Ka hoʻohana kūpono o ka hoʻonani magnetic transcranial i loko o ka paʻakikī e mālama i ka maʻi maʻamau (2016)

Hōʻuluʻulu Manaʻo

Introduction

ʻO ka maʻi Hypersexual ka mea mua i kuhihewa ʻia me ka hōʻeha ʻana o ka makemake moekolohe, me kahi ʻāpana impulsivity.1] He mau hōʻailona ia e hōʻeuʻeu, hoʻoikaika, a me nā wahi hoʻohālikelike e like me ka hana mau a me ka manaʻo pili kino, nā koi ʻana, a i ʻole nā ​​ʻano, hiki ʻole i ka mālama a pani i ka moekolohe, a me ka hana hou ʻana i nā hana moekolohe i ka pili ʻana i nā hanana e pili ana.1,2] Ua wehe ʻia nā mea hoʻomau olakino serotonin, lāʻau lapaʻau antihormonal (medroxyprogesterone acetate [MPA], cyproterone acetate, gonadotropin-hoʻokuʻu i nā hila hormon), a me nā mea lapaʻau hou (naltrexone, topiramate) i hōʻike ʻia e hōʻemi i ka moekolohe i kekahi mau mea maʻi; Eia nō naʻe, ua nele ka hōʻike nui o ka hana pono.2] Ua hoʻohiki ka Transcranial magnetic stimulate (TMS) i ka mālama ʻana i nā ʻano maʻi like ʻole e pili ana i nā hana impulsive-compulsive e like me ka hoʻowalewale ʻana i ka lāʻau, ka maʻi obsessive-compulsive (OCD), a me Tourette's Syndrome.3] No ka noʻonoʻo ʻana i ka maʻi hypersexual ma luna o ka spulsive-compulsive spective, hiki i TMS ke hoʻohana pono i ka hoʻokele.

RĀKAHI KAPA

Hōʻike mākou i ka hihia o kahi keikikāne 29 makahiki i hōʻike ʻia me nā hoʻopiʻi i ka nui a me ka pale ʻole ʻana i nā koi kolohe no nā makahiki 15 i hala. E hoʻohālikelike ka mea maʻi me nā mea hoʻonaninani kūloko i ka hapa nui o ka manawa. Lā ʻo ia e hele, fridge, heluhelu i nā puke erotic, masturbate i nā manawa pinepine i ka lā, kipa aku i nā limahana hana, a e hōʻoluʻolu i ka loaʻa ʻana o nā hana moekolohe. Ua manaʻo ʻia he mea leʻaleʻa kēia mau manaʻo no nā kāne a me nā mea hoʻohiwahiwa. Aia ka hoʻonui hoʻonui hoʻonui i ka maʻamau a me ka paʻakikī o ka hōʻailona, ​​ka mea i hoʻohemo ai i ka mare ʻana a me ka hoʻopōʻino i ka hana o kēlā me kēia lā. No ka poʻe hopohopo, ua hoʻāʻo ʻo ia e hoʻopili i kāna moʻomeheu ma o ka mea ʻoi a me ka maikaʻi ʻole.

Ua ʻimi mua ka mea maʻi mai ke kūkākūkā ʻana mai nā mea mālama olakino āpau a loaʻa i nā hoʻokolohua o nā antidepresan lehulehu (fluoxetine, sertraline, clomipramine, ʻoiai me ka hoʻohui pū ʻana) no ka nui o nā hewa a me ka lōʻihi. ʻO ka hoʻāʻo ʻana me ka hoʻonui ʻana antipsychotic, ka naʻau pili naʻau, a me ka lāʻau electroconvulsive i hoʻāʻo ʻia me ka loaʻa ʻole o kahi pono nui. Ua hōʻike ʻo ia i ka holomua ma depot MPA akā ua kāpae ʻia ia ma muli o nā hopena ʻaoʻao intolerable. ʻOi kāna mōʻaukala olakino. Hoʻohui ʻia ka pākuʻikepili tomografi o ka lolo a me nā assays hormonal (nā hoʻokolohua hana thyroid, ka pae prolactin, pae cortisol, a me nā pae androgen) he mea maʻamau. Ua hana ʻia kahi hōʻike o ka hana moʻo ʻana (ICD-10 F52.7). Paha ʻo ia i ke 109 ma ka 14-item mea moʻo i loko o ka hanana (SDI) a me 40 ma 10-item mea hana ulu (SCS); ka pae pae kūpono loa ma nā pae unahi. ʻAʻole makemake ka mea maʻi no ka lāʻau hormonal ma muli o nā hanana ʻino i hala. Ua kau ʻia ʻo ia iā escitalopram (a hiki i 20 mg / lā). Hoʻowili ʻia nā ʻano naʻau olakino e like me ka hoʻonohonoho ʻana o nā hana i kēlā me kēia lā, hana hoʻomaha, a me ka noʻonoʻo noʻonoʻo ʻana. ʻOiai ʻaʻohe holomua koʻikoʻi ma luna o nā hana e hoʻomau nei, ua hoʻolālā ʻia ka repetitive-TMS (rTMS) no ka hoʻonui ʻia ʻana o ka mālama ʻana. Ua wehewehe ʻia ka lāʻau lapaʻau iā ia, a ua loaʻa ke ʻae ʻia i kākau ʻia. Ua hoʻoholo ʻia ka paepae holo kaʻa (RMT), a ua mālama ʻia ʻo 1 Hz TMS ma 80% o RMT ma luna o ka wahi no ka mīkini hoʻohui (SMA) e hoʻohana ana i ka ʻōnaehana ʻo MAX (X-30) TMS (pūnaha medicaid). I ka pae o ka hoʻokaumaha ma ka hana o ka ʻelua o ka lima kanalima a me ka posterior ʻekolu-lima (e like me ke International 10 / 20 System of electrode placement) o ka ka huhū nasion-inion ma ka waena waena. ʻO kēlā me kēia papa mālama i ke ʻano o nā kaʻa o 14 he kanawalukū pākahi pākahi me kēlā me kēia 5 kekona waena o ke kaʻa kaʻa i hāʻawi ʻia ma 19 mau minuke, e hāʻawi ana i ka nui o nā pūkana / 1120. Ua hōʻike ʻia ma nā hālāwai he 22, ma mua o 4 mau pule i hala. Loaʻa ka holomua nui o kāna mau hōʻailona. Loaʻa iā ia kahi hoʻomalu maikaʻi aʻe i kāna mau moekolohe a ke emi iho nei ka pinepine o ka masturbation. Ma kahi e pili ana i ka hōʻemi ʻana o 90% ma nā helu SDI a me SCS ma luna o ka manawa 4-pule ma ka manawa rTMS a me ka ʻoihana ʻoihana. Ke hoʻomau nei ka hoʻomaikaʻi ʻana a hiki i ka helu ʻana o 3 i ka manawa e emi nui ai ka noʻonoʻo ʻana o nā manaʻo noʻonoʻo a hoʻomaka hou kāna hana.

KA HOOHOLO

Hiki i nā maʻi hypersexual i lalo o nā underpinnings neurobiological e like me nā maʻi spulsive-compulsive ʻokoʻa hou kahi i hōʻike ʻia ai nā maʻi o ka cortical-striatal-thalamic-cortical (CSTC).4] Ma ka CSTC loiloi, nā wahi cortical ʻokoʻa (e like me ka dorsolateral prefrontal cortex, SMA, orbitofrontal cortex, medial prefrontal cortex, a anterior cingulate gyrus) pili me nā ʻāina neurocognitive ʻokoʻa.4,5] Ua hōʻike ʻia nā Kula he mau hana ākea ākea me nā wahi ʻē aʻe o ka lolo i pili i nā kaʻina cognitive a me ka hoʻokele kaʻa. Eia nō, ua hōʻike ʻia ka hulahula pālua ʻo SMA i nā maʻi e hōʻeha ʻia ana i ka OCD. Ua hōʻike hou nā haʻawina i ka hoʻemi ʻana o ka hoʻoponopono cortico-subortortical a me ka hoʻonui nui ʻana i ka cortical excitability e hoʻokau i ke ʻāpana i nā ʻano hana.6,7] Ua hōʻike ʻia ʻo rTMS e pili ana i kēia pūlaki (ka hona maoli no ka SMA) i ka hoʻohaʻahaʻa ʻana i nā ʻano hoʻohālikelike i nā mea maʻi OCD, a ʻo nā mea kikowaena lalo e pili ana i ka hopena pōmaikaʻi i kā mākou mea maʻi.6]

ʻO TMS kahi palekana palekana e mālama ai. Ma kahi o 5% nā maʻi e hoʻopiʻi e pili ana i kekahi mau hanana ʻino e like me ke poʻo a me ka maʻi nausea, ma hope o ka hōʻike ʻana o TMS.8] ʻO nā mea maʻi me nā implant metallic (nā peʻa aneurysmal, nā mea kanu cochlear) a me ka pacemaker e pono e makaʻala e like me ka hoʻololi ʻana i ka hana a ke kumu no ka hoʻopilikia kino ʻana.9] ʻO ka Seizure kahi hopena maikaʻi loa ia me TMS, ʻike ʻia i nā mea maʻi e hoʻohana ana i nā lāʻau lapaʻau e hoʻohaʻahaʻa ana i ko lākou paepae hoʻoo.9]

ʻO kēia, i ka maikaʻi loa o kā mākou ʻike, ka hōʻike ʻokoʻa i hōʻike ʻia i ka pono o ka RTMS i ka maʻi kuko hypersexual. I kā mākou hihia, he maikaʻi ʻo TMS i ke kāohi ʻana i ka paʻakikī o ka mālama ʻana i nā hōʻailona hypersexual me ka palekana. No laila, hiki i ka TMS ke noʻonoʻo i kahi koho mālama maʻi i nā maʻi me ka maʻi hypersexual.

E hoʻomaopopo '