Paraparesis ke mofuta o bobebe oa ho holofala ha karolo e tlase e bakoang ke liphatsa tsa lefutso kapa e bakoang ke vaerase. Bohloko le li-spasms li ka imoloha ka meriana, 'me phekolo ea' mele le boikoetliso li ka boloka ho sisinyeha le matla a mesifa.

Tlhaloso ea paraparesis

Paraparesis ke lentsoe la bongaka le sebelisetsoang ho bontša bofokoli bo tsoelang pele bo tsamaeang le likonteraka tsa mesifa (bofokoli ba spastic) lipheletsong tse tlaase. Ke mofuta o bobebe oa paraplegia (ho holofala ha maoto le matsoho a tlase).

Spastic paraparesis ke sehlopha sa mafu a bakoang ke mathata a lesapo la mokokotlo.

Mefuta ea paraparesis

Spastic paraparesis e ka ba lefutso kapa e bakoa ke kokoana-hloko.

Hereditary spastic paraparesis

Li arotsoe ka tse sa rarahanang (kapa tse hloekileng) le tse rarahaneng (kapa tse rarahaneng) maemong ao matšoao a khale a ho fokola ha maoto le matsoho a tsamaeang le matšoao a mang a kang:

• Cerebellar atrophy: ho fokotseha ha molumo kapa boholo ba cerebellum
• corpus callosum e tšesaane (kopano pakeng tsa li-hemispheres tse peli tsa boko)
• Ataxia: bothata ba ho tsamaisana le motsamao ka lebaka la ho senyeha ha cerebellum

Ka liphatsa tsa lefutso, paraparesis ea spastic e ka aroloa ho latela mokhoa oa bona oa phetisetso:

• E laolang: ho lekane hore ntho e sa tloaelehang e ama kopi e le 'ngoe ea lefutso bakeng sa lefu lena.
• Recessive: bothata bo tlameha ho ama likopi tse peli tsa lefutso, e 'ngoe le e' ngoe e futsitsoe ho motsoali e mong, hore lefu lena le hōle.
• X-linked: Banna, ba nang le X chromosome e le 'ngoe feela, ba tšoaroa ke lefu lena haeba ba e-na le ntho e sa tloaelehang koping ea bona e le 'ngoe ea lefutso.

Sebaka sa tropike sa spastic paraparesis

E boetse e bitsoa HTLV-1 e amanang le myelopathy, ke lefu le ntseng le hōla butle la lesapo la mokokotlo le bakoang ke kokoana-hloko ea mofuta oa 1 ea lymphotrophic T (HTLV-1).

Lisosa tsa spastic paraparesis

Hereditary spastic paraparesis e ka ba litholoana tsa mefuta e mengata ea liphatsa tsa lefutso tse sa tloaelehang kapa li ka itlhahisa ka botsona. Hona joale, ho tsejoa mefuta e 41 ea lefutso la spastic paraparesis, empa ke 17 feela eo liphatsa tsa lefutso tse ikarabellang li khethiloeng ho tsona.

Tropical spastic paraparesis e bakoa ke kokoana-hloko ea HTLV-1.

Diagnostic

Hereditary spastic paraparesis e belaelloa ka lebaka la ho ba teng ha histori ea lelapa le letšoao leha e le lefe la spastic paraparesis.

Tlhahlobo ea pele e ipapisitse le ho qheleloa ka thoko ho lisosa tse ling tse ka bang teng:

• Adrenoleukodystrophy, lefu le amanang le X le amanang le neurodegenerative
• Multiple sclerosis
• Lefu le amang upper motor neuron (primary lateral sclerosis kapa amyotrophic lateral sclerosis)
• tšoaetso ea HIV kapa HTLV-1
• Ho haella ha vithamine B12, vithamine E kapa koporo
• Spinocerebellar ataxia, lefu la neuromuscular le amang cerebellum
• Lesapo la mokokotlo arteriovenous malformation
• Hlahala ea moko oa masapo
• Cervicoarthritis myelopathy, ho fokotseha ha lesapo la mokokotlo le hatellang mohala oa popelo.

Ho fumanoa ha lefutso la spastic paresis ka linako tse ling ho etsoa ka tlhahlobo ea liphatsa tsa lefutso.

Batho ba amehang

Hereditary paraparesis e ama batho ba bong bo fapaneng ka mokhoa o sa khetheng 'me e ka etsahala ho sa tsotellehe lilemo leha e le life. E ama batho ba 3 ho isa ho ba 10 ho 100.

Lintho tse kotsi

Kotsi ea ho ba le likokoana-hloko tsa lefutso e kholoanyane haeba ho na le histori ea lelapa. Tabeng ea tropike spastic paraparesis, kotsi ea ho tšoaroa ke lefu lena e amana le kotsi ea ho pepesehela kokoana-hloko ea HTLV-1, e fetisoang ka ho kopanela liphate, tšebeliso e seng molaong ea lithethefatsi ka methapo kapa ka ho pepesehela mali. E ka boela ea fetisoa ho tloha ho 'm'a ho ea ho ngoana ka ho anyesa.

Spasticity ea maoto le matsoho a tlase

Spasticity e hlalosoa ke ho eketseha ha tonic stretch reflex, ke ho re ho fokotseha ho feteletseng ha mesifa ea reflex. E baka mesifa e phahameng haholo e ka ba sesosa sa bohloko le li-spasms, 'me e baka ho hloka matla ha litho tsa matsoho.

Khaello ea makoloi

Hangata batho ba nang le paraparesis ba na le bothata ba ho tsamaea. Li ka khoptjoa hobane li na le tšekamelo ea ho tsamaea ka menoana ea maoto, maoto a tsona a lebile ka hare. Hangata lieta li senyeha monoaneng o moholo oa leoto. Hangata batho ba na le bothata ba ho theoha litepisi kapa matsoapong, ho palama setulo kapa koloing, ho apara le ho itlhopha.

Asthenia

Asthenia ke mokhathala o sa tloaelehang ha o phehella le ka mor'a ho phomola. E baka maikutlo a ho se khone ho etsa mesebetsi ea letsatsi le letsatsi.

Mathata a proprioceptive

Ho lahleheloa ke maikutlo a boemo ba maoto le menoana

Matšoao a mang

Ka mefuta e sa rarahanang, re ka boela ra bona:

• Litšitiso tse bobebe tsa kutloelo-bohloko ea vibratory
• Matšoao a ho ntša metsi (incontinence)
• Maoto a sekoti

Ka mefuta e rarahaneng,

• Ataxia, bothata ba ho hokahanya metsamao ea methapo ea kutlo
• Amyotrophie
• Optic atrophy
• Retinopathy pigmentosa
• Ho holofala kelellong
• Matšoao a Extrapyramidal
• Dementia
• Bokooa
• Pheliso ea meriana ea mafu
• sethoathoa

Kalafo ke matšoao, ho kenyelletsa le kalafo ea ho imolla spasticity.

• Kalafo ea tsamaiso ea lithethefatsi: baclofen, dantrolene, clonazepam, diazepam, tizanidine, benzodiazepines.
• Liphekolo tsa lehae: lithibela-mafu block, botulinum chefo (targeted intromuscular), joala, opereishene (selective neurotomy)

Phekolo ea 'mele le boikoetliso bo ka thusa ho boloka ho sisinyeha le matla a mesifa, ho ntlafatsa mefuta e mengata ea ho sisinyeha le mamello, ho fokotsa mokhathala le ho thibela li-spasms.

Bakuli ba bang ba rua molemo ka ho sebelisa maqhama, molamu kapa liikokotlelo.

Bakeng sa li-paraparesia tsa tropike, litlhare tse 'maloa li ka ba molemo ho loants'a vaerase:

• Interferon alpha
• Immunoglobulin (ka methapo)
• Corticosteroids (tse kang oral methylprednisolone)

Ho qoba tšoaetso ea tropike spastic paraparesis, ho kopana le kokoana-hloko ea HTLV-1 ho lokela ho fokotsoa. E fetisoa ke:

• Ho kopanela liphate
• Tšebeliso ea lithethefatsi e seng molaong ka methapo
• Ho pepesetsoa mali

E ka fetisoa ho tloha ho 'm'a ho ea ho ngoana ka ho anyesa. E tloaelehile haholo har'a matekatse, basebelisi ba lithethefatsi ba entang, batho ba sebelisang hemodialysis le baahi ba libakeng tse itseng ho kenyeletsoa haufi le equator, boroa ho Japane le Amerika Boroa.