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Intractable insomnia

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[Intro]

Description: insomnia as a symptom, rather common, our scholars speculate that the population incidence rate of 10% to 20%. Classification of insomnia, intractable insomnia is a common disease, and compared with secondary insomnia, it's difficult to treat and more.

[Cause]

choroideremia disease is caused by what the?

(a) causes

majority of patients with genetic factors.

(B) the pathogenesis

1. genetic factors of the disease is X-chromosome recessive inheritance has been recognized, its mechanism has not been elucidated. Male disease, and for the progressive, female gene carriers.

2. immune factors from the histological and ultrastructural changes were found in macrophage phagocytosis of photoreceptor outer segments and pigment, the pigment in swallowing may cause allergic reactions in the protein, the collapse of the choroidal stroma, Bruch membrane and blood vessels disappear, the occurrence of full-thickness choroidal atrophy.

3. biochemical defect found to have biochemical cyclic guanosine monophosphate (cGMP) decreased.

[Sign]

choroideremia disease early symptoms?

1. as early onset of functional changes may have been born, and even vision loss decreased to light perception. Concentric narrowing field of vision for sexual orientation. Atrophic changes began in the periphery, extend to the center with age, the last remnants of the central part, had become the tubular vision. Usually 10 to 30 years old with moderate visual acuity decreased, but remained the central field of vision, 40 to 50 years old involving the macula, in order to control the TV or associated with peripheral island, the last vision disappeared. To the center depending on the temporal side of the island and the remaining patients, as the island disappears completely blind. Early-onset blind every night, was shot cone degeneration, rod dark adaptation final threshold was progressively increased, late undetectable dark adaptation curve. color vision disorder, as the red-green blindness. Electrophysiological measurement of the eye, early normal photopic ERG, erg dark adaptation for low-wave, off late. EOG low wave or no wave. Male patients with this disease for the disease early erg changes that adapt to the part of the erg may be normal, but the dark-adapted part of a wave and b-wave amplitude decreased, b-wave latency, late erg off. Women with vision, vision, dark adaptation, color, EOG, ERG, mostly normal, but the occasional exception. female carriers show significantly eroded in the eyes like pigment disorders and the accumulation of cases, the erg response is still normal, erg amplitude can be reduced or increased. EOG changes of the disease is more obvious than the ERG, no visual function in patients with choroidal an unusual feature of the baseline EOG potential decreased, the late potential is almost undetectable baseline EOG light peak completely disappeared. More female patients no abnormal changes in visual function, but a few patients may have abnormalities.

2. fundus changes in fundus changes may occur in early childhood, but also later, even after the age of only 40 initial change. Can be divided into three.

(1) early stage: mild atypical peripheral pigmented retinopathy, due to degeneration of retinal pigment epithelium, equatorial and peripheral fundus showed flare yellow, deep pigment particles, pigment zone between depigmentation, it was pepper-like eyes. pigment was not like bone cells.

(2) medium: the lesions gradually developed from the periphery back pole, the inner layer of the retina without pigment, then there choroidal and RPE atrophy, showing a small area of ​​choroidal large vessels exposure.

(3) late: the choroid and RPE to the posterior pole retinal atrophy. retinal pigment epithelium was almost completely destroyed, lost, and choroidal atrophy (Figure 1), sometimes leaving only a small macular choroid, its clear boundary. At the same time can be left a peripheral choroidal island, but after the age of 50 to 60 also gradually disappear. As the pigment epithelium and choroidal blood vessels disappear, exposing the sclera of the eyes white reflective. Residual islands can be brownish-red, with the peripheral circular or irregular pigmentation spots, but all eyes are rarely seen white, no visible choroidal vessels. Although choroidal lesions significantly, often to maintain normal retina and optic nerve. Late disc can atrophy, retinal blood vessels may be a little thin.

female patients as carriers, typical fundus changes in patients with similar young men. But the fundus into the stationary nature of light, and normal vision. Retinal depigmentation and can be expressed as pigment hyperplasia, atrophy was salt and pepper, and more at the equator of the fundus, pigment particle size, arranged in clusters and the surrounding strip for the radiation. Is a very peripheral hypopigmentation. Some cases there is a small macular pigmentation, retinal and optic disc normal.

3. fluorescein angiography showed early RPE defects in a wide range of strong fluorescent area, then the retinal pigment epithelium atrophy and choroidal capillaries disappear, only to see the filling of the choroidal fluorescence great vessels. Late shows a wide range of non-fluorescent zone, where the sparse remnants of large choroidal vessels. female gene carriers of the fluorescein angiography shows RPE atrophy, was see through a wide range of strong fluorescence or fluorescence.

male patients with this disease, clinical features of night blindness, concentric narrowing of vision, blue vision defects, dark adaptation threshold was elevated and progressive full choroidal and RPE atrophy. according to the typical fundus changes, electrophysiological changes and family history, can make the correct diagnosis.

[Aftertreat]

choroideremia disease ate?

[Prevent]

intractable insomnia how to prevent?

prevention: drug therapy for many patients with intractable insomnia for most treatments, such as stability, diazepam, sulpiride, triazolam and other sedative drugs, but These chemical drug addiction and dependence, and can not help patients with insomnia, but because of the drugs so that patients can not be divorced from normal sleep, which leads to the increase in patients with insomnia. For traditional Chinese medicine, acupuncture insomnia treatment in the early to relieve symptoms may play a certain effect, but for severe intractable insomnia and insomnia in patients with the disease increased and the disease can not be cured until the effect of the current in the field of medicine has emerged for intractable insomnia many of the exact effect of pure Chinese medicine, such as bupleurum sedative compound particles, the treatment mechanism is the focus from the liver, heart and kidney transport, the overall conditioning; some uneasiness of mind, brain and other sedative drugs.

[Treat]

no pre-treatment of choroidal disease precautions?

(a) treatment

no special treatment.

(b) the prognosis

progressive disease progresses, patients can be blind.

no treatment for choroidal disease medicine

No information

non-Western treatment of choroidal disease

No information

[Examine]

intractable insomnia should be how?

diagnosis: clinical manifestations were difficulty falling asleep and difficulty maintaining sleep, daytime fatigue, sleep at night they want the more difficult to fall asleep as soon as possible, add to the psychological conflict , resulting in anxiety, mood swings, excessive worry, insomnia conscious pain even leading to a vicious cycle.

[Diff]

intractable insomnia symptoms easily confused with what?

differential diagnosis: 1) secondary insomnia. Caused by a common cause of secondary insomnia are the following aspects: ① any physical disease affecting the central nervous system; ② physical pain or discomfort, such as skin diseases, itching or pain, cancer pain, often caused by insomnia; ③ wine , coffee, food or drugs causing insomnia; ④ mental disorders. Most patients with insomnia symptoms of mental disorders, especially anxiety and depression are almost insomnia. As long as the clinical manifestations (including medical history, physical examination, various test results) were sufficient to diagnose these diseases, the diagnosis of primary insomnia not be considered.

2) other sleep disorders such as night terrors, nightmares patient may have insomnia, night terrors and nightmares if the typical symptoms of view is not considered insomnia.

3) a transient sleep disorder. This is common in everyday life, without any treatment, the body can do naturally adjust, so the diagnosis is not insufficient duration of insomnia.

diagnosis: clinical manifestations were difficulty falling asleep and difficulty maintaining sleep, daytime fatigue, sleep at night they want the more difficult to fall asleep as soon as possible, add to the psychological conflict, resulting in anxiety, emotions stability, excessive worry, insomnia conscious pain even leading to a vicious cycle.

[Disease]

stubborn insomnia-related diseases

by the line of fatal familial insomnia insomnia insomnia

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