanachiremba tinoziva zvatiri kureva, asi patinoedza kushandisa izvi munzvimbo yakaoma, zvinotowedzera kuoma. Saizvozvowo nekuchinja-chinja kwemafambiro emuviri, kupera kwemushonga kusingatarisirwi uye kwakanyorwa seON/OFF kunopera.

Saka izvi zvaisawanzotsanangurwa zvakajeka, saka taifanira kushandisa zvese zvataigona [00:09:00] mukati metsanangudzo dzekiriniki. Saka aya ndiwo mamwe ematambudziko makuru atakasangana nawo maererano nenzira yekushandisa zvinodiwa pakuongorora nyaya dzekare kuti tiedze kuona kuti idzi dzaive dzakakodzera sei muzviitiko zvakasimbiswa nechirwere.

Dr. Eduardo de Pablo-Fernández: Zvakanakisa. Uye zvese zviri pachena kuti zvinhu izvi zvinoratidza kuti zvinotsigira izvi. Zviripo zvakanyanya muboka reParkinson's zvichienzaniswa nezvimwe zvirwere zvinogona kurwara. Asi kana uchifanira kupfupisa mhedzisiro yacho, ndezvipi zvinhu zveMDS criteria zvingangovandudzwa? Kana muchitipa pfupiso yemhedziso huru.

Dr. Susan Fox: Ehe. Saka ndinofunga zvakare, kutora zvinhu zvega zvega, icho chaive chinangwa chedu pano. Saka kana tikafunga nezvenzira dzekutsigira, idzo dzakaramba dzakasimba yaive mhinduro yelevodopa. Mukati memashoko andataura. [00:10:00] Anosmia kana hyposmia yaivewo chiratidzo chaicho, kunyangwe pakanga pasina data rakawanda pamusoro peParkinson's isingawanzoitiki.

Zvinhu zvaigona kutorwa mukati mezvinodiwa zve2015 zvaive zveMIBG-spect, uko kutaura chokwadi hatina kuwana zvidzidzo zvakaratidza hukama hwekiriniki neongororo iyi. Saka pamwe zvingave zvisina kudzokororwa, tinogona kutaura nezvezvimwe zviratidzo zvebiomarker gare gare, asi zviri pachena kuti ndiyo biomarker yekutanga yakabatanidzwa muzvinodiwa zve2015.

Ndichitarisa zvinodiwa kuti munhu asatore mishonga iyi zvachose, ndinofunga kuti mimwe yacho inogona kubatsira. Hazvingaite kuti murwere ane chirwere cheParkinson agare pamberi pako kana aine zviratidzo zvecerebellar, kusaonekwa kwemhinduro yake kana atora mishonga yakawanda yelevodopa, uye aine DaT-SPECT presynaptic imaging yakajairika.

Saka zvese izvi zvaizobvisa chirwere cheParkinson, uye ndinofunga kuti izvi zvingave zvakakosha pakusarudza kusabvisa zvachose [00:11:00]. Chimwe chezvikamu izvi chatakaona chakaoma zvikuru itsananguro yekuchinja kwemaitiro, frontotemporal dementia frontal cognitive changes. Ichi chaive, zvakare, chiratidzo chisina kujeka chakatsanangurwa munhevedzano dzakawanda, asi chisina kujeka uye pamwe chinoda tsananguro iri nani.

Imwe iyo isina munhu akambotaura nezvechirwere ichi ndeye Parkinsonia yaingowanikwa mumakumbo nemakumbo kwenguva inopfuura makore matatu chete. Pamwe chiratidzo chaicho chiri kutsvagwa nevanhu uye pamwe hachina kunyorwa muchikamu chipi zvacho chezvirwere zvatakanyora.

Uye pakupedzisira, mukati mezviratidzo zvitsvuku, ndinofunga kuti zvimwe zvezviratidzo zvitsvuku zvinobatsira kufunga nezvazvo. Chimwe chirwere, kwete chirwere cheParkinson, chaive chirwere chepfungwa, icho chakaonekwa zvakajeka muMSA. Matambudziko emudumbu, anowanzoonekwa muMSA PSP, uye zviratidzo zvekutanga zve bulbar, zvakare, zvakajairika muPSP [00:12:00] MSA.

Saka zvitatu izvi zvinoita sezvinobatsira zvikuru. Chandinofunga ndechekuti, pamwe ndicho chisina kujeka, uye hatina kuwana ongororo dzakaongorora izvi kwaiva kusavapo kwezviratidzo zvemuviri zvisiri zvemuviri kunyangwe paine makore mashanu echirwere ichi. Tinoziva kuti zviratidzo zvemuviri zvisiri zvemuviri zvinowanzoonekwa sei muchirwere cheParkinson uye pamwewo muParkinson's isingawanzoonekwi, asi chikamu ichocho chakanga chisina ruzivo rwechokwadi rwekurapa. Saka pamwe chinofanira kutsanangurwa zviri nani kana kutobviswa kana chisingazove chinobatsira mukati meMDS criteria.

Dr. Eduardo de Pablo-Fernández: Saka ndinotora kubva pane izvi kuti zvimwe zvinhu zvinogona kubviswa kana kurerutswa uye kuita kuti nzira dzekuongorora dzive nyore kushandisa mukurapa. Asi ndinofunga kuti zvakaoma, sezvamataura, kuva chaiyo uye mutsanangudzo kuitira kuti tikwanise, izwi iri imhando yenzira dzekurapa nemazvo uye zvakaoma kuchengetedza chiyero ichocho.

Uyewo kana ukaongorora zvinhu zve [00:13:00] chimwe nechimwe, pane zvishoma chete zvinogona kuongororwa zvizere kana zvinogona kubvisa kana kubvisa chirwere cheParkinson. Saka ndinofunga kuti zvakaoma zvikuru kugadzirisa zvinodiwa neMDS. Vamwe vanhu vanogona kutaura kuti tinogona kunge tasvika padanho repamusoro rekuongorora nekushandisa nzira dzekurapa.

Handizivi kuti uri kuronga sei kuenderera mberi neizvi, kana kuti unofunga kuti izvi zvinogona kuitwa sei, uri kuronga sei kuita shanduko idzodzo muMDS criteria nenzira inoshanda inogona kushandiswa zviri nyore mukiriniki.

Purofesa Claudia Trenkwalder: Pamwe ndinogona kuwedzera chimwe chinhu pane izvi sezvo tisina kutaura nezve co pathology. Uye zvaive zvinobatsira zvikuru kuti taiva nevanoongorora zvirwere muboka redu neGabor Kovacs. Uye kunyangwe kubva mudata, takadzidza zvakawanda kuti vazhinji vevanhu ava [00:14:00] vaive ne co pathology uye zviratidzo zvakawanda zvaive zvakaita seParkinson's disease, asi ivo pachinhu chimwe chete pamwe zviratidzo zve tauopathy. Uye kana ndichiyeuka mukiriniki, taiva nemibvunzo yakawanda, kazhinji, uyu murwere wePD chaiye here kana kuti anogona kuva ne tauopathy? Uye mhinduro yeizvi inogona kunge iri mune vamwe vevarwere ava vakaoma vavanavo vese kana kuti vanova ne co pathology. Uye ndinofunga kuti iri ishoko ratinofanira kupawo vanachiremba vedu, uye izvi zvinoita kuti zvinodiwa pakiriniki zviome zvikuru.

Uye mubvunzo ndewokuti, tinofanira here kunyatsotsvaga tsanangudzo uye kunyatsotsvaga tsanangudzo kana mune vamwe varwere ichi chisiri icho chinangwa. [00:15:00] Tinofanira kufunga nezvezvirwere zviviri, saka ndaizosarudza zvinhu zvishoma, zvishoma chimwe chete. Sezvataurwa naSusan, bvisa zvimwe zvinhu, enda kune zvakaoma chaizvo, senge ataxia muvarwere veParkinson.

Izvi hazviwanzoitika. Wobva wagara uchifunga nezve co pathology. Pamwe wedzera chimwe chinhu, co pathology inogona kunge iri nekuda kwechinhu chakadai. Saka ramba wakasununguka nekuti kufambira mberi kwechirwere chete ndiko kunogona kuratidza chimiro chaicho uye, uye muchikamu chinotevera, uye ichi chinhu chinofanira kukurukurwa uye padanho rakakura uye nevamwe venyanzvi vedu kubva ku neuroscience kuti vasanganise biological [00:16:00] criteria uye genetics.

Uye ndinofunga kuti mushure memakore anopfuura gumi ekuongorora MDS, uye ruzivo rwakawanda rwataive narwo mumakore mashanu apfuura nezve alpha synuclein RT-QuiC tests, SAA synuclein aggregation tests. Tinofanira kufunga kuti tingabatanidza sei ruzivo rwakawanda rwehunyanzvi nerwerabhoritari mune zvimwe zvinodiwa zvinobatsira.

Zvingasawanikwe kwese kwese, panzvimbo yega yega munyika imwe neimwe, asi kana zviripo zvinogona kuwedzera ruzivo runobatsira. Uye ndinofunga kuti zvinodiwa zvitsva zvinofanirwa kubatanidzwa, kwete kiriniki chete. Uye kunyangwe muMDS diagnostic criteria panotaurwa nezvekunhuhwirira, nuclear medicine inotaurwa, [00:17:00] saka zvatova kutanga, asi ungangofanira kuwedzera izvozvo.

Dr. Eduardo de Pablo-Fernández: Saka, ndinofunga kuti chiratidzo chekushanduka kwezvinodiwa. Kuti kumwe kuferefeta uku kunopera sei kana kuti kusanyanya kushandiswa mukurapa, uye kuti mamwe ma biomarker kana mimwe miedzo inogona kubatsira sei. Pfungwa yeizvi ndeye co pathologies. Ndinofunga kuti pamwe ndiyo imwe yemiganho yezvidzidzo zvekiriniki zvezvirwere zvakajairika zvekuti ikozvino tava kuziva zvakanyanya nezvekuwanda kwe co pathologies muchirwere cheParkinson nedzimwe neurodegenerative disorders. Asi pamwe hazvina kudaro makumi emakore apfuura. Uye zvimwe zvezvidzidzo izvi hazvina kuongorora kuvapo kwevamwe vanachiremba vezvirwere zvakadzama. Ndinofunga Claudia, pamwe wakakurukura izvi zvishoma, asi ndiwo waiva mubvunzo wangu unotevera.

Munofananidza sei zvinodiwa zvekiriniki izvi netsananguro yakakura yechirwere cheParkinson netsanangudzo dzezvehupenyu dzakataurwa munguva pfupi yapfuura, kwete chete zviratidzo zvebiomarker, asiwo sezvatakakurukura kare [00:18:00] zviratidzo zvemajini, nezvimwewo. Handizivi kana muine chekuwedzera Susan, muhurukuro iyi.

Ndeipi pfungwa dzako?

Dr. Susan Fox: Ehe. Ndinofunga kuti zvatakawana pano ndezvekuti nyanzvi dzine tsananguro dzavo dzeMDS muna 2015 dzakasimbiswa zvakanyanya nezvatakawana nekusimbisa pathological. Saka ndinofunga kuti tsananguro idzi dzekiriniki dziri kuramba dzichishanda, saka ndinofunga kuti tinoramba tichishandisa zvatiri kuita.

Asi sezvakataurwa naClaudia uye zvichienda mberi, zviri pachena kuti zvinoda kunatsiridzwa nenzira dzemazuva ano dzatinotarisira kuti dzicharamba dzichivandudza kugona kwedu kuongorora murwere ane Parkinson's, kunyanya tichishandisa ma biomarker akawanda atiri kukura muproteomics yemifananidzo uye zviri pachena kuti anosanganisira majini.

Chikamu che co pathology chakakosha zvikuru. Uye ndinofunga kuti chimwe chandinodzidza kubva pane izvi ndechekuti tichiri kuda kuramba tichiita clinical pathological series. Isu [00:19:00] tichiri kuda kuita chikamu ichocho chekutsvaga, chikamu chekutarisira kwedu kliniki kana uchida, zvichiri kuenderera mberi, chinofanira kuenderera mberi uye kunyatsonzwisisa varwere ava vane multiple pathology.

Uye izvozvo zvinogadzirisa sei kuongororwa kwedu kwechirwere. Asi ndinofunga kuti zvandinofunga kuti ndizvo zvinodiwa pakuongorora murwere ane chirwere cheParkinson. Asi zviri pachena kuti kugadzirisa izvi mune ramangwana ndizvo zvaticharonga kuita nekuvandudzwa kwemazuva ano uye kuri kuenderera mberi mu biomarkers.

Dr. Eduardo de Pablo-Fernández: Ibasa rakaoma, kuriita zvechokwadi. Asi ndinofunga zvinokurudzira kana ukatarisa zvidzidzo zvekiriniki zvezvirwere, uchitarisa kururama kwekuongororwa kwechirwere, kuti kuongororwa kwenyanzvi kuchiri pamusoro pezvese, asi sezvawataura, maitiro ekufunga kuita mazwi dzimwe nguva akaoma.

Asi ndinofunga kuti pamwe kungorerutsa mhedzisiro iyi uye kugadzirisa zvinhu zvitsva zvichabatsira zvikuru mukuita kwekiriniki uye kutsvagisa kwekiriniki. [00:20:00] Handizivi kana muine chekuwedzera muhurukuro. Ndezvipi zvirongwa zvebasa iri muMDS, matanho anotevera ekufambisa izvi mberi?

Purofesa Claudia Trenkwalder: Saka ndinofunga kuti matanho anotevera angave ekuti, ichi chikamu cheMDS, tobva tatarisa boka idzva rebasa kana komiti pakupedzisira nemvumo yekuisa mutemo weMDS ndingati shanduro yakapfava yezvinodiwa zveMDS. Uye sezvatinoziva tese, vanachiremba vazhinji vanongosarudza zvinodiwa zveMDS, asi havana kumbotarisa zvinhu zvese nekuti zvinotora nguva yakawanda.

Saka ndingada kuva nezvinodiwa zvakanyatsoongororwa uye pamwe zviri nyore. Pamwe zvisinganyatsojeka, asi tinganyatsojeka sei? Uye kana tikawedzera, sezvakataurwa naSusan, [00:21:00] mamwe matekiniki, biology, majini, izvi zvinogona kubatsira. Asi tese tinodzidza panguva iyi kuti neuropathology yakakosha sei uye kuti tine mazano akawanda senyanzvi uye mafungiro akawanda, asi pakupedzisira, kana zvasvika kuuropi, nyaya yacho inogona kusiyana.

Dr. Eduardo de Pablo-Fernández: Zvakakosha chose. Zvinobva kwandiri kuti pamwe ndine rusaruro, asi hongu, zvechokwadi tsvakiridzo yezvirwere zvekiriniki inzvimbo inokosha zvikuru uye maererano nekuongorora chirwere. Ndatenda zvikuru Susan naClaudia nehurukuro yataita nhasi. Uye ndatenda zvikuru kuvateereri.

Ndinokurudzira munhu wese kuti averenge pepa rese riri muParkinson's Disease Journal uye sarai zvakanaka izvozvi. [00:22:00]