{"id":29221,"date":"2023-05-06T22:13:04","date_gmt":"2023-05-06T15:13:04","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29221"},"modified":"2023-05-06T22:13:04","modified_gmt":"2023-05-06T15:13:04","slug":"tiep-can-chan-doan-giat-co","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/tiep-can-chan-doan-giat-co\/","title":{"rendered":"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n gi\u00e2\u0323t c\u01a1"},"content":{"rendered":"

Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n gi\u00e2\u0323t c\u01a1<\/strong>\u00a0(Myoclonus<\/a>) bao g\u1ed3m l\u1ecbch s\u1eed b\u1ec7nh l\u00fd v\u00e0 ki\u1ec3m tra th\u1ea7n kinh, k\u1ebft h\u1ee3p v\u1edbi c\u00e1c x\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh v\u00e0 x\u00e9t nghi\u1ec7m \u0111i\u1ec7n c\u01a1. Ngo\u00e0i ra, c\u00e1c b\u00e1c s\u0129 c\u0169ng c\u1ea7n ki\u1ec3m tra c\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c nhau nh\u01b0 thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn th\u1ea7n kinh v\u00e0 s\u1ef1 ti\u1ebfp x\u00fac v\u1edbi c\u00e1c ch\u1ea5t \u0111\u1ed9c h\u1ea1i. Sau \u0111\u00f3, b\u00e1c s\u0129 s\u1ebd \u0111\u01b0a ra ch\u1ea9n \u0111o\u00e1n v\u00e0 l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p cho b\u1ec7nh nh\u00e2n d\u1ef1a tr\u00ean nguy\u00ean nh\u00e2n g\u00e2y ra gi\u1eadt c\u01a1.<\/p>\n

\"Ti\u1ebfp
Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n gi\u00e2\u0323t c\u01a1<\/figcaption><\/figure>\n

Ba\u0300i vi\u00ea\u0301t tri\u0301ch ngu\u00f4\u0300n t\u01b0\u0300 H\u00f4\u0323i th\u00e2\u0300n kinh ho\u0323c Vi\u00ea\u0323t Nam<\/a><\/p>\n

Ta\u0301c gia\u0309: Tr\u1ea7n Thanh H\u00f9ng1<\/sup> , \u0110inh Vinh Quang2<\/sup>
\n\u0110\u1ea1i H\u1ecdc Y D\u01b0\u1ee3c TP.HCM, B\u1ec7nh vi\u1ec7n Nh\u00e2n D\u00e2n 115\u00a01<\/sup>
\nB\u1ec7nh vi\u1ec7n Nh\u00e2n D\u00e2n 115, TP. HCM2<\/sup><\/p>\n

1. Gi\u01a1\u0301i thi\u00ea\u0323u va\u0300 \u0111i\u0323nh nghi\u0303a<\/strong><\/h2>\n

Gi\u1eadt c\u01a1 (myoclonus) l\u00e0 d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng \u0111\u1eb7c tr\u01b0ng b\u1edfi nh\u1eefng c\u1eed \u0111\u1ed9ng kh\u00f4ng ch\u1ee7 \u00fd nhanh, ng\u1eafn do s\u1ef1 co c\u01a1 ho\u1eb7c \u1ee9c ch\u1ebf co c\u01a1. Co c\u01a1 g\u00e2y ra gi\u1eadt c\u01a1 d\u01b0\u01a1ng t\u00ednh, trong khi \u1ee9c ch\u1ebf co c\u01a1 g\u00e2y ra gi\u1eadt c\u01a1 \u00e2m t\u00ednh (run v\u1eaby). B\u1ec7nh nh\u00e2n th\u01b0\u1eddng m\u00f4 t\u1ea3 gi\u1eadt c\u01a1 l\u00e0 \u201cgi\u1eadt\u201d, \u201cl\u1eafc\u201d ho\u1eb7c \u201cco th\u1eaft\u201d. Gi\u1eadt c\u01a1 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i d\u1ef1a tr\u00ean bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng, k\u1ebft qu\u1ea3 th\u0103m kh\u00e1m v\u00e0 kh\u1ea3o s\u00e1t \u0111i\u1ec7n sinh l\u00fd th\u1ea7n kinh l\u00e2m s\u00e0ng v\u00e0 nguy\u00ean nh\u00e2n.<\/p>\n

2. Di\u0323ch t\u00ea\u0303 ho\u0323c<\/strong><\/h2>\n

Tr\u1ea1ng th\u00e1i sau thi\u1ebfu oxy n\u00e3o, b\u1ec7nh tho\u00e1i h\u00f3a th\u1ea7n kinh v\u00e0 c\u00e1c h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng kinh l\u00e0 c\u00e1c nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t g\u00e2y gi\u1eadt c\u01a1. \u0110\u1ed9c ch\u1ea5t \u2013chuy\u1ec3n h\u00f3a v\u00e0 thu\u1ed1c l\u00e0 c\u00e1c nguy\u00ean nh\u00e2n r\u1ea5t th\u01b0\u1eddng g\u1eb7p trong m\u00f4i tr\u01b0\u1eddng b\u1ec7nh vi\u1ec7n.<\/p>\n

3. Ph\u00e2n loa\u0323i theo l\u00e2m sa\u0300ng va\u0300 nguy\u00ean nh\u00e2n<\/strong><\/h2>\n

Theo Marsden v\u00e0 c\u1ed9ng s\u1ef1, gi\u1eadt c\u01a1 \u0111\u01b0\u1ee3c chia l\u00e0m 4 nh\u00f3m nguy\u00ean nh\u00e2n ch\u00ednh:
\n\u2013 Sinh l\u00fd
\n\u2013 V\u00f4 c\u0103n
\n\u2013 \u0110\u1ed9ng kinh
\n\u2013 Th\u1ee9 ph\u00e1t (tri\u1ec7u ch\u1ee9ng)<\/p>\n

3.1. Gi\u1eadt c\u01a1 sinh l\u00fd<\/strong><\/h3>\n

Gi\u1eadt c\u01a1 sinh l\u00fd l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng b\u00ecnh th\u01b0\u1eddng \u1edf ng\u01b0\u1eddi kh\u1ecfe m\u1ea1nh, kh\u00f4ng g\u00e2y \u1ea3nh h\u01b0\u1edfng ch\u1ee9c n\u0103ng ho\u1eb7c \u1ea3nh h\u01b0\u1edfng ch\u1ee9c n\u0103ng nh\u1eb9, th\u0103m kh\u00e1m l\u00e2m s\u00e0ng th\u01b0\u1eddng kh\u00f4ng c\u00f3 b\u1ea5t th\u01b0\u1eddng.
\nV\u00ed d\u1ee5 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 gi\u1eadt c\u01a1 l\u00fac ng\u1ee7 ho\u1eb7c l\u00fac s\u1eafp ng\u1ee7.<\/p>\n

3.2. Gi\u1eadt c\u01a1 v\u00f4 c\u0103n<\/strong><\/h3>\n

Trong gi\u1eadt c\u01a1 v\u00f4 c\u0103n, gi\u1eadt c\u01a1 l\u00e0 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng n\u1ed5i b\u1eadt nh\u1ea5t ho\u1eb7c l\u00e0 duy nh\u1ea5t. B\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u00f3 \u1ea3nh h\u01b0\u1edfng ch\u1ee9c n\u0103ng nh\u1eb9. B\u1ec7nh kh\u00f4ng ti\u1ebfn tri\u1ec3n ho\u1eb7c ti\u1ebfn tri\u1ec3n ch\u1eadm. Nh\u1eadn th\u1ee9c kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng.
\nGi\u1eadt c\u01a1 v\u00f4 c\u0103n \u0111\u01b0\u1ee3c chia th\u00e0nh 2 nh\u00f3m: gi\u1eadt c\u01a1 l\u1ebb t\u1ebb v\u00e0 gi\u1eadt c\u01a1 di truy\u1ec1n.<\/p>\n

3.2.1. Gi\u1eadt c\u01a1 l\u1ebb t\u1ebb: gi\u1eadt c\u01a1 kh\u1ea9u c\u00e1i<\/strong><\/h4>\n

Gi\u1eadt c\u01a1 kh\u1ea9u c\u00e1i th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 th\u1ee9 ph\u00e1t do t\u1ed5n th\u01b0\u1eddng th\u00e2n n\u00e3o v\u00e0\/ho\u1eb7c ti\u1ec3u n\u00e3o.
\nTuy nhi\u00ean, m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u1ea5u tr\u00fac r\u00f5 r\u00e0ng v\u00e0 \u0111\u01b0\u1ee3c xem l\u00e0 gi\u1eadt c\u01a1 kh\u1ea9u c\u00e1i v\u00f4 c\u0103n. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111\u00f3, gi\u1eadt c\u01a1 th\u01b0\u1eddng do co c\u01a1 c\u0103ng m\u00e0n kh\u1ea9u c\u00e1i. Ng\u01b0\u1ee3c l\u1ea1i, gi\u1eadt c\u01a1 kh\u1ea9u c\u00e1i th\u1ee9 ph\u00e1t (tri\u1ec7u ch\u1ee9ng) th\u01b0\u1eddng do co c\u01a1 n\u00e2ng m\u00e0n kh\u1ea9u c\u00e1i. Gi\u1eadt c\u01a1 tai gi\u1eefa c\u00f3 th\u1ec3 l\u00e0 v\u00f4 c\u0103n ho\u1eb7c th\u1ee9 ph\u00e1t v\u00e0 \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 co c\u01a1 c\u0103ng m\u00e0n nh\u0129 v\u00e0\/ho\u1eb7c c\u01a1 b\u00e0n \u0111\u1ea1p. Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y s\u1ebd g\u00e2y ra \u00f9 tai ho\u1eb7c ti\u1ebfng click trong tai.<\/p>\n

3.2.2. Gi\u1eadt c\u01a1 v\u00f4 c\u0103n di truy\u1ec1n<\/strong><\/h4>\n

Gi\u1eadt c\u01a1 v\u00f4 c\u0103n di truy\u1ec1n c\u00f3 nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng sau:
\n\u2013 Kh\u1edfi ph\u00e1t tr\u01b0\u1edbc 20 tu\u1ed5i
\n\u2013 Di truy\u1ec1n tr\u1ed9i nhi\u1ec5m s\u1eafc th\u1ec3 th\u01b0\u1eddng v\u1edbi \u0111\u1ed9 bi\u1ec3u hi\u1ec7n \u0111a d\u1ea1ng
\n\u2013 Di\u1ec5n ti\u1ebfn l\u00e0nh t\u00ednh v\u1edbi tu\u1ed5i th\u1ecd b\u00ecnh th\u01b0\u1eddng
\n\u2013 Kh\u00f4ng c\u00f3 th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o, co c\u1ee9ng c\u01a1, sa s\u00fat tr\u00ed tu\u1ec7 v\u00e0 c\u01a1n \u0111\u1ed9ng kinh
\nGi\u1eadt c\u01a1 th\u01b0\u1eddng x\u1ea3y ra \u1edf hai chi tr\u00ean v\u00e0 c\u01a1 th\u00e2n tr\u1ee5c, n\u1eb7ng l\u00ean khi v\u1eadn \u0111\u1ed9ng c\u01a1 v\u00e0 gi\u1ea3m \u0111i r\u00f5 r\u1ec7t khi u\u1ed1ng r\u01b0\u1ee3u. Gi\u1eadt c\u01a1 v\u00f4 c\u0103n di truy\u1ec1n c\u00f3 ngu\u1ed3n g\u1ed1c d\u01b0\u1edbi v\u1ecf-kh\u00f4ng khoanh \u0111o\u1ea1n (subcortical-nonsegmental).
\nLo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 l\u00e0 \u0111\u1eb7c \u0111i\u1ec3m th\u01b0\u1eddng th\u1ea5y trong gi\u1eadt c\u01a1 v\u00f4 c\u0103n di truy\u1ec1n v\u00e0 khi xu\u1ea5t hi\u1ec7n c\u00f9ng l\u00fac, t\u00ecnh tr\u1ea1ng n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 h\u1ed9i ch\u1ee9ng gi\u1eadt c\u01a1-lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1. Ngo\u00e0i gi\u1eadt c\u01a1, h\u1ed9i ch\u1ee9ng n\u00e0y c\u00f2n bi\u1ec3u hi\u1ec7n lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 v\u1edbi m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau, nh\u01b0ng th\u01b0\u1eddng l\u00e0 nh\u1eb9, th\u01b0\u1eddng hi\u1ec7n di\u1ec7n \u1edf c\u1ed5 v\u00e0\/ho\u1eb7c chi.<\/p>\n

3.3. Gi\u1eadt c\u01a1 \u0111\u1ed9ng kinh<\/strong><\/h3>\n

Gi\u1eadt c\u01a1 \u0111\u1ed9ng kinh \u00e1m ch\u1ec9 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a gi\u1eadt c\u01a1 trong b\u1ed1i c\u1ea3nh b\u1ec7nh \u0111\u1ed9ng kinh. C\u00e1c c\u01a1n \u0111\u1ed9ng kinh l\u00e0 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng n\u1ed5i b\u1eadt trong gi\u1eadt c\u01a1 \u0111\u1ed9ng kinh. Nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 v\u00f4 c\u0103n, do gen ho\u1eb7c b\u1ec7nh n\u00e3o t\u0129nh tr\u1ea1ng.
\nGi\u1eadt c\u01a1 c\u00f3 th\u1ec3 x\u1ea3y ra nh\u01b0 l\u00e0 m\u1ed9t trong c\u00e1c th\u00e0nh ph\u1ea7n c\u1ee7a c\u01a1n \u0111\u1ed9ng kinh, ho\u1eb7c bi\u1ec3u hi\u1ec7n duy nh\u1ea5t c\u1ee7a c\u01a1n \u0111\u1ed9ng kinh (c\u01a1n \u0111\u1ed9ng kinh gi\u1eadt c\u01a1) ho\u1eb7c l\u00e0 m\u1ed9t trong c\u00e1c lo\u1ea1i c\u01a1n \u0111\u1ed9ng kinh c\u1ee7a m\u1ed9t h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng kinh nh\u1ea5t \u0111\u1ecbnh. C\u00e1c lo\u1ea1i gi\u1eadt c\u01a1 \u0111\u1ed9ng kinh kh\u00e1c nhau c\u00f3 th\u1ec3 c\u00f3 ngu\u1ed3n g\u1ed1c sinh l\u00fd v\u1ecf n\u00e3o ho\u1eb7c v\u1ecf n\u00e3o-d\u01b0\u1edbi v\u1ecf.<\/p>\n

3.4. Gi\u1eadt c\u01a1 nguy\u00ean ph\u00e1t<\/strong><\/h3>\n

Gi\u1eadt c\u01a1 \u0111\u01a1n \u0111\u1ed9c g\u1eb7p trong gi\u1eadt c\u01a1 ti\u1ebfn tri\u1ec3n nguy\u00ean ph\u00e1t c\u1ee7a tu\u1ed5i gi\u00e0 v\u00e0 gi\u1eadt c\u01a1 v\u1ecf n\u00e3o gia \u0111\u00ecnh.<\/p>\n

3.5. Gi\u1eadt c\u01a1 tri\u1ec7u ch\u1ee9ng<\/strong><\/h3>\n

Gi\u1eadt c\u01a1 x\u1ea3y ra do r\u1ed1i lo\u1ea1n th\u1ea7n kinh ho\u1eb7c kh\u00f4ng ph\u1ea3i do th\u1ea7n kinh, \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 gi\u1eadt c\u01a1 tri\u1ec7u ch\u1ee9ng.
\nGi\u1eadt c\u01a1 tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 x\u1ea3y ra b\u1ea5t c\u1ee9 b\u1ec7nh th\u1ea7n kinh n\u00e0o. C\u00e1c nh\u00f3m ch\u00ednh bao g\u1ed3m:
\n\u2013 Do thu\u1ed1c, do \u0111\u1ed9c ch\u1ea5t
\n\u2013 B\u1ec7nh n\u00e3o, bao g\u1ed3m b\u1ec7nh n\u00e3o do thi\u1ebfu oxy
\n\u2013 B\u1ec7nh tho\u00e1i h\u00f3a th\u1ea7n kinh
\n\u2013 T\u1ed5n th\u01b0\u01a1ng khu tr\u00fa h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng
\n\u2013 \u0110\u1ed9ng kinh gi\u1eadt c\u01a1 ti\u1ebfn tri\u1ec3n
\n\u2013 Th\u1ea5t \u0111i\u1ec1u gi\u1eadt c\u01a1 ti\u1ebfn tri\u1ec3n
\n\u2013 Nhi\u1ec5m tr\u00f9ng v\u00e0 h\u1eadu nhi\u1ec5m
\n\u2013 Vi\u00eam t\u1ef1 mi\u1ec5n, bao g\u1ed3m h\u1ed9i ch\u1ee9ng opsoclonus-myoclonus
\n\u2013 R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a.
\n\u2013 R\u1ed1i lo\u1ea1n \u1ea3nh h\u01b0\u1edfng nhi\u1ec1u c\u01a1 quan, bao g\u1ed3m c\u00e1c b\u1ec7nh ti th\u1ec3.
\n\u2013 B\u1ec7nh do r\u1ed1i lo\u1ea1n d\u1ef1 tr\u1eef.
\n\u2013 H\u1ed9i ch\u1ee9ng gi\u1eadt m\u00ecnh qu\u00e1 m\u1ee9c (exaggerated startle syndrome).
\n\u2013 Gi\u1eadt c\u01a1 do t\u00e2m l\u00fd.<\/p>\n

4. Ph\u00e2n loa\u0323i d\u01b0\u0323a tr\u00ean sinh ly\u0301 va\u0300 gia\u0309i ph\u00e2\u0303u<\/h2>\n

Ngo\u00e0i ph\u00e2n lo\u1ea1i d\u1ef1a tr\u00ean l\u00e2m s\u00e0ng v\u00e0 nguy\u00ean nh\u00e2n, gi\u1eadt c\u01a1 c\u00f2n c\u00f3 th\u1ec3 ph\u00e2n lo\u1ea1i d\u1ef1a tr\u00ean v\u1ecb tr\u00ed c\u1ee7a c\u01a1 ch\u1ebf sinh l\u00fd g\u00e2y ra gi\u1eadt c\u01a1. Nh\u1eefng v\u1ecb tr\u00ed sinh l\u00fd \u2013 gi\u1ea3i ph\u1eabu bao g\u1ed3m:
\n\u2013 V\u1ecf n\u00e3o
\n\u2013 V\u1ecf n\u00e3o \u2013 d\u01b0\u1edbi v\u1ecf
\n\u2013 D\u01b0\u1edbi v\u1ecf \u2013 kh\u00f4ng khoanh \u0111o\u1ea1n
\n\u2013 Khoanh \u0111o\u1ea1n (segmental)
\n\u2013 Ngo\u1ea1i bi\u00ean
\nS\u01a1 \u0111\u1ed3 ph\u00e2n lo\u1ea1i n\u00e0y c\u00f3 th\u1ec3 gi\u00fap x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng, h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n m\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n gi\u1eadt c\u01a1 v\u00e0 h\u01b0\u1edbng d\u1eabn l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb cho m\u1ed9t s\u1ed1 lo\u1ea1i gi\u1eadt c\u01a1.<\/p>\n

4.1. V\u1ecf n\u00e3o<\/strong><\/h3>\n

Trong gi\u1eadt c\u01a1 v\u1ecf n\u00e3o, \u1ed5 ph\u00f3ng \u0111i\u1ec7n khu tr\u00fa t\u1eeb v\u1ecf n\u00e3o c\u1ea3m gi\u00e1c \u2013 v\u1eadn \u0111\u1ed9ng nguy\u00ean ph\u00e1t, g\u00e2y n\u00ean gi\u1eadt c\u01a1 sau m\u1ed9t kho\u1ea3ng th\u1eddi gian d\u1eabn truy\u1ec1n theo b\u00f3 v\u1ecf gai. Lo\u1ea1i gi\u1eadt c\u01a1 n\u00e0y x\u1ea3y ra do s\u1ef1 \u1ee9c ch\u1ebf kh\u00f4ng hi\u1ec7u qu\u1ea3 b\u00ean trong c\u00e1c v\u00f2ng neuron c\u1ee7a v\u1ecf n\u00e3o v\u1eadn \u0111\u1ed9ng nguy\u00ean ph\u00e1t, v\u1ecf n\u00e3o c\u1ea3m gi\u00e1c nguy\u00ean ph\u00e1t hay c\u1ea3 hai.
\nGi\u1eadt c\u01a1 v\u1ecf n\u00e3o c\u00f3 th\u1ec3 x\u1ea3y ra khi c\u00f3 k\u00edch th\u00edch ph\u1ea3n x\u1ea1 c\u1ea3m gi\u00e1c (gi\u1eadt c\u01a1 v\u1ecf n\u00e3o ph\u1ea3n x\u1ea1: cortical reflex myoclonus), khi v\u1eadn \u0111\u1ed9ng c\u01a1 (gi\u1eadt c\u01a1 v\u1ecf n\u00e3o khi v\u1eadn \u0111\u1ed9ng), khi ngh\u1ec9 (c\u01a1n \u0111\u1ed9ng kinh v\u1eadn \u0111\u1ed9ng c\u1ee5c b\u1ed9) ho\u1eb7c k\u1ebft h\u1ee3p c\u00e1c lo\u1ea1i tr\u00ean.
\nTrong gi\u1eadt c\u01a1 v\u1ecf n\u00e3o ph\u1ea3n x\u1ea1, m\u1ed9t \u0111\u00e1p \u1ee9ng v\u1ecf n\u00e3o qu\u00e1 m\u1ee9c \u0111\u1ed1i v\u1edbi k\u00edch th\u00edch c\u1ea3m gi\u00e1c b\u1ea3n th\u1ec3 g\u00e2y ra gi\u1eadt c\u01a1, nh\u01b0ng sau \u0111\u00f3 to\u00e0n b\u1ed9 v\u1ecf n\u00e3o v\u1eadn \u0111\u1ed9ng-c\u1ea3m gi\u00e1c s\u1ebd g\u00e2y ra \u0111i\u1ec7n th\u1ebf g\u1ee3i c\u1ea3m gi\u00e1c b\u1ea3n th\u1ec3 (SEP) kh\u1ed5ng l\u1ed3 \u1edf v\u1ecf n\u00e3o v\u00e0 gi\u1eadt c\u01a1 ph\u1ea3n x\u1ea1. V\u1ecf n\u00e3o c\u1ea3m gi\u00e1c-v\u1eadn \u0111\u1ed9ng ph\u00f3ng \u0111i\u1ec7n nh\u1ecbp nh\u00e0ng hay b\u00e1n nh\u1ecbp nh\u00e0ng c\u00f3 th\u1ec3 g\u00e2y ra v\u1eadn \u0111\u1ed9ng l\u1eb7p l\u1ea1i g\u1ea7n gi\u1ed1ng nh\u01b0 run.
\nM\u1ed9t c\u01a1 ch\u1ebf b\u1ec7nh sinh \u0111\u1ed3ng nh\u1ea5t c\u1ee7a gi\u1eadt c\u01a1 v\u1ecf n\u00e3o th\u00ec v\u1eabn c\u00f2n ch\u01b0a r\u00f5 r\u00e0ng v\u00e0 c\u00f3 th\u1ec3 do nhi\u1ec1u c\u01a1 ch\u1ebf ph\u1ed1i h\u1ee3p.<\/p>\n

4.2. V\u1ecf n\u00e3o-d\u01b0\u1edbi v\u1ecf<\/strong><\/h3>\n

Sinh l\u00fd v\u1ecf n\u00e3o-d\u01b0\u1edbi v\u1ecf l\u00e0 c\u01a1 ch\u1ebf ch\u00ednh c\u1ee7a gi\u1eadt c\u01a1 \u0111\u1ed9ng kinh m\u00e0 n\u00f3 x\u1ea3y ra trong c\u00e1c h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng kinh to\u00e0n th\u1ec3 nguy\u00ean ph\u00e1t (v\u00ed d\u1ee5: gi\u1eadt c\u01a1 \u0111\u1ed9ng kinh thi\u1ebfu ni\u00ean) v\u00e0 trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p kh\u00e1c (v\u00ed d\u1ee5: \u0111a gi\u1eadt c\u01a1 nh\u1ecf (minipolymyoclonus)).
\nC\u00e1c v\u00ed d\u1ee5 bao g\u1ed3m gi\u1eadt c\u01a1 \u0111\u1ed9ng kinh thi\u1ebfu ni\u00ean v\u00e0 \u0111\u1ed9ng kinh v\u1eafng \u00fd th\u1ee9c. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y, c\u00e1c m\u1ea1ng l\u01b0\u1edbi th\u1ea7n kinh \u1edf \u0111\u1ed3i th\u1ecb \u0111\u01b0\u1ee3c cho l\u00e0 k\u1ebft h\u1ee3p m\u1ed9t c\u00e1ch b\u1ea5t th\u01b0\u1eddng v\u1edbi c\u00e1c v\u00f9ng l\u1edbn c\u1ee7a v\u1ecf n\u00e3o, g\u00e2y ra ho\u1ea1t \u0111\u1ed9ng th\u1ea7n kinh qu\u00e1 m\u1ee9c v\u00e0 c\u00e1c c\u01a1n gi\u1eadt c\u01a1 \u0111\u1ed9ng kinh. C\u00e1c gi\u1eadt c\u01a1 x\u1ea3y ra th\u01b0\u1eddng l\u00e0 to\u00e0n th\u1ec3 ho\u1eb7c \u0111\u1ed3ng th\u1eddi hai b\u00ean.<\/p>\n

4.3. D\u01b0\u1edbi v\u1ecf \u2013 kh\u00f4ng khoanh \u0111o\u1ea1n<\/strong><\/h3>\n

Gi\u1eadt c\u01a1 d\u01b0\u1edbi v\u1ecf \u2013 kh\u00f4ng khoanh \u0111o\u1ea1n \u0111\u01b0\u1ee3c t\u1ea1o ra \u1edf v\u1ecb tr\u00ed d\u01b0\u1edbi v\u1ecf, nh\u01b0ng \u0111\u1eb7c \u0111i\u1ec3m quan tr\u1ecdng l\u00e0 gi\u1eadt c\u01a1 bi\u1ec3u hi\u1ec7n v\u01b0\u1ee3t ra kh\u1ecfi c\u00e1c khoanh \u0111o\u1ea1n \u1edf g\u1ea7n v\u1ecb tr\u00ed t\u1ea1o ra gi\u1eadt c\u01a1.
\nBi\u1ec3u hi\u1ec7n sinh l\u00fd \u0111\u1eb7c tr\u01b0ng nh\u1ea5t c\u1ee7a gi\u1eadt c\u01a1 d\u01b0\u1edbi v\u1ecf-kh\u00f4ng khoanh \u0111o\u1ea1n l\u00e0 gi\u1eadt c\u01a1 h\u1ec7 l\u01b0\u1edbi ph\u1ea3n x\u1ea1 (reticular\u2013reflex myoclonus) v\u00e0 gi\u1eadt c\u01a1 c\u1ed9t sau t\u1ee7y s\u1ed1ng (propriospinal myoclonus). Trong c\u1ea3 2 v\u00ed d\u1ee5 tr\u00ean, ho\u1ea1t \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng xu\u1ea5t ph\u00e1t \u1edf m\u1ed9t v\u1ecb tr\u00ed c\u1ee5c b\u1ed9 c\u1ee7a tr\u1ee5c th\u1ea7n kinh, sau \u0111\u00f3 lan ra c\u1ea3 2 chi\u1ec1u l\u00ean tr\u00ean v\u00e0 xu\u1ed1ng d\u01b0\u1edbi, g\u00e2y n\u00ean gi\u1eadt c\u01a1 to\u00e0n th\u1ec3 do \u1ea3nh h\u01b0\u1edfng con \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n \u1edf c\u1ea3 hai b\u00ean.
\nPh\u00e2n lo\u1ea1i sinh l\u00fd v\u00e0 gi\u1ea3i ph\u1eabu c\u1ee7a c\u00e1c gi\u1eadt c\u01a1 th\u01b0\u1eddng g\u1eb7p<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
V\u1ecf n\u00e3o<\/strong><\/td>\n<\/tr>\n
Run v\u1eaby (m\u1ed9t v\u00e0i tr\u01b0\u1eddng h\u1ee3p)<\/td>\n<\/tr>\n
\u0110\u1ed9ng kinh c\u1ee5c b\u1ed9 li\u00ean t\u1ee5c<\/td>\n<\/tr>\n
Gi\u1eadt c\u01a1 v\u1ecf n\u00e3o ph\u1ea3n x\u1ea1<\/td>\n<\/tr>\n
Gi\u1eadt c\u01a1 v\u1ecf n\u00e3o kh\u00f4ng k\u00e8m gia t\u0103ng ph\u1ea3n x\u1ea1<\/td>\n<\/tr>\n
Gi\u1eadt c\u01a1 do m\u1ed9t s\u1ed1 thu\u1ed1c, \u0111\u1ed9c ch\u1ea5t, r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a nh\u1ea5t \u0111\u1ecbnh<\/td>\n<\/tr>\n
B\u1ec7nh tho\u00e1i h\u00f3a th\u1ea7n kinh c\u00f3 \u1ea3nh h\u01b0\u1edfng v\u1ecf n\u00e3o nh\u01b0:<\/td>\n<\/tr>\n
B\u1ec7nh Alzheimer<\/td>\n<\/tr>\n
Tho\u00e1i h\u00f3a v\u1ecf n\u00e3o h\u1ea1ch n\u1ec1n<\/td>\n<\/tr>\n
B\u1ec7nh Creutzfeldt \u2013 Jakob<\/td>\n<\/tr>\n
B\u1ec7nh Huntington<\/td>\n<\/tr>\n
B\u1ec7nh Parkinson v\u00e0 b\u1ec7nh c\u00e1c b\u1ec7nh th\u1ec3 Lewy<\/td>\n<\/tr>\n
Gi\u1eadt c\u01a1 do v\u1eadn \u0111\u1ed9ng sau thi\u1ebfu oxy n\u00e3o (gi\u1eadt c\u01a1 Lance \u2013 Adams)<\/td>\n<\/tr>\n
Th\u1ea5t \u0111i\u1ec1u gi\u1eadt c\u01a1 ti\u1ebfn tri\u1ec3n<\/td>\n<\/tr>\n
\u0110\u1ed9ng kinh gi\u1eadt c\u01a1 ti\u1ebfn tri\u1ec3n<\/td>\n<\/tr>\n
V\u1ecf n\u00e3o \u2013 d\u01b0\u1edbi v\u1ecf<\/strong><\/td>\n<\/tr>\n
C\u01a1n \u0111\u1ed9ng kinh v\u1eafng \u00fd th\u1ee9c<\/td>\n<\/tr>\n
Gi\u1eadt c\u01a1 \u0111\u1ed9ng kinh to\u00e0n th\u1ec3 nguy\u00ean ph\u00e1t<\/td>\n<\/tr>\n
C\u01a1n \u0111\u1ed9ng kinh gi\u1eadt c\u01a1 to\u00e0n th\u1ec3 nguy\u00ean ph\u00e1t<\/td>\n<\/tr>\n
D\u01b0\u1edbi v\u1ecf-kh\u00f4ng khoanh \u0111o\u1ea1n<\/strong><\/td>\n<\/tr>\n
Gi\u1eadt c\u01a1 v\u00f4 c\u0103n (di truy\u1ec1n)<\/td>\n<\/tr>\n
Tr\u1ea1ng th\u00e1i gi\u1eadt m\u00ecnh qu\u00e1 m\u1ee9c<\/td>\n<\/tr>\n
H\u1ed9i ch\u1ee9ng opsoclonus-myoclonus<\/td>\n<\/tr>\n
Gi\u1eadt c\u01a1 c\u1ed9t sau t\u1ee7y s\u1ed1ng<\/td>\n<\/tr>\n
Gi\u1eadt c\u01a1 h\u1ec7 l\u01b0\u1edbi ph\u1ea3n x\u1ea1<\/td>\n<\/tr>\n
Khoanh \u0111o\u1ea1n<\/strong><\/td>\n<\/tr>\n
Gi\u1eadt c\u01a1 kh\u1ea9u c\u00e1i<\/td>\n<\/tr>\n
Gi\u1eadt c\u01a1 khoanh \u0111o\u1ea1n t\u1ee7y s\u1ed1ng<\/td>\n<\/tr>\n
Ngo\u1ea1i bi\u00ean<\/strong><\/td>\n<\/tr>\n
Co th\u1eaft n\u1eeda m\u1eb7t<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

C\u0169ng c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y h\u1ed9i ch\u1ee9ng gi\u1eadt c\u01a1\u2013lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 c\u00f3 c\u01a1 ch\u1ebf sinh l\u00fd d\u01b0\u1edbi v\u1ecf-kh\u00f4ng khoanh \u0111o\u1ea1n. V\u1ecb tr\u00ed ch\u00ednh x\u00e1c c\u1ee7a \u1ed5 ph\u00f3ng xung d\u01b0\u1edbi v\u1ecf trong gi\u1eadt c\u01a1\u2013lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 th\u00ec v\u1eabn ch\u01b0a r\u00f5, nh\u01b0ng s\u1ef1 ph\u00e2n b\u1ed1 c\u1ee7a gi\u1eadt c\u01a1 lan r\u1ed9ng qua kh\u1ecfi v\u00f9ng \u0111\u1ea7u, c\u1ed5, th\u00e2n tr\u00ean v\u00e0 hai chi tr\u00ean.<\/p>\n

4.4. Khoanh \u0111o\u1ea1n<\/strong><\/h3>\n

Gi\u1eadt c\u01a1 khoanh \u0111o\u1ea1n \u0111\u01b0\u1ee3c t\u1ea1o ra t\u1ea1i m\u1ed9t khoanh \u0111o\u1ea1n nh\u1ea5t \u0111\u1ecbnh ho\u1eb7c t\u1ea1i c\u00e1c khoanh \u0111o\u1ea1n k\u1ebf c\u1eadn nhau c\u1ee7a th\u00e2n n\u00e3o v\u00e0\/ho\u1eb7c t\u1ee7y s\u1ed1ng. Dao \u0111\u1ed9ng v\u1eadn \u0111\u1ed9ng b\u1ec7nh l\u00fd trong d\u1ea1ng gi\u1eadt c\u01a1 n\u00e0y x\u1ea3y ra v\u1edbi t\u1ea7n s\u1ed1 th\u1ea5p h\u01a1n so v\u1edbi run.
\nGi\u1eadt c\u01a1 khoanh \u0111o\u1ea1n bi\u1ec3u hi\u1ec7n \u1edf khoanh \u0111o\u1ea1n, ho\u1eb7c g\u1ea7n v\u1edbi m\u1ed9t khoanh \u0111o\u1ea1n nh\u1ea5t \u0111\u1ecbnh ho\u1eb7c t\u1ea1i c\u00e1c khoanh \u0111o\u1ea1n k\u1ebf c\u1eadn nhau c\u1ee7a c\u01a1 th\u1ec3 (v\u00ed d\u1ee5: gi\u1eadt c\u01a1 kh\u1ea9u c\u00e1i, gi\u1eadt c\u01a1 khoanh \u0111o\u1ea1n t\u1ee7y s\u1ed1ng).<\/p>\n

4.5. Ngo\u1ea1i bi\u00ean<\/strong><\/h3>\n

Gi\u1eadt c\u01a1 ngo\u1ea1i bi\u00ean l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh ngo\u1ea1i bi\u00ean g\u00e2y ra ph\u00f3ng xung v\u1eadn \u0111\u1ed9ng qu\u00e1 m\u1ee9c \u0111\u1ebfn c\u01a1 m\u00e0 n\u00f3 chi ph\u1ed1i (v\u00ed d\u1ee5: co th\u1eaft n\u1eeda m\u1eb7t).<\/p>\n

5. Kha\u0309o sa\u0301t<\/h2>\n

C\u00e1c h\u01b0\u1edbng d\u1eabn kh\u1ea3o s\u00e1t m\u1ed9t b\u1ec7nh nh\u00e2n gi\u1eadt c\u01a1 c\u00f3 th\u1ec3 chia l\u00e0m 4 ph\u1ea7n:
\n\u2013 X\u00e1c \u0111\u1ecbnh h\u1ed9i ch\u1ee9ng d\u1ef1a tr\u00ean \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng.
\n\u2013 C\u1eadn l\u00e2m s\u00e0ng h\u1ed7 tr\u1ee3.
\n\u2013 \u0110i\u1ec7n sinh l\u00fd th\u1ea7n kinh l\u00e2m s\u00e0ng
\n\u2013 X\u00e9t nghi\u1ec7m cho c\u00e1c nguy\u00ean nh\u00e2n hi\u1ebfm g\u1eb7p.<\/p>\n

5.1. X\u00e1c \u0111\u1ecbnh h\u1ed9i ch\u1ee9ng<\/strong><\/h3>\n

B\u01b0\u1edbc \u0111\u1ea7u ti\u00ean \u0111\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n gi\u1eadt c\u01a1 l\u00e0 khai th\u00e1c b\u1ec7nh s\u1eed v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng.
\nCh\u1ea9n \u0111o\u00e1n d\u1ec5 d\u00e0ng h\u1ea7u h\u1ebft gi\u1eadt c\u01a1 d\u1ef1a tr\u00ean quan s\u00e1t l\u00e2m s\u00e0ng. Th\u0103m kh\u00e1m b\u1ec7nh nh\u00e2n gi\u1eadt c\u01a1 c\u1ea7n ch\u00fa \u00fd s\u1ef1 ph\u00e2n b\u1ed1, di\u1ec5n ti\u1ebfn theo th\u1eddi gian v\u00e0 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m ho\u1ea1t h\u00f3a.
\n\u2013 Ph\u00e2n b\u1ed1 c\u00f3 th\u1ec3 c\u1ee5c b\u1ed9, nhi\u1ec1u \u1ed5, khoanh \u0111o\u1ea1n ho\u1eb7c to\u00e0n th\u1ec3. Ph\u00e2n b\u1ed1 nhi\u1ec1u \u1ed5 c\u00f3 th\u1ec3 c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e0 c\u00e1c v\u1eadn \u0111\u1ed9ng \u0111\u1ed3ng b\u1ed9 hai b\u00ean c\u01a1 th\u1ec3.
\n\u2013 Di\u1ec5n ti\u1ebfn theo th\u1eddi gian c\u00f3 th\u1ec3 li\u00ean t\u1ee5c ho\u1eb7c t\u1eebng l\u00fac, c\u1eed \u0111\u1ed9ng c\u00f3 th\u1ec3 th\u00e0nh nh\u1ecbp ho\u1eb7c kh\u00f4ng \u0111\u1ec1u. Gi\u1eadt c\u01a1 t\u1eebng l\u00fac c\u00f3 th\u1ec3 x\u1ea3y ra \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c th\u00e0nh chu\u1ed7i l\u1eb7p l\u1ea1i.
\n\u2013 S\u1ef1 ho\u1ea1t h\u00f3a gi\u1eadt c\u01a1 c\u00f3 th\u1ec3 l\u00fac ngh\u1ec9 (t\u1ef1 ph\u00e1t), do c\u00f3 k\u00edch th\u00edch kh\u00e1c nhau (gi\u1eadt c\u01a1 ph\u1ea3n x\u1ea1), do v\u1eadn \u0111\u1ed9ng ch\u1ee7 \u00fd (gi\u1eadt c\u01a1 do v\u1eadn \u0111\u1ed9ng), ho\u1eb7c ph\u1ed1i h\u1ee3p c\u00e1c y\u1ebfu t\u1ed1 tr\u00ean. T\u1ea5t c\u1ea3 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m ho\u1ea1t h\u00f3a gi\u1eadt c\u01a1 n\u00ean \u0111\u01b0\u1ee3c ghi ch\u00fa l\u1ea1i, d\u00f9 c\u00f3 hay kh\u00f4ng.
\n\u0110\u00f4i khi, quan s\u00e1t b\u1eb1ng m\u1eaft r\u1ea5t kh\u00f3 \u0111\u1ec3 ph\u00e2n bi\u1ec7t gi\u1eadt c\u01a1 v\u1edbi c\u00e1c v\u1eadn \u0111\u1ed9ng kh\u00f4ng ch\u1ee7 \u00fd kh\u00e1c (m\u00faa gi\u1eadt, lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1, run). Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, \u0111i\u1ec7n sinh l\u00fd th\u1ea7n kinh l\u00e2m s\u00e0ng s\u1ebd \u0111\u1eb7c bi\u1ec7t c\u00f3 \u00edch.
\nGi\u1eadt c\u01a1 do thu\u1ed1c ho\u1eb7c \u0111\u1ed9c ch\u1ea5t th\u00ec c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c, v\u00ec trong tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec3n h\u00ecnh, gi\u1eadt c\u01a1 s\u1ebd h\u1ebft khi ng\u01b0ng thu\u1ed1c. C\u1ea7n xem x\u00e9t k\u0129 l\u01b0\u1ee1ng t\u1ea5t c\u1ea3 c\u00e1c thu\u1ed1c, k\u1ec3 c\u1ea3 khi d\u00f9ng \u0111\u01a1n \u0111\u1ed9c hay ph\u1ed1i h\u1ee3p, khi \u0111\u00e1nh gi\u00e1 c\u00e1c nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 g\u00e2y gi\u1eadt c\u01a1.<\/p>\n

5.2. X\u00e9t nghi\u1ec7m h\u1ed7 tr\u1ee3<\/strong><\/h3>\n

N\u00ean th\u1ef1c hi\u1ec7n c\u00e1c x\u00e9t nghi\u1ec7m h\u1ed7 tr\u1ee3 khi nguy\u00ean nh\u00e2n gi\u1eadt c\u01a1 v\u1eabn ch\u01b0a r\u00f5 d\u00f9 \u0111\u00e3 khai th\u00e1c b\u1ec7nh s\u1eed v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng. C\u00e1c x\u00e9t nghi\u1ec7m \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb:
\n\u2013 \u0110i\u1ec7n gi\u1ea3i \u0111\u1ed3 (bao g\u1ed3m calci, magie).
\n\u2013 Bismuth.
\n\u2013 Glucose.
\n\u2013 Ch\u1ee9c n\u0103ng th\u1eadn.
\n\u2013 Ch\u1ee9c n\u0103ng gan.
\n\u2013 Kh\u00e1ng th\u1ec3 tuy\u1ebfn gi\u00e1p v\u00e0 ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p.
\n\u2013 Kh\u00e1ng th\u1ec3 c\u1eadn ung (b\u1ed9 x\u00e9t nghi\u1ec7m \u0111\u1ea7y \u0111\u1ee7).
\n\u2013 N\u1ed3ng \u0111\u1ed9 vitamin E.
\n\u2013 S\u00e0ng l\u1ecdc thu\u1ed1c v\u00e0 \u0111\u1ed9c ch\u1ea5t n\u1ebfu l\u00e2m s\u00e0ng nghi ng\u1edd s\u1eed d\u1ee5ng thu\u1ed1c kh\u00f4ng r\u00f5 ho\u1eb7c d\u00f9ng c\u00e1c ch\u1ea5t kh\u00f4ng h\u1ee3p ph\u00e1p ho\u1eb7c thu\u1ed1c h\u01b0\u1edbng th\u1ea7n.
\n\u2013 \u0110i\u1ec7n n\u00e3o \u0111\u1ed3.
\n\u2013 H\u00ecnh \u1ea3nh h\u1ecdc n\u00e3o b\u1ed9.
\n\u2013 H\u00ecnh \u1ea3nh h\u1ecdc t\u1ee7y s\u1ed1ng (n\u1ebfu gi\u1eadt c\u01a1 c\u1ee5c b\u1ed9 ho\u1eb7c gi\u1eadt c\u01a1 khoanh \u0111o\u1ea1n).
\n\u2013 Bilan nhi\u1ec5m tr\u00f9ng (t\u1ed5ng ph\u00e2n t\u00edch t\u1ebf b\u00e0o m\u00e1u, t\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u, c\u1ea5y m\u00e1u, ch\u1ecdc d\u1ecbch n\u00e3o t\u1ee7y, X quang ph\u1ed5i) n\u1ebfu c\u00f3 d\u1ea5u \u0111\u1ecbnh v\u1ecb nh\u01b0 s\u1ed1t, t\u0103ng b\u1ea1ch c\u1ea7u, ho\u1eb7c b\u1ec7nh n\u00e3o.
\n\u2013 Ph\u00e2n t\u00edch d\u1ecbch n\u00e3o t\u1ee7y trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh n\u00e3o, d\u1ea5u hi\u1ec7u c\u1ee7a nhi\u1ec5m tr\u00f9ng, nghi ng\u1edd b\u1ec7nh do r\u1ed1i lo\u1ea1n mi\u1ec5n d\u1ecbch ho\u1eb7c b\u1ec7nh do prion (v\u00ed d\u1ee5: CJD).
\nNh\u1eefng x\u00e9t nghi\u1ec7m n\u00e0y bao tr\u00f9m c\u00e1c nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a gi\u1eadt c\u01a1 do r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i, r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a m\u1eafc ph\u1ea3i. H\u00ecnh \u1ea3nh h\u1ecdc n\u00e3o b\u1ed9 v\u00e0 t\u1ee7y s\u1ed1ng c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng ho\u1eb7c teo n\u00e3o t\u1ee7y, gi\u00fap cho ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n \u0111\u1eb7c hi\u1ec7u c\u1ee7a gi\u1eadt c\u01a1. X\u00e9t nghi\u1ec7m d\u1ecbch n\u00e3o t\u1ee7y gi\u00fap ph\u00e2n bi\u1ec7t c\u00e1c nguy\u00ean nh\u00e2n nhi\u1ec5m tr\u00f9ng, vi\u00eam v\u1edbi \u0111\u1ed9c ch\u1ea5t, do thu\u1ed1c ho\u1eb7c chuy\u1ec3n h\u00f3a.
\n\u0110i\u1ec7n n\u00e3o \u0111\u1ed3 gi\u00fap x\u00e1c \u0111\u1ecbnh c\u00e1c ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n n\u00e3o trong c\u01a1n ho\u1eb7c gi\u1eefa c\u00e1c c\u01a1n trong nh\u00f3m gi\u1eadt c\u01a1 \u0111\u1ed9ng kinh. V\u00ed d\u1ee5 nh\u01b0 c\u00e1c gai to\u00e0n th\u1ec3 v\u00e0 ph\u1ee9c h\u1ee3p gai\u2013s\u00f3ng t\u1ea7n s\u1ed1 3-6 Hz l\u00e0 \u0111\u1eb7c tr\u01b0ng c\u1ee7a gi\u1eadt c\u01a1 \u0111\u1ed9ng kinh to\u00e0n th\u1ec3 nguy\u00ean ph\u00e1t, trong khi ph\u1ee9c h\u1ee3p gai\u2013s\u00f3ng t\u1ea7n s\u1ed1 3 Hz g\u1eb7p trong \u0111\u1ed9ng kinh v\u1eafng \u00fd th\u1ee9c.<\/p>\n

5.3. \u0110i\u1ec7n sinh l\u00fd th\u1ea7n kinh l\u00e2m s\u00e0ng<\/strong><\/h3>\n

\u0110i\u1ec7n sinh l\u00fd th\u1ea7n kinh l\u00e2m s\u00e0ng gi\u00fap ph\u00e2n lo\u1ea1i sinh l\u00fd gi\u1eadt c\u01a1 v\u00e0 h\u1ed7 tr\u1ee3 \u0111\u1ecbnh khu gi\u1ea3i ph\u1eabu th\u1ea7n kinh c\u0169ng nh\u01b0 nguy\u00ean nh\u00e2n. Ngo\u00e0i ra, x\u00e9t nghi\u1ec7m n\u00e0y c\u00f2n gi\u00fap \u00edch khi quan s\u00e1t l\u00e2m s\u00e0ng \u0111\u01a1n thu\u1ea7n kh\u00f4ng th\u1ec3 ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c gi\u1eadt c\u01a1 v\u1edbi c\u00e1c lo\u1ea1i v\u1eadn \u0111\u1ed9ng kh\u00f4ng ch\u1ee7 \u00fd kh\u00e1c nh\u01b0 m\u00faa gi\u1eadt, lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 v\u00e0 run.
\nC\u00e1c k\u1ef9 thu\u1eadt \u0111a k\u00ed \u0111\u1ec3 ph\u00e2n lo\u1ea1i sinh l\u00fd gi\u1eadt c\u01a1 bao g\u1ed3m:
\n\u2013 \u0110i\u1ec7n c\u01a1 b\u1ec1 m\u1eb7t (surface electromyography).
\n\u2013 \u0110a k\u00ed \u0111i\u1ec7n n\u00e3o \u0111\u1ed3-\u0111i\u1ec7n c\u01a1 \u0111\u1ed3 \u0111\u1ed3ng th\u1eddi (simultaneous EEG-EMG polygraphy).
\n\u2013 \u0110i\u1ec7n th\u1ebf g\u1ee3i c\u1ea3m gi\u00e1c b\u1ea3n th\u1ec3.
\n\u2013 K\u0129 thu\u1eadt trung b\u00ecnh h\u00f3a ng\u01b0\u1ee3c ho\u1ea1t \u0111\u1ed9ng EEG tho\u00e1ng qua, c\u1ed1 \u0111\u1ecbnh theo gi\u1eadt c\u01a1 (Jerk\u2013locked back\u2013averaging of EEG transient) v\u00e0\/ho\u1eb7c \u0111o \u0111i\u1ec7n th\u1ebf g\u1ee3i c\u1ea3m gi\u00e1c b\u1ea3n th\u1ec3 theo ph\u00f3ng \u0111i\u1ec7n EMG.
\n\u2013 \u0110\u00e1p \u1ee9ng EMG ti\u1ec1m th\u1eddi d\u00e0i v\u1edbi k\u00edch th\u00edch th\u1ea7n kinh ngo\u1ea1i bi\u00ean (long latency EMG responses to peripheral nerve stimulation), v\u00ed d\u1ee5: ph\u1ea3n x\u1ea1 C.
\nX\u00e9t nghi\u1ec7m \u0111i\u1ec7n sinh l\u00fd th\u1ea7n kinh l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh n\u1ebfu nh\u01b0 ch\u1ea9n \u0111o\u00e1n v\u1eabn kh\u00f4ng r\u00f5 r\u00e0ng sau khi khai th\u00e1c b\u1ec7nh s\u1eed, th\u0103m kh\u00e1m v\u00e0 l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m h\u1ed7 tr\u1ee3 kh\u00e1c.
\n\u0110\u1eb7c \u0111i\u1ec3m \u0111i\u1ec7n sinh l\u00fd th\u1ea7n kinh c\u1ee7a gi\u1eadt c\u01a1 theo ph\u00e2n lo\u1ea1i gi\u1ea3i ph\u1eabu \u2013 sinh l\u00fd:
\n\u2013 V\u1ecf n\u00e3o: gi\u1eadt c\u01a1 v\u1ecf n\u00e3o x\u1ea3y ra do s\u1ef1 ph\u00f3ng \u0111i\u1ec7n c\u1ee5c b\u1ed9 \u1edf v\u1ecf n\u00e3o c\u1ea3m gi\u00e1c \u2013 v\u1eadn \u0111\u1ed9ng nguy\u00ean ph\u00e1t. Th\u1eddi kho\u1ea3ng ph\u00f3ng \u0111i\u1ec7n EMG \u0111i\u1ec3n h\u00ecnh <75 ms v\u00e0 c\u00f3 ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n n\u00e3o khu tr\u00fa tho\u00e1ng qua khi l\u00e0m k\u1ef9 thu\u1eadt trung b\u00ecnh h\u00f3a ng\u01b0\u1ee3c. \u0110i\u1ec7n th\u1ebf g\u1ee3i c\u1ea3m gi\u00e1c b\u1ea3n th\u1ec3 kh\u1ed5ng l\u1ed3 v\u00e0 \u0111\u00e1p \u1ee9ng EMG ti\u1ec1m th\u1eddi d\u00e0i t\u0103ng l\u00ean (v\u00ed d\u1ee5: ph\u1ea3n x\u1ea1 C) l\u00e0 \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a gi\u1eadt c\u01a1 v\u1ecf n\u00e3o ph\u1ea3n x\u1ea1.
\n\u2013 V\u1ecf n\u00e3o \u2013 d\u01b0\u1edbi v\u1ecf: sinh l\u00fd gi\u1eadt c\u01a1 v\u1ecf n\u00e3o \u2013 d\u01b0\u1edbi v\u1ecf bao g\u1ed3m c\u00e1c dao \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng, k\u1ecbch ph\u00e1t, qu\u00e1 m\u1ee9c trong c\u00e1c k\u1ebft n\u1ed1i hai chi\u1ec1u gi\u1eefa c\u00e1c v\u1ecb tr\u00ed v\u1ecf n\u00e3o v\u00e0 d\u01b0\u1edbi v\u1ecf. Tr\u00ean \u0111i\u1ec7n c\u01a1 b\u1ec1 m\u1eb7t, th\u1eddi kho\u1ea3ng ph\u00f3ng \u0111i\u1ec7n \u0111i\u1ec3n h\u00ecnh l\u00e0 <100 ms v\u00e0 c\u00e1c h\u00ecnh \u1ea3nh \u0111i\u1ec7n n\u00e3o tho\u00e1ng qua (v\u00ed d\u1ee5: ph\u1ee9c h\u1ee3p gai-s\u00f3ng) th\u01b0\u1eddng lan t\u1ecfa. B\u1eb1ng k\u1ef9 thu\u1eadt trung b\u00ecnh h\u00f3a ng\u01b0\u1ee3c, trong tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec3n h\u00ecnh s\u1ebd th\u1ea5y ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n n\u00e3o tho\u00e1ng qua t\u01b0\u01a1ng \u1ee9ng v\u1edbi ph\u00f3ng \u0111i\u1ec7n tr\u00ean \u0111i\u1ec7n c\u01a1. \u0110\u00f4i khi c\u00f3 th\u1ec3 c\u00f3 \u0111i\u1ec7n th\u1ebf g\u1ee3i c\u1ea3m gi\u00e1c b\u1ea3n th\u1ec3 kh\u1ed5ng l\u1ed3 v\u00e0 gia t\u0103ng ph\u1ea3n x\u1ea1 ti\u1ec1m th\u1eddi d\u00e0i.
\n\u2013 D\u01b0\u1edbi v\u1ecf-kh\u00f4ng khoanh \u0111o\u1ea1n: gi\u1eadt c\u01a1 d\u01b0\u1edbi v\u1ecf-kh\u00f4ng khoanh \u0111o\u1ea1n c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb d\u01b0\u1edbi v\u1ecf nh\u01b0ng kh\u00f4ng ph\u1ea3i l\u00e0 khoanh \u0111o\u1ea1n (v\u00ed d\u1ee5: h\u1ed9i ch\u1ee9ng gi\u1eadt c\u01a1-lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1). Th\u1eddi kho\u1ea3ng ph\u00f3ng \u0111i\u1ec7n tr\u00ean \u0111i\u1ec7n c\u01a1 thay \u0111\u1ed5i. K\u1ef9 thu\u1eadt trung b\u00ecnh h\u00f3a ng\u01b0\u1ee3c c\u1ed1 \u0111\u1ecbnh theo gi\u1eadt c\u01a1 kh\u00f4ng cho th\u1ea5y ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n n\u00e3o tho\u00e1ng qua t\u01b0\u01a1ng \u1ee9ng v\u1edbi ph\u00f3ng \u0111i\u1ec7n tr\u00ean \u0111i\u1ec7n c\u01a1. \u0110i\u1ec7n th\u1ebf g\u1ee3i c\u1ea3m gi\u00e1c b\u1ea3n th\u1ec3 b\u00ecnh th\u01b0\u1eddng. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 \u0111\u00e1p \u1ee9ng ph\u1ea3n x\u1ea1 EMG v\u1edbi k\u00edch th\u00edch \u00e2m thanh.
\n\u2013 Khoanh \u0111o\u1ea1n: gi\u1eadt c\u01a1 khoanh \u0111o\u1ea1n c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb m\u1ed9t khoanh \u0111o\u1ea1n nh\u1ea5t \u0111\u1ecbnh ho\u1eb7c c\u00e1c khoanh \u0111o\u1ea1n li\u00ean ti\u1ebfp c\u1ee7a th\u00e2n n\u00e3o v\u00e0\/ho\u1eb7c t\u1ee7y s\u1ed1ng. Th\u1eddi kho\u1ea3ng ph\u00f3ng \u0111i\u1ec7n tr\u00ean EMG th\u01b0\u1eddng k\u00e9o d\u00e0i > 100 ms v\u00e0 th\u01b0\u1eddng th\u00e0nh nh\u1ecbp. V\u1edbi test ph\u1ea3n x\u1ea1 EMG, m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p gi\u1eadt c\u01a1 khoanh \u0111o\u1ea1n c\u00f3 \u0111\u00e1p \u1ee9ng ti\u1ec1m th\u1eddi r\u1ea5t ng\u1eafn, kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi ngu\u1ed3n g\u1ed1c tr\u00ean t\u1ee7y s\u1ed1ng.
\n\u2013 Ngo\u1ea1i bi\u00ean: gi\u1eadt c\u01a1 ngo\u1ea1i bi\u00ean c\u00f3 ngu\u1ed3n g\u1ed1c ngo\u1ea1i bi\u00ean (ngh\u0129a l\u00e0 d\u00e2y th\u1ea7n kinh ngo\u1ea1i bi\u00ean). Th\u1eddi kho\u1ea3ng ph\u00f3ng \u0111i\u1ec7n EMG thay \u0111\u1ed5i v\u00e0 kh\u00f4ng \u0111\u1ec1u.<\/p>\n

5.4. X\u00e9t nghi\u1ec7m cho c\u00e1c nguy\u00ean nh\u00e2n hi\u1ebfm c\u1ee7a gi\u1eadt c\u01a1:<\/strong><\/h3>\n

Xem x\u00e9t l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m n\u00e0y n\u1ebfu nh\u01b0 c\u00e1c kh\u1ea3o s\u00e1t ti\u00eau chu\u1ea9n bao g\u1ed3m c\u1ea3 kh\u1ea3o s\u00e1t \u0111i\u1ec7n sinh l\u00fd th\u1ea7n kinh l\u00e2m s\u00e0ng v\u1eabn kh\u00f4ng t\u00ecm \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n. V\u00ed d\u1ee5 nh\u01b0:
\n\u2013 X\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh h\u1ecdc to\u00e0n c\u01a1 th\u1ec3 \u0111\u1ec3 t\u00ecm ung th\u01b0 \u1ea9n, th\u1eadm ch\u00ed trong tr\u01b0\u1eddng h\u1ee3p c\u00e1c kh\u00e1ng th\u1ec3 c\u1eadn ung th\u01b0 \u0111\u1ec1u \u00e2m t\u00ednh.
\n\u2013 X\u00e9t nghi\u1ec7m enzyme t\u00ecm c\u00e1c b\u1ec7nh thi\u1ebfu h\u1ee5t men neuraminidase v\u00e0 biotinidase.
\n\u2013 X\u00e9t nghi\u1ec7m b\u1ec7nh Wilson.
\n\u2013 X\u00e9t nghi\u1ec7m gen (v\u00e0 sinh thi\u1ebft m\u00f4 n\u1ebfu c\u1ea7n) v\u1edbi c\u00e1c r\u1ed1i lo\u1ea1n di truy\u1ec1n, nh\u01b0 b\u1ec7nh Unverricht-Lundborg (gen EMP1), b\u1ec7nh th\u1ec3 Lafora (EMP2A v\u00e0 EMP2B), b\u1ec7nh Huntington v\u00e0 b\u1ec7nh t\u00edch t\u1ee5 ceroid lipofuscin \u1edf h\u1ec7 th\u1ea7n kinh.
\n\u2013 Kh\u1ea3o s\u00e1t b\u1ec7nh ti th\u1ec3, bao g\u1ed3m lactat m\u00e1u, sinh thi\u1ebft c\u01a1, x\u00e9t nghi\u1ec7m gen.<\/p>\n

T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/h2>\n

1. Kojovic M, Cordivari C, Bhatia K (2011). Myoclonic disorders: a practical approach for diagnosis and treatment. Ther Adv Neurol Disord.;4(1):47-62.
\n2. Lozsadi D (2012). Myoclonus: a pragmatic approach. Practical Neurology ;12:215-224.
\n3. Rodi Zutt, Jan W. Elting, Jonathan C. van Zijl, et al (2018). Electrophysiologic testing aids diagnosis and subtyping of myoclonus. Neurology, 90 (8) e647-e657.
\n4. Zutt, R., van Egmond, M., Elting, J. et al (2015) A novel diagnostic approach to patients with myoclonus. Nat Rev Neurol 11, 687\u2013697.<\/p>\n","protected":false},"excerpt":{"rendered":"

Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n gi\u00e2\u0323t c\u01a1\u00a0(Myoclonus) bao g\u1ed3m l\u1ecbch s\u1eed b\u1ec7nh l\u00fd v\u00e0 ki\u1ec3m tra th\u1ea7n kinh, k\u1ebft h\u1ee3p v\u1edbi c\u00e1c x\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh v\u00e0 x\u00e9t nghi\u1ec7m \u0111i\u1ec7n c\u01a1. Ngo\u00e0i ra, c\u00e1c b\u00e1c s\u0129 c\u0169ng c\u1ea7n ki\u1ec3m tra c\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c nhau nh\u01b0 thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn […]<\/p>\n","protected":false},"author":42,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10,33],"tags":[],"yoast_head":"\nTi\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n gi\u00e2\u0323t c\u01a1 - Vinmec<\/title>\n<meta name=\"description\" content=\"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n gi\u00e2\u0323t c\u01a1 g\u1ed3m l\u1ecbch s\u1eed b\u1ec7nh l\u00fd v\u00e0 ki\u1ec3m tra th\u1ea7n kinh, k\u1ebft h\u1ee3p v\u1edbi c\u00e1c x\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh v\u00e0 x\u00e9t nghi\u1ec7m \u0111i\u1ec7n c\u01a1.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n gi\u00e2\u0323t c\u01a1 - 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