PARKINSON KASALLIGINING IV BOSQICH TREMOR-RIGID SHAKLIDA IKKI TOMONLAMA TALAMIK MIYA CHUQUR STIMULYATSIYASI: MULTIMODAL KLINIK VA STEREOTAKTIK BAHOLASH BILAN KLINIK HOLAT
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Parkinson kasalligi, DBS, miyaning chuqur stimulyatsiyasi, talamus, ventrolateral yadro, tremor, rigidlik, stereotaksiya, MDS-UPDRS, neyromodulyatsiya##article.abstract##
Kirish. Miyaning chuqur stimulyatsiyasi (deep brain stimulation, DBS) Parkinson kasalligida dori vositalari bilan yetarli nazorat qilinmaydigan tremor, motor fluktuatsiyalar va rivojlangan harakat buzilishlarida qo‘llaniladigan zamonaviy funksional neyroxirurgik davolash usulidir. Ushbu maqolada 1968-yilda tug‘ilgan, 2016-yildan buyon Parkinson kasalligi bilan kasallangan ayol bemorning klinik holati keltirilgan. Klinik manzarada tinch holatdagi va aralash tremor, gipokineziya, mushak rigidligi, gipomimiya, plastik gipertonus, “oyoqlarning yerga yopishib qolishi” fenomeni, postural beqarorlik, propulsiya, retropulsiya va lateropulsiya ustun bo‘lgan. Hoehn–Yahr bo‘yicha kasallik IV bosqichga, Karnofsky shkalasi bo‘yicha funksional holat 70 ballga to‘g‘ri kelgan.
Klinik holat. Ko‘p komponentli antiparkinsonik terapiyaga qaramay motor buzilishlar kuchaygani sababli 2025-yil 28-avgustda talamusning orqa ventrolateral yadrolari proyeksiyasiga ikki tomonlama DBS elektrodlari implantatsiyasi bajarilgan. Zamorano–Duchovny stereotaktik ramasi, MSKT-DICOM ma’lumotlari va Medtronic DBS navigatsiya dasturidan foydalanilgan. Elektrodlar frontal-parietal freza teshiklari orqali implantatsiya qilinib, C-arm yordamida nazorat qilingan va o‘ng ko‘krak sohasiga joylashtirilgan impuls generatoriga ulangan. Natijalarni baholash uchun MDS-UPDRS, Hoehn–Yahr, PDQ-39, MoCA, Berg Balance Scale, Timed Up and Go va funksional mustaqillik ko‘rsatkichlaridan foydalanilgan.
Xulosa. Ushbu klinik holat rivojlangan Parkinson kasalligida tibbiy davoga rezistent tremorni nazorat qilish uchun ikki tomonlama talamik DBSning amaliy ahamiyatini ko‘rsatadi.
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