09 con dk va dk dieu tri

Ho Huu That, MD
Pham Ngoc Thach University of Medicine


5/4/2019



Co giật – Convulsion



Cơn động kinh – Seizure



Động kinh – Epilepsy



Convulsive/Non--convulsive Seizure
Convulsive/Non



Epileptic/Non--epileptic Seizure
Epileptic/Non

2

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3


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ILAE - 2014

4




Có phải cơn động kinh (seizure) hay
khơng?
khơng
? Phân loại cơn động kinh



Nguyên nhân của seizure?
 Epilepsy

(unprovoked seizure)

Non--Epilepsy
 Non


(provoked seizure)

Nguyên nhân của epilepsy? (Các hội
chứng động kinh
kinh:: epileptic syndromes)

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ILAE - 2016

5


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6


ĐK tồn thể

ĐK cục bộ

Vơ căn
(Idiopathic)

•Childhood Absence Epilepsy
(CAE)
•Juvenile Absence Epilepsy (JAE)
•Juvenile Myoclonic Epilepsy
(JME)

•Epilepsy with GTCS alone
(EGTCS)

Panayitopoulos
Syndrome

Khơng vơ
căn (Nonidiopathic)

•Lennox Gastaut Syndrome
•West Syndrome
•Dravet Syndrome…

Symtomatic
epilepsy:
•Brain tumor
•Poststroke
•Post Head
Trauma

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

Hạn chế sự
phóng
của

điện
các

neuron bằng
cách ức chế
kênh Na+.

5/4/2019

Pharmacotherapy of the epilepsies - Goodman & Gilman's The
pharmacological Basis of Therapeutics 2011

11



Gia tăng sự
ức chế qua
synapse của
chất

dẫn

truyền thần
kinh GABA
GABA..

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Pharmacotherapy of the epilepsies - Goodman & Gilman's The
pharmacological Basis of Therapeutics 2011

12


Ức



chế

các
Ca2+

kênh

được hoạt hóa
bởi

điện

thế

(voltage-(voltage
activated Ca2+
channels)..
channels)

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Pharmacotherapy of the epilepsies - Goodman & Gilman's The
pharmacological Basis of Therapeutics 2011

13


Mechnism

Na+ channel
modulators

Drugs

PHT, CBZ, OxCBZ, LTG,
TPM, VPA.

GABAA receptor BZDs, PB, TPM, CBZ,
allosteric
OxCBZ
modulators
Ca2+ channel
blockers

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ESM, VPA, LTG

Consequences of action

block action potential propagation
stabilize neuronal membranes
 neurotransmitter release, focal firing,
and seizure spread
 membrane hyperpolarization and
seizure threshold
 focal firing
 neurotransmitter release
 slow-depolarization and spike-wave
discharges

Pharmacotherapy of the epilepsies - Goodman & Gilman's The
pharmacological Basis of Therapeutics 2011

14


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15


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16


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1.

Goodman & Gilman's The pharmacological Basis of Therapeutics
2011.

2.

Novel oral anticoagulant management issues for the stroke clinician International Journal of Stroke 2016.

3.

ILAE Treatment Guidelines – Epilepsia 2006.

4.

Incidence and associations of poststroke epilepsy – the prospective
south London stroke register. In stroke. 2013.

5.

Adams and Victor’s Principles of Neurology (2014
2014)). Cerebrovascular

diseases, 10th edition, McGraw
McGraw--Hill, New York
York.

6.

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Clinical Neuroanatomy 27th edition, McGraw
McGraw--Hill, New York, 2013
2013.

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