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paliatiuri mzrunveloba nevrologiuri daavadebebis dros progresirebadi nevrologiuri daavadebebi: epidemiologiuri da klinikuri suraTi progresirebadi gaxangrZlivebuli nevrologiur mdgomareobebis (PLNTC – progressive long-term neurological conditions) uamravi tipi arsebobs. am TavSi ganvixilavT mxolod 4 daavadebas: gafantuli sklerozi (MS) da parkinsonis daavadeba (PD) (romlebic ufro metadaa gavrcelebuli), motoruli neironis daavadeba (MND) da hantingtonis daavadeba (HD) (romlebic SedarebiT iSviaTia). mag. did britaneTSi, ojaxis eqims SeiZleba Sexvdes saSualod sami pacienti gafantuli skleroziT pacientTa mTlian nakadSi, maSin roca motoruli neironis daavadebiT pacientis momarTvianoba daaxloebiT 1/10 sixSiriTaa. am TavSi yuradReba gamaxvilebulia “avadobasa” da “gavrcelebaze”. “avadoba” – esaa daavadebis axali SemTxvevebis ricxvi weliwadSi, xolo “gavrceleba” gulisxmobs am daavadebis mqone pacientebis ricxvs drois garkveul monakveTSi. gafantuli sklerozi epidemiologia gafantuli sklerozi (MS) yvelaze gavrcelebuli nevrologiuri paTologiaa axalgazrda asakSi. igi ufro xSiria qalebSi, vidre mamakacebSi (Sefardeba 2/1). daavadeba, rogorc wesi, Tavs iCens sicocxlis mesame an meoTxe aTwleulSi. did britaneTSi gafantul sklerozze monacemTa baza ar arsebobs. uxeSi gaTvlebiT, did britaneTSi daaxloebiT 85 000 adamiania daavadebuli gafantuli skleroziT. msoflioSi gavrceleba daaxloebiT 2 500 000-ia. did britaneTSi yovelwliurad daaxl. 2500 pacienti diagnostirdeba gafantul sklerozze. gafantuli sklerozis gavrceleba msoflioSi araTanabaria. daavadebis sixSire izrdeba ekvatoridan moSorebiT regionebSi (rogorc CrdiloeTiT ise samxreTiT). mag. inglisisaTvis es niSnavs rom 1000 sul mosaxleze

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Page 1: Neurological PC.pdf

paliatiuri mzrunveloba nevrologiuri daavadebebis

dros

progresirebadi nevrologiuri daavadebebi: epidemiologiuri da

klinikuri suraTi

progresirebadi gaxangrZlivebuli nevrologiur mdgomareobebis (PLNTC –

progressive long-term neurological conditions) uamravi tipi arsebobs. am TavSi

ganvixilavT mxolod 4 daavadebas: gafantuli sklerozi (MS) da

parkinsonis daavadeba (PD) (romlebic ufro metadaa gavrcelebuli),

motoruli neironis daavadeba (MND) da hantingtonis daavadeba (HD) (romlebic SedarebiT iSviaTia). mag. did britaneTSi, ojaxis eqims SeiZleba

Sexvdes saSualod sami pacienti gafantuli skleroziT pacientTa mTlian

nakadSi, maSin roca motoruli neironis daavadebiT pacientis

momarTvianoba daaxloebiT 1/10 sixSiriTaa.

am TavSi yuradReba gamaxvilebulia “avadobasa” da “gavrcelebaze”.

“avadoba” – esaa daavadebis axali SemTxvevebis ricxvi weliwadSi, xolo

“gavrceleba” gulisxmobs am daavadebis mqone pacientebis ricxvs drois

garkveul monakveTSi.

gafantuli sklerozi

epidemiologia

gafantuli sklerozi (MS) yvelaze gavrcelebuli nevrologiuri

paTologiaa axalgazrda asakSi. igi ufro xSiria qalebSi, vidre

mamakacebSi (Sefardeba 2/1). daavadeba, rogorc wesi, Tavs iCens sicocxlis

mesame an meoTxe aTwleulSi.

did britaneTSi gafantul sklerozze monacemTa baza ar arsebobs. uxeSi

gaTvlebiT, did britaneTSi daaxloebiT 85 000 adamiania daavadebuli

gafantuli skleroziT. msoflioSi gavrceleba daaxloebiT 2 500 000-ia.

did britaneTSi yovelwliurad daaxl. 2500 pacienti diagnostirdeba

gafantul sklerozze.

gafantuli sklerozis gavrceleba msoflioSi araTanabaria. daavadebis

sixSire izrdeba ekvatoridan moSorebiT regionebSi (rogorc CrdiloeTiT

ise samxreTiT). mag. inglisisaTvis es niSnavs rom 1000 sul mosaxleze

Page 2: Neurological PC.pdf

gafantuli skleroziT avadoba ufro metia CrdiloeT SotlandiaSi, vidre

londonSi. ufro farTo masStabiani magaliTi rom moviyvanoT, daavadeba

ufro xSiria kanadaSi vidre romelime ekvatorul qveyanaSi, mag. indoeTSi.

daavadebis ganviTarebis riski moicavs mravali faqtoris, mag. genetikuri

da garemo faqtorebis urTierTqmedebas. es imiT dasturdeba, rom Tu Tqven

sacxovreblad gadaxvalT dabali riskis qveynidan (mag. indoeTidan) maRali

riskis qveyanaSi (mag. kanadaSi), gafantuli skleroziT daavadebis riski am

SemTxvevaSi damokidebulia Tqvens asakze. rac ufro naklebia migrantis

asaki, miT metia Sansi, rom mas eqneba iseTive mimRebloba rogoric im

qveynis mosaxleobas, sadac moxda migracia, da piriqiT.

gafantuli sklerozis riski did britaneTSi saSualod 700 mosaxleze 1-ia.

daavadebis risks zrdis ojaxuri anamnezic. Tu Tqvens pirveli rigis

naTesavs (mag. mSobels, da-Zmas, Svils) aqvs gafantuli sklerozi, maSin

TqvenTvis riski 1/40-zea. xolo Tu daavadeba aReniSneba meore rigis

naTesavs (mag. biZaSvilebi/mamidebi/biZebi/ZmisSvilebi), maSin es riski

mcirdeba 1/100-mde. gafantuli sklerozi warmoadgens xangrZliv

progresirebad nevrologiur mdgomareobas, romliTac pacienti xSirad

mravali wlis manZilze cxovrobs. mTlianobaSi, es daavadeba sicocxlis

mosalodnel xangrZlivobas mxolod umniSvnelod amcirebs, Tumca es

mocemuloba individualuri da farTod cvalebadia.

jer kidev ucnobia konkretulad ra garemo faqtorebi iwvevs gafantul

sklerozs. arsebobs sxvadasxva kvlevebis monacemebi, romlebic erTmaneTsac

ki Zlier ewinaaRmdegeba. savaraudo trigerebSi moiazreba individis asaki

ebStein-baris virusiT inficirebis periodSi da klimatiT inducirebuli

vitamin D-s deficiti.

gafantuli sklerozis paTofiziologia

miCneulia, rom gafantuli sklerozis ganviTarebas safuZvlad udevs

adamianis organizmis imunuri sistemis ujredebis mimarTva sakuTari

neironebis mimarT nervul sistemaSi. amas autoimunuri reaqcia ewodeba. am

SemTxvevaSi Semtev ujredebs warmoadgens T limfocitebi. es ukanasknelni

aRweven cns-Si da azianeben neironebis Semomgarsvel mielinis garss. am

process ewodeba demielinizacia. mielinis garsis dazianebis Semdeg

Zneldeba nervuli impulsis gadacema neironis gaswvriv. es niSnavs, rom

nervuli impulsi veRar midis daniSnulebis adgilas. mag. Tu dazianda

qveda kidurebis mamoZravebeli kortikaluri nervuli gza, maSin cxadia rom

siaruli gaZnelebuli iqneba, xolo Tvalis nervis dazianebisas gauaresdeba

mxedveloba.

Page 3: Neurological PC.pdf

gafantuli sklerozis adreul stadiebze SesaZloa moxdes remielinizacia,

anu aRdges dazianebuli mielinis garsi. Tumca, aRdgenili mielinis garsi

xSirad ufro Txelia winamorbedTan SedarebiT da ise kargad mainc ver

atarebs nervul impulss, rogorc Tavdapirveli mielinis garsi. droTa

ganmavlobaSi ziandeba mielinis maproducirebeli ujredebic

(oligodendrocitebi) da mielinis garsis aRdgena saerTod aRar xdeba.

mielinis garsisgan daucveli nervi (aqsoni) SemdgomSi iRupeba. im

SemTxvevaSi Tu ziandeba aqsonis mcire nawili, cns-s aqvs saSualeba

moaxdinos impulsebis gadamisamarTeba, Tumca Tu dazianeba moicavs ufro

did ares, gadamisamarTeba veRar xerxdeba da mocemuli nervuli gza

sabolood iblokeba.

gafantuli sklerozis tipebi

umravles SemTxvevaSi gafantul sklerozs sawyis etapze axasiaTebs

remisiul-recidiuli mimdinareoba, rac niSnavs, rom nevrologiur deficits

aqvs gardamavali xasiaTi: grZeldeba ramodenime kvira (recidivi), Semdeg ki

alagdeba (remisia). advilia imis warmodgena, Tu ra xdeba am dros

paTofiziologiuri TvalsazrisiT.

recidivis periodSi adgili aqvs demielinizaciis process. rogorc ki

moxdeba remielinizacia, dgeba remisiis periodi. klinikuri cdebis

Catarebisas TvalsaCinoebis mizniT, miRebulia, rom recidivad iTvleba 24

saaTze meti xangrZlivobis Seteva, romlis drosac sxeulis temperatura

normaluria, xolo imisaTvis rom Setevebi CavTvaloT calkeulad, maT

Soris naTeli intervali sul mcire 30 dRe unda iyos.

Setevebis simwvave, sixSire da recidivebs Soris intervali Zalian

cvalebadia da misi winaswar gansazRvra SeuZlebelia. pacientebis

umravlesobas gafantuli sklerozis recidiul-remisiuli formiT

aReniSnebaT saSualod 1 an 2 recidivi weliwadSi. wlebis manZilze es

modeli SeiZleba Seicvalos gafantuli sklerozis mudmivad

progresirebadi formiT. am dros recidivebis sixSire klebulobs, Tumca

invalidobis xarisxi matulobs. am formas ewodeba meoradad

progresirebadi gafantuli sklerozi.

sxvadasxva kvlevebis monacemebis mixedviT, im pacientebs, romelTac

Tavdapirvelad aReniSnebaT gafantuli sklerozis recidiul-remisiuli

forma, meoradad progresirebadi forma uviTardebaT daaxloebiT 10

weliwadSi. Tumca pacientebis nawilSi es daavadeba Tavidanve

progresirebadi formiT mimdinareobs. amas ewodeba pirveladad

progresirebadi gafantuli sklerozi. es pacientebi SedarebiT ufros

asakSi (saSualod 40 weli) avaddebian. da bolos, gafantuli sklerozis

Page 4: Neurological PC.pdf

kidev erTi tipia keTilTvisebiani forma, romlis drosac Setevebi msubuqia

da maT Soris naTeli periodi zogjer wlebis manZilze grZeldeba.

gafantuli sklerozis simptomebi

simptomebi gafantuli sklerozis dros damokidebulia imaze, Tu nervuli

sistemis romel nawilSi xdeba demielinizacia. mag. am dros xSirad

ziandeba optikuri nervi (II wy.), romelic Tavis tvins gadascems vizualur

informacias. es, rogorc wesi, erT Tvals exeba xolme da iwvevs

mxedvelobis gauaresebas, rac mtkivneulad aRiqmeba pacientis mier.

umeteswilad gansakuTrebiT ziandeba ferebis aRqma. sxva SemTxvevebSi, Tu

demielinizacia moxda wonasworobis centrSi (naTxemSi), adgili aqvs

siarulis gaZnelebas, metyvelebis darRvevas da koordinaciis problemebs.

tvinis im nawilis dazianeba, romelic akontrolebs mgrZnobelobas, iwvevs

gabuJebis an CxvletiT SegrZnebebs. Tumca, es simptomebi mxolod mwvave

SemTxvevebSi vlindeba da Tu pacienti mogvmarTavs ara-mwvave periodSi,

klinikaSi es simptomebi SeiZleba verc aRmovaCinoT.

gafantuli sklerozis sxva simptomebi moicavs nawlavisa da Sardis buStis

funqciis moSlas, mexsierebis problemebs, depresiasa da pirovnebis

cvlilebebs. aseve xSiria daRla (sisuste), romelic aRiniSneba pacientebis

daaxl. 75%-Si. mravali pacienti gafantuli skleroziT aRniSnavs

daRlilobas, rogorc mTavar problemas. daRlilobis es tipi gansxvavdeba

im daRlilobisagan, romelic gvxvdeba depresiis dros. gafantul

sklerozTan dakavSirebuli daRliloba xSirad uaresdeba sicxis,

datvirTvis gavleniT da dRis gvian monakveTSi, amasTan, igi xSirad ixsneba

mciredi dasvenebiT. depresiasTan asocirebuli daRliloba ufro

araspecifiuria da dakavSirebulia depresiis sxva simptomebTan, mag. Zilis

darRvevebTan. am simptomTa umravlesoba fluqtuirebs daavadebis sawyis

stadiaze, Tumca gafantuli sklerozis progresirebasTan erTad simptomebi

da Sesabamisad, invalidobac myardeba da mudmiv iers iZens.

gafantuli sklerozis diagnozi

pacientebi gafantuli sklerozis pirveladad progresirebadi formiT

xSirad mimarTaven eqims siarulis gaZnelebis gamo. es ukanaskneli xSirad

Zalian SeumCnevlad da nela viTardeba, ris gamoc pacienti, rogorc wesi,

axdens adaptacias da raRac doneze inarCunebs xolme funqciur aqtivobas.

am pacientebSi mZime nevrologiuri deficitebi xSirad vlindeba

poliklinikaSi an ojaxis eqimTan gasinjvisas.

gafantuli sklerozis diagnozze eWvis mitana xdeba pacientis anamnezisa

da klinikuri gasinjvis safuZvelze, Tumca gamokvlevebis Catareba mainc

aucilebelia. amJamad kvlevis standarts warmoadgens magnitur-birTvuli

Page 5: Neurological PC.pdf

rezonansi (MRI). xdeba Tavis tvinis da zogjer zurgis tvinis gamokvlevac.

gafantuli sklerozi tipiurad iwvevs Tavis tvinis TeTri nivTierebis

dazianebas, upiratesad parkuWebis garSemo. gadoliniumiT kontrastireba

saSualebas iZleva gamovavlinoT 4-6 kviraze naklebi asakis folaqebi. es

axalgazrda folaqebi, romlebic kargad krefs kontrasts, 5-10-jer ufro

xSirad gvxvdeba klinikuri recidivebis ricxvTan SedarebiT. am mizezis

gamo, maTi arseboba miiCneva mxolod surogat markerad klinikuri

kvlevebis Catarebis dros. klinikuri TvalsazrisiT, wesiT maTi arseboba

unda CaiTvalos diagnozis damadastureblad, Tumca raime eWvis SemTxvevaSi

SesaZloa gakeTdes lumbaluri punqcia oligoklonuri antisxeulebis

aRmosaCenad. am ukanasknelTa aRmoCena SesaZlebelia sxva nevrologiuri

daavadebebis drosac, Tumca pacientebis 95%-s klinikurad dadasturebuli

gafantuli skleroziT es antisxeulebi yovelTvis aqvT cerebrospinalur

siTxeSi.

zogjer aseve keTdeba eleqtruli testebi (gamowveuli potencialebi), rac

gulisxmobs nervSi an nervebSi impulsis gamtareblobis siCqaris

gansazRvras. demielinizacia iwvevs impulsis gatarebis Senelebas da

amgvarad, zrdis gamtareblobis dros. sisxlis analizebis Catareba saWiroa

im daavadebebis gamosaricxad, romlebic SeiZleba axdendes gafantuli

sklerozis mimikrias.

gafantuli sklerozis sawyisi mkurnaloba

gafantuli sklerozis sawyisi mkurnaloba gulisxmobs pacientisaTvis

diagnozis ganmartebas. sasurvelia, rom es saqme mivandoT nevrologiuri

gundis iseT wevrs, romelic gamocdilia msgavs sakiTxebSi da SeuZlia

dawvrilebiT upasuxos yvela kiTxvaze. mravali pacienti miiCnevs, rom

gafantuli sklerozis meddis CarTva adreul etapze maTTvis mniSvnelovan

daxmarebas warmoadgens. gafantuli sklerozis zogierT centrSi tardeba

kursebi saRamoobiT, romlis mizania miawodos pacientsa da misi ojaxis

wevrebs informacia gafantuli sklerozisa da misi bunebis Sesaxeb, aseve

gaaTviTcnobieros isini daavadebis sxvadasxva aspeqtebSi.

sawyis etapze recidivebis kupireba xdeba steroidebiT. es ukanasknelni

iniSneba oraluri formiT mzardi doziT (meTilprednizolonis tabletebi).

meTilprednizoloni aCqarebs gamojanmrTelebas calkeuli recidivebis

dros, Tumca saboloo gamosavalze gavlenas ver axdens. mas aseve aranairi

efeqti ara aqvs xangrZlivi kursiT invalidobis xarisxze. sxvadasxva

kvlevebis mixedviT gamovlenili iqna ramodenime medikamenti, romlebic

ramdenadme cvlis daavadebis kurss, esenia: interferoni, CAMPATH

Page 6: Neurological PC.pdf

(Alemtuzumab), natalizumabi da metoqsantroni. es wamlebi gamoiyeneba

daavadebis progresirebis SesaCereblad, rac gulisxmobs recidivebis

sixSirisa da invalidobis xarisxis Semcirebas. did britaneTSi es wamlebi

xelmisawvdomia specializirebul gafantuli sklerozis klinikebSi,

zogjer am wamlebis mopoveba SeiZleba klinikur kvlevebSi CarTvis gziT.

idealurma mkurnalobam wesiT unda SeaCeros recidivebi, Seaferxos

daavadebis progresireba da aRadginos invalidobis nebismieri forma.

Tumca, samwuxarod, aseTi medikamenti jerjerobiT ar arsebobs.

gafantuli sklerozis dros aseve xSirad gamoiyeneba simptomuri

mkurnaloba. magaliTad, tkivili SeiZleba moixsnas Cveulebrivi

tkivilgamayuCeblebiT, rogoricaa paracetamoli and aass-ebi

(arasteroiduli anTebis sawinaaRmdego saSualebebi), anda ufro naklebad

gamoyenebadi tkivilis kupirebis saSualebebiT, mag. antikonvulsantebi da

antidepresantebi. Sardis buStis problemebi yvelaze kargad imarTeba

specialuri konsultantis mier. es SeiZleba gulisxmobdes medikamentebs an

kaTeterizacias. zogierT SemTxveveaSi kaTeterizacia SeiZleba gakeTdes

TviTon pacientis mier dReSi ramdenjerme, Sardis buStis efeqturad

daclis mizniT, Tanac ise rom Tavi avaridoT permanentul kaTeters.

depresiis marTva xSirad xdeba antidepresantebiT (tabletirebuli forma)

da fsiqologiuri mxardaWeriT, Tu amis saSualeba arsebobs lokalurad.

daRlilobis moxsna zogjer SesaZlebelia medikamenturi saSualebebiT,

Tumca yvelaze kargad igi imarTeba ufro pragmatuli midgomiT. am

midgomaSi igulisxmeba yvela mxaris (pacientis, pacientze mzrunvelis,

damqiraveblis) ganaTleba, raTa moxdes yoveldRiuri saqmianobisadmi

morgeba maqsimaluri moqnilobiT. magaliTad, SeiZleba Zalian didi

sargeblis momtani aRmoCndes SuadRis Zili, Tumca zog pacients SeiZleba

dasWirdes darwmuneba da gamxneveba amis misaRebad. aseve, damqiravebelic

SeiZleba daTanxmdes amaze, Tu kargad avuxsniT mis mniSvnelobasa da

sargebels.

gafantuli sklerozis umravles stadiaze, udidesi mniSvnelobda aqvs

specialuri Terapevtis CarTvas, fizioTerapevts, okupaciuri Terapevtis da

metyvelebisa da enis Terapevtis CaTvliT. magaliTad, fizioTerapevts

SeuZlia daexmaros pacients damoukidebeli siaruli unaris SenarCunebaSi,

sanam es SesaZlebelia da Semdgom, daavadebis raRac etapze urCios

sagoravebliani savarZeli. okupaciuri Terapevtis roli mdgomareobs

pacientis saxlis mowyobaSi, raTa maT ufro usafrTxod icxovron maTTvis

Cveul garemoSi. metyvelebisa da enis Terapevti xSirad monawileobs

ylapvis unaris SefasebaSi.

Page 7: Neurological PC.pdf

motoruli neironis daavadeba (mnd)

mnd-s epidemiologia

gafantuli sklerozisagan gansxvavebiT, mnd iSviaTi paTologiaa. avadoba

daaxl. 1.5-2-ia 100 000 sul mosaxleze, xolo gavrceleba ki – 5-7 / 100 000-ze.

mamakacebi 2-jer ufro xSirad avaddebian vidre qalebi. mnd upiratesad

vlindeba ufros asakSi, asakis piki diagnostirebisas 55-57 welia. Tumca

zogjer SeiZleba gamovlindes sicocxlis meore dekadaSic.

mnd-iT avadoba 50-150-jer ufro maRalia dasavleT wynari okeanis regionSi,

msoflios danarCen regionebTan SedarebiT. savaraudod es ukavSirdeba

mcenareTa (mag. cikadebis) TeslSi arsebul toqsinebs. daavadebis 5%-Si

mizezi genetikuri gadacemaa. erTaderTi mutacia, romelic dRemde aris

dadgenili, ukavSideba superoqsid-dismutazas gens, romelic autosomur

dominanturi tipiT gadaecema.

mnd rogorc wesi, sicocxlis xangrZlivobas amoklebs. mosalodneli

sicocxlis xangrZlivoba diagnozis dasmidan saSualod 2 welia, Tumca es

monacemic farTod varirebs individebs Soris.

mnd-s paTofiziologia

mnd-s dros xdeba motoruli neironebis gadagvareba. lokalizacia farToa

da moicavs Tavis tvinis qerqs, tvinis Reros, zurgis tvinsa da

kortikospinalur traqts. neironebis degeneraciis mizezi ucnobia. am dros

aRdgenis process adgili ara aqvs, ase rom gafantuli sklerozisgan

gansxvavebiT, daavadeba dasawyisidanve uwyvetad progresirebadia. mnd-s

dros ar ziandeba nervuli sistemis nawilebi, romlebic ganagebs nawlavisa

da Sardis buStis funqcias, mgrZnobelobiT da Tvalis mamoZravebel

sistemas.

mnd-s tipebi

mnd-s yvelaze gavrcelebuli tipia gverdiTi amiotrofuli sklerozi (gas)

(ALS – amyotrophic lateral sclerosis). am formis mnd-s dros ziandeba rogorc zeda, aseve qveda motoruli neironi. zeda motoruli neironi warmoadgens

motorul gamtar gzas Tavis tvinidan zurgis tvinamde, xolo qveda

motoruli neironi ki qmnis gamtar gzas zurgis tvinidan kunTebamde.

amgvarad, gas-is dros kompleqsuradaa warmodgenili rogorc zeda, ise

qveda motoruli neironis problemebi.

sxva SemTxvevaSi, SesaZloa gvqondes mxolod zeda motoruli neironis

dazianeba. am mdgomareobas hqvia “pirveladi gverdiTi sklerozi”. aseve

Page 8: Neurological PC.pdf

SeiZleba Segvxvdes sufTad qveda motoruli neironis daavadeba, romlis

drosac rogorc wesi warmodgenilia metyvelebisa da ylapvis problemebi.

mnd-is simptomebi

mnd-iT daavadebul pacientebs uviTardebaT sxvadasxva simptomebis mTeli

speqtri. xSirad maT aqvT sisuste kidurebSi da siarulis gaZneleba. xSirad

es CaiTrevs mxolod erT fexs daavadebis dasawyisSi. meore xSiri simptomia

xelis moxmarebis gaZneleba, es exeba ufro natifi moZraobebis Sesrulebas,

rogoricaa mag. Rilis Sekvra. SesaZloa daziandes metyveleba da pacienti

amCnevs, rogor Seunelda da gaurkveveli gaxda metyveleba, anda gauWirda

artikulacia. pirvel simptomebad SeiZleba gamovlindes ylapvis

problemebi, rac vlindeba sakvebis gadacdeniT. daavadebis

progresirebasTan erTad Cndeba axali simptomebic. SesaZloa es swrafad

moxdes, mag. ramodenime kviris ganmavlobaSi. sxva SemTxvevaSi, daavadeba

SesaZloa progresirebdes ufro nela, ramodenime Tvis manZilze. mnd ar

azianebs mxedvelobas, mgrZnobelobiT sistemasa da Sekavebis funqcias. mnd-s

dros SesaZloa daziandes kognituri da mexsierebis sferoebi, Tumca

xSirad misi diferencireba Zneldeba metyvelebis moSlis gamo.

rogorc wesi, am dros irRveva respiratoruli funqcia. pacientebs

uviTardebaT orTopnoe (sunTqvis gaZneleba woliT mdgomareobaSi). xSirad

ziandeba Ramis sunTqvis faza, ramac SeiZleba gamoiwvios sisxlSi CO2-is

donis mateba. Sesabamisad, es iwvevs Ramis Zilis ciklis moSlas da dRisiT

Zilianobas, an Tavis tkivils.

mnd-s diagnozi

mnd warmoadgens fatalur mdgomareobas da amitom swor diagnozs arsebiTi

mniSvneloba eniWeba. diagnostikis oqros standartad miCneulia farTod

aRiarebuli el eskorialis kriteriumebis Skala. TumcaRa, am ukanasknels

ufro kvlvevebsa da klinikur gamocdebSi iyeneben da Sesabamisad, klinikur

praqtikaSi maTi Sesruleba iSviaTad xdeba.

praqtikaSi diagnozi ismeba nervis gamtareblobis kvlevebiTa da

eleqtromiografiiT, sadac vlindeba mnd-s damaxasiaTebeli niSnebi. aseve

gamoiyeneba neirovizualizaciuri kvlevebi, sisxlis analizi da SesaZloa

lumbaluri punqciac, raTa gamoiricxos sxva daavadebis arseboba. xSiria

diagnostikis problemebi, gansakuTrebiT im pacientebSi, romelTac

gamoxatuli aqvT mxolod zeda an mxolod qveda motoruli neironis

dazianebis niSnebi, da ara maTi kompleqsi.

mnd-s diagnozis ganmarteba pacientisTvis sakmaod problemuria da

moiTxovs am daavadebis mxriv gamocdilebis mqone nevrologis CarTvas.

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saWiroa winaswari (proviziuli) sqemis qona, romelic SeTanxmebuli unda

iqnas pacientTan; moxdes Tu ara gagzavna specialur TerapevtTan, CaerTos

Tu ara pacientis marTvaSi mnd-s movlis koordinatori, moxdes Tu ara

mimarTva respiratoruli marTvis gundTan, Tu moxdes yvela

zemoTCamoTvlili RonisZiebebis kombinacia. pacientis Sefaseba (kontroli)

rogorc wesi sakmaod swrafad unda xorcieldebodes, nevrologis an mnd-s

gundis sxva gamocdili wevris mier. mraval qveyanaSi axla arsebobs

specializebuli mnd-s klinikebi, romelsac xelmZRvanelobs erTi an ori

nevrologi centridan, metyvelebisa da enis TerapevtTan, dietologTan,

fizioTerapevtTan da paliatiuri mzrunvelobis eqimTan an eqTanTan erTad.

amgvari multidisciplinaruli gundis arsebobis SemTxvevaSi SesaZlebeli

xdeba mnd-iT daavadebuli pacientisTvis sicocxlis xarisxis gaumjobeseba

da maqsimalurad gaxangrZliveba.

mnd-s sawyisi mkurnaloba

dReisaTvis erTaderTi licenzirebuli preparati mnd-s mkurnalobisTvis

aris riluzoli. igi amcirebs glutamatis gamoTavisuflebasa da xels

uSlis neironis dazianebas in vitro. igi ufro moqmedebs daavadebis kursze, da ar warmoadgens simptomatur preparats: naCvenebia, rom riluzoli

axangrZlivebs sicocxles ramodenime TviT iseT pacientebSi, romelTac ar

aReniSnebaT bulbaruli (metyvelebisa da ylapvis) problemebi. rogorc

wesi, preparati kargad gadaitaneba. mravali nevrologi am wamals niSnavs

pacientisTvis imedis misacemad, vidre raime fizikuri sargeblis motanis

TvalsazrisiT.

ukanaskneli kvlevebiT naCvenebi iqna, rom mnd-s garkveul SemTxvevebSi

arainvaziuri ventilaciis gamoyenebiT SesaZlebelia gavzardoT sicocxlis

xangrZlivoba da metic, gavuumjobesoT sicocxlis xarisxi rogorc

pacients, ise mis momvlels. sunTqviTi moculoba rogorc wesi, fasdeba

specialuri sunTqviTi testebiT, xSirad amas akeTeben specializirebul

klinikebSi. arainvaziuri ventilatorebi portatulia da saWiroebs saxis

niRabs. mravali pacienti Tavdapirvelad arainvaziur ventilators iyenebs

mxolod RamiT, an mxolod roca aqvT sunTqvis ukmarisobis SegrZneba,

Tumca zogierTs uwevs am aparatis gamoyeneba 24 saaTis ganmavlobaSi.

mnd-s dros kidev erTi gasaTvaliswinebeli sakiTxia kveba. daavadebis

nebismier stadiaze SeiZleba moiSalos ylapvis funqcia. ylapvis Sefasebas

axdens da mkurnalobas marTavs metyvelebis specialisti da enis Terapevti.

sawyis etapze SeiZleba sakmarisi iyos dietis modificireba, mag. rbili an

naxevrad Txevadi sakvebiT, Tumca sabolood mainc saWiro xdeba damatebiTi

enteraluri kveba. rogorc wesi, es miiRweva PEG zondis CasmiT (kangavliTi

gziT, muclis kedlidan kuWSi), rac ylapvis saWiroebas xsnis. arsebobs

Page 10: Neurological PC.pdf

zondis Casmis ori meTodi: endoskopiuri an radiologiuri. zondi

gamoiyeneba kaloriebis, anda sakvebi nivTierebebisa da siTxeebis Sevsebis

mizniT. mnd-s specializirebul dawesebulebebSi amgvari zondis Casmas

ZiriTadad ganixilaven daavadebis iseT etapze, roca pacienti SedarebiT

kargad grZnobs Tavs, vinaidan daavadebis gvian stadiaze, roca pacientis

mdgomareoba saeWvoa, zondireba ufro sariskoa.

mnd-Ti daavadebuli pacientebi, iseve rogorc gafantuli sklerozis

SemTxvevaSi, saWiroeben multidisciplinaruli samedicino gundis CarTvas.

daavadebis Zlier cudi prognozisa da xSirad mdgomareobis swrafad

damZimebis gamo, multidisciplinaruli gundis eqimebi xSirad Zalian

aqtiurad arian CarTuli yoveli pacientis marTvaSi, daavadebis

diagnozidan sikvdilamde.

parkinsonis daavadeba

parkinsonis daavadeba (pd) pirvelad aRwera jeims parkinsonma triadiT,

romelic moicavda tremors, rigidobas da bradikinezias.

epidemiologia

pd-iT avadoba daaxloebiT udris 300 / 100 000 sul mosaxleze. avadoba

asakis matebasTan erTad izrdeba. ZiriTadad igi vlindeba 50 wlis zemoT

asakSi. pacientebis 2/3 70 welze ufrosi asakisaa. pd-Ti daavadebis zogadi

riski udris 2%-s mamakacebisaTvis da 1.3%-s qalebisaTvis. zogierTi kvlevis

mixedviT, kavkasiuri rasa ufro xSirad avaddeba afroamerikelebTan

SedarebiT, Tumca am mosazrebis damadasturebeli monacemebi ar arsebobs.

pd-s uniformuli diagnostikuri kriteriumebi mwiria, riTac SeiZleba

aixsnas avadobis gansxvavebuli monacemebi sxvadasxva qveyanaSi.

arsebobs kvlevebi, romlebiTac Sefasebulia mwvelobisa da alkoholis

moxmarebis kavSiri pd-s ganviTarebasTan. am kvelvebis monacemebis mixedviT,

mweveloba SesaZloa xels uSlides pd-s ganviTarebas. populaciuri

kvlevebi uCvenebs, rom pd ufro xSiria industriul regionebSi, vidre

qalaqgareT; aseve, igi ufro xSiria CrdiloeT amerikasa da evropaSi,

Soreul aRmosavleTTan SedarebiT.

pd zogjer memkvidreobiTia. pd-s gamomwvevi pirveli geni dadgenil iqna 1997

wels; mas Semdeg kidev ramodenime aseTi iqna aRmoCenili. maTgan zogi

dominanturia, zogi ki recesiuli saxiT gadaecema.

pd-is paTofiziologia

pd-s dros niSandoblivia Tavis tvinis Savi nivTierebis kompaqtur nawilSi

(pars compacta substantia nigra) dofamin-Semcveli ujredebis degeneracia.

Page 11: Neurological PC.pdf

ujredTa kargva aseve xdeba tvinis Reros sxva pigmentirebul birTvebSi,

autonomiur birTvebsa da piramiduli ujredebis SreSi.

pd-is gamovlineba

klasikurad, pd warmodgenilia tremoris, rigidobisa da bradikineziis

triadiT, rac pirvelad aRwera jeims parkinsonma. daavadebis dasawyisSi

simptomebi rogorc wesi, calmxrivia. retrospeqtulad, anamnezis SekrebiT,

pacientma SeiZleba gaixsenos, rom diagnozis dasmamde ramodenime wliT

adre awuxebda sxvadasxva msgavsi simptomebi, mag. SeboWiloba, saxsrebis

tkivili, weris gaZneleba da kidurSi moZraobis unaris mzardi daqveiTeba.

am simptomebs xSirad SecdomiT afaseben, rogorc arTrits, an miaweren

daberebas. mosvenebiTi tremoris arseboba (anu, tremori, romelic

warmodgenilia mosvenebiT mdgomareobaSi da qreba mizanmimarTuli

moZraobis dawyebisas) xSirad aZlevs klinicists pd-s diagnozis dasmis

safuZvels. dgomis dros poza Cveulebriv moxrilia, xolo siaruli – nela

da barbaciT. metyveleba SesaZloa gaxdes monotonuri da Cumi. saxis

mimikebi da Tvalebis moZraoba mcirdeba. es niSnebi SeiZleba Tavdapirvelad

sustad iyos gamoxatuli.

pd-s progresirebasTan erTad simptomebic mZimdeba. siaruli Zalian neldeba

da SesaZloa ganviTardes gaSeSebac. es ukanaskneli gulisxmobs normaluri

siarulis SeCerebas da gagrZelebis SeuZleblobas. wonasworobis dacva

Zneldeba da SeiZleba gvqondes davardnis epizodebic. SesaZloa gaWirdes

ylapva. kognituri cvlilebebi Tavidan xSirad vlindeba rogorc

halucinaciebi. es ukanaskneli rogorc wesi vizualuria da saSiSi ar aris.

ufro mogvianebiT stadiaze SeiZleba ganviTardes demencia.

pd-s dros xSiria Zilis moSla. pacientebs uviTardebaT REM Zilis (REM –

rapid eye movement) fazis darRvevebi, rac ganapirobebs mkveTr sizmrebs,

ZilSi yvirils da zogjer partniorze Tandasxmas RamiT. rogorc wesi, amas

pacientebi nebiT ar hyvebian, Tu specialurad ar CavekiTxebiT.

pd-sTan dakavSirebuli sxva xSiri problemebi moicavs aseve Sekrulobas,

kanis cximianobas, xasiaTis cvlilebebs (gansakuTrebiT depresias),

seqsualur disfunqcias, urologiur problemebs, ylapvis problemebsa da

autonomiur disregulacias.

pd-s diagnozi

pd ZiriTadad klinikurad diagnostirdeba. diferenciuli diagnozi unda

gatardes esenciur tremors, medikamentiT inducirebul parkinsonizmsa da

vaskulur parkinsonizms Soris.

Page 12: Neurological PC.pdf

zogjer diagnostikisTvis gamoiyeneba ioflupani. igi warmoadgens birTvul

samedicino neirovizualizaciis meTods, romelic sazRvravs dofaminis

xelaxla aTvisebas Tavis tvinSi.

pd-s sawyisi marTva

did britaneTSi, pd-s sawyisi marTva gulisxmobs diagnozis axsnas da

detalebis ganmartebas, aseve mxardaWeras informaciuli TvalsazrisiT,

rasac uzrunvelyofs parkinsonis daavadebis sazogadoeba. Tavidan xSirad

wamlis daniSvna araa saWiro. simptomebis progresirebasTan erTad, roca

ukve Zneldeba yoveldRiuri saqmianobis Sesruleba, dRis wesrigSi dgeba

medikamenturi Terapiis dawyebis sakiTxi. medikamenturi Terapiis mTavar

RerZs warmoadgens levodopa. igi inSneba iseT preparatTan erTad, romelic

iZleva levodopis nawlavSi Sewovis saSualebas misi metabolizebis gareSe.

ramodenime wlis Semdeg, pacientebs xSirad uviTardebaT problemebi

levodopas mimarT, rac gamoixateba wamlis koncentraciuli pikis swrafad

miRwevaSi, ris Semdegac misi done swrafad vardeba; es iwvevs

gadaWarbebuli mobilobis (diskineziebis) da aramobilobis (gaSeSebis)

periodebis monacvleobas. mkurnalobis kidev erTi meTodia dofaminis

agonistebi, romlebic zogjer damatebiTi Terapiis saxiT iniSneba

levodopasTan erTad. arsebobs monacemebi, rom Tuki am preparatebs

Tavidanve davniSnavT, levodopasTan dakavSirebuli problemebi cota gvian

warmoiSveba. Tumca mxolod es medikamentebi araa sakmarisad Zlieri

imisaTvis, rom marTos daavadebis simptomatologia. ZiriTadad, dofaminis

agonistebi iniSneba rogorc pirveli rigis preparatebi im pacientebSi,

romelTac SedarebiT axalgazrda asakSi daewyoT simptomebi. sxva

medikamentebi moicavs amantadins, romelic iniSneba susti bradikineziis da

rigidobis dros da antiqolinergul saSualebebs axalgazrda

pacientebisaTvis tremoriT.

bolo dros inergeba pd-s mkurnalobis neiroqirurgiuli meTodebi. es

ukanasknelni moiazreba ufro bolo stadiaSi myofi pacientebisaTvis. did

britaneTSi am meTodebTan dakavSirebiT arsebobs mkacri gaidlainebi,

romlebic mowodebulia NICE-s (National Institute for Health and Clinical Excellence) mier.

hantingtonis daavadeba

hantingtonis daavadeba (hd) warmoadgens autosomur dominantur

mdgomareobas. igi iwvevs moZraobis moSlilobebsa da kognitur

cvlilebebs. hd progresirebadi daavadebaa da iwvevs naadrev sikvdils.

hd-s epidemiologia

Page 13: Neurological PC.pdf

hd genetikurad determinirebuli, autosomur-dominanturi mdgomareobaa. es

niSnavs, rom daavadebuli adamianis STamomavlobis naxevars aqvs am

daavadebis ganviTarebis Sansi. hd SeiZleba Segvxvdes sporaduladac, Tumca

Tu dawvrilebiT gamovikiTxavT anamnezs, aRmoCndeba rom pacients mSobeli

adre gardaecvala, anda aris naSvilebi. did britaneTSi hd-s gavrceleba 4-

10-ia 100 000 sul mosaxleze.

cnobilia, rom hd-s iwvevs arastabiluri trinukleotiduri ganmeoreba me-4

qromosomaze. yvela daavadebul individSi am ganmeorebaTa ricxvi 35-s

aRemateba. ganmeorebebis raodenoba mocemul pacientSi ganapirobebs

daavadebis gamovlenis asaks. hd-s axasiaTebs anticipacia, rac niSnavs, rom

Semdgom TaobebSi misi gamovlenis asaki SeiZleba sul ufro Semcirdes.

trinukleotiduri ganmeoreba akodirebs cilas, romelsac ewodeba

hantingtini.

hd-s paTofiziologia

hd-s paTofiziologia Zalian variabeluria. umravles SemTxvevebSi bolo

stadiaze xdeba bazaluri gangliebis nawilebis (kudiani birTvisa da

CenCos), aseve qerqisa da subkortikaluri struqturebis atrofia.

sainteresoa isic, rom asimptomur pacientebs SeiZleba hqondeT

gavrcelebuli paTologiuri cvlilebebi Tavis tvinSi, xolo simptomebis

mqone pacientebs SesaZloa piriqiT, umniSvnelo cvlilebebi aReniSnebodeT.

hd-s simptomatologia

samwuxarod, hd xSirad emarTeba pacients ojaxuri anamneziT, rac imas

niSnavs, rom pacientma mSvenivrad icis, ra diagnozi unda dausvan. daavadeba

SeiZleba gamovlindes nebismier asakSi, bavSvobidan dawyebuli

moxucebulobis asakiT damTavrebuli. umravles SemTxvevebSi daavadebis

sawyisi gamovlenis asaki 30-dan 50 wlamde meryeobs.

pacientebis 2/3 Tavdapirvelad aRniSnavs motorul problemebs, ZiriTadad

qoreis saxiT. es ukanaskneli gulisxmobs uneblie talRisebr (grexviT)

moZraobebs kidurebSi da/an tanSi. amas SeiZleba Tan axldes bradikinezia

da rigidoba. daavadebis progresirebasTan erTad viTardeba mzardi

imobiloba, davardnebi, aseve Zneldeba metyveleba da ylapva. SesaZloa

problemuri gaxdes wonis kargvac, rac gamowveulia rogorc Tavad qoreiT,

ise ylapvis gaZnelebiT.

pacientebis danarCen 1/3-Si sawyisi simptomebi moicavs kognitur problemebs.

Tavidan vlindeba gaRizianebadoba, apaTia, mousvenroba da xasiaTis

cvlilebebi. TavisTavad, es gavlenas axdens samsaxurze, Semosavalsa da

Page 14: Neurological PC.pdf

ojaxur urTierTobebze. xSiria depresia, ramac SeiZleba miiyvanos pacienti

TviTdazianebamde. aseve SeiZleba aSkarad iqnas gamoxatuli demencia.

hd-s diagnozi

hd-s diagnozi ZiriTadad genetikuria. anu, diagnozi ismeba pacientis dnm-is

analiziT. es analizi rogorc wesi keTdeba genetikuri konsultaciis

mixedviT genetikosis an nevrologis mier, romelic specifiurad

dainteresebulia da muSaobs hd-s ganxriT. rogorc yvela genetikuri

diagnozis dros, am drosac diagnozs aqvs farTo qveteqsti ojaxuri

TvalsazrisiT. 50 wlis qvemoT pacientebSi aucileblad unda gamoiricxos

vilsonis daavadeba, romelic aseve SeiZleba gamovlindes moZraobis

anomaliebiTa da kognituri cvlilebebiT. vilsonis daavadeba viTardeba

spilenZis metabolizmis darRvevis Sedegad da misi diferenciuli diagnozi

aucileblad unda gakeTdes bioqimiuri testirebiT.

hd-s sawyisi mkurnaloba

hd-s paTognomuri mkurnaloba ar arsebobs. moZraobis aSlilobebs SeiZleba

vumkurnaloT tetrabenaziniT an sxva nevrologiuri medikamentebiT.

depresiis mkurnaloba unda moxdes simZimis Sesabamisad. fsiqozis

SemTxvevaSi SeiZleba saWiro gaxdes neiroleptikebi. diagnozis dasmidanve

saWiroa multidisciplinaruli gundis CarTva, rac Cveulebriv moicavs

nevrologs, fizioTerapevts, okupaciur Terapevts, metyvelebisa da enis

Terapevts da dietologs. yvela zemoTCamoTvlili gaerTianebulia

specializirebul hd-s klinikebSi. fsiqiatrisa da paliatiuri

mzrunvelobis CarTva xSirad saWiro xdeba daavadebis adreul etapze, rac

moicavs sazogadoebriv CarTulobas, gadavadebuli da xangrZlivi movlis

uzrunvelyofas.

daskvna

PLTNC mdgomareobebi Zlier gansxvavdeba erTmaneTisgan simptomatologiis,

progresirebis siCqarisa da sicocxlis xangrZlivobaze gavlenis mxriv. am

TavSi Cven mokled mimovixileT gafantuli sklerozis, parkinsonis

daavadebis, motoruli neironis daavadebisa da hantingtonis daavadebis

epidemiologia, paTofiziologia da diagnostikis meTodebi. am daavadebebs

mravali ganmasxvavebeli niSnebi gaaCnia, Tumca maT saerTo aqvT

problemebis mTeli speqtri, romlis winaSec dgebian daavadebuli

pacientebi. sxva PLTNC mdgomareobebis msgavsad, am pacientebsac sWirdebaT

multidisciplinaruli midgoma daavadebis paliatiur stadiaze,

invalidobis xarisxisa da tanjvis Sesamcireblad.

Page 15: Neurological PC.pdf

paliatiuri mzrunvelobis gamowvevebi

paliatiuri mzrunveloba gaxangrZlivebuli mdgomareobebis dros

tradiciulad da istoriuladac, paliatiuri mzrunveloba exeboda mxolod

kibos bolo stadiaze myof pacientebs. rogorc Cans, aman ganapiroba

ganmtkiceba ideisa, rom paliatiuri mzrunveloba exeba mxolod sicocxlis

bolo Tveebs an kvirebs. Tumca axla ukve farTodaa aRiarebuli, rom

praqtikaSi kuraciuli mkurnalobidan paliatiur mzrunvelobaze gadasvla

mkveTrad sulac ar xdeba, gansakuTrebiT es exeba pacientebs

gaxangrZlivebuli mdgomareobebiT. pacientze mzrunvelobis es ori saxe

(kuraciuli da paliatiuri) SesaZloa paralelurad arsebobdes xangrZlivi

drois manZilze, Tumca pacientis saWiroebisa da situaciis mixedviT,

aqcenti inacvlebs an icvleba romelime maTganis sasargeblod.

adreul stadiaze paliatiuri mzrunvelobis mimarTvasTan dakavSirebuli

erT-erTi problemaa amgvari midgomis Sefaseba da misi mniSvnelobis

sworad gageba, aseve gansazRvra imisa, Tu rodis unda vurCioT pacients,

mimarTos paliatiuri mzurnvelobis specialists rCevisTvis. miuxedavad

farTod miRebuli azrisa, rom paliatiur mzrunvelobas didi roli

akisria mZime daavadebis adreul stadiaze, praqtikaSi amgvari tipis

mzrunveloba xSirad pacients miewodeba daavadebis gvian etapze. amis

mizezebi mravalgvaria, SesaZloa es nawilobriv gamowveuli iyos

daavadebis, sikvdilisa da jandacvis mimarT kulturul an socialur

damokidebulebebze, anda aseve prognostikaciis sakiTxebze. pacientebi,

romelTac aqvT ara kibo aramed sxva letaluri kondicia, SesaZloa

gansakuTrebiT iqnan invalidizirebuli, ara paliatiuri mzrunvelobis da

misi saWiroebis arcodnis gamo maTi eqimebis mxriv, aramed TviTon

daavadebis moulodneli da winaswar ganusazRvreli mimdinareobis gamo.

paliatiuri mzrunvelobisa da mxardaWeris saWiroeba

progresirebadi gaxangrZlivebuli nevrologiuri

mdgomareobebis dros: mokle mimoxilva

am TavSi mocemulia mokle mimoxilva paliatiuri mzrunvelobisa da

mxardaWeris saWiroebebze, aseve im problemebze, romlebic aqvT pacientebs

Page 16: Neurological PC.pdf

progresirebadi gaxangrZlivebuli nevrologiuri mdgomareobebiT, aseve

maTi ojaxis wevrebsa da megobrebs, romlebic uSualod monawileoben

yoveldRiur movlaSi. rogorc zemoT aRvniSneT, Cven ZiriTadad yuradRebas

vamaxvilebT oTx yvelaze gavrcelebul progresirebad mdgomareobaze,

esenia: motoruli neironis daavadeba, parkinsonis daavadeba, gafantuli

sklerozi da hantingtonis daavadeba; Tumca arsebobs sxva mravali msgavsi

daavadebac, romelTa drosac warmoiSveba msgavsi an gansxvavebuli

problemebi, ris gamoc SeiZleba maTi gaerTianeba PLTNC-ebTan erTad erTi

qolgis qveS. kerZod, am TavSi mimovixilavT im gaidlainebs, romlebic

ukanasknel xans gaxda xelmisawvdomi inglisis paliatiuri mzrunvelobis

erovnuli sabWos mier Catarebuli programis Sedegad. es ukanaskneli

ikvlevda paliatiuri, reabilitaciuri da nevrologiuri mzrunvelobis

modelebs sxvadasxva PLTNC-mdgomareobebis SemTxvevaSi. am gaidlainebis

ganxilvamde, moviyvanT ramodenime mTavar epidemiologiur maxasiaTeblebs

da mokled SevexebiT politikur mimarTulebebs, romlebic Camoyalibda

did britaneTSi am sakiTxTan dakavSirebiT.

mokle epidemiologiuri monaxazi

did britaneTSi amJamad sikvdilis ZiriTadi mizezi qronikuli daavadebebia;

inglisSi daaxloebiT 15 milioni adamiani saWiroebs gaxangrZlivebul

movlas qronikul mdgomareobaTa gamo. aseTi mosaxleobis ricxvi kidev

ufro gaizrdeba momavalSi, sicocxlis saSualo xangrZlivobis matebis

gamo. rogorc wesi, qronikuli mdgomareobebi xangrZlivad grZeldeba, an

aqvT rekurentuli xasiaTi da ar ikurneba. isini yovelTvis progresirebadi

araa da xSirad ar qmnis sikvdilis mkveTr saSiSroebas, Tumca

progresirebis SemTxvevaSi isini saboloo jamSi amokleben sicocxlis

xangrZlivobas.

NHS Healthcare Workforce –is monacemebis mixedviT:

did britaneTSi daaxloebiT 10 milion adamians aqvs PLTNC, rac Seadgens mwvave hospitaluri miRebis 20%-s;

350 000 adamians did britaneTSi esaWiroeba daxmareba yoveldRiuri

saqmianobis Sesasruleblad, nevrologiuri mizezebis gamo;

850 000 adamiani aris nevrologiuri pacientis momvleli;

daavadebulTa saWiroebebi kompleqsuri da variabeluria, ZiriTadi aqcenti

modis yoveldRiur saqmianobebze, rac SeiZleba wlebis manZilze

gagrZeldes. saWiroebebi cvalebadobs mdgomareobisda mixedviT, mcire

saWiroebebidan dawyebuli uwyveti paliatiuri mzrunvelobis saWiroebiT

Page 17: Neurological PC.pdf

damTavrebuli, rac sicocxlis bolo etapze xorcieldeba. paliatiuri

mzrunvelobis erovnuli sabWo gamohyofs mTel rig mTavar maxasiaTeblebs

(saWiroebebis TvalsazrisiT), romlebic ganasxvavebs nevrologiur

mdgomareobebs “tipiuri” kibos SemTxvevebisgan:

- umravles SemTxvevebSi, PLTNC-s axasiaTebs ufro xangrZlivi da

cvalebadi mimdinareoba;

- umravles PLTNC-s axasiaTebs remisiebi da recidivebi, ris gamoc

xSirad Znelia gansazRvro, imyofeba Tu ara pacienti sicocxlis

bolo etapze;

- simptomebi PLTNC-s dros Zalian gansxvavebuli da kompleqsuria,

romelTac xSirad Tan axlavs kognituri, qceviTi da komunikaciis

problemebi, fizikur simptomebTan erTad, rogoricaa tkivili da

invalidobis sxvadasxva tipebi.

politika: koteqsti da gamowvevebi did britaneTSi

nevrologiuri mdgomareobebis paliatiuri mzrunvelobis mxriv mravali

politikuri mimarTulebani iqna aRebuli bolo wlebis manZilze did

britaneTSi. kerZod, arsebobs zogadi paliatiuri mzrunvelobis principebis

gadmotanisa da gamoyenebis tendencia yvela mdgomareobisa da garemos

SemTxvevaSi, nacvlad imisa, rom fokusi gakeTebuliyo specializirebul

paliatiur mzrunvelobaze. paliatiuri mzrunvelobis erovnuli sabWos

mixedviT, zogadi paliatiuri mzrunvelobis principebi moicavs:

- sicocxlis xarisxze fokusis aRebas;

- “mTliani pirovnebisadmi” midgomas;

- mzrunvelobas, romelic moicavs aramxolod pacients, aramed mis

axloblebsac;

- arCevanisa da avtonomiuri uflebebis pativiscemas;

- Ria urTierToebebze koncentrirebas.

sicocxlis bolo etapis strategia inglisSi gansazRvravs sicocxlis

bolo etapis saorganizacio sakiTxebs, rac moicavs Semdeg safexurebs:

- im adamianebis identifikacia, romlebic uaxlovdebian sicocxlis

saboloo etaps da saboloo etapze mzrunvelobis upiratesi formebis

ganxilvis dawyeba;

- mzrunvelobis dagegmva: saWiroebebis da pacientis arCevanis Sefaseba,

maTi mixedviT paliatiuri mzrunvelobis modelis SerCeva da misi

regularuli gadamowmeba;

- mzrunvelobis koordinacia;

Page 18: Neurological PC.pdf

- maRalxarisxiani servisis uzrunvelyofa yvela adgilmdebareobisTvis;

- sicocxlis ukanaskneli dReebis marTva;

- mzrunveloba gardacvalebis Semdeg;

- pacientis axloblebis Tanadgoma, rogorc misi avadmyofobis

periodSi, ise gardacvalebis Semdeg.

Tanadgomisa da paliatiuri mzrunvelobis saWiroebani: monacemTa mokle

mimoxilva

Tanadgomisa da paliatiuri mzrunvelobis saWiroebebi PLTNC-Ti

daavadebul pacientebSi SesaZloa warmoiSvas diagnozis dasmidanve, Tumca

daavadebis xangrZlivi kursi (mag. gafantuli skleroziT, parkinsonis

daavadebiT da hantingtonis daavadebiT pacientma SeiZleba icocxlos 15-dan

25 wlamde) ganapirobebs siZneleebs, rac gamoixatebaSi imaSi, rom Znelia

gansazRvra, rodis gavakeToT aqcenti ufro paliatiur mzrunvelobaze, da

ara daavadebis mkurnalobaze. Tumca amisgan gansxvavebiT, motoruli

neironis daavadebiT pacientma SeiZleba mxolod ramodenime Tve icocxlos,

amasTan mdgomareoba am drois manZilze swrafad uaresdeba, rac moiTxovs

paliatiuri mzrunvelobis swraf reagirebas da CarTvas. yvela SemTxvevaSi

SesaZloa saWiro gaxdes reabilitaciuri da Terapiuli jgufebis

intensiuri CarTva simptomebis marTvasa da sxva araklinikur paliatiur

mzrunvelobasTan erTad. PLTNC-ebs axasiaTebs motoruli, sensoruli da

kognituri funqciebis daqveiTeba, rac iwvevs progresirebad invalidobas

da gareSe pirze damokidebulebas. miuxedavad zemoTCamoTvlili saerTo

maxasiaTeblebisa rac Tan axlavs daavadebis progresirebas, pacientebs

SeiZleba hqondeT mravalferovani individualuri saWiroebebi. mag.:

sxvadasxva mdgomareobebis damaxasiaTebeli simptomebi, aseve erTidaigive

mdgomareobis simptomebi farTod varirebs individualur SemTxvevebSi,

garda amisa pacients SeiZleba ganuviTardes mravali gansxvavebuli

simptomebi droTa ganmavlobaSi. zogierTi simptomi xSirad Seqcevadia,

Tumca zogi maTgani mxolod nawilobriv ganicdis ukuganviTarebas da mas

Caenacvleba sxva axali simptomi an simptomTa jgufi. es garveulwilad

aZnelebs xangrZlivi paliatiuri mzrunvelobis dagegmvas. aseT pacientebs

bolo stadiaze warmodgenili aqvT rigi problemebi, romlebic arTulebs

da problematurs xdis rogorc paliatiur mzrunvelobis ganxorcielebas,

ise am ukanasknelis dagegmvas sicocxlis bolo etapze: eTikurad,

praqtikulad da klinikuradac. es xdeba rigi fizikuri, kognituri da

emociuri problemebis gamo, romelic Tavs iCens sicocxlis bolo

stadiaze, aseve problematuria komunikaciis, kvebaze gadawyvetilebis

miRebis, sicocxlis SemanarCunebeli teqnologiebis gamoyenebis da ojaxze

mzrunvelobis sakiTxebi.

Page 19: Neurological PC.pdf

motoruli neironis daavadeba

motoruli neironis daavadeba (mnd) warmoadgens iSviaT progresirebad

daavadebas, romelic xSirad swrafad ganviTarebadia da iwvevs

sicocxlesTan SeuTavseblobas. daavadebas iwvevs nervuli sistemis

dazianeba yvela doneze. misi gamomwvevi mizezebi ZiriTadad ucnobia. mcire

SemTxvvebSi gamovlenilia genetikuri faqtorebi. daavadeba iwvevs kraniuli

da ConCxis kunTebis damblas. daavadebis simZime vrceldeba rogorc

pacientze, ise mis axloblebze. umravles SemTxvevebSi inteleqti

gardacvalebamde SenarCunebulia, miuxedavad imisa rom invalidoba swrafad

progresirebs da pacienti mTlianad damokidebuli xdeba momvlelze. mnd-Ti

pacientebis gadmocemiT isini ganicdian egzistenciur kriziss, romelic

gamowveulia sicocxlis yvela aspeqtis kontrolis dakargviT: organizmis,

socialuri da komunikaciuri, rac gulisxmobs imasTan Seguebas, rom

daxmareba sxvisgan unda miiRon.

pacientebis daaxloebiT naxevarSi sicocxlis mosalodneli xangrZlivoba

diagnozis dasmidan 3 welia, Tumca zogierT SemTxvevebSi es periodi

ramodenime Tves Seadgens. zogierT pacients aReniSneba “bulbaluri

dasawyisi”, romelic moicavs metyvelebis gauaresebas (dizarTria), ylapvis

gaZnelebas (disfagia), an orives. sxva SemTxvevebSi SeiZleba sawyisi

simptomebi iyos zeda an qveda kiduris sisuste. bulbaluri dasawyisi,

SedarebiT xandazmul asakTan da cud sunTqvis maCveneblebTan erTad ufro

cudi prognozis maCvenebelia. qvemoT CamoTvlilia simptomebi, romlebic

rogorc wesi uviTardebaT mnd-Ti pacientebs.

mnd-s simptomebi:

sisuste da atrofia

fascikulaciebi da kunTovani krampebi

spastiuroba

dizarTria

disfagia da nerwyvdena

dispnoe

paTologiuri sicili an tirili

fsiqikuri aSlilobebi

Zilis darRvevebi

tkivili

sqeli lorwovani sekretebi

hipoventilacia

Sekruloba

Page 20: Neurological PC.pdf

mnd-Ti pacientebs SeiZleba ganuviTardeT undobloba eqimis mimarT

diagnozis dasmis dros (radgan daavadebis pirveli niSnebis gamovlenidan

isini ramdenime Tvis manZilze ar mimarTaven eqims), zogierT SemTxvevaSi ki

eZeben sxva, maTTvis misaReb diagnozs. sabolood, diagnozis gaazrebis

Semdgom maT uviTardebaT Zlieri SiSi. Sesabamisad, diagnozis ganmartebis

dros kargi komunikaciuri unarCvevebi aucilebelia, rac xSirad

gansazRvravs paliatiuri mzrunvelobis Semdgom efeqturobas da karg

damokidebulebas samedicino gunds, pacientsa da ojaxs Soris.

gafantuli sklerozi

gafantuli sklerozi yvelaze gavrcelebuli mademielinizirebeli

daavadebaa, anu paTologia, romelic azianebs nervuli sistemis mielinis

garss. rogorc wesi, mas axasiaTebs moulodneli remisiul-recidiuli

mimdinareoba, rasac mosdevs progresirebadi gauareseba terminalur

stadiamde, amasTan, yoveli momdevno recidivis Semdeg gamojanmrTeleba

arasrulia. igi warmoadgens nevrologiuri invalidobis yvelaze xSir

mizezs axalgazrda zrdasrulebSi, amasTan, igi ufro xSiria qalebSi,

vidre mamakacebSi. iseve rogorc mnd-s SemTxvevaSi, aqac gamomwvevi mizezi

ucnobia, Tumca daavadebis ganviTarebaSi moiazreba sxvadasxva genetikuri

da garemo faqtorebi. gafantuli skleroziT gamowveuli dazianebani

moicavs tvinis farTo areals lokalizaciis TvalsazrisiT da Sesabamisad,

simptomatikac Zalian mravalferovania. yvela pacients safexurebrivad

uviTardeba da umZimdeba daavadeba sxvadasxva simptomebiT, rac moicavs

sisustes, spastiurobas, tremors, moZraobis unaris daqveiTebas,

daRlilobas, mxedvelobis problemebs da Sardvis funqciis moSlas.

zogierT pacients SesaZloa hqondes ylapvis problemebi, aseve zogierT

SemTxvevaSi Zlier problematuria tkivili, romlis simZimec

dakavSirebulia demielinizaciis xarisxTan. iSviaTad aRiniSneba emociuri

gamoxatvis moSlilobani, rac ganapirobebs imas, rom pacients uWirs

emociebis kontroli, an ver gamoxatavs emocias im saxiT, romelic sworad

Seesabameba mis Sinagan mdgomareobas. xSir SemTxvevaSi pacientebs Zalian

uWirT im simptomebis gadatana, romlebic ase vTqvaT, sxvebisTvis

“SeumCnevelia”: amgvari tipis uxSiresi problemaa daRliloba. diagnozis

dasmidan 15 wlis Semdeg, pacientebis 1/3-dan 2/3-mde sWirdebaT daxmareba

siarulis dros, rac ganapirobebs samuSaoze uaris Tqmas, xolo zog

SemTxvevaSi ki pacienti sawolze xdeba mijaWvuli. iseve rogorc mnd-s

SemTxvevaSi, gafantuli sklerozis drosac daavadebis simZime da misgan

gamowveuli invalidoba Zalian Zneli gadasatania rogorc pacientis, ise

misi axloblebisTvis, miuxedavad imisa, rom daavadebis kursi ufro

xangrZlivia. rogorc parkinsonis daavadebis SemTxvevaSi (romelsac qvemoT

Page 21: Neurological PC.pdf

ganvixilavT), gafantuli sklerozis drosac sikvdilianoba dakavSirebulia

Tanmxleb infeqciasTan an komorbiduli daavadebis, mag. gulis

paTologiebis arsebobasTan.

parkinsonis daavadeba

parkinsonis daavadeba (pd) sakmaod gavrcelebuli PLTNC paTologiaa,

romelic, monacemebis mixedviT, aReniSneba 500 adamianidan erTs did

britaneTSi, amasTan, gavrceleba asakis matebasTan erTad izrdeba.

daavadebis paTofiziologia ukavSirdeba dofamin-maproducirebeli

ujredebis gamofitvas (kvdomas), rac ganapirobebs daavadebis kargad

nacnobi motoruli simptomatikis ganviTarebas: mosvenebis tremori,

rigiduloba da bradikinezia. daavadebis mimdinareobis manZilze gaCenili

aramotoruli simptomatikac, mag. depresia da mousvenroba, Zilis

darRvevebi, autonomiuri disfunqcia (rac iwvevs mag. Sardvis problemebs an

impotencias) da mravalgvari variabeluri tkivilis simptomebi aseve iwvevs

invalidobas da Rrma, xagrZliv stress. daavadeba progresirebs adreuli,

Sualeduri da saboloo stadiebiT, amasTan terminaluri faza ufro

gaxangrZlivebulia. miRebulia, rom daavadebis saboloo stadiad iTvleba

etapi, romlis drosac warmodgenilia ori an meti simptomi qvemoT

CamoTvlilTagan:

- medikamenturi mkurnaloba araefeqturia;

- medikamenturi mkurnalobis reJimebi sul ufro da ufro rTuldeba;

- “ukontaqtobis” periodebi (“off” periods); - diskineziebi;

- moZraobis problemebi da davardnebi;

- ylapvis problemebi;

- fsiqiatriuli niSnebi (depresia, mousvenroba, halucinaciebi, fsiqozi);

- damoukideblobis SezRudva;

- kontrolis da winaswar gansazRvris naklebi SesaZlebloba mTliani

daavadebis suraTSi.

pd-s dros sikvdilianobis uSualo mizezia Tanmxlebi infeqcia an

komorbiduli mdgomareoba, da ara TviTon daavadebis pirdapiri Sedegebi.

hantingtonis daavadeba

hantingtonis daavadeba (hd) genetikurad determinirebuli paTologiaa,

romelic iwvevs fizikuri, kognituri da emociuri statusis progresul

gauaresebas, ise rom pacienti Rrma invalidizaciamde midis. daavadebuli

adamianis Svilebs daavadebis damemkvidrebis 50% Sansi aqvT. hd ZiriTadad

viTardeba mogvianebiT, zrdasruli asakis Sua periodSi, Tumca aRwerilia

iSviaTi SemTxvevebi bavSvebSic.

Page 22: Neurological PC.pdf

daavadebis niSnebisa da simptomebis naTel klinikur gamovlinebas SesaZloa

win uswrebdes mcire anomaliebi (mag. mousvenroba), romelic ramodenime

wlis ganmavlobaSi grZeldeba da rCeba yuradRebis miRma. letaluri

gamosavali dgeba naTeli klinikuri gamovlinebidan daaxloebiT 10-20 wlis

Semdeg da iseve rogorc parkinsonis daavadebisa da gafantuli sklerozis

SemTxvevaSi, mas iwvevs meoradi infeqcia. daavadebas axasiaTebs

progresirebadi demencia da damaxasiaTebeli uneblie moZraobebi, romelsac

qorea ewodeba, aseve qceviTi anomaliebi. es ukanaskneli moicavs mkveTr da

uecar afeTqebebs sibrazis an agresiis saxiT, romelTa winaswarmetyveleba

da Sesabamisad, gamklaveba axloblebs uWirT. zog SemTxvevaSi igi

dakavSirebuli kriminalur faqtebTanac. zogjer piriqiT, hd-Ti daavadebul

pacientebs aReniSnebaT mkveTri apaTia da uinteresoba garSemo samyaros

mimarT, anda aqvT faruli depresia. suicidis sixSire hd-is dros 4-jer

maRalia janmrTel mosaxleobasTan SedarebiT. hd iTvleba erT-erT yvelaze

gamanadgurebel mdgomareobad, da aramarto misi ojaxuri tipis gamo.

ojaxis wevrebi, romlebic xSirad uSualod monawileoben pacientis

movlaSi, potenciurad TviTonac am daavadebis ganviTarebis riskis qveS

arian.

diagnozis ganmarteba: paliatiuri mzrunvelobis midgoma komunikaciis

sakiTxebSi PLTNC-ebis dros

PLTNC diagnozis ganmarteba yovelTvis dakavSirebulia sirTuleebTan

rogorc pacientis, ise misi axloblebisTvis. paliatiuri mzrunvelobis

sxvadasxva dargebis mier komunikaciur praqtikaSi SemuSavebulia cudi

ambis miwodebis principebi, romlebic, sworad Sesrulebis SemTxvevaSi,

qmnis im safuZvels, romelzec eyrdnoba pacientsa da ojaxze mzrunvelobis

mTeli Semdgomi sistema.

usiamovno informaciis miwodebisas mniSvnelovania:

1. saubari martivad da gasagebad;

2. pacientis rwmenisa da codnis donis gansazRvra (raTa gaadvildes

misTvis faqtebis axsnis ukeTesi gzis moZebna);

3. gaxsovdeT, rom Sokisa da SiSis zemoqmedebis qveS myofi pirovneba

ganicdis Zlier depresias;

4. mieciT pacients neba da dro reaqciisaTvis. ar SezRudoT misi emociebi

(xmiT tirili, moTqma) didaqtikuri saubriT. did Secdomas warmoadgens

rTuli axsna-ganmartebebis micema pacientis martiv SekiTxvebze.

gaxsovdeT, zogjer maT mxolod sakuTari grZnobebis gamoxatva surT;

Page 23: Neurological PC.pdf

5. gaiTvaliswineT iseTi reaqciebi, rogoricaa Soki, tirili, sicili,

rwmenis dakargva, pesimizmi, Caketiloba, Zlieri agzneba. swored aseT

SemTxvevaSia aucilebeli agrZnobinoT pacients mxardaWera;

6. misceT pacients dro informaciis gasaanalizeblad, darToT neba

imoqmedos survilisamebr da daTanxmdes mkurnalobas Zaldautaneblad.

eqimisa da pacientis urTierToba dafuZnebulia simarTlis Tqmaze. misi

xelSewyoba gapirobebulia gulaxdilobiT, xolo tyuili ki misi rRvevis

garantiaa.

arasodes moatyuoT pacienti;

moerideT windauxedav gulwrfelobas.

`cudi ambis~ miwodebis ZiriTadi principebi:

I. Sesaferisi fizikuri garemoTi uzrunvelyofa:

mniSvnelovania ganmartoveba

saubari auCqareblad, pauzebis gareSe

pacientTan saubris periodSi iyoT Tavisufali sxva saqmeebisgan.

II. dadgena imisa, Tu ra icis pacientma da risi codna surs:

miusadagoT informacia pacientis SegrZnebebs;

gansazRvroT ZiriTadi problemebi, nerviulobis sagani;

esaubroT martivi eniT, Jargonebis gareSe.

III. saubris dawyeba Tavisufali SekiTxvebiT:

`Tqveni azriT, ra SeiZleba yofiliyo arsebuli simptomebis

mizezi?~

`rogor grZnobdiT Tavs operaciis Semdeg?~

`aRniSnuli avadmyofoba grZeldeba dausruleblad? nerviulobT

sakuTar Tavze?~

PLTNC diagnozis ganmartebisas yvelaze mniSvnelovani punqtia klinikuri

gundis mier pacientis da misi axloblebis ndobis mopoveba da Ria

urTierTobebis damyareba, aseve informaciis maqsimaluri gaziareba, raTa

Semdgomi strategia dagegmili iqnas maqsimalurad pacientis interesebis

gaTvaliswinebiT, mocemuli situaciis moqnilad marTvis CaTvliT. am gziT

SesaZlebelia mkveTri krizisebis Tavidan acileba. imisaTvis, rom eqimTan

viziti nayofierad CaiTvalos, aucilebelia piraduli garemos Seqmna,

mosmenis survilis gamoxatva, naklebad CarTva maT saubarSi da Tbili,

TanagrZnobiTi damokidebuleba. qvemoT mocemulia sloanisa da kolegebis

mier mowodebuli rekomendaciebi mnd-s diagnozis gamJRavnebis dros, rac

praqtikaSi iqna gamocdili:

Page 24: Neurological PC.pdf

1. ar daumaloT informacia pacients, Tu mas surs misi miReba;

2. ar misceT pacients informacia, Tu mas ar surs misi miReba;

3. winaswar SeafaseT pacientis mosalodneli reaqcia da imoqmedeT

adeqvaturad mis sapasuxod.

am etapze vlindeba mniSvnelovani gansxvavebebi, rac ukavSirdeba

kulturul da eTikur sakiTxebs, aseve pacientis socialur klass da

ganaTlebas, an religiur Sexedulebebs. yvelasTvis erTi modeli ar

gamodgeba, amitom es faza erT-erTi yvelaze rTuli gadasalaxia

klinicistis mxridan.

diagnozis ganmartebis sworad SerCeuli modeli pirdapir moqmedebs

pacientisa da misi ojaxis wevrebis momaval SesaZleblobebze -

gaumklavdnen im problemebsa da dilemebs, rac warmoiSveba PLTNC daavadebebis mimdinareobis dros. gansakuTrebiT es exeba hantingtonis

daavadebas. misi ojaxuri tipi gulisxmobs imas, rom diagnozs eniWeba

Sorsmimavali mniSvneloba, romelic vrceldeba ojaxis wevrebzec. rogorc

wesi, ojaxSi Cndeba dilema, mouaron mSobels, romelsac aqvs am daavadebis

dasawyisi da paralelurad gadawyviton, gaukeTon Tu ara Svilebs

diagnostikuri testi hantingtonis daavadebaze. roca ojaxSi aris gayris an

calke cxovrebis situacia, es sakiTxebi kidev ufro mZimdeba.

o’braienis kvlevis monacemebis mixedviT, romelic moicavda mnd-Ti

daavadebuli 50 pacientis TviTSegrZnebis aRweras, aRmoCnda rom pacientebis

umravlesoba poulobda pozitiur elements diagnozis ganmartebaSi, radgan

igi swor axsnas aZlevda im simptomebsa da problemebs, rac hqondaT maT am

xnis ganmavlobaSi. umravlesoba aRniSnavda, rom erCivna diagnozis

ganmarteba moesmina eqimis mxridan pirdapiri, Tumca TangrZnobis

gamomxatveli saxiT, vinme axlobelTan erTad. mnd-Ti daavadebuli

pacientebis SemTxvevaSi, diagnozis ganmartebis Semdeg zogierTi aRniSnavda

SiSis grZnobas sikvdilis procesis mimarT, gansakuTrebiT aSinebdaT

“moxrCobis” SesaZlebloba. Sesabamisad rekomendirebuli iyo, rom aseTi

pacientebisaTvis, aseve maTTvis, romelTa forsirebuli amosunTqvis

moculoba 50%-ze dabla ecemoda, SeeTavazebinaT dawvrilebiTi axsna-

ganmarteba terminaluri fazis Sesaxeb, sicocxlis tipiuri bolo etapis

aRweriT, rac umravlesi pacientebis SemTxvevaSi gulisxmobs komas da mSvid

gardacvalebas.

yvela SemTxvevaSi, PLTNC-Ti daavadebul pacientebs surT hqondeT mudmivi

sando mxardaWerisa da informaciis wyaro saxlSi dabrunebis Semdeg.

diagnozis ganmartebisas zedmeti informaciis miwodeba SesaZloa mravali

adamianisTvis Zlier stresuli aRmoCndes. Tumca, informaciis wyarosa da

kontaqtis naklebobis SemTxvevaSi, diagnozis ganmartebis Semdgomi periodi

Page 25: Neurological PC.pdf

SeiZleba analogiurad mZime aRmoCndes pacientisa da misi ojaxisaTvis.

daavadebaTa asociaciebis roli (mag. hantingtonis daavadebis asociacia an

motoruli neironis daavadebis asociacia) Zalian mniSvnelovania am

daavadebebis marTvaSi, radgan maT aqvT kargad damuSvebuli, lakonuri

beWdviTi informaciuli masala pacientebisaTvis, aseve gamocdili rCevebi

da rekomendaciebi maTTvis, rogor moiZion daxmareba da nebismier kiTxvaze

pasuxi. aseve Zalian mniSvnelovania uSualo muSa personalis, mag.

klinikuri meddebis CarTuloba, radgan swored isini axorcieleben

pacientis vizitebsa da monitorings saxlis pirobebSi. mzrunvelobis es

uwyveti tipi pacientebisa da maTi ojaxebisaTvis gadamwyveti

mniSvnelobisaa, radganac igi warmoadgens diagnozis Semdgom xangrZlivi

paliatiuri mzrunvelobis safuZvels.

fsiqosocialuri saWiroebani PLTNC mdgomareobebis dros: Rirsebisa da

mniSvnelobis SenarCuneba

diagnozis ganmartebidan dawyebuli fsiqosocialuri saWiroebebi

warmoiSveba PLTNC-iT pacientis daavadebis mTeli kursis manZilze.

fsiqosocialuri daxmarebis uzrunvelyofa gulisxmobs mraval aspeqts,

rac moicavs: pacientisa da ojaxis Tanadgomas, informirebas da maTTvis

Rirsebisa da mniSvnelobis grZnobis SenarCunebas, raTa maT garkveulwilad

Tavad moaxerxon gamklaveba problemebisadmi da CaerTon situaciis

marTvaSi. igi aseve moicavs gardacvalebasa da glovasTan dakavSirebul

sxvadasxva sulier, religiur, emociur da socialur sakiTxebs, romlebic

yovelTvis Tan axlavs inkurabelur daavadebas. fsiqosocialuri daxmarebis

uzrunvelyofas aqvs uzarmazari dadebiTi gavlena pacientisa da misi

ojaxis zogad mdgomareobaze, rac grZeldeba glovis periodSic. Tumca,

PLTNC-s fsiqosocialuri aspeqtebi naklebadaa Seswavlili. mnd-s

SemTxvevaSi naCvenebia, rom pacientebi, romelTac dakmayofilebuli aqvT

fsiqosocialuri saWiroebani, ufro kargad umklavdebian sakuTar

mdgomareobas, ufro naklebad aReniSnebaT depresia da aqvT sicocxlis

xarisxis ufro maRali maCveneblebi, im SemTxvevebSic ki, roca gvaqvs ufro

xandazmuli asaki da mZime statusi daavadebis mxriv. piriqiT, rodesac

fsiqosocialuri mxare Seuvsebelia, saxezea tanjvis, SiSis, uimedobis

gancda da naCqarevi sikvdilis survili.

fsiqosocialuri saWiroebebis Sevseba xdeba paliatiuri mzrunvelobis

mTavari muSa jgufis mier (es SesaZloa iyos medda, socialuri muSaki,

fsiqologi an eqimi, romlebic muSaoben calke an erTad

multidisciplinaluri gundis saxiT). am personals unda hqondes saWiro

unar-Cvevebi imisaTvis, rom imuSavos rTul da zogjer problemur

situaciebSi ojaxuri TvalsazrisiT. maT unda hqondeT unari, daxmareba

Page 26: Neurological PC.pdf

gauwion rogorc pacients, ise ojaxs mocemuli situaciisadmi SeguebaSi da

CarTon isini mniSvnelovani gadawyvetilebebis miRebaSi mimdinare

mzrunvelobis dagegmvis Sesaxeb, gansakuTrebiT rodesac miviwevT

terminaluri fazisken. fsiqosocialuri daxmarebisaTvis aucilebeli

Tvisebaa kargi komunikacis, aseve mosmenis, gulwrfeli interesis, zrunvisa

da TanagrZnobis gamoxatvis unari. personals, romelic muSaobs pacientTan

da mis ojaxTan, esaWiroeba gansakuTrebuli midgomebis da faseulobebis

Camoyalibeba sakuTar TavSi, rogoricaa: ara-gankiTxva; urTierToba

pacientTan da mis ojaxTan rogorc partniorebTan; pacientis uflebebis

pativiscema, rac niSnavs, rom mas SeuZlia moiqces Tavisi survilisa da

gadawyvetilebis mixedviT, misi SesaZleblobebisda mixedviT.

galaherisa da monros mier Catarebul kvlevaSi mnd-Ti daavadebul

pacientebze fsiqosocialuri mzrunvelobis Sesaxeb, yuradReba

gamaxvilebulia Semdeg sakiTxebze, romlebic aucilebelia

gaTvaliswinebuli iqnas yoveli pacientisa da ojaxis Sefasebisas:

- individualuri pacientis gageba;

- daavadebis zegavlena ojaxSi pacientis rolsa da ojaxur

urTierTobebze;

- ojaxis wevrebis piradi istoriebi;

- ojaxis sasicocxlo ciklTan dakavSirebuli sakiTxebi da maTi aRqma

pacientisa da ojaxis mier;

- adre arsebuli daavadeba an krizisuli situacia ojaxSi da rogor

moxda masTan gamklaveba;

- sxva susti (mowyvladi) individebi ojaxSi;

- ojaxis fizikuri da socialuri resursebi.

mTavari sayuradRebo sakiTxi amgvari Sefasebis Catarebisas aris is, Tu

ramdenad sworad esmis msmenels pacientisa da misi axloblebis mier

gadmocemuli azri da dagegmili perspeqtivebi. msmenelma aseve unda

gaiTvaliswinos isic, rom monaTxrobi ojaxur movlenebze warmoadgens

dinamiur, “cocxal” ambebs, romlis drosac am movlenebze ojaxis reaqcia

da maTi aRqma iseve mniSvnelovania, rogorc TviTon masSi arsebuli

“faqtebis” Sinaarsi. ufro metic, Sexedulebebi da Rrmad gamjdari rwmena

garkveuli movlenebis Sesaxeb SesaZloa swrafad Seicvalos droTa

ganmavlobaSi, amitom kargi fsiqosocialuri damxarebis

uzrunvelyofisaTvis saWiroa moxdes gegmebis Tavidan ganxilva da

gadafaseba, gansakuTrebiT es exeba im SemTxvevas, roca pacientis

mdgomareoba swrafad mZimdeba. hd-Ti daavadebul pacientebze Catarebulma

kvlevam aCvena, rom mzrunvelobis koordinatorebs (romelTac ar

moeTxovebaT klinikuri gamocdilebis qona) ekisrebaT Zalian didi roli

informaciis miwodebis, daxmarebis centrebisaTvis mimarTvis, emociuri da

Page 27: Neurological PC.pdf

moraluri mxardaWeris uzrunvelyofis da mimdinare mzrunvelobis gegmebis

mudmivi ganxilvisa da Sefasebis mxriv.

tkivilis marTvis mTavari principebi PLTNC mdgomareobebis dros

aq mxolod mokled da zogadad ganvixilavT tkivilis marTvis principebs,

radgan dawvrilebiT igi mocemulia Semdeg nawilSi.

rogorc zemoT aRvniSneT, tkivili damaxasiaTebelia yvela PLTNC mdgomareobisTvis. gansakuTrebiT xSiria tkivili gafantuli sklerozisa

da motoruli neironis daavadebis dros, igi aRiniSneba 50%-dan 75%-mde

SemTxvevebSi – es monacemi kibos zogierTi SemTxvevebis monacemebze ufro

maRalia. tkivilis ganviTarebas mravali mizezi aqvs, Tumca xSirad igi aris

neiropaTiuri an kunTovani genezis. neiropaTiuri tkivili – esaa tkivili,

romelic gamowveulia nervul sistemaSi arsebuli paTologiis Sedegad, mag.

periferiuli nervis, dorsaluri fesvis gangliis an dorsaluri fesvis, an

cns-is dazianebis mizeziT. mxolod bolo ramodenime welia, rac tkivili

aRiarebuli iqna rogorc mniSvnelovani problema PLTNC mdgomareobis dros. Tanamedrove klasikuri ganmartebis mixedviT tkivili aris:

- individualuri SegrZneba;

- Sedgeba emociuri da sensoruli komponentebisgan;

- aqvs temporaluri maxasiaTeblebi;

- aqvs SeuzRudavi sazRvrebi.

PLTNC-ebis dros umTavresad saxezea tkivilis qronikuli forma.

gansxvavebiT mwvave tkivilisgan, romelic normaSi warmoiSveba qsovilis

dazianebis Sedegad, qronikuli tkivili mudmivia da rCeba qsovilis

aRdgenis Semdeg, an SeiZleba ganviTardes dazianebis ararsebobis dros.

qronikuli tkivili dakavSirebulia nevrologiuri disfunqciis rTul

meqanizmebTan da xSirad rTulia misi sruli aRmofxvra mxolod

medikamentebis saSualebiT. aseT tkivils esaWiroeba kompleqsuri da

mravalmxrivi midgoma mkurnalobis TvalsazrisiT, radgan igi ufro Rrma

zegavlenas axdens pacientis zogad mdgomareobaze, vidre mwvave tkivili:

qronikuli tkivili xSirad moqmedebs xasiaTze, iwvevs pirovnebis

cvlilebebs da aseve cvlis socialur urTierTobebs. arsebobs aseve

urTierTkavSiri tkivilis gancdasa da mis asociaciebs Soris, romelic

individualurad aRiqmeba pacientis mier. magaliTad, Tu pacientisTvis

tkivili asocirebulia mzardi invalidobis an ucnobisadmi SiSis

gancdasTan, aseTi tkivili ufro Zneli samarTavia da SesaZloa TandaTan

ufro gauaresdes. pacientebSi aranamkurnalebi tkiviliT xSirad viTardeba

Tanmxlebi depresia, Zilis darRvevebi, daRliloba, qveiTdeba zogadi

fizikuri da mentaluri funqcia. qronikuli tkivilis, gansakuTrebiT ki

Page 28: Neurological PC.pdf

neiropaTiuri tkivilis mkurnaloba saWiroebs farmakologiuri da ara-

farmakologiuri meTodebis kombinirebas. zogierT pacientSi SeiZleba

Zlier efeqturi aRmoCndes damatebiTi fizioTerapiuli an alternatiuli

mkurnalobis meTodebi, mag. refleqsologia an masaJi. farmakologiuri

mkurnalobis saWiroebisas unda vimoqmedoT janmo-s mier mowodebuli

tkivilis marTvis samsafexuriani sqemiT. es samsafexuriani sqema

aRiarebulia rogorc yvelaze usafrTxo da efeqturi gaidlaini, romelic

safuZvlad udevs tkivilis kontrols. meTodi gulisxmobs, rom

mkurnalobas viwyebT martivi araopioiduri analgetikebiT, romelsac

SeiZleba daematos adiuvanturi saSualebebi saWiroebis SemTxvevaSi

(pirveli etapi), romlis araefeqturobis SemTxvevaSi gadavdivarT sust

opioidebsa da saWiroebis SemTxvevaSi adiuvantebze (meore etapi), xolo

sabolood ki mesame etapze, romelic moicavs opioidur analgetikebs,

romelTa titraciac xdeba frTxilad, mzardi dozebiT sanam tkivili ar

gayuCdeba. am etapzec, saWiroebis SemTxvevaSi ixmareba adiuvanturi

(damatebiTi) saSualebebi. janmo-s mier mowodebul rekomendaciebSi

gansakuTrebuli yuradReba eniWeba analgetikebis oralurad daniSvnis

upiratesobas regularuli intervalebiT, amasTan mkurnalobis sqema unda

eqvemdebarebodes mudmiv gadaxedvas. analgeziuri mkurnalobis swori doza

da kombinacia aris is, romelic srulad axdens tkivilis kupirebas

mocemul pacientSi.

janmos tkivilis marTvis 3-safexuriani sqema

msubuqi (1-3 qula) saSualo (4-6 qula) mZime (7-10 qula) acetaminofeni a/kodeini morfini aspirini a/hidrokodoni fentanili aass-ebi a/oqsikodoni hidromorfoni +/- adiuvantebi tramadoli levorfanoli +/- adiuvantebi metadoni oqsikodoni oqsimorfoni +/- adiuvantebi

movla sicocxlis bolo etapze da misi dagegmva PLTNC mdgomareobebis

dros

rogorc ukve aRvniSneT, mnd-Ti daavadebul pacientebSi gardacvaleba xdeba

sunTqvis ukmarisobis Sedegad, maSin roca sxva mdgomareobebis dros

sikvdilis uSualo mizezia Tanmxlebi infeqcia, rasac amwvavebs

Page 29: Neurological PC.pdf

progresirebadi daavadebis Sedegad gamowveuli organizmis sisuste da

aramdgradoba.

mnd-s dros, sunTqvis ukmarisoba SeiZleba ganviTardes sakmaod swrafad da

amis gamo, gardacvalebac moxdes SedarebiT moulodnelad. Sesabamisad,

aucilebelia rom gadawyvetilebebi pacientisa da misi ojaxis mxridan

winaswar iqnas miRebuli imis Sesaxeb, Tu ra unda movimoqmedoT an

saerTod vimoqmedoT Tu ara respiratoruli ukmarisobis SemTxvevaSi. axali

teqnologiebis SemotanasTan erTad, rogoricaa mag. arainvaziuri

ventilacia da kangavliTi endoskopiuri gastrostomiT (PEG) kveba (PEG –

percutaneous endoscopic gastrostomy), mnd-s terminaluri faza SesaZlebelia

mniSvnelovnad gavaxangrZlivoT, Tumca es meTodebi naklebad moqmedebs

TviTon terminaluri fazis modelze. gasaTvaliswinebelia isic, rom

zogierT pacients urCevnia daTanxmdes amgvar Carevebze, rac maT kidev

ramdenime Zvirfas dRes, kviras Tu Tves Sematebs, Tumca yvelasTvis igive

arCevani misaRebi araa. terminaluri fazis dawyebamde misi marTva unda

daigegmos winaswar, SesaZloa ramodenime kviriT an TviT adrec ki, raTa

gaziarebuli iqnas informacia, ra aris pacientisTvis ukeTesi an rogor

urCevnia TviTon pacients da mis ojaxs.

zogierT pacients SeiZleba mtkiced ar surdes teqnologiuri Carevebis

warmoeba bolo stadiaze, radganac miaCniaT, rom es ubralod gardauvali

Sedegis gadavadebaa. am SemTxvevebSi, rodesac eqimi darwmundeba rom

pacients SeuZlia miRebuli informaciis sworad aRqma da analizi, ris

Sedegadac iRebs igi mocemul gadawyvetilebas, pacients SeuZlia misces

eqims werilobiTi dasturi sicocxlis SemanarCunebeli Terapiebis

uaryofis Sesaxeb. am dokuments, Tuki igi Sefasebulia validurad, aqvs

iuridiuli Zala 2005 wlis mentaluri unaris aqtis mixedviT (didi

britaneTi). nebismier SemTxvevaSi, sikvdilis procesis detaluri aRweriT

SeiZleba Zalian SevaSinoT pacienti da misi ojaxi. mag. mnd-Ti pacientebis

umravlesobas eSinia moxrCobiT sikvdilis, Tumca kvlevebiT

dadasturebuli iqna, rom es SiSi metwilad usafuZvloa. pacientebsa da maT

ojaxs aseve kargad unda ganvumartoT opioidebis (mag. morfinis) roli

simptomebis marTvaSi, avuxsnaT, rom mocemuli standartebis Sesabamisad

gamoyenebisas opioidebi ar aCqareben sikvdils da SeiZleba maTi mzardi

dozebiT gamoyeneba saTanado adiuvantur TerapiebTan erTad, tkivilisa da

sxva simptomebis kargi kontrolis mizniT. qvemoT CamoTvlilia tipiuri

medikamentebi, romlebic gamoiyeneba terminalur fazaSi:

- analgetikebi – tkivilis mosaxsnelad, mag. morfini;

- anqsiolitikebi (trankvilizatorebi) / sedaciuri saSualebebi –

sunTqvis ukmarisobisa da stresis mosaxsnelad, mag. midazolami;

Page 30: Neurological PC.pdf

- anti-sekreciuli preparatebi – respiratorul traqtSi sekretebis

Sesamcireblad, mag. hioscinis hidrobromidi;

- antiemetikuri preparatebi – gulisrevisa da Rebinebis mosaxsnelad,

mag. ciklizini.

zogierT pacients SeiZleba hqondes specifikuri problemebi, romlebic

moiTxovs maTi ojaxis eqimis an kerZo specialistebis Carevas. erT-erTi

magaliTia sulieri stresi. PLTNC mdgomareobebis dros gansakuTrebul

problemas qmnis komunikaciis unaris dakargva pacientebSi. gansakuTrebiT

es exeba mnd-sa da hd-s. invalidobis xarisxi aseT pacientebSi ukiduresad

mZimea. Tumca, pacientTan xSiri yofna da misi simptomebis mogvarebis

mcdeloba aadvilebs terminaluri fazis marTvas. kargi movla gulisxmobs

klinikuri gundis erTad muSaobas imisaTvis, rom kritikulad iqnas

Sefasebuli is miznebi da amocanebi, rac dgas dRis wesrigSi mocemuli

pacientisa da misi ojaxisaTvis. kiTxvebi, rogoricaa mag. “ratom vakeTebT

amas?” an “risi miRwevis imedi gvaqvs am konkretuli gegmiT Tu TerapiiT?” -

yovelTvis unda iqnas dasmuli imisaTvis, rom klinikuri qmedeba morgebuli

iyos maqsimalurad individualurad, pacientis interesebis

gaTvaliswinebiT, da ar iyos nakarnaxevi biosamedicino moTxovnebiT an

rutinuli klinikuri praqtikis wesebiT. sicocxlis bolo stadiaze

movlisa da Tundac mkurnalobis zogadi da mTavari mizania, swrafad da

efeqturad movaxdinoT reagireba im saWiroebebze, romlebic SeiZleba

warmoeSvas pacients da mis axloblebs, raTa miRweuli iqnas maqsimaluri

komforti da sicocxlis xarisxi SesaZleblobis farglebSi. qvemoT

CamoTvlilia ZiriTadi principebi, romlebic safuZvlad udevs terminaluri

etapis marTvas nebismieri mdgomareobis SemTxvevaSi:

- mimdinare mkurnalobis reJimis Sefaseba da arasaWiro wamlebis

Sewyveta;

- saWiroebis SemTxvevaSi, iniSneba medikamenti kanqveS misaRebad

SeTanxmebuli protokolis mixedviT, tkivilis, aforiaqebis,

gulisreva-Rebinebisa da respiratorul traqtSi sekreciebis

mosaxsnelad;

- xdeba gadawyvetilebis miReba arasaWiro Carevebis Sewyvetis Sesaxeb,

rac moicavs mag. sisxlis analizebs, intravenuri siTxeebis Seyvanas

da vitaluri niSnebis monitorings;

- pacients, ojaxsa da momvlelebs Soris Camoyalibebuli unda iqnas

gasagebi ena komunikaciisTvis;

- dgindeba pacientis, ojaxisa da momvlelTa aRqmisunarianoba

pacientis mdgomareobis mimarT;

- fasdeba pacientis, ojaxisa da momvlelTa religiuri da sulieri

saWiroebani;

Page 31: Neurological PC.pdf

- ojaxsa da momvlelebs eZlevaT Sesabamisi werilobiTi informacia;

- ojaxis eqims acnobeben pacientis mdgomareobis Sesaxeb;

- unda moxdes Semdgomi movlis gegmis ganmarteba da ganxilva

ramdenadac es SesaZlebelia, pacientTan an mis ojaxTan, anda sxva

momvlelebTan erTad.

simptomebis marTva nevrologiur paliatiur mzrunvelobaSi

nevrologiur mdgomareobebs axasiaTebT mravali saerTo simptomi,

romlebic Rrma zemoqmedebas axdens pacientis sicocxlis xarisxze. karg

simptom-kontrols ganapirobebs dawvrilebiTi anamnezis Sekreba,

yuradRebiT gasinjva da Sesabamisi gamokvlevebis Catareba, rac saSualebas

aZlevs eqims gaakeTos daavadebis SesaZlo procesebis mTliani monaxazi da

Seafasos, rogor zegavlenas axdens igi pirovnebasa da mis momvlelebze.

Ria diskusia pacientTan (da mis momvlelebTan, roca amas mdgomareoba

saWiroebs) Zlier mniSvnelovania da Terapiuli efeqtic aqvs; igi

gulisxmobs axsna-ganmartebis micemas problemis SesaZlo mizezze da

moicavs mkurnalobis ama Tu im sqemis ormxriv ganxilvas maTi plusebisa da

minusebis gaTvaliswinebiT. am TavSi mocemulia rigi problemebi, romlebic

rogorc wesi gvxvdeba PLTNC mdgomareobebis dros da maTi marTvis xerxebi,

rac efuZneba avtorebis klinikur gamocdilebas da xelmisawvdom

gamoqveynebul monacemebs am sakiTxze.

siarulis gaZneleba

siarulis gaZnelebis mizezi mravalgvaria da saWiroebs srulyofil

Sefasebas da menejments. saWiroa mxedvelobaSi iqnas miRebuli Semdegi

faqtorebi:

- sisuste fexebSi SeiZleba iyos distaluri an proqsimaluri;

- spastiuroba iwvevs SeboWilobas da zambarisebur siaruls, aseve

fexis TiTebiT iatakis daWeras (rac iwvevs davardnebs);

- parkinsonis daavadebiT pacientebs tipiurad axasiaTebT neli siaruli

moxrili posturiT da mokle nabijebiT, davardnis tendenciiT;

- ataqsia, farTo dgoma da aramyari nabijebi miuTiTebs naTxemis

dazianebis niSnebze, romelsac xSirad Tan axlavs nistagmi da

dizarTria, anda mgrZnobelobis dakargva periferiuli mgrZnobelobis

dazianebis gamo, mag, polineiropaTiis dros. am ukanasknelis dros

SeiZleba siaruli ufro gaZneldes sibneleSi, Tu dazianeba moicavs

Rrma mgrZnobelobasac;

Page 32: Neurological PC.pdf

- frontaluri wilis daavadebam SeiZleba gamoiwvios apraqsia, rac

ganapirobebs siarulis qerqul darRvevas, rasac xSirad Tan axlavs

Seukavebloba an demencia;

- sxvadasxva mizeziT gamowveulma tkivilma aseve SeiZleba xeli

SeuSalos pacients gadaadgilebaSi.

mkurnalobis mizani am SemTxvevaSi aris pacientisaTvis usafrTxoebis da

damoukideblobis unaris SenarCuneba, ramdenadac es SesaZlebelia.

aucilebelia pacientis dawvrilebiTi gamokvleva fizioTerapevtis mier.

sisuste

sisuste xSirad Tan axlavs nevrologiuri daavadebis bolo stadiebs. qveda

kidurebSi sisusteze miuTiTebs dakiduli terfi, fexis wamokvris

tendencia, skamidan adgomis gaZneleba da siarulisas Zalian advilad

daRla. sisuste aseve Zlier invalidizacias iwvevs zeda kidurebSi, rac

gamoixateba maTraxisebri (dakiduli) mklavebiT (rodesac ziandeba

proqsimaluri kunTebi) an natifi moZraobebis darRveviT (distaluri

kunTebis dazianebisas), mag. pacients ar SeuZlia boTlis gaxsna, gasaRebis

gadatrialeba da xelidan uvardeba sagnebi.

damxmare mowyobilobebis Semotana pacientis cxovrebaSi cota safrTxilo

sakiTxia, radgan man SesaZloa es aRiqvas mdgomareobis gauaresebis

dadasturebad eqimis mxridan; Tumca amJamad arsebuli saSualebebi Zalian

moxerxebulia pacientis komfortisaTvis. yavarjnebisa da sagoravebeli

savarZelis garda, es SeiZleba iyos msubuqi wonis danebi da misTana

saojaxo xelsawyoebi, aseve moZravi Sxapis kabina an distanciuri marTvis

sistemebi.

tkivili

gafantuli sklerozis garda, gaxangrZlivebuli nevrologiuri

mdgomareobebiT pacientebis umravlesobaSi tkivili xSirad ar moiazreba

umTavres problemad. Tumca, xSirad igi ignorirebulia pacientis mier, Tu

ar CavekiTxebiT specialurad, maT SesaZloa arc aRniSnon igi. arsebobs

tkivilis gamomwvevi ramodenime SesaZlo etiologiuri faqtori, aseve

pacients SeiZleba aReniSnebodes erTdroulad ramodenime tkivilis

sindromi. gafantuli sklerozis dros, mwvave da qronikuli tkivilis

sindromebi gvxvdeba pacientebis 30-80%-Si, xolo motoruli neironis

daavadebis dros ki - 73%-Si, monacemebis mixedviT.

kunT-saxsrovani tkivili

moZraobis SezRudvam SeiZleba gamoiwvios saxsrebis SeboWiloba da

potenciurad mtkivneuli kontraqturebi. amas garda, saxsrebis garSemo

Page 33: Neurological PC.pdf

kunTovani tonusis daqveiTebis gamo xdeba moZraobis diapazonis gazrda,

ramac SeiZleba gamoiwvios amovardnilobebi. yvelaze xSirad es xdeba mxris

saxsarSi. am dros mniSvnelovani roli eniWeba fizioTerapias, romelic

afasebs moZraobis diapazons. fizioTerapia uzrunvelyofs adeqvaturi da

efeqturi damxmare saSualebebis miwodebas, aswavlis pacients (mis

momvlels) pasiur moZraobebs, rac xels uSlis kontraqturebis

ganviTarebas, aseve sxvadasxva varjiSebs. am dros SeiZleba efeqturi iyos

farmakologiuri an sxva ara-farmakologiuri meTodebis gamoyenebac.

- adgilobrivad siTbos an eleqtruli kangavliTi nervuli

stimulaciis gamoyeneba (TENS – transcutaneous electrical nerve stimulation); - xSirad efeqturia paracetamoli da sxva aass-ebi;

- lokalurad aass-is gelis gamoyeneba;

- mwvave tkivilis dros, Tu zemoT CamoTvlili saSualebebi

araefeqturia, SeiZleba zogjer saWiro gaxdes opioidebi. SeiZleba

sakmarisi iyos susti opioidebis daniSvna, mag. kodeini

paracetamolTan kombinaciaSi, mag. ko-kodamoli 30/500 dReSi 4-jer,

magram Tu igi araefeqturia, maSin unda dainiSnos ufro Zlieri

opioidi. dozis titraciis TvalsazrisiT mosaxerxebelia xanmokle

moqmedebis opioidi, mag. morfinis xsnari, romelic aseve SeiZleba

miRebuli iqnas mosalodneli mtkivneuli Setevebis dawyebamde

naxevari saaTiT adre. Tu tkivili mudmivad grZeldeba, maSin

SesaZloa saWiro gaxdes neli gamoTavisuflebis opioidebi. ylapvis

gaZnelebis dros gansakuTrebiT efeqturia opioidebis, mag.

buprenorfinis an fentanilis transdermuli mwebavi safenebi.

nawolebi

pacientebis invalidobis zrdasTan erTad maTi moZraobis diapazoni

mcirdeba, radgan ufro da ufro met dros atareben savarZelSi an sawolSi,

amasTan xSirad arc SeuZliaT damoukideblad pozis Secvla. kanze zewolis

adgilebze yuradRebis miqceva aucilebelia. zewolis adgilebSi

ganviTarebuli wylulebi (nawolebi) aris tkivilisa da stresis gamomwvevi

mTavari mizezi, ris gamoc pacientebi saWiroeben analgetikebs, janmos

samsafexuriani analgetikebis sqemis mixedviT. aseve yuradReba unda mieqces

tansacmelsa da pacientis moTavsebas sawolSi. Camoyalibebuli nawolebis

dros SesaZloa efeqturi iyos topikuri opioidebi.

nevropaTiuli tkivili

es gansakuTrebiT problemuria gafantuli sklerozis dros; igi moicavs

mtkivneul paroqsizmul simptomebsa da dizesTezias wvis SegrZnebiT.

centraluri tkivili, romelic viTardeba cns-Si gafantuli sklerozis

Page 34: Neurological PC.pdf

folaqebiT tkivilis gamtari gzebis dazianebis Sedegad, warmodgenilia

pacientebis daaxloebiT 33%-Si.

nevropaTiuli tkivilis dros naCvenebia Semdegi medikamentebi:

- tricikluri antidepresantebi: tkivilis gasakontroleblad

sakmarisia ufro dabali dozebis daniSvna, vidre misi rogorc

antidepresantis gamoyenebis dros, mag. amitriptilini 10-50 mg RamiT.

gverdiTi movlenebi moicavs piris simSrales da sedacias, romelic

SeiZleba sasargebloc ki iyos pacientisTvis;

- antiepilefsiuri preparatebi: tradiciulad, karbamazepini

gamoiyeneboda trigeminaluri nevralgiis dros. ufro mogvianebiT

daiwyes gabapentinis da pregabalinis gamoyeneba nevropaTiuri

tkivilis dros. rogorc wesi, isini kargad gadaitaneba pacientis mier

da maTi upiratesobaa naklebi urTierTqmedeba sxva wamlebTan;

- opioidebi: opioidebis efeqturoba naCvenebia nevropaTiuri tkivilis

dros, Sesabamisad SeiZleba vifiqroT opioidebis CarTvaze, Tu

zemoTCamoTvlili meTodebi araefeqturia;

- kanabinoidebis mag. oraluri dronabinolis roli tkivilis

kontrolSi jer kidev daudgenelia, Tumca zogierTi kvlevis

monacemebiT, igi efeqturia centraluri genezis tkivilis dros.

zogierTi pacienti, gansakuTrebiT gafantuli skleroziT pacientebi

zogjer iyeneben kanafs, amtkiceben ra, rom igi exmareba maT tkivilisa

da spazmis moxsnaSi. Tumca, preparatis legaluri statusidan

gamomdinare, misi daniSvna eqims xSirad ar SeuZlia.

kunTovani spazmi da krampebi

am SemTxvevaSi SesaZloa saWiro gaxdes arafarmakologiuri da

farmakologiuri meTodebis kombinirebulad gamoyeneba.

- aucilebelia spastiurobis Sefaseba da misi marTva sxvadasxva

specialistis mier;

- mtkivneuli krampebis dros SeiZleba efeqturi aRmoCndes daWimvebi da

fizioTerapia;

- zogierTi pacienti aRniSnavs qininis efeqturobas, 200-300 mg. RamiT;

- sistemuri kvlevebiT naCvenebia antispazmuri preparatebis / kunTovani

relaqsantebis SesaZlo efeqturoba, Tumca maTi efeqturobisa da

alternatiuli saSualebebi moicavs:

baklofeni 5-20 mg 3-jer dReSi;

Page 35: Neurological PC.pdf

trizanidini 2-24 mg dReSi, 3-4-jerad gayofili doziT;

diazepami 5 mg RamiT, dozis zrdiT 10 mg-mde 4-jer dReSi;

klonazepami 1-4 mg RamiT;

dantroleni 25-100 mg 4-jer dReSi.

maTi gamoyeneba SezRudulia arasasurveli gverdiTi efeqtebis gamo,

rogoricaa mag. kunTovani sisuste (risi Sansic SeiZleba ufro meti iyos

baklofenisa da dantrolenis SemTxvevaSi), Zilianoba da piris simSrale

(tizanidini). dantroleni moqmedebs periferiulad kunTovan SekumSvaze da

amgvarad iwvevs kunTovan sisustes. arsebobs aseve monacemebi

hepatotoqsiurobaze.

- mtkivneuli tonuri spazmebis dros SeiZleba kargi efeqti mogvces

antiepilefsiurma preparatebma, mag. gabapentinma da karbamazepinma;

- TENS-ma SeiZleba kargi Sedegi mogvces tkivilisa da kunTovani

spazmebis dros (nervis kangavliTi eleqtruli stimulacia).

spastiuroba

spastiuroba Cveulebrivi simptomia gafantuli sklerozis dros da

vlindeba pacientebis 40-60%-Si, Tumca igi aseve aRiniSneba sxva

gaxangrZlivebuli nevrologiuri mdgomareobebis dros, rodesac saxezea

zeda motoruli neironis dazianeba. igi ganapirobebs tkivils, SeboWilobas

da kunTovan spazms, rac sabolood iwvevs moZraobis da yoveldRiuri

saqmianobis mniSvnelovan SezRudvas, anu amcirebs pacientis siarulis,

gadaadgilebis, aseve damoukideblad dabanis da Cacmis unars. spastiurobis

xarisxi SeiZleba dRiTidRe cvalebadobdes, misi gamwvaveba SeiZleba

gamoiwvios mtkivneulma stimulma, mag. nawolebma, Sekrulobam.

aranamkurnalebma spastiurobam SeiZleba mogvces kontraqturebis

ganviTareba, romelic kidev ufro zrdis tkivilis xarisxs, higienasa da

yoveldRiur aqtivobebTan dakavSirebul problemebs, igi aseve zrdis

dawylulebisadmi midrekilebas.

arsebiTi mniSvneloba eniWeba gundur muSaobas; mxedvelobaSi unda iqnas

miRebuli sakiTxebi rogoricaa mag. daRlilobis marTva, specializirebuli

mowyobilobebis da fsiqologiuri mxardaWeris uzrunvelyofa, mag. sxeulis

suraTis, seqsualobis da ojaxSi rolebis cvlilebebis gamo.

fizioTerapevts SeuZlia daxmareba gauwios pacients loginSi mdebareobis,

aqtiuri da pasiuri varjiSebis da mobilobis Sefasebis sakiTxebSi. amas

garda, mkurnaloba mimarTuli unda iyos nawolebis, saSarde infeqciebis da

da Sekrulobis prevenciisken. spastiurobis mosaxsnelad gamoiyeneba

farmakologiuri saSualebebic, Tumca daniSvnamde preparati sifrTxiliT

Page 36: Neurological PC.pdf

unda iqnas Sefasebuli; arsebobs Semdegi midgomebi, romelTa roli da

efeqturobac jer kidev ganxilvas saWiroebs:

- spastiurobis dros SesaZloa raRac efeqti hqondes antispazmur

saSualebebs (ix. zemoT); Tumca man SeiZleba ufro aSkarad

gamoavlinos dainteresebuli kunTebis sisuste da daRliloba da

Sesabamisad, gaauaresos pacientis gadaadgilebis unari da mobiloba;

- intraTekaluri baklofeni Teoriulad efeqtur alternativas

warmoadgens difuzuri mwvave spastiurobis dros, radganac igi

gverds uvlis hematoencefalur bariers da ZiriTadad

koncentrirdeba motoruli neironebis doneze, cns-Si mcire difuziiT.

Tavdapirvelad keTdeba intraTekaluri testi bolusiT. dadebiTi

Sedegis miRebis SemTxvevaSi xdeba intraTekaluri Seyvanis aparatis

implantacia. dRiuri doza SeiZleba vcvaloT saWiroebisda mixedviT

manam, sanam ar miiRweva mudmivi bazisuri efeqti. naCvenebia, rom

baklofenis mudmivi intraTekaluri infuzia amcirebs spastiurobas

da spazmebs da amgvarad aumjobesebs zogad funqcias da sicocxlis

xarisxs;

- botulinis toqsinis inieqciebi efeqturi saSualebaa fokaluri

spastiurobis mosaxsnelad da aqvs kargi funqciuri Sedegi. dadebiTi

Sedegis SemTxvevaSi, SeiZleba misi ganmeoreba 3-4 Tvis intervalebiT;

- zogjer SeiZleba naCvenebi iyos periferiuli nevrotomiis gakeTeba,

fokaluri spastiurobis an distoniis mosaxsnelad;

- kanabinoidebi SesaZloa aRmoCndes efeqturi kunTis spastiurobisa da

tkivilis Sesamcireblad, radgan isini moqmedeben kanabinoidur

receptorebze (CB1) cns-Si. Catarebuli kvlevebi miuTiTebs, rom

gafantuli skleroziT pacientebSi es preparatebi amcireben rogorc

spastiurobas, ise masTan dakavSirebul tkivils. Tumca, jer kidev

kiTxvis qveS rCeba kanabinoidebis upiratesobis sakiTxi arsebul

konvenciur medikamentebTan SedarebiT, romlebic gamoiyeneba

tkivilisa da spastiurobis samkurnalod. garda amisa, mxedvelobaSia

misaRebi uaryofiTi gverdiTi efeqtebi, mag. Tavbrusxveva, romelic

SeiZleba sakmaod Semawuxebeli iyos.

moZraobis darRvevebi

moZraobis darRvevebi umTavresad vlindeba parkinsonis daavadebisa da

hantingtonis daavadebis dros da iyofa or jgufad:

1. moZraobis Semcireba (bradikinezia, akinezia);

2. hiperkinezuli uneblie moZraobebi, mag. tremori, distonia, qorea,

mioklonusi, tikebi. qvemoT mocemulia calk-calke maTi marTvis

sqemebi.

Page 37: Neurological PC.pdf

tremori

- mosvenebis tremori warmoadgens kardinalur simptoms parkinsonis

daavadebis dros. misi Semcireba SeiZleba dofaminerguli

preparatebis maRali dozebis saSualebiT;

- aseve efeqturi SeiZleba iyos antiqolinerguli saSualebebi, mag.

benzheqsoli, Tumca maT SeiZleba gamoiwvion cnobierebis Secvla

(konfuzia);

- SesaZloa efeqturi iyos botulinis toqsinis inieqcia winamxris

kunTebSi (metwilad momxrelebSi). uaryofiTi efeqtebi moicavs

gamSleli kunTebis fokalur sisustes, rac aZnelebs mtevnebSi natifi

moZraobebis Sesrulebas. procedura saWiroebs daaxloebiT 1 kviras

Sedegis misaRebad da Sedegi grZeldeba 3-4 Tve;

- aRwerilia aseve botulinis toqsinis inieqciebis gamoyeneba qveda ybis

tremoris dros;

- iSviaTad, mwvave tremoris an distoniis dros ganixileba qirurgiuli

Carevis sakiTxi, rac moicavs Talamotomias, palidotomias da tvinis

Rrma stimulacias (DBS – deep brain stimulation).

distonia

- gaxangrZlivebuli kunTovani SekumSvebi iwvevs grexviT da

paroqsizmul (ganmeorebiT) moZraobebs an anomaluri posturis

ganviTarebas, SeiZleba iyos lokaluri an generalizirebuli;

- levodopam SeiZleba moxsnas an piriqiT, gaamwvavos distonia;

- monacemebis mixedviT, botulinis toqsinis inieqciebiT mkurnalobis

efeqti cvalebadia, Tumca igi SeiZleba efeqturi aRmoCndes

mtkivneuli terfis distoniis dros;

- damtkicebulia botulinum A da botulinum B-s inieqciebis dadebiTi

efeqti cervikaluri (kisris) distoniis dros.

blefarospazmi warmoadgens fokaluri distoniis formas, romelic

Tavdapirvelad gamoixateba arakontrolirebadi xamxamiT, Semdeg ki gadadis

quTuToebis uneblie, mZlavr moxuWvaSi. igi SeiZleba warmoadgendes

problemas progresuli supranuklearuli dambliT, an parkinsonis

daavadebiT pacientebSi. botulinis toqsinis inieqcia Tvalis irgvliv

kunTebSi SesaZloa funqciurad dadebiTi Sedegis momtani aRmoCndes,

zogjer saWiro xdeba antiqolinerguli preparatebis damateba, SeiZleba

aseve quTuToebis damWeris gamoyenebac.

qorea

- krTomiTi fsevdo-mizanmimarTuli moZraobebi, gansakuTrebiT

gamoxatulia hantingtonis daavadebis dros;

Page 38: Neurological PC.pdf

- qoreisa da masTan erTad fsiqiatriuli simptomebi hantingtonis

daavadebis dros SesaZloa vmarToT neiroleptikebiT, mag.

haloperidoli, flufenazini;

- atipiur neiroleptikebs eqstrapiramiduli movlenebis ganviTarebis

ufro naklebi riski gaaCnia, Tumca maT SesaZloa gamoiwvion wonis

mateba, mag. klozapini, olanzapini;

- naCvenebia, rom tetrabenazini, romelic amcirebs dofaminis

koncentracias nervis daboloebebSi, amcirebs qoreis intensivobas,

Tumca siarulis gaZnelebis an parkinsonizmis dros misi daniSvna

aramizanSewonilia.

respiratoruli problemebi

qoSini

qoSini progresirebadi nevrologiuri daavadebiT pacientebSi SeiZleba

gamowveuli iyos ramodenime mizeziT:

1. qveda sasunTqi gzebis infeqcia: es ukanaskneli SeiZleba ganviTardes

sasunTqi kunTebis sisustis gamo, rac iwvevs gulmkerdis eqskursiis

SezRudvas sunTqvis dros, amoxvelebis, sekretebis amowmendis

gaZnelebas da Sereul aspiracias;

2. filtvis arteriebSi emboliebi, rac gamowveulia pacientis naklebi

moZraobiT;

3. sasunTqi kunTebis sisuste – gansakuTrebuli problemaa mnd-s dros,

rasac kidev ufro amZimebs arasulfasovani kveba. procesSi SeiZleba

CarTuli iyos rogorc diafragmis, ise neknTaSua kunTebi;

4. Tanmxlebi gulis an filtvis paTologia.

mkurnaloba damokidebulia gamomwvev mizezze. Tu dadgindeba, rom mizezia

sasunTqi gzebis infeqcia, maSin iniSneba Sesaferisi antibiotiki da

SesaZloa damatebiT fizioTerapiac. umjobesia, rom nevrologiuri

daavadebis bolo stadaze pacientebs gaukeTdeT gripis virusis

sawinaaRmdego acra. Tu xelisSemwyob faqtorad moiazreba aspiracia, maSin

ganxiluli unda iqnas da SeirCes kvebis alternatiuli meTodebi.

hipoventilaciiTa da hipoqsiiT gamowveul simptomebs kargad xsnis

arainvaziuri ventilacia (ix. qvemoT). aseve kargi efeqtis SeiZleba

aRmoCndes qvemoT CamoTvlili simptomuri midgomebi:

- sawolSi moTavseba – wamomjdar mdgomareobaSi baliSebiT an sxva

damWeri saSualebebiT garSemo;

- saxeze sufTa haeris nakadi, mag. ventilatoriT an Ria fanjridan;

- sunTqviTi savarjiSoebi, moduneba da sityvieri damSvideba;

Page 39: Neurological PC.pdf

- bolo dros Catarebul koxreinis kvlevaSi naCvenebi iqna, rom

siarulis maSvelebi, kunTis neiro-eleqtruli stimulacia da

gulmkerdis kedlis vibracia efeqturad moqmedebs qronikuli

daavadebis bolo stadiaze myof sxvadasxva tipis pacientebSi, Tumca

kvlevebis umetesi nawili Catarebuli iyo pacientebSi filtvis

qronikuli obstruqciuli daavadebiT.

farmakologiuri mkurnalobis reJimebi

- qoSinis mosaxsnelad efeqturia opioidebi, mag. oraluri morfini,

dasawyisSi 2-5 mg 4 saaTSi erTxel, titracia saWiroebis Sesabamisad;

- benzodiazepinebi Svelis qoSinTan dakavSirebul aRelvebasa da

panikas, mag. diazepami 2-5 mg Zilis win / dReSi samjer, an lorazepami

0.5-1 mg, romelic SeiZleba mivceT enis qveS mwvave Setevis dros. unda

gaviTvaliswinoT, rom es preparatebi Tavidan unda mivceT mcire

dozebiT da titracia unda movaxdinoT frTxilad, radgan pacients

isedac daqveiTebuli aqvs respiratoruli funqcia.

- seleqtiuri serotoninis ukumitacebis inhibitorebi (SSRI-ebi) efeqturi da usafrTxo preparatebia panikisa da aRelvebis

mosaxsnelad da SeiZleba gamoyenebuli iyos xangrZlivad.

sunTqvis (ventilaciuri) ukmarisoba

mnd-Ti daavadebul pacientebSi daavadebis progresirebasTan erTad ufro

da ufro matulobs sasuTqi kunTebis sisuste. pacientebis nawils eqimTan

vizitisas ukve aReniSneba respiratoruli ukmarisoba. miuxedavad imisa, rom

simptomebi vlindeba maSin, rodesac forsirebuli amosunTqvis moculoba

(FEV) ecema 50%-ze dabla, es formulireba mainc cvalebadia da zogierT

pacients SeiZleba ganuviTardes respiratoruli ukmarisoba iseT

maCvenebelzec ki, rodesac sasicocxlo moculoba (VC – vital capacity) 75%-is

tolia (respiratorul ukmarisobad iTvleba, rodesac arteriul sisxlSi

an yuris bibiloSi pCO2>6.5 kPa). es SeiZleba ganviTardes mosvenebiTi

qoSinis an orTopnoes ararsebobis drosac ki. sasicocxlo moculoba

respiratoruli funqciis Sesafaseblad sando maCvenebels ar warmoadgens,

gansakuTrebiT pacientebSi bulburi simptomebiT, amitom gamoiyeneba sxva

maCveneblebi, mag. nazaluri haeris nakadis wneva.

mnd-s dros respiratoruli ukmarisobis erT-erT pirvel niSans

warmoadgens Zilis darRvevebi. hipoventilacia Tavdapirvelad viTardeba

REM Zilis dros, rodesac damxmare sasunTqi kunTebi naklebad aqtiuria da

ventilaciis procesi ZiriTadad damokidebuli xdeba diafragmis

moZraobaze, xolo am ukanasknelis funqcia ki mwoliare mdgomareobaSi

klebulobs. hipoventilaciisa da masTan dakavSirebuli Jangbadis

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desaturaciis epizodebma Ramis ganmavlobaSi SeiZleba gamoiwvios

ganmeorebiTi gamoRviZebebi. Ramis hiperkapniis ganviTareba SemdgomSi iwvevs

daqveiTebul koncentraciis unars, Zilianobas, dilis Tavis tkivils,

gulisrevas, gaRizianebadobas, anoreqsiisa da depresiis ganviTarebas.

pacients SesaZloa aReniSnebodes dispnea daZabvisas an laparakis dros. Tu

eWvi arsebobs hipoqsiaze, pacientTan saubris Semdgom igi unda gavagzavnoT

ftiziatrTan respiratoruli funqciis srulyofilad SefasebisTvis.

dReRamuri arteriuli Jangbadis saturaciis sazomi mowyobiloba SesaZloa

saxlis pirobebSic iqnas gamoyenebuli, esaa patara zomis aparati, romelic

magrdeba TiTze. Sedegebi Semdgom SeiZleba gadacemuli iqnas

respiratoruli samedicino jgufisTvis diliT.

hipoventilaciiT gamowveuli simptomebi mniSvnelovnad umjobesdeba

arainvaziuri dadebiTi wneviT ventilaciis (NIPPV – non-invasive positive pressure

ventilation) meTodiT. aRniSnuli meTodi iyenebs ventilaciur sistemebs

niRbiT, romlebic uzrunvelyofs wyvetilad inspiratoruli dadebiTi

wneviT haeris nakadis miwodebas (mag. “NIPPY”, B & D Electromedical, UK), an bi-fazur dadebiTi wnevis aparatebs, romlebic uzrunvelyofs sxvadasxva

faziT (doniT) dadebiTi wneviT haeris nakadis miwodebas rogorc

CasunTqvis, ise amosunTqvis dros (BiPAP). arsebobs mravali sxvadasxva

tipis arCevani sasunTqi aparatebis gamoyenebisas, nazaluri niRbidan

dawyebuli mTliani saxis niRbiT da nazaluri burTulakebiT

damTavrebuli, Tumca am dros arsebobs gawiTlebis an wylulebis gaCenis

saSiSroeba. arsebobs aseve mcire zomis portatuli aparatebi. NIPPV

aparatebis gamoyeneba garkveul sazrianobas da codnas moiTxovs, amitom

pacientebi SeiZleba Tavad ver gaumklavdnen maT marTvas, riTac

momvlelebs sazrunavi kidev ufro ematebaT. pacientebs gamoxatuli

bulburi simptomatikiT SesaZloa hqondeT NIPPV aparatTan dakavSirebuli

problemebi, radgan maT uviTardebaT obstruqciis epizodebi, rac

dakavSirebulia xmovani iogebis disfunqciasTan, aseve aqvT aspiraciis

ufro meti riski.

rodesac mosalodnelia respiratoruli problemebi, mag. pacientebSi mnd-

iT, aucileblad adridanve unda daviwyoT pacientTan erTad am sakiTxis

ganxilva, raTa mivceT mas dro mosafiqreblad da gadasawyvetad, surT Tu

ara da ra tipis RonisZieba undaT rom iqnas miRebuli maT konkretul

SemTxvevaSi respiratoruli problemebis warmoqmnisas. erT-erTi

randomizebuli klinikuri gamocdis Sedegebma aCvena, rom saSualo

gadarCenis maCvenebeli izrdeboda daaxloebiT 7 TviT pacientebSi kargi

bulbaluri funqciiT, romlebSic gamoyenebuli iyo arainvaziuri

ventilaciis meTodi, sicocxlis xarisxis gaumjobesebisaken mimarTul

RonisZiebebTan erTad. saWiroebis dadgenis Semdeg, pacientebi xSirad

Page 41: Neurological PC.pdf

iwyeben arainvaziuri ventilaciis gamoyenebas RamiT, Tumca daavadebis

progresirebasTan erTad, maT SesaZloa dRis periodebSic daiwyon misi

gamoyeneba. am SemTxvevaSi mosalodnelia ventilatorze mzardi

damokidebulebis ganviTareba, amitom pacients unda ganvumartoT

mkurnalobis arsebuli SezRudvebi.

invaziuri ventilacia traqeostomiT sasunTq gzebs icavs sekretebiT

daxSobisgan da Sesabamisad, SeuZlia sicocxlis gaxangrZliveba daavadebis

progresirebisas. did britaneTSi es ukanaskneli iSviaTad keTdeba da

dakavSirebulia rTul eTikur sakiTxebTan. rodesac mnd-Ti daavadebul

pacients utardeba aqtiuri ventilacia, dadasturebuli diagnoziT an mis

gareSe, ventilatorisgan damoukidebloba iSviaTad miiRwva. Sesabamisad,

Zalian mniSvnelovania, rom ventilaciisa da zogadad, sicocxlis bolo

stadiaze mzrunvelobis sakiTxebi ganxiluli iqnas pacientTan da mis

axloblebTan erTad manamde, sanam warmoiSveba gadaudebeli mdgomareoba,

xolo miRebuli gadawyvetilebebi dawvrilebiT unda iqnas asaxuli

werilobiT dokumentaciaSi.

xvela

xvela xSirad susti da araproduqtiulia da SeiZleba ganviTardes ylapvis

mcdelobis dros. xvelisa da moxrCobis epizodebi xSiria mnd-Ti

daavadebul pacientebSi, Tumca igi iSviaTad ukavSirdeba xilul

respiratorul infeqcias. mkurnaloba mimarTuli unda iyos gamomwvevi

mizezis winaaRmdeg. rezistentuli da Semawuxebeli xvelis dros SeiZleba

efeqturi aRmoCndes opioidebi.

klinikuri marTva moicavs Semdgom midgomebs:

- arsebuli infeqciis gamovlena da Sesabamisi mkurnaloba;

- fizioTerapiis CarTva; pacientebsa da maT momvlelebs SeiZleba

vaswavloT meTodebi, romlebic exmareba amosunTqviT moZraobebSi

xvelis dros;

- portatuli, saxlis pirobebSi gamosadegi gamwovi aparati sekretebis

mosacileblad;

- meqanikuri Caberva-amoqaCvis aparati (“xvelis maSveli”), zrdis

amosunTqviTi nakadis siCqares da xels uwyobs sekretebisa da

lorwovani sacobebis amowmendas;

- Tu arsebobs apiraciis saSiSroeba, unda vifiqroT kvebis

alternatiul meTodebze;

- xvela SeiZleba gamoiwvios mJava refluqsma – SegiZliaT daniSnoT

metoklopramidi, protonuli tumbos inhibitorebi;

Page 42: Neurological PC.pdf

- Tu aris sqeli naxveli, romelic aZnelebs amoxvelebas, SegiZliaT

gamoiyenoT:

mariliani xsnari nebulaizeriT sekretebis gasaTxeleblad, an

haeris damatenianebeli;

karbocisteini 250-750 mg samjer dReSi.

- Ramis xvelis dros zogjer efeqturia lokaluri anesTetikis miReba

nebulaizeriT.

moxrCoba (laringospazmi) / respiratoruli distres sindromi

laringospazmis, xvelis paroqsizmebisa da inspiratoruli stridoris

epizodebi Tanmxlebi apnoeTi rogorc wesi mxolod ramodenime wami

grZeldeba, Tumca SesaZloa Zalian SemaSinebeli iyos pacientisTvis. es

epizodebi SeiZleba ganviTardes rogorc dRisiT ise Ramis manZilze da

SesaZloa misi trigeri gaxdes gastro-ezofaguri refluqsi an mavne qimiuri

nivTierebebisa da kvamlis SesunTqva. epizodebis prevencia SeiZleba

movaxdinoT antisekretoruli da prokinetikuri medikamentebiT, romlebic

iniSneba yoveli Wamis win, aseve Zilis win kvebisagan Tavis SekavebiT. mwvave

situaciaSi SeiZleba efeqturi aRmoCndes wamojdoma, mklavebis daWera

sxeulis stabilizaciisTvis da sunTqvis Seneleba. Tu respiratoruli

distresi grZeldeba, SesaZloa mdgomareoba gavaumjobesoT lorazepamis

micemiT enis qveS.

ylapvis problemebi

mnd-Ti daavadebuli pacientebis daaxloebiT 80%-Si sabolood viTardeba

mZime bulbaluri disfunqcia, Tumca ylapvis problemebi aseve

warmodgenilia gafantuli sklerozis, parkinsonis daavadebisa da

hantingtonis daavadebis mogvianebiT stadiebze. ReWva da ylapva Zneldeba

da xdeba damRleli, rasac Tan axlavs xSiri gadacdena (moxrCoba),

regurgitacia da sakvebis mikvra saylapavze. mnd-Ti pacientebis daaxloebiT

21%-Si aRiniSneba malnutricia. zogierT maTganSi amis mizezia disfagia,

Tumca nerwyvis dena da Wamis neli tempi aseve iwvevs socialur

diskomforts. sisuste xelebSi aseve xels uSlis Wamis process da

sakvebisa da siTxis miRebis TvalsazrisiT pacients sxvaze damokidebuls

xdis.

menejmenti moicavs Semdeg midgomebs:

- saWiroa enisa da metyvelebis Terapevtis CarTva, raTa Sefasebuli

iqnas ylapvis problemebis mizezebi, pacients gavacnoT usafrTxo

ylapvis meTodebi da miRebul iqnas gadawyvetileba gastrostomiuli

milis Cadgmaze, dietologTan erTad mWidro TanamSromlobiT;

Page 43: Neurological PC.pdf

- sakvebis teqsturisa da konsistenciis Secvla (sakvebis daqucmaceba,

siTxeebis gasqeleba da a.S.);

- posturisa da Tavis poziciis Secvla SesaZloa dadebiTi Sedegis

momtani iyos, mag. Wama wamomjdar mdgomareobaSi win gamoSverili

nikapiT, rac icavs sasunTq gzebs;

- alternatiuli kvebis meTodebis ganxilva.

kveba gastrostomiiT umjobesia dainiSnos wonis dakargvis prevenciis

mizniT, aseve aspiraciis riskis Sesamcireblad. gastrostomiiT kvebaze

saubari unda warimarTos da gadawyvetileba miRebuli unda iqnas

daavadebis adreul etapze. proceduris Catarebas maSin, roca pacients ukve

daqveiTebuli aqvs respiratoruli funqcia, meti riski axlavs Tan. PEG

zondis Cadgmidan momdevno erTi Tvis manZilze sikvdilis riski mcirea im

SemTxvevaSi, rodesac filtvis sasicocxlo moculoba (VC) metia 50%-ze.

gastrostomiuli zondebi SeiZleba Caidgas endoskopiurad (PEG zondi), an

radiologiuri kontroliT (RIG zondi). gastrostomiuli zondis

radiologiurad Cadgma xSirad ufro kargad gadaitaneba, radgan am dros

sedacia mcired an saerTod araa saWiro, Sesabamisad, igi aris arCevis

meTodi respiratoruli disfunqciiT pacientebSi. naCvenebia, rom PEG zondiT kveba amcirebs wonis dakargvis Sanss da aumjobesebs sicocxlis

xarisxs mnd-Ti daavadebul pacientebSi.

sialorea (nerwyvis dena)

sialorea (nerwyvis gaZlierebuli dena) xSiri simptomia sxvadasxva PLTNC mdgomareobebis dros, gansakuTrebiT parkinsonis daavadebis (70-80%-Si) da

mnd-s (20-30%-Si) dros. nerwyvi gamomuSavdeba ybisqveSa, enisqveSa da ybayura

jirkvlebis mier, romlebsac ainervirebs parasimpaTikuri nervuli sistema.

ybisqveSa da enisqveSa jirkvlebi gamoimuSaveben nerwyvis ZiriTad nawils,

romelic ufro blantia. ybayura jirkvlebi gamoimuSavebs Txel serozul

sekretebs, rac ufro metad xorcieldeba Wamisa da smis procesSi. fiqroben,

rom muskarinuli M3 receptoris neirotransmiter acetilqoliniT

stimulacia iwvevs salivacias. Tumca, nerwyvis nakadi SeiZleba

gaZlierebuli iqnas aseve simpaTikuri inervaciiTac, romelic zrdis

nerwyvis sadinarebis garSemo arsebuli kunTovani boWkoebis SekumSvas.

sialoreis mizezi ZiriTadad aris iSviaTi da gaZnelebuli ylapva, rasac

Tan axlavs saxisa da piris aparatis daqveiTebuli nervkunTovani

kontroli. pacientebs SeiZleba uWirdeT nerwyvis gadaadgileba pirSi.

situacia ufro rTuldeba parkinsonis daavadebis dros, radgan amas emateba

pirRiaobisken midrekileba da moxrili postura. zogadad, nerwyvis

gamomuSaveba parkinsonis daavadebis dros mcirdeba. Tumca zogjer

arsebobs SemTxvevebi, rodesac viTardeba autonomiuri disfunqcia, rac

Page 44: Neurological PC.pdf

iwvevs saylapavismier disfagia da nerwyvis hipersekrecia. garda amisa,

hipersekrecia SeiZleba gamoiwvios anTebiTma procesmac (mag. kbilis kariesi

da gingiviti, gastro-ezofaguri refluqsi) da zogierTma medikamentmac (mag.

klozapinma). nerwyvis dena mniSvnelovnad moqmedebs pacientis sicocxlis

xarisxze, iwvevs kanis gaRizianebas, infeqciebs, cud suns piridan,

aspiracias, sircxvilis grZnobas da mzard damokidebulebas.

arafarmakologiuri midgomebi

SesaZloa efeqturi aRmoCndes Semdgomi midgomebi calkeulad an

medikamentebTan erTad kombinaciaSi gamoyenebisas:

- enisa da metyvelebis Terapevtis CarTva, romelic aswavlis pacients

sxvadasxva xerxebs nerwyis denisa da ylapvasTan dakavSirebiT, mieces

instruqcia rom ufro xSirad gadaylapos nerwyvi da gamoiyenos

broSis magvari aparati, romelic regularul intervalebSi xmovani

signaliT axsenebs pacients rom nerwyvi unda gadaylapos. sustad

gamoxatuli daavadebis dros es meTodi sakmaod efeqturia;

- vaswavloT pacients Tavis Weris stabilizacia, uzrunvelvyoT Tavis

sazurgiani sagoravebeli etli;

- saxlis pirobebis gamwovi aparati.

farmakologiuri mkurnaloba

klinikur praqtikaSi gamoiyeneba Semdegi medikamentebi:

1. antiqolinerguli preparatebi:

am preparatebis gamoyeneba SezRudulia maTi gverdiTi efeqtebis

gamo, rac moicavs Sekrulobas, dizorientacias (konfuzia), piris

simSrales, Sardis Sekavebas, mxedvelobis gabundovanebas da

Tavbrusxvevas. isini ukunaCvenebia pacientebSi kardialuri

ariTmiebiT, daxurulkuTxovani glaukomiT da prostatis

hipertrofiiT. kvlevebis umetesoba am preparatebze Catarebulia

bavSvebSi, mag. cerebruli dambliT.

arCevis preparatebia:

I. hioscinis hidrobromidis mwebavi safenebi, 1 mg 72 saaTSi

erTxel, SeiZleba gamoviyenoT 1-dan 3 safenamde, titracia

reaqciis Sesabamisad. kvlevebiT naCvenebia maTi efeqturoba

bavSvebSi nerwyvis deniT. SesaZloa problematuri iyos

lokaluri gaRizianeba da qavili safenis mikvris adgilze;

II. atropini: bulbaluri mnd-Ti an parkinsonis daavadebiT, aseve

progresuli supranuklearuli dambliT pacientebSi naCvenebia

rom nerwyvis denis xarisxi rogorc obieqturi ise subieqturi

SefasebiT ukve 1 kviraSi klebulobs. rogorc wesi, gamoiyeneba

Page 45: Neurological PC.pdf

(Tumca es forma aralicenzirebulia) atropinis 0.5%-iani Tvalis

wveTebi (0.5 mg) dReSi 2-4-jer enis qveS;

III. glikopirolati: es preparati hematoencefalur barierSi ver

aRwevs, amitom ufro mcire centraluri efeqtebi aqvs. igi

yvelaze metadaa gamokvleuli sxva antiqolinergul preparatebs

Soris, Tumca arsebobs mxolod erTi randomizebuli, ormagad

brma placebo-kontrolirebuli kvleva, romelSic naCvenebia

nerwyvis denis mniSvnelovani gaumjobeseba subieqturi SefasebiT,

Tumca am kvlevaSi pacientebis 30%-ma preparati Sewyvita. misi

gamoyeneba SeiZleba Semdegi formebiT:

kanqveSa infuzia, 1.2 mg 24 saaTis manZilze;

tabletebi, 1 an 2 mg. mozrdilebSi 0.5 mg dReSi 1-3-jer, titracia maqsimum 8 mg-mde/dReSi;

glikopirolatis inhalacia nebulaizeriT.

IV. sxva antiqolinerguli preparatebi, romlebic aseve SeiZleba

efeqturi iyos, moicavs:

benztropini

benzheqsoli

ipratropiumis bromidis sprei enis qveS.

V. amitriptilini: dabali dozebiT, mag. 10-25 mg RamiT. man SeiZleba

xeli Seuwyos sekretebis Semcirebas, gaaumjobesos Zili da

moxsnas SfoTva.

2. beta blokerebi:

antiqolinerguli preparatebis uefeqtobis SemTxvevaSi, an rodesac

sekretebi Zlier blantia, SeiZleba vcadoT mag. propranololi 10

mg. dReSi samjer, Tumca man SeiZleba gaamwvavos daRliloba.

botulinis toqsini

es neirotoqsini, romelic gamomuSavdeba clostridia botulinum-is mier,

ablokirebs acetilqolinis gamoTavisuflebas qolinerguli

neirosekretoruli sinafsebidan da amgvarad xels uSlis sanerwyve

jirkvlis stimulacias. inieqciebi keTdeba ybayura da/an ybisqveSa

jirkvlebSi. am sakiTxTan dakavSirebiT mravali kvlevaa Catarebuli,

dadebiTi Sedegebia miRebuli Ria da randomizebuli

kontrolirebuli kvelvebiT.

oTxi randomizebuli kontrolirebuli kvlevis Sedegebma aCvena, rom

A tipis botulinis toqsinis gamoyeneba pacientebSi parkinsonis

daavadebiT, mnd-Ti, multisistemuri atrofiiT da kortikobazaluri

degeneraciiT mniSvnelovnad amcirebs nerwyvis gamomuSavebas

rogorc subieqturi, ise obieqturi analizis mixedviT. aseve

Page 46: Neurological PC.pdf

umjobesdeboda ojaxuri da socialuri stresisa da sircxvilis

maCveneblebi.

Tumca botulinis toqsinis efeqturobaze monacemebi cvalebadobs

sxvadasxva pacientTa jgufebSi, mag. gafantuli skleroziT

pacientebSi B tipis botulinis toqsinis gamoyenebisas aRiniSna rom

dadebiTi efeqtis xangrZlivoba ufro naklebi iyo, xolo blanti

nerwyvis gamomuSavebis maCvenebeli ufro maRali, parkinsonis

daavadebiT pacientebTan SedarebiT.

botulinis toqsinis inieqciebi ZiriTadad kargad gadaitaneba, ise

rom pacientebis 80%-ze meti rCeba kmayofili mkurnalobiT da

gamoxataven inieqciebis gagrZelebis survils. uaryofiTi gverdiTi

movlenebi rogorc wesi msubuqi xasiaTisaa da moicavs piris

simSrales, gardamaval gripismagvar simptomebs, diskomforts

inieqciis adgilas da nerwyvis gasqelebas. Tumca, arsebobs

gardamavali ylapvis gaZnelebis riski. naCvenebia, rom es inieqciebi

iseve efeqturia rogorc skopolamini, Tumca gaaCnia ufro naklebi

uaryofiTi efeqtebi am ukanasknelTan SedarebiT. jer kidev arsebobs

gaurkvevlobebi optimalur dozasTan dakavSirebiT, Tumca naCvenebia,

rom A tipis botulinis toqsinis 75 MU (mikroerTeulis) inieqcia

yovel ybayura jirkvalSi ufro efeqturia, vidre dabali dozebi.

aseve arsebobs debatebi eqoskopiis kontroliT proceduris

Catarebaze, Tumca es ukanaskneli albaT ufro mniSvnelovania

ybisqveSa jirkvlebSi inieqciis SemTxvevaSi, maTi ufro naklebad

misadgomi anatomiuri lokalizaciis gamo. rogorc weis, dadebiTi

efeqti grZeldeba 3-dan 8 Tvemde da SeiZleba proceduris

ganmeorebac.

radioTerapia

xSirad efeqturia ybayura jirkvlis dasxiveba, Tumca doza,

romelic saWiroa sanerwyve jirkvlis atrofiis misaRwevad,

cvalebadobs individualur SemTxvevebSi. tipiurad, pacients jer

sTavazoeben radioTerapias mxolod erT mxares, xolo mniSvnelovani

efeqtis ararsebobis SemTxvevaSi, sTavazoben meore mxares

dasxivebasac. uaryofiTi movlenebi moicavs kanis wvas, romelic

SesaZloa gagrZeldes ramodenime kvira alagebamde. qserostomia

(piris simSrale) SeiZleba gagrZeldes ramodenime Tvidan ramodenime

wlamde. dasxivebul adgilas arsebobs mogvianebiT avTvisebiani

procesis ganviTarebis momatebuli riski proceduris Catarebidan 10-

15 wlis Semdeg, Tumca es ukanaskneli mniSvnelovan faqtors ar

warmoadgens im pacientebisTvis, romelTa prognozic xanmoklea.

aseve arsebobs ybis ZvalSi osteonekrozis ganviTarebis riski.

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qirurgiuli Careva

mwvave sialoreis SemTxvevaSi, romelic ar emorCileba farmako- da

radioTerapias, SeiZleba ganvixiloT qirurgiuli Carevis varianti.

procedurebi moicavs:

- transtimpanuri nevreqtomia: es SedarebiT martivi qirurgiuli

Carevaa, xorcieldeba Sua yuridan midgomiT da ar saWiroebs

generalur anesTezias, Tumca SeiZleba aman imoqmedos gemovnebis

funqciaze. nervis boWkoebi rogorc wesi regeneracias ganicdis 6-18

TveSi;

- ybisqveSa an ybayura jirkvlis amokveTa;

- ybisqveSa an ybayura jirkvlis sadinaris gadanacvleba.

tipiuri procedura gulisxmobs ybayura jirkvlis sadinaris gadakvanZvas

da ybisqveSa jirkvlis amokveTas, an misi sadinris gadanacvlebas. Tumca, es

ukanaskneli Zalian seriozuli operaciaa da iwvevs Seuqcevad piris

simSrales, aseve sialocelesa da kbilis kariesis ganviTarebis risks.

garda amisa, ybisqveSa jirkvlis amokveTis Semdeg rCeba garegani nawiburi

da saxis kunTebis sisustis potenciuri riski.

metyveleba

mraval pacientSi SeiZleba ganviTardes vokalizaciis gaZneleba, Cumi

saubridan dawyebuli dizarTriisa da anarTriis CaTvliT. metyvelebis

Seneleba (gabundovaneba), romelic gamowveulia enis moZraobis

disfunqciiT, rogorc wesi vlindeba disfagiis ganviTarebamde. menejmenti

gulisxmobs rCevebis micemas da axsnas, Tu rogor unda movaxdinoT

metyvelebis optimizacia ise, rom igi gaxdes gasagebi, aseve xmis gaZliereba

(tonis momateba) SeiZleba efeqturi aRmoCndes im pacientebisaTvis,

romelTac aqvT kargi artikulacia, magram susti xma sasunTqi kunTebis

sisustis gamo. daavadebis progresirebasTan erTad unda ganvixiloT

metyvelebis alternatiuli meTodebis Semotanis sakiTxi, mag. werilobiTi,

komunikaciuri mowyobilobebi (“Lighwriter”), CamrTvelebi da skaneruli

sistemebi, anbaniani dafebi da individualuri komunikaciuri ruqebi.

partniors an momvlels SesaZloa jer kidev esmodes pacientis metyveleba,

magram ufro farTo komunikaciisaTvis aucilebelia enisa da metyvelebis

Terapevtis adreuli CarTva, raTa Camoyalibebuli iqnas komunikaciis

alternatiuli saSualebebi.

Sekruloba

Sekruloba xSiri simptomia nevrologiuri daavadebis bolo stadiaze da

mas mravali mizezi gaaCnia. xelisSemwyob faqtorebad miiCneva sisuste, maT

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Soris muclis kunTebis Zalis daqveiTeba da gaWinTvis SeuZlebloba,

umoZraoba, medikamentebis, gansakuTrebiT antiqolinerguli preparatebis

efeqti, naklebi narCeni moculobis dieta da dehidratacia. igi aseve

SeiZleba iyos autonomiuri disfunqciis niSani, rasac axasiaTebs kuWis

daclis dayovneba myari masisagan da msxvili nawlavis peristaltikis

daqveiTeba Wamis Semdeg. Sekrulobis prevencia Zalian mniSvnelovania, rac

xorcieldeba adeqvaturi hidrataciiT, balansirebuli dietiT da

laqsativebiT (gamaTxiereblebiT).

menejmenti moicavs Semdgom meTodebs:

- pirvel rigSi unda aRmoifxvras gamomwvevi mizezi, anu Sewydes im

preparatis miReba romelic iwvevs Sekrulobas da dainiSnos

Sesabamisi dieta;

- adeqvaturi hidrataciis uzrunvelyofa;

- laqsativebi – efeqturia stimulantisa da gamaTxeleblis kombinacia,

mag:

ko-dantrameri an kondantruzati (5-10 ml 2-jer dReSi, titracia

saWiroebisda mixedviT);

sena da laqtuloza (5-10 ml 2-jer dReSi);

movikoli (1-2 paketiT erTxel dReSi, mzardi doziT dReSi 8

paketamde).

- ganavlis Seukavebloba SeiZleba ganviTardes normaluri

mgrZnobelobis dakargvis gamo, Tumca mkurnalobam unda gamoricxos

rogorc gauvaloba, ise faRaraTi;

- pacients aseve SeiZleba vurCioT mimarTos raionis eqTnis samsaxurs.

Sardvis problemebi

Sardvis problemebi aRiniSneba gafantuli skleroziT daavadebuli

pacientebis 50-75%-Si, Tumca igi aseve xSiria parkinsonis daavadebis dros.

hantingtonis daavadebis bolo stadiaze pacientebma aseve SeiZleba

dakargon nawlavis da Sardis buStis kontrolis unari. Sardis

buStismierma problemebma SeiZleba gamoiwvios socialuri izolacia,

seqsualuri problemebi da daqveiTebuli TviTSefaseba, iseve rogorc

meoradi janmrTelobis problemebi, mag. saSarde traqtis infeqciebi.

yvelaze xSiri problemaa gadaudebeli moTxovnileba Sardvaze, rac xSirad

asocirebulia xSir SardvasTan da Sardis SeukaveblobasTan gadaudebeli

moTxovnilebis gamo. simptomebis simwvave qveda kidurebSi arsebuli

piramiduli paTologiis xarisxis pirdapirproporciulia, rac miuTiTebs

spinaluri dazianebis xarisxze. SesaZloa efeqturi iyos Semdegi

medikamentebi:

Page 49: Neurological PC.pdf

- antiqolinerguli an gluvi kunTebis relaqsanti preparatebi, mag.

propanTelini, oqsibutinini;

- antiqolinerguli antidepresantebi – imipramini, amitriptilini;

- intranazaluri desmopresini SeiZleba kargi Sedegis momtani iyos

Sardvis gaxSirebisa da Seukaveblobis dros, amasTan, igi kargad

gadaitaneba.

garda amisa, pacientebisTvis SeiZleba sasargeblo aRmoCndes raionis eqTnis

samsaxurSi viziti an Seukaveblobis specialistTan mimarTva Sefasebisa da

rCevebisaTvis. unda SevTavazoT specialuri leibebisa da zewrebis

gamoyeneba.

Sardvis Sekaveba an dayovneba SeiZleba gamoiwveuli iyos Sardis buStis

kunTovani kedlis daqveiTebuli an ararsebuli SekumSvis gamo. zogjer

efeqturia am dros beTaneqoli, Tumca xSirad saWiro xdeba kaTeterizacia.

im SemTxvevaSi Tu pacienti jer kidev sakmaod mobiluria da damoukidebeli

moqmedebis unari gaaCnia, SeiZleba umjobesi iyos ganmeorebiTi TviT-

kaTeterizaciis gakeTeba, rac amcirebs saSarde traqtis infeqciebis risks

simptomebis moxsnamde.

kognituri da xasiaTTan dakavSirebuli problemebi

SfoTva

SfoTva mraval pacients aReniSneba da gansakuTrebiT Semawuxebelia RamiT.

mniSvnelovania pacientis damSvideba, praqtikuli mxardaWera da simptomebis

kontrolze yuradRebis gamaxvileba. pacientebisTvis SesaZloa sasargeblo

aRmoCndes fsiqologiuri mxardaWera, mag. kognituri da qceviTi

(bihevioruli) meTodebi, an saWiro gaxdes farmakologiuri Careva. xanmokle

moqmedebis benzodiazepinebi, mag. temazepami 10-20 RamiT xsnis SfoTvas da

xels uwyobs CaZinebas. panikuri Setevebi dRis manZilze SeiZleba moixsnas

lorazepamiT 0.5-1 mg, SeiZleba mivceT enis qveS. Tu SfoTva mainc grZeldeba

dRis manZilze, arCevis preparatia ufro xangrZlivi moqmedebis

benzodiazepini, mag. diazepami 5 mg RamiT, an SSRI. citaloprams aqvs is

upiratesoba, rom arsebobs wveTebis formiTac, ase rom SesaZlebelia dozis

neli titracia.

depresia

sevda, depresia da mwuxareba xSirad aRiniSneba pacientebSi PLTNC mdgomareobebiT, rasac kidev ufro amwvavebs gaurkveveli prognozi, mzardi

damokidebuleba da xSirad ojaxSi rolis dakargva. aman SeiZleba

gamoiwvios yovlismomcveli uimedobis grZnoba da TviTfaseulobis

dakargva. pacientebs iseve rogorc maT axloblebs unda gaewioT rogorc

Page 50: Neurological PC.pdf

praqtikuli ise fsiqologiuri mxardaWera. SeiZleba ganvixiloT

konvenciuri antidepresantebis, mag. SSRI-ebis daniSvnis sakiTxi. aseve

efeqturi SeiZleba iyos amitriptilini da mirtazepini.

demencia

demencia parkinsonisa da hantingtonis daavadebis gviani stadiebis

damaxasiaTebeli simptomia, romelic mniSvnelovan stress iwvevs pacientis

momvlelebSi. garda amisa, gafantuli skleroziT pacientebis daaxloebiT

50%-s aseve aReniSneba raRac xarisxiT gamoxatuli kognituri problemebi.

frontotemporaluri demencia gvxvdeba mnd-Ti daavadebuli pacientebis

daaxloebiT 5%-Si. Tavidan pacients SeiZleba aReniSnebodes Senelebuli

qceva da rTuli davalebebis Sesrulebis, aseve gadawyvetilebis miRebis

gaZneleba. procesis progresirebasTan erTad SeiZleba pacients

ganuviTardes xisti qceva da gaxdes arakontaqturi (Senelebuli).

pacientebis met nawilSi (20-40%-Si) aRiniSneba ufro sustad gamoxatuli

kognituri problemebi, romelic ufro xSiria pacientebSi upiratesad

bulburi simptomebiT, kidurebis problemebiT pacientebTan SedarebiT.

sufTa fsiqozi nevrologiuri daavadebis bolo stadiaze iSviaTia, Tumca

igi xSirad aRiniSneba hantingtonis daavadebis dros. misi moxsna

SesaZlebelia antifsiqozuri preparatiT, mag. resperidoniT. bihevioruli

simptomebis dros hantingtonis daavadebis SemTxvevaSi aseve kargi efeqtisaa

olanzapini, haloperidoli da buspironi.

emociuri labiloba

es ukanaskneli aRiarebuli simptomia PLTNC-Ti pacientebSi, gansakuTrebiT

igi aRiniSneba gafantuli sklerozis dros. garda amisa, zog pacients aqvs

spontanuri, paTologiuri sicilisa da tirilis epizodebi (fsevdobulburi

efeqti), miuxedavad normaluri tonusisa, ramac SeiZleba gamoiwvios Zlieri

stresi. igi aRiniSneba gafantuli skleroziT pacientebis daaxloebiT 10%-

Si da mnd-ti pacientebis daaxloebiT 50%-Si.

arCevis preparatebia:

- SSRI-ebi – isini efeqturia ufro mcire dozebiT gamoyenebisas, vidre

gamoiyeneba depresiis dros;

- amitriptilini an misi msgavsi tricikluri antidepresanti;

- arsebobs aseve monacemebi deqstrometorfanis da qinidinis gamoyenebis

Sesaxeb.

Page 51: Neurological PC.pdf

Zilis darRvevebi

nevrologiuri daavadebis bolo stadiaze pacientebs xSirad aReniSnebaT

Zilis darRvevebi, romelic xSirad sakmaod mwvavea, Tumca arasaTanadodaa

Sefasebuli da araefeqturad namkurnalebi. insomnia SeiZleba gamowveuli

iyos tkiviliT, SfoTviT, depresiiT, xveliT Warbi sekretebis gamo da

hipoqsiiT, romelic iwvevs RamiT xSir gamoRviZebas da dRisiT Zilianobas.

dRisiT Warbi Zilianoba SeiZleba problemad iqces, gansakuTrebiT

parkinsonis daavadebisa da gafantuli sklerozis dros, amasTan, mizezi

SeiZleba iyos TviTon daavadeba an medkamentebi. SeiZleba efeqturi iyos

stimulantis daniSnva, mag. modafinili 200 mg erTxel dReSi.

daRliloba

daRliloba xSirad aRiniSneba PLTNC-Ti pacientebSi da warmoadgens mZime

problemas. potenciuri xelisSemwyobi faqtorebi moicavs Zilis darRvevas,

noqturias, qronikul tkivils, medikamentebs (mag. antidepresantebs da

spastiurobis mosaxsnel preparatebs), depresias da problemis

gamklavebisaTvis SerCeul cud strategias. aucilebelia Rrma Sefaseba

mTlianobaSi da energiis SenarCunebis swavleba, aseve damxmare

saSualebebisa da mowyobilobebis uzrunvelyofa.

seqsualuri disfunqcia

pacientebi xSirad malaven seqsualur problemebs, miuxedavad imisa, rom igi

mniSvnelovan stress iwvevs maTSi da mxolod SeiZleba upasuxon

delikaturad dasmul kiTxvebs imis Taobaze, Tu ra gavlenas axdens

daavadeba maT partniorul urTierTobebze. fizikuri faqtorebi, romlebic

xels uwyobs seqsualur disfunqcias, moicavs menjis kunTebis sisustes,

spastiurobas, zogad daRlilobas, autonomiuri nervuli sistemis

moSlilobebs da medikamentebis efeqtebs. garda amisa, Tanabrad

mniSvnelovania aseve fsiqologiuri faqtorebi, romlebic ukavSirdeba

depresiasa da SfoTvas, sxeulis suraTis Secvlas da rolis cvlilebebs

ojaxsa Tu partniorul urTierTobebSi.

menejmenti moicavs Semdgom midgomebs:

- ganmarteba, fsiqologiuri mxardaWera da konsultacia, rac zogjer

saWiroebs specializirebul samsaxurebSi mimarTvas;

- fizikuri simptomebis optimaluri menejmenti, tkivilisa da

spastiurobis CaTvliT;

- medikamentebis, mag. antidepresantebis, beta blokerebis

racionalizacia;

- sildenafilis an intrakavernozuli papaverinis gamoyeneba.

Page 52: Neurological PC.pdf

sxva nevrologiuri simptomebi

pacientebs nevrologiuri daavadebis bolo stadiaze SeiZleba

aReniSnebodeT uamravi simptomi romelic dakavSirebulia maT

daavadebasTan. eseni moicavs aramyar dgomas, Tavis simsubuqis SegrZnebas,

cnobierebis cvlilebas, mxedvelobis problemebs, rogoricaa optikuri

nervis nevropaTia gafantuli sklerozis dros, Tavbrusxvevas, yurebSi

xmaurs da epilefsiur sindromebs. saWiroa am simptomebis srulyofili

Sefaseba da saTanado mkurnaloba. mgrZnobelobis daqveiTeba zrdis kanis

wylulebis da infeqciis risks, amitom mniSvnelovania kanis kargi movla da

pacientis ganaTleba am mxriv.

autonomiuri disfunqcia sul ufro da ufro metad moiazreba, rogorc

mravali nevrologiuri mdgomareobis damaxasiaTebeli niSani, romlebic

moicavs multisistemur atrofias, parkinsonis daavadebas, gafantul

sklerozs da motoruli neironis daavadebas. oflianobis tipebi, romlebic

sakmaod Semawuxebelia da xSirad aRiniSneba parkinsonis daavadebis dros,

ZiriTadad dakavSirebulia autonomiur disfunqciasTan, aseve gamorTvis

periodebsa (off periods) da diskineziebTan. aqsialuri hiperhidrozi xSirad

vlindeba, rogorc kompensatoruli movlena kidurebSi daqveiTebuli

simpaTikuri funqciis dros, rodesac aRiniSneba xelisgulis Semcirebuli

oflianoba. autonomiuri disfunqcia aseve aRwerilia mnd-s mwvave

SemTxvevebSi.

komunikaciis problemebi

komunikaciis problemebi mudmivad warmoiSveba ukurnebeli seniT

daavadebuli pacientis movlisas sicocxlis bolo stadiaze. politikuri

mimarTulebebi bolo dros yuradRebas amaxvilebs komunikaciaze

jandacvisa da socialur sferos Soris, aseve ayalibebs saukeTeso

komunikaciis gagebas praqtikaSi. efeqturi komunikacia paliatiuri

mzrunvelobis midgomis mTavari principia. es pirvel rigSi gulisxmobs Ria

da TanagrZnobiT komunikacias, romelic vrceldeba pacientebze,

araformalur momvlelebsa da profesiul kolegebze. qvemoT mocemulia

gaxangrZlivebuli (nevrologiuri) mdgomareobebis erovnuli samsaxuris

mier mowodebuli rekomendaciebi efeqturi komunikaciis Sesaxeb:

- kargi praqtikis magaliTebis gaziareba;

- samsaxurebs Soris komunikaciuri kavSirebis gaumjobeseba;

- momxmarebelTa CarTva sakomunikacio sakiTxebSi da cvlilebaTa

wamowyeba;

Page 53: Neurological PC.pdf

- praqtikosi eqimisTvis rekomendaciis gaweva specializirebuli unar-

Cvevebisa da codnis SeZenisaTvis, rac daexmareba mas pacientTan, mis

ojaxTan da kolegebTan urTierTobaSi.

organizaciuli midgoma aucilebelia imisaTvis, rom kargi praqtikis

individualuri magaliTebi gavrceldes da miRebuli iqnas saerTo

praqtikaSi. aseve unda iTqvas isic, rom praqtikosi eqimis qcevis tipi

mniSvnelovn rols TamaSobs maTi komunikaciis unarSi, kerZod, igulisxmeba

maTi piradi kultura garemos Seqmnis mxriv, monawile pirovnebebi, TviTon

praqtikosi eqimis religiuri mrwamsi da misi damokidebuleba sikvdilis

mimarT. komunikaciis TvalsazrisiT zemoT CamoTvlili aspeqtebi ufro

mniSvnelovania, vidre eqimis specialuri ganaTleba an komunikaciuri unar-

Cvevebis codna.

komunikaciis problema exeba jandacvis yvela sferos da socialur

samsaxurebs, miuxedavad maTi rolisa Tu praqtikis garemosi. cudi

komunikacia iSviTadaa ganpirobebuli konkretulad praqtikosi eqimis

mizeziT. igi ufro gamowveulia komunikaciisadmi midgomis arsebuli

samedicino modeliT, romelSic fokusireba keTdeba daavadebis

paTologiur kurssa da anamnezis Sekrebaze, xolo ufro farTo

individualuri saWiroebani da pacientis perspeqtivebi yuradRebis miRma

rCeba.

profesionalTa mxridan rTuli saubrisTvis Tavis arideba SeiZleba

gamowveuli iyos ramdenime mizeziT:

- isini SezRuduli arian sakuTari samuSao ganrigiT;

- danaSaulis (pasuxismgeblobis) SiSi;

- sakuTar ZalebSi naklebi TviTrwmena;

- drois naklebobis SegrZneba;

- cudi organizaciuli unar-Cvevebi;

- SiSi pacientis mxridan iseTi reaqciisa, romelsac hgoniaT rom ver

gaumklavdebian;

- sakuTari SezRudvebis SegrZneba;

- SegrZneba imisa, rom maT ara aqvT uflebamosileba pasuxi gascen

dasmul kiTxvebs.

paliatiuri mzrunvelobis calke dargad CamoyalibebasTan erTad, igi

yovelTvis eZiebda efeqtur meTodebs imisaTvis, rom daxmareboda pacientsa

da mis ojaxs rTuli gadawyvetilebebis miRebaSi; rTuli saubrebis

warmoebisa da profesiuli SiSis mosaSoreblad saWiro iyo naTeli da

pirdapiri meTodebis Camoyalibeba komunikaciuri TvalsazrisiT. qvemoT

Page 54: Neurological PC.pdf

CamoTvlilia is unar-Cvvevebi, romlebic unda gaaCndes praqtikos eqims

kargi komunikaciisaTvis:

praqtikos eqims unda SeeZlos

- uzrunvelyos iseTi saxis mzrunveloba, romelic xelmisawvdomia

komunikaciuri TvalsazrisiT SezRuduli adamianebisaTvis;

- unda icodes im potenciuri komunikaciuri siZneleebis Sesaxeb,

romelic warmoiSveba praqtikaSi, aseve barieris gadasalaxad saWiro

unar-Cvevebi, rac ganapirobebs efeqtur ormxriv komunikacias;

- unda icodes stresis Sefasebis mTeli rigi meTodebi, romelTac

gansakuTrebuli mniSvneloba eniWeba SezRuduli verbaluri an

kognituri SesaZleblobebis dros;

- Caataros pacientisa da misi ojaxis Sesabamisi paliatiuri

mzrunvelobis globaluri Sefaseba maTi fizikuri, fsiqologiuri,

socialuri, sulieri da informaciuli saWiroebebis TvalsazrisiT;

- unda esmodes da icodes, rodis da rogor mimarTos rCevisaTvis

specializirebuli paliatiuri mzurnvelobis samsaxurs da/an sxva

organizaciebs, imisaTvis rom daakmayofilos pacientis saWiroebebi;

- aRiaros sakuTari codnis an unar-Cvevebis nakleboba da gaakeTos

Sesabamisi gadamisamarTeba.

komunikaciis garTuleba ukavSirdeba mTel rig mizezebs:

- drois nakleboba;

- eqimis codnis an unar-Cvevebis simwire;

- pacientis saWiroeba da misi mdgomareoba mocemul etapze;

- garemo;

- gaugebroba da aRqmis sxvadasxvaoba.

es CamonaTvali arasrulia, Tumca igi zogadad asaxavs im siZneleebs rac

realurad gvxvdeba praqtikaSi.

komunikaciis problemebi gaxangrZlivebuli nevrologiuri mdgomareobebis

dros

PLTNC-Ti pacientebis movla mTel rig problemebs ukavSirdeba

komunikaciis TvalsazrisiT, rogorc eqimis, ise socialuri muSakisa da

pacientis momvlelebis mxriv. es xSirad moicavs saWiroebaTa mTel nusxas,

romelSic CarTulia mravali samsaxuri. efeqturi profesiuli komunikacia

arsebiTi mniSvnelobisaa koordinaciis gaumjobesebis da Sesabamisi movlis

uzrunvelyofis mxriv. PLTNC-Ti pacientebs Tavidan normaluri verbaluri

da weriTi unarebi aqvT, Tumca daavadebis progresirebasTan erTad maTi

unarebi uaresdeba. individualuri pacientis, misi ojaxisa da momvlelebis

Page 55: Neurological PC.pdf

daxmareba yovldRiuri movlis dagegmvasa da modifikaciaSi saWiroebisda

mixedviT saWiroebs kreatiul da Rrma midgomas. qvemoT moyvanilia

ZiriTadi fizikuri faqtorebi, romlebic warmoiSveba sxvadasxva

nevrologiuri mdgomareobis dros da xdeba komunikaciis garTulebis

mizezi:

- kognituri gauareseba: nevrologiuri daavadebebiT gamowveuli

potenciuri kognituri cvlilebebi moicavs Senelebul procesings,

xanmokle mexsierebisa da mentaluri SesaZleblobebis daqveiTebas,

aseve mTavar Temaze koncentraciis siZneles saubris dros;

- tuCebis funqcia: tuCebisa da loyis kunTebi SeiZleba daziandes

motoruli neironis daavadebis an insultis dros. kunTis funqciis

cvlilebebi aZnelebs sityvis sworad warmoTqmas, rac Znelad

gasagebs xdis pacientis saubars;

- rbili sasis da xaxis funqcia: iseve rogorc tuCebis SemTxvevaSi,

rbili sasa da xaxac monawileobs warmoTqmuli bgerebis formirebaSi.

rodesac maTi funqcia ziandeba, Sesabamisad irRveva bgerebic da

metyveleba xdeba bundovani da gaurkveveli;

- enis funqcia: enis funqciis daqveiTeba gansakuTrebuli problemaa

gverdiTi amiotrofuli skleroziT pacientebSi. igi iwvevs

warmoTqmuli bgerebis Semcirebas, amitom daavadebis

progresirebasTan erTad, metyveleba ufro da ufro dabinduli da

gaugebari xdeba;

- xorxis funqcia: metyvelebis unars gansazRvravs xorxi da xmovani

iogebi. xmovani iogebis sisuste xSiri problemaa da igi

mniSvnelovnad arRvevs komunikaciis unars. zeda da qveda motoruli

neironis disfunqciam SeiZleba gamoiwvios xmovani iogebis moZraobis

unaris daqveiTeba, rac ganapirobebs xmis tembris, tonisa da bgeris

xangrZlivobis cvlilebas;

- respiratoruli funqcia: respiratoruli sistemis funqciis

daqveiTebam SesaZloa imoqmedos pacientis komunikaciis unarzec.

laparakisaTvis saWiroa filtvis sasunTqi moculobis garkveuli

done. respiratoruli funqciis daqveiTebam SeiZleba Secvalos xmis

toni, riTmi, intonacia da siZliere. infeqciiT gamowveuli

respiratoruli disfunqciis dros SeiZleba gvqondes komunikaciis

problemebi. zurgis tvinSi garkveuli ubnebis disfunqciis an

dazianebis gamo, rac iwvevs zeda an qveda motoruli neironis

gamoTiSvas, qveiTdeba sasunTqi Zala da pacients uWirs sakmarisi

moculobis amosunTqvis warmoeba, imisaTvis rom misi xma gasagebi

iyos, an ver ambobs erTi-or sityvaze mets erT amosunTqvaze;

- sxeulis poza: sxeulis poza aseve moqmedebs pacientis komunikaciis

unarze. cudi (mouxerxebeli) pozis gamo pacients SeiZleba fizikurad

Page 56: Neurological PC.pdf

ar SeeZlos xmis amoReba, anda uWirdes im pozis didxans SenarCuneba,

romelic mas komunikacias uadvilebs. pozis gamo zemoaRniSnuli

fizikuri problemebi SeiZleba kidev ufro gauaresdes;

- daRliloba: daRliloba xSirad Tan axlavs progresirebad

nevrologiur daavadebebs. Tanmxlebi simptomebi, mag. disfazia imdenad

Rlis pacients, rom maT komunikaciaSi CarTvis energia aRar aqvT;

- paTologiuri sicili da tirili: fizikuri problemebis an daavadebis

gamo zogierTi nevrologiuri mdgomareobis dros SeiZleba

Seicvalos nevrologiuri funqcia, rac iwvevs arakontrolirebad

sicils an tirils, rac arTulebs komunikacias.

zemoT CamoTvlili faqtorebi moqmedebs pacientis komunikaciis unarze, ris

gamoc isini ver axerxeben maTi saWiroebebis gadmocemas, xdebian

asocialurebi da kargaven damoukideblobas.

saukeTeso praqtikis saxelmZRvanelo principebi

kargi komunikaciis principebi yvela situaciisaTvis saerToa. Tumca isini

damokidebulia pacientis smenis, mxedvelobis da metyvelebis unarze. es

unarebi gansxvavdeba yoveli konkretuli pacientisaTvis PLTNC mdgomareobebis SemTxvevaSi, amitom saWiroa individualuri da kreatiuli

midgomis Camoyalibeba komunikaciuri TvalsazrisiT yoveli konkretuli

pacientis mimarT. qvemoT moyvanilia komunikaciis is mTavari principebi,

romlebic gamoiyeneba zogadad sicocxlis bolo stadiaze:

- iyaviT gulwrfeli da pirdapiri;

- gamoikiTxeT pacientis faseulobebi da miznebi;

- daexmareT pacients arCevanis gamokveTaSi misi faseulobebisa da

miznebis mixedviT;

- xeli SeuwyeT SekiTxvebs pacientis mxridan;

- hkiTxeT Tqvens Tavs, “ras vizamdi, es rom Cemi ojaxis wevri iyos?”

- gamoyaviT dro mosasmenad;

- ar aaridoT Tavi rTul saubars, aramed eZieT daxmareba sxva

kolegebis mxridan, Tu mocemuli sakiTxi aRemateba Tqvens

kompetencias an SesaZleblobebis farglebs;

- iyaviT mzad saubris dawyebisaTvis.

gunduri muSaoba da koordinacia

qronikuli daavadebiT pacientebs uamrav specialistTan aqvT Sexeba mTeli

avadmyofobis manZilze. PLTNC-s dros warmoSobili sirTuleebi moiTxovs

efeqtur da koordinirebul profesiul komunikacias. centraluri muSakis

Page 57: Neurological PC.pdf

CarTva, romelsac aqvs sruli monacemebi da Canaweri pacientis Sesaxeb,

metad moxerxebulia, radgan igi amcirebs arasaWiro ganmeorebebs,

gvexmareba komunikaciis gaRmavebaSi da Tavidan gvacilebs uxerxuli

gaugebrobebis warmoSobas. dokumentaciis saerTo bazis SemoReba, romelic

gankuTvnilia profesionalebisa da momvlelebisTvis, xels uwyobs saubris

Semdgom gagrZelebas da ar exeba erTidaigive Temas komunikaciis dros.

arsebuli literatura miuTiTebs, rom efeqturi TanamSromlobisTvis

gundebs esaWiroebaT TviT-analizis, TanagrZnobis da moqnilobis unari,

rac gansazRvravs naTeli mimarTulebis aRebas da qmnis mSvid, megobrul

garemos arsebuli problemebis gamovlenisa da maTze diskusiisTvis.

rodesac komunikacia gansakuTrebiT rTuldeba, SegiZliaT CarToT

procesSi eqsperti praqtikosi, romelsac gaaCnia gamocdileba am mxriv.

enisa da metyvelebis TerapevtTan adreuli mimarTva SeiZleba saWiro iyos

zogierTi gaxangrZlivebuli nevrologiuri mdgomareobis adreul stadiaze,

raTa pacientma da misma ojaxma miiRos rCevebi da maTTan erTad

gansazRvrul iqnas momavali strategiebi, Tu ra unda gakeTdes

metyvelebisa da komunikaciis mkveTrad gauaresebis SemTxvevaSi.

diagnozis gamxela

diagnozis gamxelasTan dakavSirebulma kvlevebma aCvena, rom eqTnebi

yovelTvis winaaRmdegi iyvnen diagnozis damalvisa naTesavebis moTxovniT,

radgan miiCnevdnen, rom didxans motyueba SeuZlebelia da amasTan, mas aqvs

stresuli Sedegebi pacientisa da misi ojaxisTvis. naTesavebis ZiriTadi

motivacia iyo gardacvalebaze saubris SiSi da pacientze mZime zegavlenis

moxdenis saSiSroeba, risganac maT surdaT sayvareli adamianis dacva.

istoriulad cnobilia paternistuli midgoma, romelic bolo dros

gadawyvetilebis miRebis uflebisa da eTikuri sakiTxebis ganviTarebasTan

erTad Seicvala. Tumca arsebobs garkveuli principebi, romlebic unda

iqnas daculi diagnozis an prognozis gamxelis dros:

- gamxela mgrZnobiare da pozitiuri meTodiT;

- pirovnebis drouli da saTanado mxardaWera;

- informaciis adreuli gaziareba;

- profesionalTa da momvlelTa urTierTTanamSromloba pacientis

dasaxmareblad.

mzrunvelobis dagegmva sicocxlis bolo stadiaze

mzrunvelobis dagegmva sicocxlis bolo stadiaze prevenciuli jandacvis

mniSvnelovani nawilia da moiTxovs mgrZnobiare da mizanSewonil midgomas,

rogoricaa mag. 4-safexuriani dagegmvis procesi bolo stadiaze (ix.

Page 58: Neurological PC.pdf

cxrili). Tumca mas ewinaaRmdegeba realobis gamocda: 10 barieri bolo

stadiaze mzrunvelobis dagegmvisas:

4-safexuriani dagegmvis procesi bolo stadiaze

1. Temis warmodgena 2. diskusiisaTvis xelis Sewyoba 3. bolo etapze strategiis

gansazRvra da dokumentacia 4. dokumentebis regularuli

ganxilva da saWiroebis mixedviT ganaxleba

realobis gamocda: 10 barieri bolo stadiaze mzrunvelobis dagegmvisas

1. pacientisa da provaideris sizarmace

2. drois SezRudvebi 3. varaudebi 4. uaryofa da gadadeba 5. ararealuri molodini

6. gadadeba krizisis dadgomamde 7. diskomforti paliatiuri

mzrunvelobis dagegmvisas

8. dokumentaciis nakleboba

9. kulturuli da jandacvis

sistemis mxridan barierebi

10. pacientis mzaoba

mzrunvelobis dagegmva SeiZleba garTuldes iseT situaciaSi, rodesac

pacients uWirs metyveleba. arsebobs mravali damxmare meTodi Sefasebis

Casatareblad, mag. invalidobis distres meTodi, romlis meSveobiTac

SeiZleba Sefaseba CavataroT ufro sistemuri da detaluri formiT. Tumca,

nebismieri meTodi sifrTxiliT unda iqnas gamoyenebuli da mudmivad unda

iqnas gadaxedili, raTa damowmdes maTi Sesabamisoba da sandooba mocemul

situaciaSi.

SesaZleblobis/unaris Sefaseba

did britaneTSi miRebuli mentaluri SesaZleblobis aqti (Mental Capacity Act

– MCA) miznad isaxavda paliatiuri mzrunvelobis xarisxis gaumjobesebas im

pacientebisTvis, romelTac ar SeeZloT damoukideblad gadawyvetilebis

miReba an sakuTari mzrunvelobis dagegmvaSi monawileobis miReba. es

sakiTxi gansakuTrebiT mwvaved dgas gaxangrZlivebuli nevrologiuri

mdgomareobebis dros, rodesac daavadeba iwvevs pacientis mentaluri

unaris daqveiTebas imdenad, rom mas aRar SeuZlia gadawyvetilebis miReba

sakuTar mdgomareobasTan dakavSirebiT. rodesac saxezea mentaluri unaris

cvlileba, praqtikosi eqimis roli pacientTan efeqturi komunikaciis xelis

Page 59: Neurological PC.pdf

Sewyobis mxriv matulobs (rac SemdgomSi aadvilebs gadawyvetilebis

miRebas). es ukanaskneli SeiZleba moicavdes Semdeg midgomebs:

- saubris dagegmva dasvenebis periodis Semdeg, an dRis garkveul

monakveTSi, roca pacientTan komunikaciis SesaZlebloba yvelaze

maRalia;

- dRis manZilze drois daxuruli monakveTis gamonaxva, romelic

saSualebas miscems eqims saubari waiyvanos pacientisTvis misaRebi

tempiT;

- saubris uzrunvelyofa Sesaferis garemoSi, xelisSemSleli mizezebis

gamoricxviT;

- komunikaciis gamaadvilebeli strategiis gamoyeneba da daxmareba

gadawyvetilebis miRebaSi, romelic maqsimalurad pasuxobs konkretuli

pacientis saWiroebebs.

mentaluri SesaZleblobis aqtis mixedviT, pacients ar gaaCnia sakuTar

Tavze gadawyvetilebis miRebis mentaluri unari, Tu mas ar ZaluZs:

- gadawyvetilebis miRebisaTvis saWiro informaciis gageba (aRqma);

- informaciis damaxsovreba;

- informaciis awon-dawona an misi gamoyeneba gadawyvetilebis miRebis

procesSi, an

- sakuTar gadawyvetilebaze komunikacia (saubriT, niSnebis eniT an sxva

saSualebebis gamoyenebiT).

amgvar situaciaSi praqtikosma eqimma unda gadawyvitos, unda CaiTvalos Tu

ara pacienti informaciis miRebis unaris armqoned, romelic exeba

gadawyvetilebis miRebas, an gaarkvios, SeuZlia Tu ara pacients am

informaciis gageba, Tu mas mivawvdiT misTvis gasagebi ganmartebiT da im

formiT, romelis maqsimalurad Seefereba mis situacias (mag. martivi enis,

vizualuri an sxva saSualebebis gamoyenebiT). im SemTxvevaSic ki, rodesac

pacients mxolod mcire droiT SeuZlia informaciis damaxsovreba

gadawyvetilebis miRebis Sesaxeb, es ar niSnavs imas, rom pacienti unda

CaiTvalos gadawyvetilebis miRebis unaris armqoned. eqimma unda scados

gadawyvetilebis Taobaze informaciis gadacema iseTi saxiT, rom

paralelurad miwodebuli iqnas informacia ama Tu im gadawyvetilebis

miRebis SemTxvevaSi realurad mosalodneli Sedegebis warmoSobis Sesaxeb,

an im Sedegebze, rac mohyveba gadawyvetilebis miuReblobas.

SesaZleblobisda mixedviT, procesSi CarTuli unda iqnan aseve pacientis

ojaxis wevrebi da momvlelebic.

mentaluri SesaZleblobis aqts udidesi mniSvneloba eniWeba sicocxlis

bolo stadiaze gadawyvetilebebis miRebis procesSi. rodesac arsebobs

Page 60: Neurological PC.pdf

eWvi, rom pacients ar aqvs gadawyvetilebis miRebis mentaluri unari, vinme

sxvam unda miiRos gadawyvetileba pacientis magivrad, oRond pacientis

interesebis maqsimalurad gaTvaliswinebiT. “interesebis maqsimalurad

gaTvaliswineba” gulisxmobs gadawyvetilebis miRebas sxvis magier, rodesac

eqimi an mzrunvelobis jgufi adasturebs, rom es gadawyvetileba aris

yvelaze optimaluri varianti pacientisaTvis, mocemuli garemoebebis

gaTvaliswinebiT. rodesac sakiTxi dgeba pacientis interesebis

gaTvaliswinebiT gadawyvetilebis miRebaze, logikurad unda

ganxorcieldes Semdgomi etapebi:

1. im pirTa dadgena, romlebic unda iqnan CarTuli gadawyvetilebis

miRebis procesSi da mTavari pasuxismgebelis gamovlena;

2. SeTavazebuli midgomis da mkurnalobis sxva variantebis zustad

dadgena;

3. sxvadasxva sakiTxebis mxedvelobaSi miReba diskusiisaTvis

momzadebisTvis;

4. mTavar xelmZRvanel pirebTan Sexvedra SeTavazebuli midgomis

ganxilvisaTvis;

5. miRebuli gadawyvetilebis naTlad registracia da dokumentacia.