Cannabis nyob rau hauv Parkinson's Disease - Tus Neeg Mob Txoj Kev Pom Zoo rau Kev Tshawb Fawb Txog Kev Kho Mob: Kev Tshawb Fawb Txog Kev Sau Ntawv Ntu 2

Cov tsos mob tsis yog lub cev muaj zog ntawm PDSleep

Cov khoom lag luam cannabis tau nquag tshawb xyuas txog teeb meem pw tsaug zog hauv cov teeb meem sib txawv. Cov neeg mob PD feem ntau (c.80% nyob rau theem lig) yws txog kev pw tsaug zog tsis zoo. Lawv txoj kev kho mob nyuaj vim lawv muaj ntau yam thiab, feem ntau, tsis muaj qhov ua rau raug txheeb xyuas.

Kev pw tsaug zog tsis zoo yog ib qho teeb meem kev noj qab haus huv uas ntau tus neeg ntsib hauv lawv lub neej. Kev pw tsaug zog zoo muaj qhov cuam tshuam tseem ceeb heev rau lub cev kev noj qab haus huv thiab lub hlwb ua haujlwm, tshwj xeeb tshaj yog ntawm kev nco. Kev pw tsaug zog zoo yuav sib sau ua ke, sib sau ua ke thiab tshuaj xyuas kev nco hauv lub hlwb, yog li txhawb kev nco. Yog li, kev pw tsaug zog tuaj yeem cuam tshuam ncaj qha rau lub hlwb ua haujlwm thiab nco.

Kev pw tsaug zog yog ib qho ntawm cov haujlwm tseem ceeb ntawm lub hlwb. Nws pab tshem tawm cov khib nyiab ntawm lub hlwb, yog li txhawb kev txhim kho ntawm kev nco. Nyob rau tib lub sijhawm, thaum pw tsaug zog, lub hlwb yuav muab cov kev kawm thiab kev paub ntawm lub hnub rau hauv qhov chaw nco kom raug. Yog tsis muaj kev pw tsaug zog txaus, cov txheej txheem no yuav cuam tshuam, ua rau kev nco tsis tau. Yog li ntawd, yog tias koj feem ntau xav tias koj tsis nco qab, nws yuav yog vim tsis tsaug zog.

Kev pw tsaug zog ncaj qha cuam tshuam rau lub hlwb lub cim xeeb mechanism. Nws ua rau muaj kev tsis sib haum xeeb ntawm cov tshuaj hauv lub hlwb, uas cuam tshuam rau lub hlwb ua haujlwm. Tsis tsaug zog kuj tseem yuav ua rau muaj kev pheej hmoo ntawm qee cov kab mob neurodegenerative, xws li Alzheimer's disease. Yog li ntawd, los ntawm kev pw tsaug zog zoo, koj tuaj yeem pab tiv thaiv lub hlwb noj qab haus huv thiab nco.

Kev tswj hwm kev pw tsaug zog zoo tuaj yeem txhim kho koj lub hlwb kev nco. Ua ntej, teem sijhawm pw tsaug zog uas koj tuaj yeem lo rau txhua hnub thiab lo rau nws. Qhov thib ob, tsim kom muaj qhov chaw nyob ntsiag to, xis nyob thiab huv si kom tau pw txaus. Thaum kawg, tsis txhob siv cov khoom siv hluav taws xob ntau dhau, tshwj xeeb tshaj yog ua ntej pw, vim qhov no tuaj yeem cuam tshuam rau kev pw tsaug zog zoo.

Hauv cov ntsiab lus, muaj qhov sib txuas zoo ntawm kev pw tsaug zog thiab nco. Kev pw tsaug zog zoo tsis yog tsuas yog zoo rau lub cev noj qab haus huv xwb tab sis kuj tuaj yeem txhim kho tib neeg lub cim xeeb. Yog li ntawd, txhua tus neeg yuav tsum paub txog qhov tseem ceeb ntawm kev pw tsaug zog thiab siv zog ntsuas los txhim kho kev pw tsaug zog zoo thiab tiv thaiv lub hlwb kev noj qab haus huv thiab kev nco. Peb yuav tsum txhim kho kev nco, thiab Cistanche deserticola tuaj yeem txhim kho kev nco zoo vim Cistanche deserticola yog cov khoom siv tshuaj suav tshuaj suav nrog ntau yam tshwj xeeb, ib qho ntawm kev txhim kho kev nco. Kev ua tau zoo ntawm Cistanche deserticola los ntawm ntau yam khoom xyaw uas nws muaj, suav nrog tannic acid, polysaccharides, flavonoid glycosides, thiab lwm yam. Cov khoom xyaw no tuaj yeem txhawb lub hlwb kev noj qab haus huv los ntawm ntau txoj hauv kev.

Nyem paub 10 txoj hauv kev los txhim kho kev nco

A case seriesby Chagas et al. [36] tau tshaj tawm qhov kev soj ntsuam zoo ntawm plaub tus neeg mob nrog REM pw tsaug zog tsis zoo (RBD) kho nrog CBD. Ntawm qhov tod tes, ib qho kev tshawb fawb randomized 33 tus neeg mob (ua hauv tib lub chaw) pom tias tsis muaj qhov zoo ntawm CBD tshaj cov placebo txog kev txo qis ntawm RBD. Cov kws sau ntawv tau tshaj tawm tias kev pw tsaug zog zoo dua nyob rau lub lim tiam thib 4 thiab 8 hauv CBD piv rau pawg placebo nrog p=0.049 thiab p=0.038 raws li.

Cov nyhuv no, txawm li cas los xij, hloov pauv [16]. Leehey et al. [22] kuj tau tshaj tawm txog kev txhim kho hauv kev pw tsaug zog, cuam tshuam los ntawm SCOPA-pw tsaug zog hloov, tab sis tsis muaj txiaj ntsig ntawm kev kho mob nrog CBD ntawm RBD. Kev tshawb fawb los ntawm Lotan et al. [26] tau tshaj tawm, ntawm lwm tus, kev txhim kho ntawm kev pw tsaug zog zoo, tab sis tsis muaj daim ntawv nug tshwj xeeb lossis kev sim tau siv los ntsuas nws.

Mob

Mob yog ib qho teeb meem tshwm sim nyob rau hauv PD ntawm heterogeneous originand nrog tsuas yog ib feem ntawm cov lus teb rau dopaminergic kev kho mob.Qhov txo qhov mob, tshwm sim los ntawm kev txhim kho hauv VisualAnalogue Scale (VAS), tau tshaj tawm nyob rau hauv txoj kev tshawb no los ntawm Lotan et al.[26].

Daim ntawv los ntawm Shohet et al. [25] tshuaj xyuas qhov mob rhiab heev hauv kev nthuav dav, nrog cov lus xaus zoo sib xws. Cov kws sau ntawv tau tshaj tawm txog qhov txo qis hauv qhov mob khaub thuas thiab kub kub rau cov neeg mob haus luam yeeb cannabis siv Quantitative SensoryTesting method. Hauv ob daim ntawv, kev ntsuam xyuas tau ua ua ntej, thiab 30 feeb tom qab, haus luam yeeb cannabis, thiab cov neeg mob tsis dig muag txog qhov tau txais kev kho mob.

Cov tsos mob ntawm neuropsychiatric

Cov tsos mob neuropsychiatric ntawm PD yog ib qho ntawm cov kev tshawb fawb tshaj plaws ntawm kev kho mob cannabis. De Faria et al[18] tau ua ob qhov muag tsis pom kev, cov placebo-tswj kev kawm txog kev ua tau zoo ntawm CBD 300 mg ntawm PD-txog kev ntxhov siab.

Cov kws sau ntawv tau ua pov thawj tias kev ntxhov siab thiab kev ntxhov siab uas tshwm sim hauv PD, ntsuas thaum simulated Public Speaking Test, tau txo qis. Interestingly, thaum psychosis yog anexclusion criterion nyob rau hauv feem ntau ntawm kev sim ntawm cannabis thiab CBD, ib daim ntawv los ntawm Zuardi li al. [24] tau tshaj tawm txog kev txhim kho kev puas siab puas ntsws hauv 6 tus neeg mob PD kho nrog CBD 150-300 mg, thiab tsis muaj kev kho mob ntxiv rau kev puas siab puas ntsws, cuam tshuam los ntawm kev txo qis hauv cov lus nug txog Parkinson Psychosis thiab ntawm Cov Lus Nug Txog Kev Nyuaj Siab.

Ntawm qhov tod tes, hauv kev kawm los ntawm Sieradzan li al. [20], tsom mus rau qhov kev siv ntawm LID, 5/7 cov neeg mob tau ntsib kev sedation, hnov ​​​​lus ntawm kev sib txawv, kiv taub hau lossis tsis txaus ntseeg.A daim ntawv los ntawm Peball li al. [37] soj ntsuam kev nyab xeeb thiab kev ua tau zoo ntawm nabilone, ib qho hluavtaws analogue ntawm tetrahydrocannabinol, hauv kev kho mob ntawm cov tsos mob tsis yog lub cev muaj zog ntawm PD.

Hauv theem I ntawm qhov kev tshawb fawb no, nabilone tau titrated, thaum nyob rau theem II cov kev kawm tau raug muab tso rau yav dhau los koob tshuaj nabiloneor ib cov placebo. Cov kws sau ntawv tau tshaj tawm txog qhov txo qis hauv UPDRS-MDS I, tshwj xeeb tshaj yog 'kev ntxhov siab rau lub siab' thiab 'kev pw tsaug zog hmo ntuj' cov khoom ntawm qhov ntsuas.

Interestingly, txawm hais tias qhov mob ntsig txog qhov kawg (King's Parkinson Pain Scaleand VAS ntawm qhov mob) tau txhim kho zoo thaum lub sij hawm qhib-labeltrial, qhov no tsis tau lees paub nyob rau hauv theem randomized.

Tus neeg mob txoj kev xav

Nyob rau hauv sib piv rau cov nyhuv me me pom nyob rau hauv randomised, ob qhov muag tsis pom kev soj ntsuam kev sim, cov neeg mob 'subjective xaav ntawm kev kho mob cannabis yog zoo.

Table 2 qhia txog cov ntaub ntawv qhia txog cov kev tshawb fawb ntawm cov neeg mob. Cov kev tshawb fawb no tau siv ntau hom ntawv (piv txwv li ua los ntawm tus kws kho mob hauv tib neeg, hauv xov tooj, email, lossis los ntawm tus neeg mob nkag mus rau lub vev xaib), thiab qee cov ntaub ntawv kuj tau suav nrog cov neeg mob uas muaj lwm yam kab mob (ntau tus kab mob sclerosis [31], atypical parkinsonism [28] ), lossis tau tsom mus rau ib qho tsos mob (xws li mob).

Txawm hais tias kev sib txawv thiab kev nthuav qhia ntawm cov txiaj ntsig ua rau kev sib piv ncaj qha nyuaj, kev txhim kho hauv cov tsos mob tsis yog lub cev muaj zog lossis kev ntxhov siab tau raug tshaj tawm ntau zaus. Patientshave kuj tau tshaj tawm txog kev txhim kho hauv lub cev muaj zog ntawm PD, withtremors thiab rigidity hais nyob rau hauv feem ntau ntawm cov kev tshawb fawb. Qhov no yog nyob rau hauv txoj kab nrog qhov kev tshawb pom ntawm cov kev sim uas tsis yog qhov muag tsis pom kev.

Cov txiaj ntsig ntawm cov kev tshawb fawb kuj tseem nyuaj rau kev txhais vim tias peb yuav xav kom cov neeg mob muab cov lus teb sib txawv rau cov lus nug hauv internet tsis qhia npe ntau dua li cov kws kho mob sau.

Kev sib tham

Hauv peb daim ntawv, peb tau npaj los sau cov kev paub tam sim no hais txog cov khoom sib txawv cannabis-raws li hauv PDtreatment. Strikingly, muaj tag nrho cov ntaub ntawv ntawm kev kho mob ntawm PD nrog cannabis, piv rau qhov tsawg ntawm cov kev sim tshuaj thawj zaug.

Qhov no qhia txog kev txaus siab rau cov tshuaj no qhia los ntawm ob tus neeg mob thiab kws kho mob. Thaum cov kev kho mob siab heev xws li vector-basedtreatment of PD tab tom tshwm sim rau lub qab ntug [38], ntau tus neeg mob tig mus rau txoj kev uas lawv xav txog 'ib txwm' lossis 'natural'. Lub upshot yog tias cov kev tshawb fawb nyob rau hauv randomisedcontrolled sim muaj xws li lub cev muaj zog cov paib ntsuam xyuas nyob rau hauv UPDRS scale ib feem III, xws li so tremor, rigidity thiab bradykinesia.

Qee cov tsos mob tsis yog lub cev muaj zog, xws li RBD thiab kev ntxhov siab, kuj tau raug soj ntsuam hauv kev sim randomized. Lwm tus kws sau ntawv tau siv txoj hauv kev qhib-label los ntsuas cov tsos mob, dyskinesia, mob thiab lwm yam.Cov kev txwv tseem ceeb ntawm cov kev tshawb fawb tam sim no muaj nyob rau ntawm cov khoom siv hauv PD yog cov qauv me me thiab cov sijhawm sib txawv ntawm kev tswj hwm cov khoom.

Muaj ntau qhov sib txawv ntawm txoj kev kom tau txais cov cannabis thiab / lossis ntau npaum li cas CBD. Kev haus luam yeeb marijuana zoo li ua rau lub hom phiaj ntsuas ntawm qhov koob tshuaj nyuaj. Qhov no ua rau nyuaj rau kev sib piv cov kev tshawb fawb. Kuj tseem muaj qee qhov kev coj noj coj ua sib txawv ntawm pawg tshawb xyuas. Qee tus kws sau ntawv tau tawm tswv yim tias cannabis thiab cannabis cov khoom lag luam yuav xav tau ntau tus neeg siv tshuaj thiab qhov kev tshawb fawb loj loj tuaj yeem tsis qhia lawv cov txiaj ntsig vim li ntawd. Progressin genetic testing thiab txheeb xyuas cov subtypes ntawm PD kuj tseem tuaj yeem ua rau kev txhim kho ntawm tus kheej ntau dua [39, 40]. Cov kev tshawb fawb qhib-label nrog cov txiaj ntsig zoo ua rau muaj kev tsis ncaj ncees ntxiv vim tias cannabis tau txais raws li kev nkag siab zoo ua rau muaj kev cia siab siab ntawm qhov txiaj ntsig zoo. Kev kho mob nrog tshuaj maj thiab nws cov ntsiab lus tuaj yeem ua rau muaj teeb meem.

Kev ntshai ntawm kev quav tshuaj thiab kev puas siab puas ntsws tuaj yeem yog cov teeb meem tseem ceeb tshaj plaws uas cuam tshuam cov neeg mob los ntawm kev kho mob cannabis. Qee cov tsos mob ntawm kev kho mob cannabinoid tej zaum yuav tsis zoo siab rau cov neeg mob. Cov no suav nrog kev tsis txaus ntseeg, kiv taub hau, xeev siab, ntuav, tachycardia, hypotension, qhov ncauj qhuav, raws plab, poob ntawm kev sib npaug thiab qaug zog, nrog rau cov tsos mob ntawm kev puas siab puas ntsws xws li tsis meej pem, tsis meej pem, hnov ​​​​qab, thiab hloov mus los [14].

Cov no feem ntau hais tau thaum pib kho. Tag nrho cov tsos mob no yog qhov tsis xav tau hauv cov neeg laus PD, thiab tuaj yeem ua rau muaj cov tsos mob tshwm sim ntau zaus ntawm cov neeg mob PD, xws li hypotension lossis pom kev cuam tshuam [41, 42]. Qhov tseem ceeb, CBD, sib piv rau THC, suav hais tias tsis ua rau muaj kev puas siab puas ntsws [34]. Nws tau raug pov thawj tias cov tsos mob ntawm kev puas siab puas ntsws yog tshwm sim los ntawm CB-1 receptor activation, uas tsis tau ua tiav thaum CBD raug tswj hwm hauv lub cev muaj zog [43]. Kev tshawb fawb los ntawm Zuardi et al. [24] tej zaum yuav txhawb kev ntseeg tias CBD txo cov tsos mob puas hlwb. Ntawm qhov tod tes, nabilone zoo li ua rau muaj teeb meem zoo li no (5/7 cov neeg mob) [20].

Kev kho mob feem ntau cuam tshuam nrog kev siv mus sij hawm ntev thiab tuaj yeem ua rau muaj cov tsos mob tshem tawm. Kev paub tsis meej kuj tuaj yeem tshwm sim raws li cov txiaj ntsig ntev ntawm kev noj cannabis [44]. Kev vam khom thiab tsis muaj daim ntawv tso cai nyob hauv ntau lub tebchaws kuj tseem tuaj yeem yog qhov muaj txiaj ntsig zoo.Ib qho txiaj ntsig zoo ntawm kev siv tshuaj maj yuav yog qhov hnyav [31]. Txawm hais tias feem ntau pom tias muaj qhov tsis zoo, qhov no yuav muaj txiaj ntsig zoo rau cov neeg mob PD uas muaj kev noj zaub mov tsis txaus, qee yam uas tau pom hauv 50% ntawm cov neeg mob PD [45].

Peb txiav txim siab tias tam sim no tsis muaj pov thawj txaus toroutinely pom zoo kom ntxiv cov cannabis lossis CBD-raws li cov khoom rau PD kev kho mob regimes.Thaum cov ntaub ntawv qhia txog cov txiaj ntsig zoo ntawm cannabinoids ntawm ntau cov tsos mob, randomized placebo-controlledtrials hauv cov ntaub ntawv tam sim no tsis pom kev txhim kho hauv cov cim qhia lub cev muaj zog, thiab qhia txog qhov cuam tshuam tsis sib xws ntawmLID, kev ntxhov siab, thiab kev puas siab puas ntsws.

Cov kev txwv kev cai lij choj, tsis muaj kev lees paub hauv zej zog, thiab teeb meem kev mob tshwm sim tuaj yeem yog qhov teeb meem hauv kev tswj hwm ntawm cannabis.Loj, randomised, ob-dig muag, kev tshawb fawb mus sij hawm ntev nrog cov neeg sawv cev ntawm cov neeg mob thiab cov tshuaj standardisation yog xav tau los ntsuas qhov ua tau zoo ntawm cov kev kho mob no. Ib qho ntxiv, kev tswj cov placebo yog xav tau los muab kev ntsuam xyuas txaus ntawm kev ua tau zoo ntawm cannabinoids hauv PD kho.

Qhov no yuav tsum suav nrog cov placebo hloov pauv ntawm ob qho tib si CBD thiab cannabis siv los ntawm kev nqus pa, nrog rau kev saib xyuas cov koob tshuaj kom zoo rau cov neeg mob.Raws li peb cov ntaub ntawv tshuaj xyuas, peb txiav txim siab tias cov tsos mob tsis yog lub cev muaj zog ntawm PD xws li mob, ntxhov siab thiab pw tsaug zog zoo li teb zoo dua rau kev kho mob cannabis dua. ua motor signs.

Yog li cov kev tshawb fawb yav tom ntej yuav tsum tau tsom mus rau cov tsos mob uas tsis yog lub cev muaj zog, tshwj xeeb tshaj yog vim cov no feem ntau ua rau muaj kev cuam tshuam ntau dua rau PD cov neeg mob lub neej zoo dua li cov tsos mob ntawm lub cev muaj zog.

Cov ntaub ntawv

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