S\u00ebmundja e Parkinsonit \u00ebsht\u00eb nj\u00eb s\u00ebmundje q\u00eb prek kryesisht l\u00ebvizshm\u00ebrin\u00eb. L\u00ebvizjet e pacientit jan\u00eb t\u00eb ngadalta (deri n\u00eb pal\u00ebvizshm\u00ebri t\u00eb plot\u00eb ve\u00e7an\u00ebrisht n\u00eb fazat e avancuara t\u00eb s\u00ebmundjes ose kur pacienti \u00ebsht\u00eb n\u00eb hap\u00ebsira t\u00eb mbyllura), muskujt jan\u00eb t\u00eb ngurt\u00eb (ngurt\u00ebsi) dhe n\u00eb pacient\u00ebt 90% shfaqet nj\u00eb dridhje (dridhje) karakteristike n\u00eb. gjymtyr\u00ebt e sip\u00ebrme dhe t\u00eb poshtme por edhe n\u00eb kok\u00eb (nofulla e poshtme, gjuha, buz\u00ebt), sidomos kur \u00ebsht\u00eb n\u00eb pushim. Zakonisht ka nj\u00eb pamje pa shprehje, "t\u00eb ngrir\u00eb" si mask\u00eb, dhe klithmat zvog\u00eblohen. Fjalimi \u00ebsht\u00eb monoton, prozodia humbet dhe v\u00ebllimi i z\u00ebrit \u00ebsht\u00eb i ul\u00ebt. Pacienti ndryshon dor\u00ebshkrimin dhe shkruan me shkronja t\u00eb vogla. Dhe themi se \u00ebsht\u00eb \u201ckryesisht\u201d nj\u00eb \u00e7rregullim l\u00ebvizjeje sepse s\u00ebmundja (si s\u00ebmundje neurodegjenerative) shfaq edhe t\u00eb ashtuquajturat simptoma jo motorike si dhimbje, \u00e7rregullime t\u00eb kujtes\u00ebs q\u00eb arrijn\u00eb deri te \u00e7menduria n\u00eb fazat m\u00eb t\u00eb avancuara apo disa element\u00eb psikotik\u00eb si p.sh. si dhe shqet\u00ebsime t\u00eb nuhatjes tashm\u00eb n\u00eb fazat e hershme. Simptoma t\u00eb tjera jan\u00eb ng\u00ebr\u00e7et, depresioni por edhe shum\u00eb ankth, \u00e7rregullime t\u00eb gjumit si dhe disa \u00e7rregullime t\u00eb Sistemit Nervor Autonom q\u00eb mund t\u00eb b\u00ebhen shum\u00eb t\u00eb vazhdueshme dhe shqet\u00ebsuese (si\u00e7 \u00ebsht\u00eb hipotensioni ortostatik i r\u00ebnduar nga mjekimi me L-Dopa).<\/p>\n
Megjithat\u00eb, pacienti do t'i drejtohet neurologut kryesisht p\u00ebr shkak t\u00eb simptomave motorike t\u00eb s\u00ebmundjes. Ekzaminimi i par\u00eb i pacientit, me simptoma q\u00eb ai mund t\u00eb ankohet ose jo, dhe q\u00eb duhet t\u00eb merret n\u00eb pyetje ose t\u00eb gjendet nga neurologu, zgjat t\u00eb pakt\u00ebn nj\u00eb or\u00eb. Diagnoza e s\u00ebmundjes \u00ebsht\u00eb thjesht klinike dhe n\u00eb shum\u00eb raste nevojitet ndjekja e rregullt e pacientit p\u00ebr disa muaj p\u00ebr t\u00eb kontrolluar p\u00ebrgjigjen e tij ndaj trajtimit dhe q\u00eb neurologi t\u00eb fus\u00eb n\u00eb m\u00ebnyr\u00eb t\u00eb sigurt diagnoz\u00ebn e "s\u00ebmundjes s\u00eb Parkinsonit". dosjen e pacientit.<\/p>\n
Besoj se diagnoza e s\u00ebmundjes, planifikimi korrekt afatgjat\u00eb i nj\u00eb strategjie p\u00ebr p\u00ebrballimin e saj si dhe komplikacionet e barnave dhe polifarmacis\u00eb bashk\u00ebekzistuese, por edhe manifestimet e saj p\u00ebrkeq\u00ebsuese me p\u00ebrparimin e s\u00ebmundjes, e b\u00ebjn\u00eb s\u00ebmundjen e Parkinsonit nj\u00eb nga s\u00ebmundjet m\u00eb t\u00eb v\u00ebshtira dhe k\u00ebrkuese me t\u00eb cilat duhet t\u00eb p\u00ebrballet neurologu klinik n\u00eb praktik\u00ebn e p\u00ebrditshme. Pacienti, duke u ndjer\u00eb i bllokuar n\u00eb trupin e tij, pret shum\u00eb nga mjeku kurues, po ashtu edhe t\u00eb af\u00ebrmit. N\u00eb nj\u00eb s\u00ebmundje t\u00eb till\u00eb lindin shum\u00eb probleme t\u00eb vogla por edhe t\u00eb m\u00ebdha t\u00eb p\u00ebrditshme p\u00ebr t\u00eb cilat duhen dh\u00ebn\u00eb zgjidhje t\u00eb thjeshta, gj\u00eb q\u00eb shpesh b\u00ebhet mjaft e v\u00ebshtir\u00eb.<\/p>\n
S\u00ebmundja karakterizohet gjithashtu nga simptoma gastrointestinale si p\u00ebshtym\u00eb (n\u00eb m\u00eb shum\u00eb se gjysm\u00ebn e pacient\u00ebve), disfagi, nauze dhe kapsll\u00ebk. Deri n\u00eb 25% pacient\u00eb vuajn\u00eb nga nauze dhe t\u00eb vjella, nd\u00ebrsa 45% prej tyre ankohen p\u00ebr \u201cfryrje\u201d. K\u00ebto simptoma zakonisht jan\u00eb mjaft t\u00eb bezdisshme dhe shqet\u00ebsojn\u00eb pacientin q\u00eb merr masa vet\u00eb-leht\u00ebsuese, ve\u00e7an\u00ebrisht kur b\u00ebhet fjal\u00eb p\u00ebr kapsll\u00ebk q\u00eb mund t\u00eb jet\u00eb burim stresi i tepruar p\u00ebr pacientin. Mosfunksionimet e sistemit gastrointestinal, p\u00ebrve\u00e7 shqet\u00ebsimit subjektiv q\u00eb shkaktojn\u00eb, mund t\u00eb luajn\u00eb nj\u00eb rol edhe n\u00eb humbjen e pesh\u00ebs q\u00eb p\u00ebrjetojn\u00eb t\u00eb s\u00ebmur\u00ebt. Nj\u00eb meta-analiz\u00eb e vitit 2012 nga van der Marck et al., e 12 studimeve t\u00eb publikuara dhe gjithsej 812 pacient\u00ebsh, zbuloi se pacient\u00ebt me s\u00ebmundjen e Parkinsonit kishin nj\u00eb indeks t\u00eb mas\u00ebs trupore (BMI) m\u00eb t\u00eb ul\u00ebt n\u00eb krahasim me kontrollet e sh\u00ebndetshme. Pesha e ul\u00ebt trupore dhe p\u00ebr rrjedhoj\u00eb BMI e ul\u00ebt v\u00ebrehet ve\u00e7an\u00ebrisht n\u00eb stadet m\u00eb t\u00eb avancuara t\u00eb s\u00ebmundjes. K\u00ebshtu, pacient\u00ebt q\u00eb jan\u00eb n\u00eb faz\u00ebn 2 t\u00eb shkall\u00ebs Hoehn & Yahr kan\u00eb nj\u00eb BMI rreth 25, nd\u00ebrsa n\u00eb faz\u00ebn 3 indeksi p\u00ebrkat\u00ebs \u00ebsht\u00eb n\u00ebn 22. Edhe pse nuk \u00ebsht\u00eb e qart\u00eb pse shkaktohet r\u00ebnia n\u00eb pesh\u00eb, faktor\u00eb t\u00eb till\u00eb si diskinezia, disfagjia. , dyshohet p\u00ebr hiposmi ose anosmi, anoreksi t\u00eb p\u00ebrgjithshme dhe rritje t\u00eb k\u00ebrkesave p\u00ebr energji.<\/p>\n
Nj\u00eb nga simptomat e sistemit gastrointestinal \u00ebsht\u00eb disfagia, si\u00e7 \u00ebsht\u00eb p\u00ebrmendur tashm\u00eb. Disfagia ka t\u00eb b\u00ebj\u00eb kryesisht me faz\u00ebn orofaringeale t\u00eb g\u00eblltitjes \u2013 vet\u00ebm mendoni se nj\u00eb p\u00ebrqindje e pacient\u00ebve kan\u00eb dridhje n\u00eb gjuh\u00eb, buz\u00eb dhe nofull\u00ebn e poshtme. Dihet se disfagjia n\u00eb p\u00ebrgjith\u00ebsi ndikon n\u00eb cil\u00ebsin\u00eb e jet\u00ebs s\u00eb pacient\u00ebve me s\u00ebmundjen e Parkinsonit dhe rrit qart\u00eb rrezikun e aspirimit dhe pneumonis\u00eb. Por s\u00eb pari, sa e zakonshme \u00ebsht\u00eb disfagia? Nj\u00eb meta-analiz\u00eb nga Kalf et al gjeti disfagi n\u00eb nj\u00eb t\u00eb tret\u00ebn e pacient\u00ebve me k\u00ebt\u00eb s\u00ebmundje. Pacient\u00ebt kan\u00eb tre her\u00eb m\u00eb shum\u00eb gjasa t\u00eb ken\u00eb \u00e7rregullime t\u00eb g\u00eblltitjes sesa individ\u00ebt e sh\u00ebndetsh\u00ebm. Sa m\u00eb e avancuar t\u00eb jet\u00eb s\u00ebmundja, aq m\u00eb e madhe \u00ebsht\u00eb mund\u00ebsia e disfagjis\u00eb. Prandaj, kur nj\u00eb pacient tregon disfagji q\u00eb n\u00eb fazat e hershme t\u00eb s\u00ebmundjes, neurologu klinik duhet t\u00eb marr\u00eb parasysh edhe sindromat e mundshme atipike parkinsoniane. Dhe kjo p\u00ebr shkak se n\u00eb Atrofin\u00eb e Sistemit t\u00eb Shum\u00ebfisht\u00eb (MSA) ose Paraliz\u00ebn Progresive Supranukleare (PSP) ndodh disfagia p\u00ebrkat\u00ebsisht n\u00eb 73% dhe 83%. Gjithashtu, disfagjia n\u00eb s\u00ebmundjen e Parkinsonit \u00ebsht\u00eb zakonisht m\u00eb e leht\u00eb sesa n\u00eb sindromat atipike parkinsoniane ose s\u00ebmundje t\u00eb tjera neurodegjenerative.<\/p>\n
M\u00eb rrall\u00eb, disfagia mund t\u00eb shoq\u00ebrohet me mosfunksionim t\u00eb ezofagut, si kalimi i ngadalt\u00eb i ushqimit n\u00ebp\u00ebr ezofag ose mosfunksionimi i sfinkterit t\u00eb posht\u00ebm t\u00eb ezofagut. Nuk dihet n\u00ebse disfagjia nga mosfunksionimi i ezofagut \u00ebsht\u00eb nj\u00eb n\u00ebnprodukt i s\u00ebmundjes ose mosh\u00ebs dhe n\u00ebse ajo ka t\u00eb nj\u00ebjt\u00ebn prevalenc\u00eb tek joparkinson\u00ebt e p\u00ebrputhur me mosh\u00ebn. Megjithat\u00eb, raportohet deri n\u00eb nj\u00eb p\u00ebrqindje prej 60-70% t\u00eb pacient\u00ebve me parkinson, sipas Pfeiffer n\u00eb nj\u00eb studim t\u00eb vitit 2011.<\/p>\n
Disfagjia n\u00eb s\u00ebmundje mund t\u00eb jet\u00eb subklinike dhe manifestohet p.sh. me p\u00ebrtypje t\u00eb ngadalt\u00eb dhe t\u00eb kujdesshme. Ndonj\u00ebher\u00eb mund t\u00eb mos jet\u00eb e dukshme p\u00ebr shkak t\u00eb sasis\u00eb minimale t\u00eb ushqimit t\u00eb konsumuar nga pacient\u00ebt. Gjithashtu, ata shpesh mund t\u00eb pin\u00eb nj\u00eb sasi t\u00eb vog\u00ebl l\u00ebngu me vaktin e tyre p\u00ebr t\u00eb ndihmuar g\u00eblltitjen. Nga ana tjet\u00ebr, pacient\u00ebt e moshuar, si\u00e7 \u00ebsht\u00eb rasti me s\u00ebmundjen e Parkinsonit, mund t\u00eb pranojn\u00eb pa ankesa v\u00ebshtir\u00ebsit\u00eb e p\u00ebrtypjes dhe g\u00eblltitjes, duke ia atribuar pleq\u00ebris\u00eb. Klinikisht disfagia mund t\u00eb manifestohet me v\u00ebshtir\u00ebsi n\u00eb fillimin e g\u00eblltitjes, me refluks nazal t\u00eb l\u00ebngjeve por edhe me koll\u00eb t\u00eb shpesht\u00eb dhe t\u00eb bezdisshme menj\u00ebher\u00eb pas g\u00eblltitjes. Pacient\u00ebt thjesht mund t'i raportojn\u00eb mjekut se nuk mund t\u00eb g\u00eblltisin ila\u00e7et e tyre, ve\u00e7an\u00ebrisht n\u00ebse jan\u00eb jasht\u00eb faz\u00ebs gjat\u00eb dit\u00ebs.<\/p>\n
<\/p>\n
Disfagia q\u00eb \u00e7on n\u00eb mbytje dhe aspirim mund t\u00eb \u00e7oj\u00eb gjithashtu n\u00eb pneumoni aspirative. N\u00eb nj\u00eb seri prej 252 pacient\u00ebsh me s\u00ebmundje dhe inhalacione, 10% prej tyre zhvilluan pneumoni. Dhe pneumonia (jo posa\u00e7\u00ebrisht pneumonia e aspirat\u00ebs) dihet se \u00ebsht\u00eb shkaku kryesor i vdekjes n\u00eb pacient\u00ebt me Parkinson. Megjithat\u00eb, n\u00eb p\u00ebrgjith\u00ebsi, ka s\u00ebmundje dhe gjendje neurologjike q\u00eb jan\u00eb shkaktar\u00eb t\u00eb mbytjes, aspirimit dhe pneumonis\u00eb. T\u00eb tilla jan\u00eb lezionet e nervit vagus (kund\u00ebrlateral ose dypal\u00ebsh), miopatit\u00eb dhe s\u00ebmundjet e sinaps\u00ebs neuromuskulare (miasthenia) ose S\u00ebmundja e Neuronit Motorik.<\/p>\n
P\u00ebr m\u00eb tep\u00ebr, lezione n\u00eb traktin medular q\u00eb prekin b\u00ebrtham\u00ebn e tuf\u00ebs solitare ose infarktet medulare an\u00ebsore n\u00eb goditje ose tumore t\u00eb trungut ose lezione t\u00eb tipit siringomieli ose syringopromecia. G\u00eblltitja e pakoordinuar shkaktohet edhe nga s\u00ebmundje q\u00eb nd\u00ebrpresin lidhjen kortikale dhe protuberane, si paraliza pseudoprometike, ose nga goditjet e m\u00ebdha hemisferike. T\u00eb gjitha k\u00ebto shkaqe t\u00eb mundshme t\u00eb d\u00ebmtimit duhet t\u00eb merren parasysh n\u00ebse disfagia ose shfaqet si nj\u00eb simptom\u00eb e re ose disfagia para-ekzistuese p\u00ebrkeq\u00ebsohet me shpejt\u00ebsi te pacient\u00ebt me s\u00ebmundjen e Parkinsonit.<\/p>\n
<\/p>\n
BIBLIOGRAFI
\n\u2013 Heetun ZS, Quigley EMM. Gastroparesis dhe s\u00ebmundja e Parkinsonit: Nj\u00eb p\u00ebrmbledhje sistematike. Parkinsonizmi dhe \u00e7rregullimet e lidhura me to 18 (2012): 433-440<\/p>\n
\u2013 Kalf JG, Swart BJM, Bloem BR, Munneke M. Prevalenca e disfagjis\u00eb orofaringeale n\u00eb Parkinson? S\u00ebmundja: Nj\u00eb meta-analiz\u00eb. Parkinsonizmi dhe \u00e7rregullimet e lidhura 18 (2012): 311-315<\/p>\n
\u2013 Pfeiffer RF. Mosfunksionimi gastrointestinal n\u00eb s\u00ebmundjen e Parkinsonit. Parkinsonizmi dhe \u00e7rregullimet e lidhura me to 17 (2011): 10-15<\/p>\n
\u2013 Van der Marck, MA, Dicke HC, Uc EY, Kentin ZHA et al. Indeksi i mas\u00ebs trupore n\u00eb s\u00ebmundjen e Parkinsonit: Nj\u00eb meta-analiz\u00eb. Parkinsonizmi dhe \u00e7rregullimet e lidhura 18 (2012): 263-267<\/p>\n
\u2013 Silbergleit AK, LeWitt P, Junn F, Schultz LR et al. Krahasimi i disfagjis\u00eb para dhe pas stimulimit t\u00eb thell\u00eb t\u00eb trurit n\u00eb s\u00ebmundjen e Parkinsonit. \u00c7rregullimet e l\u00ebvizjes 27, Numri 14 (2012): 1763- 1768<\/p>\n
\u2013 Asahi T, Inoue Y, Hayashi N, Araki K et al. Zbutja e disfagjis\u00eb pas stimulimit t\u00eb thell\u00eb t\u00eb trurit: rezulton nga nj\u00eb pacient me s\u00ebmundjen e Parkinsonit. \u00c7rregullimet e l\u00ebvizjes 27, Numri 2 (2012): 1763- 1768<\/p>\n
\u2013 Mendenopoulos G, Bouras K. S\u00ebmundja e Parkinsonit. University Studio Press, Selanik 2008. \u2013 Adams and Victor?s. Neurologjia. Pashalidi i 2-t\u00eb, 2003.<\/p>","protected":false},"excerpt":{"rendered":"
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