Ukusetshenziswa okuphumelelayo kokugqugquzela amagnetic ukudlulisa amandla kunzima ukuphatha isifo se-hypersexual (2016)

. I-2016 Jul-Sep; I-9 (3): 207-209.

doi:  10.4103 / 0974-1208.192074

I-PMCID: PMC5070404

abstract

I-Hypersexual disorder ine-phenomenological efana nokuphazamiseka okungabonakali okukhona emzimbeni. I-Inhibitory repetitive transcranial magnetic stimulation (rTMS) ngaphezulu kwendawo yezimoto ezingezelelweyo (i-SMA) kutholakale ukuthi isebenza kahle ekuphathweni kokuziphatha okungaphoqeleli. I-Inhibitory rTMS ngaphezulu kwe-SMA ingahle ibe wusizo ekulweni ne-hypersexual disorder. Sigcizelela lapha icala lokuphazamiseka kwengqondo okuyi-hypersexual disorder (i-drive ngokweqile yocansi) ehlulekile ukuphendula ngokwanele ekwelashweni kwe-pharmacological okwejwayelekile futhi yaphendula nge-rTMS augmentation.

AMAZWI OKUQALA: I-Hypersexual disorder, ukuphindaphindwa kwe-transcranial stimulation kazibuthe, indawo eyengeziwe yezimoto

ISINGENISO

I-Hypersexual disorder ngokuyinhloko ibonwa njengengqondo yokuphazamiseka kwesifiso sobulili, esinengxenye yokuphoqelelwa. [] Inezimpawu ezisetshenziselwa ukubusa okucindezelayo, okuphoqayo, kanye nokulutha okufana nemicabango yocansi ejwayelekile futhi eqinile, ukunxusa, noma ukuziphatha, ukungakwazi ukulawula noma ukumisa ukuziphatha kocansi, nokuphindelela ukubandakanyeka ekuziphatheni kocansi ukunganaki ubungozi obuhlobene. [,] Ukukhetha i-serotonin reuptake inhibitors, imishanguzo ye-antihormonal (medroxyprogesterone acetate [MPA], cyproterone acetate, gonadotropin-ukukhulula ama-analog amahhashi), namanye ama-pharmacological agents (naltrexone, topiramate) aboniswe ukuthi anciphise ukusebenza kwezocansi kwezinye iziguli; noma kunjalo, ubufakazi obukhulu bokuthi uyasebenza buhle bukhona. [I-Transcranial magnetic stimulation (TMS) ikhombise isethembiso ekuphathweni kwezinkinga ezahlukahlukene ezibandakanya ukwakheka okungaphoqelekile njengokulutha izidakamizwa, ukuphazamiseka okucindezelayo (OCD), neTourette's syndrome. [] Uma kucatshangelwa ukuphazamiseka kwe-hypersexual ku-spectrum engaphoqeleli, i-TMS ingaba wusizo ekuphathweni.

UMBIKO WEKHAYA

Sibika udaba lowesilisa oneminyaka engu-29 owethule ngezikhalazo zesifiso sobulili esinamandla nesingalawuleki seminyaka edlule ye-15. Isiguli sizoba matasa ngemibono emibi ehlanekezelwa isikhathi esiningi. Wayevame ukuxoxa, efulethi, afunde izincwadi ezingasho lutho, enze indlwabu kaningi ngosuku, avakashele abasebenza ngocansi futhi azizwe ekhululeke ngokuzibandakanya ocansini. Wayenomuzwa wokuthi le micabango nezocansi ziyamjabulisa, kepha zibe zimbi kanye nemiphumela emibi. Kwakukhona ukwanda kancane kancane kokuvama nezimpawu zezimpawu, ezazibangela ukushada kanye nokulimazeka ekusebenzeni kwansuku zonke. Ngokuphelelwa yithemba, wake wazama ukukhumuzisa ubulili bakhe ngezikhali ezibukhali, kepha wangaphumelela.

Isiguli besivele sifunana nokubonisana nabanikezeli bezempilo abaningi futhi sathola izivivinyo zama-antidepressants amaningi (i-fluoxetine, i-sertraline, i-clomipramine, iyodwa futhi ihlanganiswa) ukuthola imithamo eyanele nobude besikhathi. Imizamo nge-antipsychotic augmentation, ukungenelela kwengqondo, kanye ne-electroconvulsive therapy nayo izamile ngaphandle kokuthola usizo olubalulekile. Ukhombise ukuthuthuka kwi-depa MPA kepha wayeka ngenxa yemiphumela emibi engabekezeleleki. Umlando wakhe wezokwelapha wawungenakunyulwa. Ukuhlolwa kwe-compact tomography kobuchopho nokuhlolwa kwe-hormonal (ukuhlolwa kokusebenza kwe-thyroid, izinga le-prolactin, izinga le-cortisol, namazinga e-androgen) bekujwayelekile. Kwatholakala ukuxilongwa kwe-sex drive ngokweqile (ICD-10 F52.7). Ushaye i-109 ku-14-intfo yesifiso sobulili yokusungula (i-SDI) ne-40 kusilinganiso se-10-nto sexiviveity (SCS); izikolo ezitholakalayo eziphezulu kuzo zombili izikali. Isiguli besingafuni ukwelashwa ngama-hormone ngenxa yemihelo eyedlule edlule. Wayenqunywe i-escitalopram (kuze kufike ku-20 mg / ngosuku). Ukungenelela kwengqondo njengokuhlela kwemisebenzi yansuku zonke, ukuzivocavoca ukuphumula, nokuzindla kwengqondo kwenziwa. Njengoba kungekho kuthuthukiswa okukhulu ekwelashweni okuqhubekayo, kuhlelwa ukuphindaphinda-TMS (rTMS) okwenyuselwe ukwelashwa. Wachazelwa inqubo yokwelapha, kwatholakala imvume ebhaliwe. Umkhawulo we-motor resting (RMT) unqunywe, kwathi i-1 Hz TMS kwa-80% ye-RMT yalawulwa ngaphezulu kwendawo yokungezelela yemoto (SMA) kusetshenziswa uhlelo lwe-MediStim (MS-30) TMS therapy (uhlelo lweMedicaid). Isiza sokuqina sasisekuhlanganeni kwe-anterior ezimbili-nanhlanu kanye ne-posterior ezintathu-ezinhlanu (ngokuya nge-International 10 / 20 System of nokubekwa kwama-electrode) yebanga le-nasion-inion maphakathi ne-midline. Isikhathi ngasinye sokwelashwa sasiqukethe izitimela ezingama-14 zamadwala angamashumi ayisishiyagalombili ngalinye elinemizuzwana engu-5 yesikhathi sokuphumula sesitimela elethwe ngaphezulu kwemizuzu ye-19, linikeza ingqikithi ye-1120 pulses / session. Inani eliphelele lamaseshini we-22, ngaphezulu kwamaviki e-4 alandelana alethwa. Kwakukhona ukuthuthuka kancane kancane kwezimpawu zakhe. Wayenokulawula okungcono imicabango yakhe yezocansi futhi imvamisa yokushaya indlwabu iyancipha. Kwakukhona cishe ukuncishiswa kwe-90% kuma-SDI nama-SCS ngaphezulu kwesonto se-4-isonto ku-rTMS kanye ne-pharmacotherapy efanayo. Ukuthuthuka kwaqhubeka kuze kulandele izinyanga ze-3 lapho imvamisa yemicabango yocansi yehliswe kakhulu futhi waphinda umsebenzi wakhe.

UKUKHULUMA

Isifo i-Hypersexual disorder singase sibe nokufikelwa kokuphazamiseka kwengqondo okufana nezinye iziphikisi ezibukwayo ezingaphoqeleli lapho ukungasebenzi kahle komjikelezo we-cortical-striatal-thalamic-cortical (CSTC) sekukhonjisiwe. [] Ku-CSTC loop, izindawo ezihlukile ze-cortical (ezinjenge-dorsolateral prewardal cortex, SMA, orbitof Pambal cortex, indort preortal cortex, ne-anterior cingulate gyrus) ezihambisana nezizinda ezihlukile ze-neurocognitive. [,] I-SMA ikhonjiswe ukuthi inokuxhumana okugcwele okukhona nezinye izindawo zobuchopho ezibandakanyeka kwinqubo yokuqonda nokulawula izimoto. Ngaphezu kwalokho, ukuxhumana okuguquliwe kwe-SMA kubonisiwe kwiziguli ezihlushwa i-OCD. Ucwaningo luphakamisa ukuthi kuncishiswe umthethonqubo we-cortico-subcortical futhi kwandise ne-cortical excitability ukubamba iqhaza ekuziphatheni okuphindaphindayo. [,] Ama-rTMS abhekiswe kule loop (ikakhulukazi kwi-SMA) akhonjiswe ukuthi anciphise ukuziphatha okuphoqelelayo ezigulini ze-OCD, futhi inqubo efanayo eyisisekelo ingaba nesibopho somphumela omuhle kwiziguli zethu. []

I-TMS yindlela evamile yokwelashwa. Cishe iziguli ze-5% zingakhalaza ngemicimbi ethile emibi efana nokuqaqanjelwa yikhanda kanye nenausea, kulandela iseshini ye-TMS. [] Iziguli ezifakelwa insimbi (iziqeshana ze-aneurysmal, ukufakwa kwe-cochlear) kanye ne-pacemaker zidinga ukuqashelwa njengoba amandla kazibuthe angashintsha ukusebenza kwawo noma angadala ukulimala kwezicubu. [] Ukuthathwa kungumphumela omubi kakhulu we-TMS, kungabonakala ezigulini zisebenzisa umuthi okwehlisa umkhawulo wazo wokubamba.]

Lokhu, ngokolwazi lwethu lonke, umbiko wokuqala oqokomisa ukusebenza kwe-rTMS ekuphazamisekeni kwesifiso kwe-hypersexual. Kithina, i-TMS ibisebenza ngempumelelo ekucindezeleni ubunzima bokwelapha izimpawu ze-hypersexual ngokuphepha. Ngakho-ke, i-TMS ingabhekwa njengendlela yokwelashwa ezigulini ezine-hypersexual disorder.

Ukwesekwa kwezezimali nokuxhaswa

Nil.

Izingxabano zesithakazelo

Azikho izingxabano zentshisekelo.

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