{"id":31005,"date":"2023-05-06T21:54:54","date_gmt":"2023-05-06T14:54:54","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31005"},"modified":"2023-05-06T21:54:54","modified_gmt":"2023-05-06T14:54:54","slug":"tong-quan-liet-tren-nhan-tien-trien","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/tong-quan-liet-tren-nhan-tien-trien\/","title":{"rendered":"T\u1ed5ng quan li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n"},"content":{"rendered":"

Li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n (PSP \u2013 Progressive supranuclear palsy) l\u00e0 b\u1ec7nh l\u00fd tho\u00e1i h\u00f3a th\u1ea7n kinh ph\u1ed5 bi\u1ebfn nh\u1ea5t trong nh\u00f3m h\u1ed9i ch\u1ee9ng Parkinson kh\u00f4ng \u0111i\u1ec3n h\u00ecnh. C\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng \u0111\u1eb7c tr\u01b0ng c\u1ee7a b\u1ec7nh g\u1ed3m li\u1ec7t li\u1ebfc d\u1ecdc, m\u1ea5t \u1ed5n \u0111\u1ecbnh t\u01b0 th\u1ebf v\u1edbi t\u00ecnh tr\u1ea1ng ng\u00e3 t\u00e1i di\u1ec5n kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n, gi\u1ea3m \u0111\u1ed9ng v\u00e0 r\u1ed1i lo\u1ea1n nh\u1eadn th\u1ee9c. V\u1ec1 m\u1eb7t b\u1ec7nh l\u00fd, li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 l\u1eafng \u0111\u1ecdng protein tau b\u1ea5t th\u01b0\u1eddng v\u00e0 \u0111\u01b0\u1ee3c x\u1ebfp v\u00e0o nh\u00f3m b\u1ec7nh l\u00fd tau protein.<\/strong><\/p>\n

Ba\u0300i vi\u00ea\u0301t T\u1ed5ng quan li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n tri\u0301ch ngu\u00f4\u0300n t\u01b0\u0300 H\u00f4\u0323i Th\u00e2\u0300n kinh ho\u0323c Vi\u00ea\u0323t Nam<\/a>.<\/strong><\/em><\/p>\n

L\u00ea Th\u1ecb Ng\u1ecdc1, Nguy\u1ec5n Thanh B\u00ecnh2<\/strong><\/em>
\nB\u1ec7nh vi\u1ec7n L\u00e3o khoa Trung \u01b0\u01a1ng1<\/sup><\/em><\/p>\n

\u0110\u1ea1i h\u1ecdc Y H\u00e0 N\u1ed9i2<\/sup><\/em><\/p>\n

1. L\u1ecbch s\u1eed cu\u0309a Li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n<\/strong><\/h2>\n

N\u0103m 1964, ba t\u00e1c gi\u1ea3 Steele, Richardson v\u00e0 Olszewski l\u00e0 nh\u1eefng ng\u01b0\u1eddi \u0111\u1ea7u ti\u00ean \u0111\u01b0a ra m\u00f4 t\u1ea3 v\u1ec1 li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n th\u00f4ng qua 9 ca b\u1ec7nh v\u1edbi c\u00e1c bi\u1ec3u hi\u1ec7n: li\u1ec7t v\u1eadn nh\u00e3n tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n, r\u1ed1i lo\u1ea1n t\u01b0 th\u1ebf v\u00e0 d\u00e1ng \u0111i, r\u1ed1i lo\u1ea1n v\u1eadn ng\u00f4n, nu\u1ed1t kh\u00f3, t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1 v\u00e0 suy gi\u1ea3m nh\u1eadn th\u1ee9c th\u00f9y tr\u00e1n. Do v\u1eady, li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n c\u00f3 t\u00ean g\u1ecdi l\u00e0 h\u1ed9i ch\u1ee9ng Steele-Richardson-Olszewski. K\u1ec3 t\u1eeb \u0111\u00f3, h\u00e0ng tr\u0103m c\u00e1c ca b\u1ec7nh t\u01b0\u01a1ng t\u1ef1 \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn. Ki\u1ec3u h\u00ecnh l\u00e2m s\u00e0ng r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng c\u1ed5 \u0111i\u1ec3n hi\u1ec7n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 h\u1ed9i ch\u1ee9ng Richardson (PSP-RS) [1].
\nN\u0103m 1972, Steele d\u1ef1 \u0111o\u00e1n c\u00e1c bi\u1ebfn th\u1ec3 l\u00e2m s\u00e0ng c\u1ee7a h\u1ed9i ch\u1ee9ng c\u00f3 kh\u1ea3 n\u0103ng x\u1ea3y ra khi b\u1ec7nh \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u00e1c nh\u00e2n th\u00e2n n\u00e3o kh\u00e1c nhau t\u1ea1i c\u00e1c th\u1eddi \u0111i\u1ec3m kh\u00e1c nhau v\u00e0 \u1edf c\u00e1c m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau. C\u00e1c ki\u1ec3u h\u00ecnh kh\u00e1c nhau \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn. M\u1ed9t s\u1ed1 bi\u1ebfn th\u1ec3 c\u1ee7a li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n bao g\u1ed3m PSP v\u1edbi bi\u1ec3u hi\u1ec7n \u0111\u00f4ng c\u1ee9ng d\u00e1ng \u0111i ti\u1ebfn tri\u1ec3n (PSP-PGF), PSP v\u1edbi h\u1ed9i ch\u1ee9ng Parkinson chi\u1ebfm \u01b0u th\u1ebf (PSP-P) v\u00e0 PSP v\u1edbi r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u00f9y tr\u00e1n chi\u1ebfm \u01b0u th\u1ebf (PSP-F).
\nTi\u00eau chu\u1ea9n li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n ban \u0111\u1ea7u \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t v\u00e0o n\u0103m 1996 v\u00e0 \u0111\u01b0\u1ee3c s\u1eeda \u0111\u1ed5i v\u00e0o n\u0103m 2017.<\/p>\n

2. D\u1ecbch t\u1ec5 ho\u0323c Li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n<\/strong><\/h2>\n

Li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh hi\u1ebfm g\u1eb7p v\u1edbi t\u1ef7 l\u1ec7 hi\u1ec7n m\u1eafc kho\u1ea3ng 5,8 \u0111\u1ebfn 6,5 tr\u00ean 100.000 [2]. T\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n h\u00e0ng n\u0103m dao \u0111\u1ed9ng t\u1eeb 0,3 \u0111\u1ebfn 0,4 tr\u00ean 100.000. T\u1ef7 l\u1ec7 m\u1eafc h\u00e0ng n\u0103m t\u0103ng theo \u0111\u1ed9 tu\u1ed5i t\u1eeb 1,7 tr\u01b0\u1eddng h\u1ee3p tr\u00ean 100.000 \u1edf \u0111\u1ed9 tu\u1ed5i 50 \u0111\u1ebfn 59 tu\u1ed5i l\u00ean 14,7 tr\u00ean 100.000 \u1edf 80 \u0111\u1ebfn 89 tu\u1ed5i.
\nTu\u1ed5i kh\u1edfi ph\u00e1t trung b\u00ecnh c\u1ee7a b\u1ec7nh li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n l\u00e0 kho\u1ea3ng 65 tu\u1ed5i, gi\u00e0 h\u01a1n so v\u1edbi b\u1ec7nh Parkinson v\u00f4 c\u0103n [3]. H\u1ea7u nh\u01b0 kh\u00f4ng c\u00f3 tr\u01b0\u1eddng h\u1ee3p li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n n\u00e0o \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn qua kh\u00e1m nghi\u1ec7m t\u1eed thi \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u01b0\u1edbi 40 tu\u1ed5i. B\u00e1o c\u00e1o ban \u0111\u1ea7u ghi nh\u1eadn t\u1ef7 l\u1ec7 nam gi\u1edbi chi\u1ebfm \u01b0u th\u1ebf (8\/1). Tuy nhi\u00ean, c\u00e1c b\u00e1o c\u00e1o sau \u0111\u00f3 kh\u00f4ng t\u00ecm th\u1ea5y \u01b0u th\u1ebf gi\u1edbi r\u00f5 r\u00e0ng trong b\u1ec7nh li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n.
\nKh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 n\u00e0o \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n tr\u1eeb tu\u1ed5i cao. Hi\u1ec7n nay c\u00f3 nhi\u1ec1u b\u00e1o c\u00e1o cho th\u1ea5y t\u00ednh nh\u1ea1y c\u1ea3m v\u1ec1 m\u1eb7t di truy\u1ec1n. Sa s\u00fat tr\u00ed tu\u1ec7 tr\u00e1n th\u00e1i d\u01b0\u01a1ng c\u00f3 h\u1ed9i ch\u1ee9ng Parkinson do \u0111\u1ed9t bi\u1ebfn gen MAPT (FTDP-17T) c\u00f3 nhi\u1ec1u bi\u1ebfn th\u1ec3 l\u00e2m s\u00e0ng v\u00e0 b\u1ec7nh h\u1ecdc, trong \u0111\u00f3 FTDP-17T do m\u00e3 h\u00f3a ho\u1eb7c gh\u00e9p n\u1ed1i exon 10 c\u00f3 nhi\u1ec1u \u0111i\u1ec3m gi\u1ed1ng li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n c\u1ea3 v\u1ec1 l\u00e2m s\u00e0ng v\u00e0 m\u00f4 b\u1ec7nh h\u1ecdc [4]. Ngo\u00e0i ra m\u1ed9t s\u1ed1 gen kh\u00e1c l\u00e0m t\u0103ng nguy c\u01a1 li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n nh\u01b0 STX6, EIF2AK3, MOBP; tuy nhi\u00ean \u00fd ngh\u0129a c\u1ee7a nh\u1eefng gen n\u00e0y c\u00f2n ch\u01b0a r\u00f5 r\u00e0ng.<\/p>\n

3. Sinh l\u00fd b\u1ec7nh v\u00e0 gi\u1ea3i ph\u1eabu b\u1ec7nh<\/strong><\/h2>\n

\u2013 Li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n th\u01b0\u1eddng th\u1ea5y teo th\u00f9y tr\u00e1n (\u0111\u1eb7c bi\u1ec7t l\u00e0 h\u1ed3i tr\u01b0\u1edbc trung t\u00e2m), n\u00e3o gi\u1eefa (\u0111\u1eb7c bi\u1ec7t l\u00e0 ph\u1ea7n m\u00e1i), c\u1ea7u n\u00e3o teo \u1edf m\u1ee9c \u0111\u1ed9 nh\u1eb9 h\u01a1n. Nh\u00e2n d\u01b0\u1edbi \u0111\u1ed3i nh\u1ecf h\u01a1n v\u00e0 c\u00f3 th\u1ec3 b\u1ecb chuy\u1ec3n sang m\u00e0u x\u00e1m. Ph\u1ea7n tr\u00ean c\u1ee7a cu\u1ed1ng ti\u1ec3u n\u00e3o v\u00e0 nh\u00e2n r\u0103ng ti\u1ec3u n\u00e3o th\u01b0\u1eddng b\u1ecb teo v\u00e0 c\u00f3 m\u00e0u x\u00e1m do m\u1ea5t s\u1ee3i myelin.
\n\u2013 \u0110\u1eb7c \u0111i\u1ec3m m\u00f4 b\u1ec7nh h\u1ecdc c\u1ee7a li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n bao g\u1ed3m m\u1ea5t t\u1ebf b\u00e0o th\u1ea7n kinh, t\u0103ng sinh x\u01a1 h\u00f3a v\u00e0 m\u00f4 \u0111\u1ec7m, th\u1ec3 v\u00f9i tau protein trong t\u1ebf b\u00e0o h\u00ecnh sao, t\u1ebf b\u00e0o \u00edt nh\u00e1nh v\u00e0 neuron ch\u1ee7 y\u1ebfu \u1edf nh\u00e2n d\u01b0\u1edbi \u0111\u1ed3i, c\u1ea7u nh\u1ea1t, th\u1ec3 v\u00e2n, nh\u00e2n \u0111\u1ecf, ch\u1ea5t \u0111en, ch\u1ecfm c\u1ea7u n\u00e3o, nh\u00e2n v\u1eadn nh\u00e3n v\u00e0 nh\u00e2n r\u0103ng. C\u00e1c \u0111\u00e1m r\u1ed1i t\u01a1 s\u1ee3i th\u1ea7n kinh ch\u1ee7 y\u1ebfu ch\u1ee9a c\u00e1c \u0111\u1ed3ng d\u1ea1ng tau v\u1edbi b\u1ed1n l\u1ea7n l\u1eb7p l\u1ea1i li\u00ean k\u1ebft vi \u1ed1ng (4R-tau) trong t\u1ebf b\u00e0o th\u1ea7n kinh \u0111\u1ec7m oligodendrocyte v\u00e0 t\u1ebf b\u00e0o h\u00ecnh sao. B\u00ecnh th\u01b0\u1eddng, tau \u0111\u01b0\u1ee3c phosphoryl h\u00f3a tr\u00ean m\u1ed9t lo\u1ea1t c\u00e1c g\u1ed1c serine v\u00e0 threonine, \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh b\u1edfi nhi\u1ec1u kinase v\u00e0 phosphatase. Trong li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n, protein tau b\u1ecb phosphoryl h\u00f3a qu\u00e1 m\u1ee9c d\u1eabn \u0111\u1ebfn m\u1ea5t \u00e1i l\u1ef1c v\u1edbi c\u00e1c vi \u1ed1ng l\u00e0m m\u1ea5t \u1ed5n \u0111\u1ecbnh, th\u00e1o r\u1eddi vi \u1ed1ng. \u0110i\u1ec1u n\u00e0y d\u1eabn \u0111\u1ebfn s\u1ef1 t\u00edch t\u1ee5 c\u1ee7a tau v\u00e0 h\u00ecnh th\u00e0nh c\u00e1c \u0111\u00e1m r\u1ed1i s\u1ee3i th\u1ea7n kinh.
\n\u2013 \u1ede b\u1ec7nh Alzheimer, s\u1ef1 h\u00ecnh th\u00e0nh \u0111\u00e1m t\u01a1 s\u1ee3i th\u1ea7n kinh do l\u1eafng \u0111\u1ecdng protein tau x\u1ea3y ra \u1edf t\u1ebf b\u00e0o th\u1ea7n kinh v\u00e0 xu\u1ea5t hi\u1ec7n \u0111\u1ea7u ti\u00ean \u1edf h\u1ec7 limbic. Trong khi \u0111\u00f3 \u1edf PSP, s\u1ef1 l\u1eafng \u0111\u1ecdng n\u00e0y xu\u1ea5t hi\u1ec7n c\u1ea3 \u1edf t\u1ebf b\u00e0o th\u1ea7n kinh v\u00e0 t\u1ebf b\u00e0o th\u1ea7n kinh \u0111\u1ec7m (bao g\u1ed3m c\u1ea3 oligodendrocyte v\u00e0 astrocyte), t\u1ed5n th\u01b0\u01a1ng xu\u1ea5t hi\u1ec7n \u0111\u1ea7u ti\u00ean \u1edf v\u1ecf n\u00e3o v\u1eadn \u0111\u1ed9ng v\u00e0 ti\u1ec1n v\u1eadn \u0111\u1ed9ng [5].<\/p>\n

4. L\u00e2m s\u00e0ng cu\u0309a Li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n<\/strong><\/h2>\n

\u0110\u1eb7c \u0111i\u1ec3m ban \u0111\u1ea7u th\u01b0\u1eddng g\u1eb7p nh\u1ea5t v\u1edbi ki\u1ec3u h\u00ecnh \u201cc\u1ed5 \u0111i\u1ec3n\u201d ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n hay h\u1ed9i ch\u1ee9ng Richardson (PSP-RS) l\u00e0 r\u1ed1i lo\u1ea1n d\u00e1ng \u0111i d\u1eabn \u0111\u1ebfn ng\u00e3. Li\u1ec7t v\u1eadn nh\u00e3n tr\u00ean nh\u00e2n l\u00e0 d\u1ea5u hi\u1ec7u nh\u1eadn bi\u1ebft c\u1ee7a b\u1ec7nh li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n. Ngo\u00e0i ra, li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n c\u00f2n c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng kh\u00e1c nh\u01b0 n\u00f3i kh\u00f3, kh\u00f3 nu\u1ed1t, li\u1ec7t gi\u1ea3 h\u00e0nh t\u1ee7y, c\u1ee9ng, gi\u1ea3m \u0111\u1ed9ng, r\u1ed1i lo\u1ea1n nh\u1eadn th\u1ee9c th\u00f9y tr\u00e1n v\u00e0 r\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng kh\u00e1 \u0111a d\u1ea1ng v\u1edbi nhi\u1ec1u ki\u1ec3u h\u00ecnh bi\u1ebfn th\u1ec3 kh\u00e1c nhau [6].<\/p>\n

4.1. M\u1ea5t \u1ed5n \u0111\u1ecbnh t\u01b0 th\u1ebf v\u00e0 ng\u00e3<\/strong><\/em><\/h3>\n

B\u1ec7nh nh\u00e2n PSP-RS c\u00f3 d\u00e1ng \u0111i c\u1ee9ng, ch\u00e2n \u0111\u1ebf r\u1ed9ng b\u01b0\u1edbc ch\u00e2n c\u00f3 \u0111\u1ed9 d\u00e0i thay \u0111\u1ed5i, \u0111\u1ea7u g\u1ed1i v\u00e0 c\u01a1 tr\u1ee5c th\u00e2n c\u00f3 xu h\u01b0\u1edbng \u1edf t\u01b0 th\u1ebf du\u1ed7i (ng\u01b0\u1ee3c l\u1ea1i v\u1edbi b\u1ec7nh nh\u00e2n Parkinson l\u00e0 t\u01b0 th\u1ebf g\u1ea5p), c\u00e1nh tay h\u01a1i d\u1ea1ng ra. C\u00e1c b\u1ea5t th\u01b0\u1eddng n\u00e0y l\u00e0m b\u1ec7nh nh\u00e2n c\u00f3 xu h\u01b0\u1edbng l\u1ea3o \u0111\u1ea3o, lo\u1ea1ng cho\u1ea1ng v\u00e0 c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u201cd\u00e1ng \u0111i c\u1ee7a th\u1ee7y th\u1ee7 say r\u01b0\u1ee3u\u201d (drunken sailor gait). Thay v\u00ec xoay ng\u01b0\u1eddi ch\u1eadm ch\u1ea1p \u0111\u01b0a c\u1ea3 th\u00e2n m\u00ecnh xoay c\u00f9ng tr\u1ee5c nh\u01b0 \u1edf b\u1ec7nh nh\u00e2n Parkinson, b\u1ec7nh nh\u00e2n PSP c\u00f3 xu h\u01b0\u1edbng xoay ng\u01b0\u1eddi kh\u00f4ng \u0111\u1ed3ng b\u1ed9 l\u00e0m t\u0103ng nguy c\u01a1 ng\u00e3. B\u1ec7nh nh\u00e2n th\u01b0\u1eddng ng\u00e3 ng\u1eeda g\u00e2y ra c\u00e1c ch\u1ea5n th\u01b0\u01a1ng b\u1ea7m t\u00edm, g\u00e3y x\u01b0\u01a1ng, ch\u1ea3y m\u00e1u n\u00e3o, th\u1eadm ch\u00ed t\u1eed vong.<\/p>\n

4.2. R\u1ed1i lo\u1ea1n v\u1eadn nh\u00e3n<\/strong><\/em><\/h3>\n

Li\u1ec7t v\u1eadn nh\u00e3n tr\u00ean nh\u00e2n l\u00e0 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng \u0111\u1eb7c tr\u01b0ng c\u1ee7a li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n. Bi\u1ec3u hi\u1ec7n \u0111\u1ea7u ti\u00ean l\u00e0 m\u1ea5t c\u1eed \u0111\u1ed9ng m\u1eaft nhanh (\u0111\u1eb7c \u0111i\u1ec3m quan tr\u1ecdng gi\u00fap ch\u1ea9n \u0111o\u00e1n s\u1edbm), sau \u0111\u00f3 l\u00e0 h\u1ea1n ch\u1ebf v\u1eadn nh\u00e3n theo chi\u1ec1u d\u1ecdc v\u00e0 ch\u1ee9c n\u0103ng nh\u00ecn xu\u1ed1ng th\u01b0\u1eddng b\u1ecb \u1ea3nh h\u01b0\u1edfng s\u1edbm h\u01a1n ch\u1ee9c n\u0103ng nh\u00ecn ngang. C\u00f3 th\u1ec3 k\u00e8m theo h\u1ea1n ch\u1ebf nh\u00ecn li\u1ebfc ngang. C\u00e1c tri\u1ec7u ch\u1ee9ng b\u1ea5t th\u01b0\u1eddng v\u1ec1 c\u1eed \u0111\u1ed9ng m\u1eaft xu\u1ea5t hi\u1ec7n trung b\u00ecnh 4 n\u0103m sau khi b\u1ec7nh kh\u1edfi ph\u00e1t. Ban \u0111\u1ea7u tri\u1ec7u ch\u1ee9ng li\u1ec7t v\u1eadn nh\u00e3n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c b\u00f9 tr\u1eeb b\u1eb1ng ph\u1ea3n x\u1ea1 m\u1eaft b\u00fap b\u00ea (Doll\u2019s eyes) nh\u01b0ng khi b\u1ec7nh ti\u1ebfn tri\u1ec3n li\u00ean quan \u0111\u1ebfn th\u00e2n n\u00e3o th\u00ec ph\u1ea3n x\u1ea1 ti\u1ec1n \u0111\u00ecnh m\u1eaft s\u1ebd m\u1ea5t \u0111i. \u1ede giai \u0111o\u1ea1n cu\u1ed1i c\u1ee7a b\u1ec7nh, m\u1eaft h\u1ea7u nh\u01b0 b\u1ea5t \u0111\u1ed9ng.
\nC\u00e1c d\u1ea5u hi\u1ec7u v\u1eadn nh\u00e3n kh\u00e1c bao g\u1ed3m: c\u1eed \u0111\u1ed9ng nh\u00e3n c\u1ea7u d\u1ea1ng gi\u1eadt s\u00f3ng vu\u00f4ng (square wave jerks) khi nh\u00ecn c\u1ed1 \u0111\u1ecbnh, co th\u1eaft mi m\u1eaft, m\u1ea5t h\u1ed9i t\u1ee5 nh\u00e3n c\u1ea7u. Gi\u1ea3m ch\u1edbp m\u1eaft, lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 m\u1eb7t, b\u1ea5t th\u01b0\u1eddng v\u1eadn nh\u00e3n l\u00e0m khu\u00f4n m\u1eb7t b\u1ec7nh nh\u00e2n lu\u00f4n bi\u1ec3u hi\u1ec7n nh\u01b0 \u201cs\u1ef1 ng\u1ea1c nhi\u00ean\u201d. H\u1ea1n ch\u1ebf li\u1ebfc d\u1ecdc th\u01b0\u1eddng l\u00e0m cho b\u1ec7nh nh\u00e2n kh\u00f3 kh\u0103n khi \u0111\u1ecdc, \u0103n u\u1ed1ng v\u00e0 \u0111i l\u1ea1i d\u1ec5 t\u00e9 ng\u00e3.<\/p>\n

4.3. C\u00e1c tri\u1ec7u ch\u1ee9ng v\u1eadn \u0111\u1ed9ng<\/strong><\/em><\/h3>\n

H\u1ed9i ch\u1ee9ng Parkinson \u1edf t\u1ea5t c\u1ea3 c\u00e1c th\u1ec3 c\u1ee7a li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n \u0111\u1ec1u \u0111\u1eb7c tr\u01b0ng b\u1edfi gi\u1ea3m \u0111\u1ed9ng v\u00e0 ch\u1eef vi\u1ebft nh\u1ecf. Li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n th\u01b0\u1eddng c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee9ng c\u01a1 \u1edf tr\u1ee5c th\u00e2n h\u01a1n \u1edf chi, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u01a1 c\u1ed5 v\u00e0 ph\u1ea7n tr\u00ean c\u1ee7a th\u00e2n m\u00ecnh. Lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 c\u1ed5 c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u0111\u1eb7c bi\u1ec7t l\u00e0 v\u1eb9o c\u1ed5 ra sau (retrocollis). Ngo\u00e0i ra c\u00f2n c\u00f3 th\u1ec3 g\u1eb7p co th\u1eaft mi m\u1eaft, lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 n\u1eeda ng\u01b0\u1eddi th\u01b0\u1eddng hi\u1ebfm g\u1eb7p.
\nKho\u1ea3ng 1\/3 s\u1ed1 b\u1ec7nh nh\u00e2n li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n c\u00f3 d\u1ea5u hi\u1ec7u th\u00e1p bao g\u1ed3m t\u0103ng ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng v\u00e0 d\u1ea5u hi\u1ec7u Babinski. D\u1ea5u hi\u1ec7u gan tay c\u1eb1m v\u00e0 c\u00e1c d\u1ea5u hi\u1ec7u gi\u1ea3i ph\u00f3ng ch\u1ee9c n\u0103ng th\u00f9y tr\u00e1n c\u00f3 th\u1ec3 g\u1eb7p. L\u01b0\u1ee1i b\u1ec7nh nh\u00e2n b\u1ecb co r\u00fat v\u00e0 v\u1eadn \u0111\u1ed9ng ch\u1eadm. R\u1ed1i lo\u1ea1n v\u1eadn ng\u00f4n, kh\u00f3 ph\u00e1t \u00e2m, kh\u00f3 nu\u1ed1t g\u1eb7p \u1edf giai \u0111o\u1ea1n gi\u1eefa v\u00e0 sau c\u1ee7a b\u1ec7nh. Ngo\u00e0i ra c\u00f3 th\u1ec3 c\u00f3 n\u00f3i l\u1eafp v\u00e0 l\u1eb7p t\u1eeb.
\nM\u1ed9t s\u1ed1 \u00edt b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u00e1p \u1ee9ng v\u1edbi li\u1ec7u ph\u00e1p dopaminergic trong giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ea3u b\u1ec7nh nh\u01b0ng ph\u1ea7n \u0111a l\u00e0 kh\u00f4ng \u0111\u00e1p \u1ee9ng.<\/p>\n

4.4. Suy gi\u1ea3m nh\u1eadn th\u1ee9c<\/strong><\/em><\/h3>\n

Suy gi\u1ea3m nh\u1eadn th\u1ee9c c\u1ee7a li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n ch\u1ee7 y\u1ebfu li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u00f9y tr\u00e1n. C\u00e1c b\u1ec7nh nh\u00e2n suy gi\u1ea3m suy ngh\u0129 tr\u1eebu t\u01b0\u1ee3ng, gi\u1ea3m kh\u1ea3 n\u0103ng n\u00f3i tr\u00f4i ch\u1ea3y, c\u00e1c c\u1eed \u0111\u1ed9ng l\u1eb7p l\u1ea1i d\u00f9 kh\u00f4ng c\u00f2n k\u00edch th\u00edch v\u00e0 r\u1ed1i lo\u1ea1n h\u00e0nh vi th\u00f9y tr\u00e1n. \u1ede giai \u0111o\u1ea1n sau c\u1ee7a b\u1ec7nh, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng \u0111i\u1ec1u h\u00e0nh bi\u1ec3u hi\u1ec7n r\u00f5.<\/p>\n

4.5. C\u00e1c r\u1ed1i lo\u1ea1n kh\u00e1c<\/strong><\/em><\/h3>\n

C\u00e1c b\u1ea5t th\u01b0\u1eddng kh\u00e1c c\u00f3 th\u1ec3 g\u1eb7p nh\u01b0 th\u1edd \u01a1, gi\u1ea3i \u1ee9c ch\u1ebf, tr\u1ea7m c\u1ea3m, lo \u00e2u, r\u1ed1i lo\u1ea1n \u00e1m \u1ea3nh c\u01b0\u1ee1ng ch\u1ebf.
\nLi\u1ec7t gi\u1ea3 h\u00e0nh t\u1ee7y l\u00e0 m\u1ed9t bi\u1ec3u hi\u1ec7n \u0111\u1eb7c tr\u01b0ng kh\u00e1c c\u1ee7a li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n.B\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u00f3 gi\u1ecdng n\u00f3i kh\u00e0n \u0111\u1eb7c tr\u01b0ng v\u00e0 kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c c\u1ea3m x\u00fac (\u00edt g\u1eb7p h\u01a1n so v\u1edbi li\u1ec7t gi\u1ea3 h\u00e0nh t\u1ee7y do c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c).
\nLi\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n c\u00f3 th\u1ec3 g\u1eb7p m\u1ea5t ng\u1ee7, kh\u00f3 duy tr\u00ec gi\u1ea5c ng\u1ee7. r\u1ed1i lo\u1ea1n h\u00e0nh vi trong gi\u1ea5c ng\u1ee7 giai \u0111o\u1ea1n \u0111\u1ed9ng m\u1eaft nhanh (RBD) \u00edt khi g\u1eb7p.<\/p>\n

5. C\u1eadn l\u00e2m s\u00e0ng cu\u0309a Li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n<\/strong><\/h2>\n

5.1. H\u00ecnh \u1ea3nh h\u1ecdc<\/strong><\/em><\/h3>\n

* C\u1ed9ng h\u01b0\u1edfng t\u1eeb c\u1ea5u tr\u00fac
\nNh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m th\u01b0\u1eddng g\u1eb7p tr\u00ean c\u1ed9ng h\u01b0\u1edfng t\u1eeb l\u00e0 teo n\u00e3o gi\u1eefa, gi\u00e3n n\u00e3o th\u1ea5t ba, teo cu\u1ed1ng ti\u1ec3u n\u00e3o tr\u00ean (SCP), teo th\u00f9y tr\u00e1n v\u00e0 th\u00e1i d\u01b0\u01a1ng.
\nTeo n\u00e3o gi\u1eefa \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n tr\u1ef1c quan qua h\u00ecnh \u1ea3nh \u201cm\u1ecf chim ru\u1ed3i\u201d khi nh\u00ecn tr\u00ean l\u00e1t c\u1eaft \u0111\u1ee9ng d\u1ecdc, h\u00ecnh \u1ea3nh \u201cchu\u1ed9t Mickey\u201d khi nh\u00ecn tr\u00ean l\u00e1t c\u1eaft ngang, h\u00ecnh \u1ea3nh \u201cmorning glory\u201d (m\u1ed9t s\u1ed1 t\u00e0i li\u1ec7u g\u1ecdi l\u00e0 d\u1ea5u hi\u1ec7u hoa m\u00f2ng bi\u1ec3n) tr\u00ean l\u00e1t c\u1eaft ngang. Teo cu\u1ed1ng ti\u1ec3u n\u00e3o tr\u00ean, d\u1ea5u hi\u1ec7u \u201cchim ru\u1ed3i\u201d, d\u1ea5u hi\u1ec7u \u201choa m\u00f2ng bi\u1ec3n\u201d tr\u00ean c\u1ed9ng h\u01b0\u1edfng t\u1eeb c\u1ea5u tr\u00fac c\u00f3 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao nh\u01b0ng \u0111\u1ed9 nh\u1ea1y k\u00e9m h\u01a1n ti\u00eau chu\u1ea9n l\u00e2m s\u00e0ng [7].<\/p>\n

\"\"<\/a><\/p>\n

H\u00ecnh 1. H\u00ecnh \u1ea3nh d\u1ea5u hi\u1ec7u \u201cchim ru\u1ed3i\u201d v\u00e0 d\u1ea5u hi\u1ec7u \u201choa m\u00f2ng bi\u1ec3n\u201d tr\u00ean xung T1 c\u1ed9ng h\u01b0\u1edfng t\u1eeb \u1edf b\u1ec7nh nh\u00e2n li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n [8]<\/p>\n

C\u00e1c ph\u00e9p \u0111o \u0111\u1ecbnh l\u01b0\u1ee3ng n\u00e3o gi\u1eefa, cu\u1ed1ng ti\u1ec3u n\u00e3o v\u00e0 c\u00e1c c\u1ea5u tr\u00fac th\u00e2n n\u00e3o kh\u00e1c, \u0111\u00e3 cho th\u1ea5y \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao h\u01a1n.
\n\u0110o l\u01b0\u1eddng chi\u1ec1u r\u1ed9ng tr\u01b0\u1edbc sau v\u00e0 th\u1ec3 t\u00edch c\u1ee7a cu\u1ed1ng n\u00e3o c\u1ee7a b\u1ec7nh nh\u00e2n PRP-RS nh\u1ecf h\u01a1n b\u1ec7nh nh\u00e2n teo \u0111a h\u1ec7 th\u1ed1ng v\u00e0 b\u1ec7nh Parkinson. Li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n c\u00f3 gi\u1ea3m di\u1ec7n t\u00edch n\u00e3o gi\u1eefa tr\u00ean m\u1eb7t ph\u1eb3ng \u0111\u1ee9ng d\u1ecdc gi\u1eefa, gi\u1ea3m t\u1ef7 l\u1ec7 cu\u1ed1ng n\u00e3o\/c\u1ea7u n\u00e3o. Tuy nhi\u00ean \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a t\u1ef7 l\u1ec7 cu\u1ed1ng n\u00e3o\/c\u1ea7u n\u00e3o ph\u00e2n bi\u1ec7t PSP-RS v\u00e0 teo \u0111a h\u1ec7 th\u1ed1ng th\u1ec3 Parkinson (MSA-P) c\u00f2n dao \u0111\u1ed9ng kh\u00e1c nhau gi\u1eefa c\u00e1c nghi\u00ean c\u1ee9u.
\nCh\u1ec9 s\u1ed1 parkinson c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRPI) [= di\u1ec7n t\u00edch c\u1ea7u n\u00e3o \/n\u00e3o gi\u1eefa) * (chi\u1ec1u r\u1ed9ng cu\u1ed1ng ti\u1ec3u n\u00e3o gi\u1eefa\/cu\u1ed1ng ti\u1ec3u n\u00e3o tr\u00ean)] c\u00f3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao trong ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n v\u1edbi MSA-P v\u00e0 b\u1ec7nh Parkinson, tuy nhi\u00ean \u0111\u1ec3 t\u00ednh \u0111\u01b0\u1ee3c ch\u1ec9 s\u1ed1 n\u00e0y y\u00eau c\u1ea7u m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111o chi ti\u1ebft, kh\u00f3 ph\u1ed5 bi\u1ebfn cho c\u00e1c trung t\u00e2m v\u00e0 \u0111\u01b0a v\u00e0o th\u01b0\u1eddng quy.
\n* PET\/ SPECT
\nCh\u1ee5p FDG-PET (18F fluorodeoxy glucose), li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n c\u00f3 h\u00ecnh \u1ea3nh gi\u1ea3m chuy\u1ec3n h\u00f3a \u1edf n\u00e3o gi\u1eefa l\u00e0 s\u1edbm nh\u1ea5t sau \u0111\u00f3 \u1edf h\u1ea1ch n\u1ec1n, \u0111\u1ed3i th\u1ecb, th\u00f9y tr\u00e1n, ch\u1ee7 y\u1ebfu v\u00f9ng tr\u01b0\u1edbc v\u1eadn \u0111\u1ed9ng, c\u00f3 \u0111\u1ed9 nh\u1ea1y 93% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 90% khi ph\u00e2n bi\u1ec7t PSP-RS v\u1edbi b\u1ec7nh Parkinson, teo \u0111a h\u1ec7 th\u1ed1ng v\u00e0 tho\u00e1i h\u00f3a v\u1ecf h\u1ea1ch n\u1ec1n.
\nTau-PET v\u1edbi ch\u1ea5t \u0111\u00e1nh d\u1ea5u li\u00ean k\u1ebft ch\u1ecdn l\u1ecdc v\u1edbi tau-protein l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 \u0111\u1ea7y h\u1ee9a h\u1eb9n cho ph\u00e9p quan s\u00e1t ph\u00e2n b\u1ed1 \u0111\u00e1m r\u1ed1i s\u1ee3i th\u1ea7n kinh. Tau-PET gi\u00fap \u0111\u00e1nh gi\u00e1 t\u01b0\u01a1ng quan gi\u1eefa h\u00ecnh \u1ea3nh v\u00e0 giai \u0111o\u1ea1n b\u1ec7nh. C\u00e1c nghi\u00ean c\u1ee9u tau-PET c\u00f3 nhi\u1ec1u h\u1ee9a h\u1eb9n tuy nhi\u00ean m\u1edbi \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong nghi\u00ean c\u1ee9u \u1edf nh\u1eefng nh\u00f3m nh\u1ecf v\u00e0 ch\u01b0a \u00e1p d\u1ee5ng l\u00e2m s\u00e0ng [9].
\nSPECT (ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh b\u1eb1ng b\u1ee9c x\u1ea1 \u0111\u01a1n photon) s\u1eed d\u1ee5ng ch\u1ea5t \u0111\u00e1nh d\u1ea5u dopamin ho\u1ea1t \u0111\u1ed9ng cho th\u1ea5y s\u1ef1 gi\u1ea3m h\u1ea5p thu ch\u1ea5t \u0111\u00e1nh d\u1ea5u trong th\u1ec3 v\u00e2n.<\/p>\n

5.2. C\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc<\/strong><\/em><\/h3>\n

C\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc trong d\u1ecbch n\u00e3o t\u1ee7y trong b\u1ec7nh li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n v\u1eabn \u0111ang \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u ph\u00e1t tri\u1ec3n. Tau protein to\u00e0n ph\u1ea7n (t-tau) v\u00e0 tau protein phosphoryl h\u00f3a (p-tau) gi\u1ea3m trong d\u1ecbch n\u00e3o t\u1ee7y c\u1ee7a b\u1ec7nh nh\u00e2n li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n so v\u1edbi nh\u00f3m ch\u1ee9ng, \u0111i\u1ec1u n\u00e0y ng\u01b0\u1ee3c l\u1ea1i \u1edf b\u1ec7nh nh\u00e2n Alzheimer. Tuy nhi\u00ean c\u00f3 s\u1ef1 ch\u1ed3ng l\u1ea5p \u0111\u00e1ng k\u1ec3 v\u00e0 nh\u1eefng d\u1ea5u \u1ea5n sinh h\u1ecdc n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e2n bi\u1ec7t li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n v\u1edbi nh\u00f3m ch\u1ee9ng c\u0169ng nh\u01b0 c\u00e1c b\u1ec7nh kh\u00e1c c\u1ee7a tau protein.
\nProtein chu\u1ed7i nh\u1eb9 Neurofilament (NfL) \u2013 m\u1ed9t d\u1ea5u \u1ea5n do s\u1ef1 ph\u00e1 h\u1ee7y s\u1ee3i tr\u1ee5c c\u00f3 th\u1ec3 l\u00e0 d\u1ea5u \u1ea5n h\u1eefu \u00edch \u1edf li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n v\u00e0 c\u00e1c b\u1ec7nh l\u00fd th\u1ea7n kinh kh\u00e1c, nh\u01b0ng kh\u00f4ng ph\u1ea3i l\u00e0 d\u1ea5u \u1ea5n c\u00f3 t\u00ednh ch\u1ea5t ch\u1ea9n \u0111o\u00e1n b\u1ec7nh li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n. NfL trong d\u1ecbch n\u00e3o t\u1ee7y \u1edf b\u1ec7nh nh\u00e2n li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n v\u00e0 h\u1ed9i ch\u1ee9ng Parkinson kh\u00f4ng \u0111i\u1ec3n h\u00ecnh cao h\u01a1n so v\u1edbi b\u1ec7nh Parkinson v\u00e0 nh\u00f3m ch\u1ee9ng. NfL c\u0169ng t\u0103ng trong m\u00e1u ngo\u1ea1i vi v\u00e0 m\u1ee9c \u0111\u1ed9 t\u0103ng t\u01b0\u01a1ng \u1ee9ng v\u1edbi m\u1ee9c \u0111\u1ed9 trong d\u1ecbch n\u00e3o t\u1ee7y [10].<\/p>\n

6. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n<\/strong><\/h2>\n

N\u0103m 2017, h\u1ed9i r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng (MDS) [11] \u0111\u00e3 \u0111\u01b0a ra ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n m\u1edbi cho b\u1ec7nh li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n n\u00e0y bao g\u1ed3m c\u00e1c ph\u1ea7n:
\n\u2013 C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u01a1 b\u1ea3n: bao g\u1ed3m ti\u00eau chu\u1ea9n b\u1eaft bu\u1ed9c v\u00e0 ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb c\u1ea7n thi\u1ebft cho ch\u1ea9n \u0111o\u00e1n.
\n\u2013 4 l\u0129nh v\u1ef1c ch\u1ee9c n\u0103ng c\u1ed1t l\u00f5i (r\u1ed1i lo\u1ea1n v\u1eadn nh\u00e3n, m\u1ea5t \u1ed5n \u0111\u1ecbnh t\u01b0 th\u1ebf, gi\u1ea3m \u0111\u1ed9ng v\u00e0 suy gi\u1ea3m nh\u1eadn th\u1ee9c): l\u00e0 c\u00e1c bi\u1ec3u hi\u1ec7n \u0111\u1eb7c tr\u01b0ng c\u1ee7a li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n.
\n\u2013 C\u00e1c ti\u00eau chu\u1ea9n h\u1ed7 tr\u1ee3 t\u0103ng \u0111\u1ed9 tin c\u1eady cho ch\u1ea9n \u0111o\u00e1n.
\n\u2013 \u0110\u1ecbnh ngh\u0129a chi ti\u1ebft c\u00e1c ti\u00eau chu\u1ea9n c\u1ed1t l\u00f5i v\u00e0 ti\u00eau chu\u1ea9n h\u1ed7 tr\u1ee3.
\n\u2013 4 m\u1ee9c \u0111\u1ed9 ch\u1eafc ch\u1eafn ch\u1ea9n \u0111o\u00e1n.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
A. C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u01a1 b\u1ea3n<\/em><\/strong>\u0110\u1eb7c \u0111i\u1ec3m c\u01a1 b\u1ea3n \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ea5t k\u1ef3 ki\u1ec3u h\u00ecnh n\u00e0o v\u00e0 \u1edf b\u1ea5t k\u1ef3 giai \u0111o\u1ea1n n\u00e0o bao g\u1ed3m c\u00e1c ti\u00eau chu\u1ea9n b\u1eaft bu\u1ed9c, c\u00e1c ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb b\u1eaft bu\u1ed9c v\u00e0 c\u00e1c ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb t\u00f9y thu\u1ed9c v\u00e0o t\u00ecnh hu\u1ed1ng.<\/td>\n<\/tr>\n
Ti\u00eau chu\u1ea9n <\/em>b\u1eaft bu\u1ed9c<\/em><\/td>\nXu\u1ea5t hi\u1ec7n l\u1ebb t\u1ebbKh\u1edfi ph\u00e1t sau 40 tu\u1ed5i<\/td>\n<\/tr>\n
Ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb b\u1eaft bu\u1ed9c:<\/em><\/td>\nL<\/em>\u00e2m<\/em>\u00a0s\u00e0ng<\/em><\/td>\nS\u1ef1 c\u00f3 m\u1eb7t \u01b0u th\u1ebf v\u00e0 kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c c\u1ee7a suy gi\u1ea3m tr\u00ed nh\u1edb theo giai \u0111o\u1ea1n (g\u1ee3i \u00fd Alzheimer).S\u1ef1 c\u00f3 m\u1eb7t \u01b0u th\u1ebf v\u00e0 kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c c\u1ee7a r\u1ed1i lo\u1ea1n th\u1ea7n kinh th\u1ef1c v\u1eadt (nh\u01b0 h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf g\u1ee3i \u00fd teo \u0111a h\u1ec7 th\u1ed1ng, b\u1ec7nh th\u1ec3 Lewy).<\/p>\n

S\u1ef1 c\u00f3 m\u1eb7t \u01b0u th\u1ebf v\u00e0 kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c c\u1ee7a \u1ea3o th\u1ecb, dao \u0111\u1ed9ng nh\u1eadn th\u1ee9c g\u1ee3i \u00fd sa s\u00fat tr\u00ed tu\u1ec7 th\u1ec3 Lewy.<\/p>\n

S\u1ef1 c\u00f3 m\u1eb7t \u01b0u th\u1ebf v\u00e0 kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c c\u1ee7a tri\u1ec7u ch\u1ee9ng neuron v\u1eadn \u0111\u1ed9ng tr\u00ean v\u00e0 neuron v\u1eadn \u0111\u1ed9ng d\u01b0\u1edbi g\u1ee3i \u00fd b\u1ec7nh neuron v\u1eadn \u0111\u1ed9ng (N\u1ebfu ch\u1ec9 c\u00f3 tri\u1ec7u ch\u1ee9ng neuron v\u1eadn \u0111\u1ed9ng tr\u00ean th\u00ec kh\u00f4ng ph\u1ea3i ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb).<\/td>\n<\/tr>\n

Ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb b\u1eaft bu\u1ed9c:<\/em><\/td>\nL<\/em>\u00e2m<\/em>\u00a0s\u00e0ng<\/em><\/td>\nKh\u1edfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t ho\u1eb7c t\u1eebng b\u1eadc ho\u1eb7c tri\u1ec7u ch\u1ee9ng ti\u1ebfn tri\u1ec3n nhanh ph\u00f9 h\u1ee3p v\u1edbi h\u00ecnh \u1ea3nh l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m g\u1ee3i \u00fd b\u1ec7nh m\u1ea1ch m\u00e1u n\u00e3o, vi\u00eam n\u00e3o t\u1ef1 mi\u1ec5n, b\u1ec7nh n\u00e3o chuy\u1ec3n h\u00f3a, b\u1ec7nh prion.Ti\u1ec1n s\u1eed vi\u00eam n\u00e3o<\/p>\n

Th\u1ea5t \u0111i\u1ec1u chi chi\u1ebfm \u01b0u th\u1ebf<\/p>\n

C\u00e1c nguy\u00ean nh\u00e2n x\u00e1c \u0111\u1ecbnh kh\u00e1c c\u1ee7a m\u1ea5t \u1ed5n \u0111\u1ecbnh t\u01b0 th\u1ebf nh\u01b0 r\u1ed1i lo\u1ea1n ti\u1ec1n \u0111\u00ecnh, m\u1ea5t c\u1ea3m gi\u00e1c, co c\u1ee9ng qu\u00e1 m\u1ee9c, h\u1ed9i ch\u1ee9ng neuron v\u1eadn \u0111\u1ed9ng d\u01b0\u1edbi.<\/td>\n<\/tr>\n

H<\/em>\u00ecnh<\/em>\u00a0\u1ea3<\/em>nh<\/em><\/td>\nT\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng nghi\u00eam tr\u1ecdngC\u00e1c b\u1ea5t th\u01b0\u1eddng c\u1ea5u tr\u00fac g\u1ee3i \u00fd ch\u1ea9n \u0111o\u00e1n kh\u00e1c (gi\u00e3n n\u00e3o th\u1ea5t \u00e1p l\u1ef1c b\u00ecnh th\u01b0\u1eddng ho\u1eb7c gi\u00e3n n\u00e3o th\u1ea5t th\u1ec3 t\u1eafc ngh\u1ebdn; nh\u1ed3i m\u00e1u, ch\u1ea3y m\u00e1u, t\u1ed5n th\u01b0\u01a1ng thi\u1ebfu oxy do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, kh\u1ed1i u ho\u1eb7c d\u1ecb d\u1ea1ng \u1edf nh\u00e2n b\u00e8o, trung n\u00e3o, c\u1ea7u n\u00e3o, t\u1ee7y s\u1ed1ng)<\/td>\n<\/tr>\n
Ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb t\u00f9y thu\u1ed9c t\u00ecnh hu\u1ed1ng:<\/em><\/p>\n

 <\/td>\n

H<\/em>\u00ecnh<\/em>\u00a0\u1ea3<\/em>nh<\/em><\/td>\nTr\u01b0\u1eddng h\u1ee3p di\u1ec5n bi\u1ebfn \u0111\u1ed9t ng\u1ed9t ho\u1eb7c theo t\u1eebng b\u1eadc c\u1ea7n lo\u1ea1i tr\u1eeb: \u0111\u1ed9t qu\u1ef5, b\u1ec7nh n\u00e3o ch\u1ea5t tr\u1eafng v\u00e0 nh\u1ed3i m\u00e1u d\u01b0\u1edbi v\u1ecf di truy\u1ec1n theo nhi\u1ec5m s\u0103c th\u1ec3 tr\u1ed9i (CADASIL), b\u1ec7nh m\u1ea1ch m\u00e1u n\u00e3o nhi\u1ec5m b\u1ed9t v\u1edbi b\u1eb1ng ch\u1ee9ng tr\u00ean c\u1ed9ng h\u01b0\u1edfng t\u1eeb \u1edf c\u00e1c xung DWI, FLAIR, T2*Tr\u01b0\u1eddng h\u1ee3p ti\u1ebfn tri\u1ec3n nhanh c\u1ea7n lo\u1ea1i tr\u1eeb t\u0103ng t\u00edn hi\u1ec7u v\u1ecf v\u00e0 d\u01b0\u1edbi v\u1ecf tr\u00ean xung DWI c\u1ed9ng h\u01b0\u1edfng t\u1eeb g\u1ee3i \u00fd b\u1ec7nh prion.<\/td>\n<\/tr>\n
X<\/em>\u00e9t<\/em>\u00a0nghi\u1ec7m<\/em><\/td>\nV\u1edbi b\u1ec7nh nh\u00e2n PSP-CBS: c\u1ea7n lo\u1ea1i tr\u1eeb b\u1ec7nh Alzheimer (t\u0103ng c\u1ea3 tau protein to\u00e0n ph\u1ea7n v\u00e0 tau protein phosphoryl h\u00f3a, gi\u1ea3m beta-amyloid 42 trong d\u1ecbch n\u00e3o t\u1ee7y; b\u1ec7nh l\u00fd beta-amyloid tr\u00ean h\u00ecnh \u1ea3nh PET)V\u1edbi b\u1ec7nh nh\u00e2n <45 tu\u1ed5i c\u1ea7n lo\u1ea1i tr\u1eeb: b\u1ec7nh Wilson, b\u1ec7nh Niemann-Pick type C, suy tuy\u1ebfn c\u1eadn gi\u00e1p, b\u1ec7nh h\u1ed3ng c\u1ea7u gai, giang mai th\u1ea7n kinh.<\/p>\n

V\u1edbi b\u1ec7nh nh\u00e2n ti\u1ebfn tri\u1ec3n nhanh c\u1ea7n lo\u1ea1i tr\u1eeb: b\u1ec7nh prion, b\u1ec7nh n\u00e3o c\u1eadn u, b\u1ec7nh Whipple.<\/p>\n

B\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m g\u1ee3i \u00fd b\u1ec7nh Whipple (c\u00e1c tri\u1ec7u ch\u1ee9ng ti\u00eau h\u00f3a, \u0111au kh\u1edbp, s\u1ed1t, tr\u1ebb tu\u1ed5i v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh kh\u00f4ng \u0111i\u1ec3n h\u00ecnh nh\u01b0 myorhythmia) c\u1ea7n ch\u1ea9n \u0111o\u00e1n lo\u1ea1i tr\u1eeb (PCR Whiple d\u1ecbch n\u00e3o t\u1ee7y).<\/td>\n<\/tr>\n

Gen<\/em><\/td>\nC\u00e1c bi\u1ebfn th\u1ec3 (\u0111\u1ed9t bi\u1ebfn)\u00a0MAPT<\/em> hi\u1ebfm g\u1eb7p kh\u00f4ng ph\u1ea3i l\u00e0 ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb, nh\u01b0ng s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a ch\u00fang x\u00e1c \u0111\u1ecbnh s\u1ef1 di truy\u1ec1n \u1edf b\u1ec7nh nh\u00e2n PSP.Ki\u1ec3u gen \u0111\u01a1n b\u1ed9i \u0111\u1ed3ng h\u1ee3p t\u1eed MAPT<\/em>\u00a0H2 kh\u00f4ng ph\u1ea3i l\u00e0 ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb, nh\u01b0ng ch\u1ea9n \u0111o\u00e1n kh\u00f4ng ch\u1eafc ch\u1eafn.<\/p>\n

C\u00e1c bi\u1ebfn th\u1ec3 hi\u1ebfm g\u1eb7p c\u1ee7a LRRK2<\/em>\u00a0v\u00e0\u00a0Parkin<\/em>\u00a0\u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y khi kh\u00e1m nghi\u1ec7m t\u1eed thi b\u1ec7nh nh\u00e2n PSP, nh\u01b0ng m\u1ed1i quan h\u1ec7 nh\u00e2n qu\u1ea3 c\u1ee7a ch\u00fang cho \u0111\u1ebfn nay v\u1eabn ch\u01b0a r\u00f5 r\u00e0ng.<\/p>\n

C\u00e1c bi\u1ebfn th\u1ec3 hi\u1ebfm \u0111\u00e3 bi\u1ebft \u1edf c\u00e1c gen kh\u00e1c l\u00e0 ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb, bao g\u1ed3m:<\/p>\n

Sa s\u00fat tr\u00ed tu\u1ec7 tr\u00e1n th\u00e1i d\u01b0\u01a1ng<\/em>\u00a0li\u00ean quan \u0111\u1ebfn non \u2013 MAPT (v\u00ed d\u1ee5:\u00a0C9orf72, GRN, FUS, TARDBP, VCP, CHMP2B<\/em>)<\/p>\n

B\u1ec7nh Parkinson (v\u00ed d\u1ee5:\u00a0SYNJ1, GBA<\/em>)<\/p>\n

B\u1ec7nh Alzheimer (APP, PSEN1, PSEN2<\/em>)<\/p>\n

B\u1ec7nh Niemann-Pick typ C (NPC1, NPC2<\/em>)<\/td>\n<\/tr>\n

Ti\u00eau chu\u1ea9n lo\u1ea1i tr\u1eeb t\u00f9y thu\u1ed9c t\u00ecnh hu\u1ed1ng:<\/em><\/p>\n

 <\/td>\n

Gen<\/em><\/td>\nH\u1ed9i ch\u1ee9ng Kufor-Rakeb (ATP13A2<\/em>)H\u1ed9i ch\u1ee9ng Perry (DCTN1<\/em>)<\/p>\n

B\u1ec7nh ty th\u1ec3 (POLG<\/em>, c\u00e1c bi\u1ebfn th\u1ec3 hi\u1ebfm g\u1eb7p c\u1ee7a ty th\u1ec3)<\/p>\n

Dentatorubral pallidoluysian atrophy (ATN1<\/em>)<\/p>\n

B\u1ec7nh li\u00ean quan \u0111\u1ebfn Prion (PRNP<\/em>)<\/p>\n

B\u1ec7nh Huntington (HTT<\/em>)<\/p>\n

Th\u1ea5t \u0111i\u1ec1u t\u1ee7y ti\u1ec3u n\u00e3o (ATXN1, 2, 3, 7, 17<\/em>)<\/td>\n<\/tr>\n

B.4 l\u0129nh v\u1ef1c ch\u1ee9c n\u0103ng c\u1ed1t l\u00f5i<\/em><\/strong>C\u00f3 4 l\u0129nh v\u1ef1c ch\u1ee9c n\u0103ng c\u1ed1t l\u00f5i trong ch\u1ea9n \u0111o\u00e1n li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n: r\u1ed1i lo\u1ea1n v\u1eadn nh\u00e3n, m\u1ea5t \u1ed5n \u0111\u1ecbnh t\u01b0 th\u1ebf, gi\u1ea3m \u0111\u1ed9ng v\u00e0 suy gi\u1ea3m nh\u1eadn th\u1ee9c. M\u1ed7i l\u0129nh v\u1ef1c c\u00f3 ba m\u1ee9c \u0111\u1ed9 ch\u1eafc ch\u1eafn v\u1ec1 l\u00e2m s\u00e0ng: 1: cao nh\u1ea5t, 2: trung b\u00ecnh, 3: th\u1ea5p nh\u1ea5t, th\u1ec3 hi\u1ec7n trong b\u1ea3ng 5.1.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n\n\n\n\n
B\u1ea3ng 5.1. B\u1ed1n l\u0129nh v\u1ef1c ch\u1ee9c n\u0103ng c\u1ed1t l\u00f5i ch\u1ea9n \u0111o\u00e1n li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n<\/td>\n<\/tr>\n
L\u0129nh <\/strong>v\u1ef1c<\/strong>M\u1ee9c \u0111\u1ed9<\/strong><\/td>\nR\u1ed1i lo\u1ea1n v\u1eadn nh\u00e3n<\/strong><\/td>\nM\u1ea5t \u1ed5n \u0111\u1ecbnh <\/strong>t\u01b0 th\u1ebf<\/strong><\/td>\nGi\u1ea3m \u0111\u1ed9ng<\/strong><\/td>\nSuy gi\u1ea3m nh\u1eadn th\u1ee9c<\/strong><\/td>\n<\/tr>\n
1<\/td>\nLi\u1ec7t li\u1ebfc d\u1ecdc tr\u00ean nh\u00e2n<\/td>\nNg\u00e3 t\u00e1i di\u1ec5n kh\u00f4ng c\u00f3 l\u00fd do trong 3 n\u0103m<\/td>\nD\u00e1ng \u0111i \u0111\u00f4ng c\u1ee9ng ti\u1ebfn tri\u1ec3n trong 3 n\u0103m<\/td>\nR\u1ed1i lo\u1ea1n l\u1eddi n\u00f3i\/ ng\u00f4n ng\u1eef: kh\u00f4ng l\u01b0u lo\u00e1t, bi\u1ebfn th\u1ec3 m\u1ea5t ng\u1eef ph\u00e1p c\u1ee7a th\u1ea5t ng\u00f4n ti\u1ebfn tri\u1ec3n ti\u00ean ph\u00e1t ho\u1eb7c m\u1ea5t th\u1ef1c d\u1ee5ng gi\u1ecdng n\u00f3i ti\u1ebfn tri\u1ec3n<\/td>\n<\/tr>\n
2<\/td>\nT\u1ed1c \u0111\u1ed9 ch\u1eadm khi th\u1ef1c hi\u1ec7n c\u1eed \u0111\u1ed9ng m\u1eaft nhanh theo chi\u1ec1u d\u1ecdc<\/td>\nXu h\u01b0\u1edbng ng\u00e3 khi th\u1ef1c hi\u1ec7n nghi\u1ec7m ph\u00e1p k\u00e9o (pull test) trong 3 n\u0103m<\/td>\nH\u1ed9i ch\u1ee9ng Parkinson c\u1ee9ng, gi\u1ea3m \u0111\u1ed9ng \u01b0u th\u1ebf tr\u1ee5c th\u00e2n, kh\u00e1ng Levodopa<\/td>\nR\u1ed1i lo\u1ea1n nh\u1eadn th\u1ee9c\/h\u00e0nh vi ki\u1ec3u th\u00f9y tr\u00e1n<\/td>\n<\/tr>\n
3<\/td>\nM\u1ea5t th\u1ef1c d\u1ee5ng nh\u1eafm m\u1edf m\u1eaft ho\u1eb7c gi\u1eadt m\u1eaft d\u1ea1ng s\u00f3ng vu\u00f4ng l\u1edbn (macro square wave jerks) th\u01b0\u1eddng xuy\u00ean<\/td>\nL\u00f9i 2 b\u01b0\u1edbc tr\u1edf l\u00ean khi th\u1ef1c hi\u1ec7n nghi\u1ec7m ph\u00e1p k\u00e9o trong 3 n\u0103m<\/td>\nH\u1ed9i ch\u1ee9ng Parkinson v\u1edbi run v\u00e0\/ho\u1eb7c kh\u00f4ng \u0111\u1ed1i x\u1ee9ng v\u00e0\/ho\u1eb7c \u0111\u00e1p \u1ee9ng v\u1edbi Levodopa<\/td>\nH\u1ed9i ch\u1ee9ng v\u1ecf n\u00e3o h\u1ea1ch n\u1ec1n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n\n\n
C. Ti\u00eau chu\u1ea9n b\u1ed5 tr\u1ee3<\/em><\/strong>C\u00e1c ti\u00eau chu\u1ea9n b\u1ed5 tr\u1ee3 chia th\u00e0nh 2 nh\u00f3m: l\u00e2m s\u00e0ng v\u00e0 h\u00ecnh \u1ea3nh<\/td>\n<\/tr>\n
L\u00e2m s\u00e0ng<\/em><\/td>\nKh\u00e1ng LevodopaGi\u1ea3m \u0111\u1ed9ng, n\u00f3i kh\u00f3 do c\u1ee9ng c\u01a1 (spastic dysarthria)<\/p>\n

Nu\u1ed1t kh\u00f3<\/p>\n

S\u1ee3 \u00e1nh s\u00e1ng<\/td>\n<\/tr>\n

H\u00ecnh \u1ea3nh<\/em><\/td>\nTeo n\u00e3o gi\u1eefa ho\u1eb7c gi\u1ea3m chuy\u1ec3n h\u00f3aTho\u00e1i h\u00f3a con \u0111\u01b0\u1eddng dopaminergic th\u1ec3 v\u00e2n h\u1eadu synap<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n\n
C. \u0110\u1ecbnh ngh\u0129a chi ti\u1ebft<\/em><\/strong>C\u00e1c ti\u00eau chu\u1ea9n c\u1ee7a MDS \u0111\u01b0a ra \u0111\u1ecbnh ngh\u0129a chi ti\u1ebft cho t\u1eebng \u0111\u1eb7c \u0111i\u1ec3m ch\u00ednh v\u00e0 b\u1ed5 tr\u1ee3 \u0111\u1ec3 chu\u1ea9n h\u00f3a vi\u1ec7c \u00e1p d\u1ee5ng cho ch\u1ea9n \u0111o\u00e1n.<\/td>\n<\/tr>\n
D. M\u1ee9c \u0111\u1ed9 ch\u1eafc ch\u1eafn ch\u1ea9n \u0111o\u00e1n<\/em><\/strong>Ch\u1eafc ch\u1eafn li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n: ti\u00eau chu\u1ea9n v\u00e0ng, ch\u1ec9 c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u1eb1ng m\u00f4 b\u1ec7nh h\u1ecdc th\u1ea7n kinh sau khi b\u1ec7nh nh\u00e2n t\u1eed vong.<\/p>\n

C\u00f3 th\u1ec3 l\u00e0 li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n: c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u00f3 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao.<\/p>\n

C\u00f3 kh\u1ea3 n\u0103ng l\u00e0 li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n: c\u00f3 m\u1eb7t c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c xem l\u00e0 t\u0103ng \u0111\u1ed9 nh\u1ea1y cho ch\u1ea9n \u0111o\u00e1n PSP.<\/p>\n

H\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng g\u1ee3i \u00fd li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n: bao g\u1ed3m nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m l\u00e0 b\u1eb1ng ch\u1ee9ng s\u1edbm ho\u1eb7c tinh t\u1ebf c\u1ee7a li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

7. Ch\u1ea9n \u0111o\u00e1n th\u1ec3 b\u1ec7nh Li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n<\/strong><\/h2>\n

Ti\u00eau ch\u00ed MDS-PSP x\u00e1c \u0111\u1ecbnh c\u00e1c lo\u1ea1i \u01b0u th\u1ebf l\u00e2m s\u00e0ng d\u1ef1a tr\u00ean c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, bao g\u1ed3m:
\n\u2022 PSP v\u1edbi h\u1ed9i ch\u1ee9ng Richardson (PSP-RS)
\n\u2022 PSP v\u1edbi h\u1ed9i ch\u1ee9ng parkinson chi\u1ebfm \u01b0u th\u1ebf (PSP-P)
\n\u2022 PSP v\u1edbi r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng v\u1eadn nh\u00e3n chi\u1ebfm \u01b0u th\u1ebf (PSP-OM)
\n\u2022 PSP v\u1edbi m\u1ea5t \u1ed5n \u0111\u1ecbnh t\u01b0 th\u1ebf chi\u1ebfm \u01b0u th\u1ebf (PSP-PI)
\n\u2022 PSP v\u1edbi \u0111\u00f4ng c\u1ee9ng d\u00e1ng \u0111i ti\u1ebfn tri\u1ec3n (PSP-PGF)
\n\u2022 PSP v\u1edbi r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u00f9y tr\u00e1n chi\u1ebfm \u01b0u th\u1ebf (PSP-F)
\n\u2022 PSP v\u1edbi ch\u1ee9ng r\u1ed1i lo\u1ea1n l\u1eddi n\u00f3i\/ng\u00f4n ng\u1eef chi\u1ebfm \u01b0u th\u1ebf (PSP-SL)
\n\u2022 PSP v\u1edbi h\u1ed9i ch\u1ee9ng v\u1ecf n\u00e3o h\u1ea1ch n\u1ec1n chi\u1ebfm \u01b0u th\u1ebf (PSP-CBS)
\nTi\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n MDS-PSP \u0111\u00e3 b\u1ecf qua hai ki\u1ec3u h\u00ecnh bi\u1ebfn th\u1ec3 hi\u1ebfm \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn kh\u00e1c (PSP v\u1edbi ch\u1ee9ng m\u1ea5t \u0111i\u1ec1u h\u00f2a ti\u1ec3u n\u00e3o chi\u1ebfm \u01b0u th\u1ebf [PSP-C] v\u00e0 PSP v\u1edbi b\u1ec7nh x\u01a1 c\u1ee9ng teo c\u01a1 b\u00ean nguy\u00ean ph\u00e1t chi\u1ebfm \u01b0u th\u1ebf [PSP-PLS]) v\u00ec b\u1eb1ng ch\u1ee9ng b\u1ec7nh h\u1ecdc l\u00e2m s\u00e0ng kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 \u0111\u01b0a ra c\u00e1c l\u00e2m s\u00e0ng ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n \u0111\u1ee7 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u.<\/p>\n

8. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t Li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n<\/strong><\/h2>\n

\u2013 B\u1ec7nh Parkinson: kh\u1edfi ph\u00e1t kh\u00f4ng \u0111\u1ed1i x\u1ee9ng, ng\u00e3 v\u00e0 nu\u1ed1t kh\u00f3 x\u1ea3y ra \u1edf giai \u0111o\u1ea1n t\u1eeb gi\u1eefa \u0111\u1ebfn ti\u1ebfn tri\u1ec3n, \u0111\u00e1p \u1ee9ng v\u1edbi levodopa, ti\u1ebfn tri\u1ec3n ch\u1eadm h\u01a1n so v\u1edbi li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n.
\n\u2013 Tho\u00e1i h\u00f3a v\u1ecf n\u00e3o h\u1ea1ch n\u1ec1n: b\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u00f3 m\u1ea5t th\u1ef1c d\u1ee5ng \u0111\u1ed9ng t\u00e1c, lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1, gi\u1eadt c\u01a1, h\u1ed9i ch\u1ee9ng b\u00e0n tay ng\u01b0\u1eddi ngo\u00e0i h\u00e0nh tinh, m\u1ea5t c\u1ea3m gi\u00e1c v\u1ecf n\u00e3o..
\n\u2013 Teo \u0111a h\u1ec7 th\u1ed1ng: r\u1ed1i lo\u1ea1n th\u1ea7n kinh t\u1ef1 ch\u1ee7 v\u00e0 h\u1ed9i ch\u1ee9ng ti\u1ec3u n\u00e3o chi\u1ebfm \u01b0u th\u1ebf trong khi nh\u1eadn th\u1ee9c \u0111\u01b0\u1ee3c b\u1ea3o t\u1ed3n.
\n\u2013 B\u1ec7nh Pick, b\u1ec7nh Alzheimer: 2 b\u1ec7nh n\u00e0y th\u01b0\u1eddng l\u00e0 sa s\u00fat tr\u00ed tu\u1ec7 ki\u1ec3u v\u1ecf n\u00e3o trong khi li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n th\u01b0\u1eddng g\u1eb7p sa s\u00fat tr\u00ed d\u01b0\u1edbi v\u1ecf.<\/p>\n

9. \u0110i\u1ec1u tr\u1ecb<\/strong><\/h2>\n

Hi\u1ec7n t\u1ea1i ch\u01b0a c\u00f3 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00e0o c\u00f3 th\u1ec3 ch\u1eefa \u0111\u01b0\u1ee3c b\u1ec7nh. M\u1ee5c \u0111\u00edch c\u1ee7a \u0111i\u1ec1u tr\u1ecb l\u00e0 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng cho b\u1ec7nh nh\u00e2n.<\/p>\n

9.1. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng<\/strong><\/em><\/h3>\n

H\u1ed9i ch\u1ee9ng Parkinson, r\u1ed1i lo\u1ea1n t\u01b0 th\u1ebf v\u00e0 ng\u00e3<\/em>
\nLevodopa \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb th\u1eed cho b\u1ec7nh nh\u00e2n ch\u1eadm v\u1eadn \u0111\u1ed9ng v\u00e0 t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1, ng\u00e3. S\u1eed d\u1ee5ng Levodopa t\u0103ng d\u1ea7n li\u1ec1u \u0111\u1ebfn 1000 mg\/ng\u00e0y v\u00e0 duy tr\u00ec \u00edt nh\u1ea5t m\u1ed9t th\u00e1ng. Li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n th\u01b0\u1eddng kh\u00f4ng c\u00f3 \u0111\u00e1p \u1ee9ng ho\u1eb7c \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi Levodopa \u1edf giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a b\u1ec7nh. Th\u1ec3 PSP-P ban \u0111\u1ea7u th\u01b0\u1eddng \u0111\u00e1p \u1ee9ng, trong khi c\u00e1c th\u1ec3 kh\u00e1c c\u1ee7a li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n th\u00ec kh\u00f4ng. C\u00e1c thu\u1ed1c \u0111\u1ed3ng v\u1eadn Dopamin v\u00e0 \u1ee9c ch\u1ebf MAO-B th\u01b0\u1eddng \u00edt hi\u1ec7u qu\u1ea3 v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng cho b\u1ec7nh nh\u00e2n li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n. Amantadin v\u1edbi li\u1ec1u t\u0103ng ch\u1eadm, \u0111\u1ebfn 100-300 mg\/ng\u00e0y c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng v\u1eadn \u0111\u1ed9ng ch\u1eadm v\u00e0 t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1, c\u0169ng nh\u01b0 \u0111\u00f4ng c\u1ee9ng d\u00e1ng \u0111i, c\u1ea3i thi\u1ec7n th\u0103ng b\u1eb1ng. C\u00f3 th\u1ec3 d\u00f9ng \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi Levodopa.
\nC\u00e1c r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng kh\u00e1c<\/em> nh\u01b0 lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 c\u1ed5, lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 \u1edf chi, co th\u1eaft mi m\u1eaft c\u00f3 th\u1ec3 \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi ti\u00eam \u0111\u1ed9c t\u1ed1 Botulinum.
\nClonazepam ho\u1eb7c Levitiracetam c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho gi\u1eadt c\u01a1 trong h\u1ed9i ch\u1ee9ng v\u1ecf n\u00e3o h\u1ea1ch n\u1ec1n.
\nDBS hi\u1ec7n kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ec7nh li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n b\u00ean ngo\u00e0i c\u01a1 s\u1edf nghi\u00ean c\u1ee9u.
\nR\u1ed1i lo\u1ea1n nh\u1eadn th\u1ee9c<\/em>
\nKh\u00f4ng c\u00f3 \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u cho r\u1ed1i lo\u1ea1n nh\u1eadn th\u1ee9c \u1edf b\u1ec7nh nh\u00e2n li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n. Th\u1ef1c t\u1ebf l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf enzym cholinesterase kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o do c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m x\u1ea5u h\u01a1n tri\u1ec7u ch\u1ee9ng v\u1eadn \u0111\u1ed9ng.
\nC\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c<\/em>
\nC\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu Serotonin ch\u1ecdn l\u1ecdc c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb tr\u1ea7m c\u1ea3m, r\u1ed1i lo\u1ea1n lo \u00e2u, r\u1ed1i lo\u1ea1n c\u1ea3m x\u00fac. Ngo\u00e0i ra, Trazodone v\u00e0 Mirtazapine c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o c\u00f3 t\u00e1c d\u1ee5ng \u0111i\u1ec1u tr\u1ecb \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n. Zolpidem c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb m\u1ea5t ng\u1ee7.
\nKh\u00f4ng c\u00f3 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb kh\u00f3 nu\u1ed1t<\/em>. \u1ede giai \u0111o\u1ea1n sau c\u1ee7a b\u1ec7nh c\u00f3 th\u1ec3 ph\u1ea3i cho \u0103n qua m\u1edf th\u00f4ng d\u1ea1 d\u00e0y.
\nCh\u1ea3y n\u01b0\u1edbc d\u00e3i c\u00f3 th\u1ec3 ki\u1ec3m so\u00e1t b\u1eb1ng Atropine 1% nh\u1ecf t\u1ea1i ch\u1ed7, th\u1eadn tr\u1ecdng v\u1edbi c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5. C\u00f3 th\u1ec3 ti\u00eam \u0111\u1ed9c t\u1ed1 Botulinum v\u00e0o tuy\u1ebfn n\u01b0\u1edbc b\u1ecdt nh\u01b0ng c\u00f3 th\u1ec3 l\u00e0m n\u1eb7ng th\u00eam kh\u00f3 nu\u1ed1t.
\nV\u1eadt l\u00fd tr\u1ecb li\u1ec7u v\u00e0 v\u1eadn \u0111\u1ed9ng, li\u1ec7u ph\u00e1p ng\u00f4n ng\u1eef, t\u1eadp nu\u1ed1t: c\u00f3 vai tr\u00f2 quan tr\u1ecdng \u0111\u1ec3 ng\u0103n ng\u1eeba t\u00e9 ng\u00e3, duy tr\u00ec kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng, ng\u00f4n ng\u1eef v\u00e0 c\u1ea3i thi\u1ec7n c\u00e1c ho\u1ea1t \u0111\u1ed9ng sinh ho\u1ea1t h\u00e0ng ng\u00e0y.<\/p>\n

9.2 C\u00e1c thu\u1ed1c thay \u0111\u1ed5i b\u1ec7nh<\/strong><\/em><\/h3>\n

Cho \u0111\u1ebfn nay, c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 c\u00e1c li\u1ec7u ph\u00e1p \u0111i\u1ec1u ch\u1ec9nh b\u1ec7nh c\u00f3 kh\u1ea3 n\u0103ng kh\u00f4ng ch\u1ee9ng minh \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ecb nghi ng\u1edd m\u1eafc b\u1ec7nh li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n. C\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean, c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1edbi gi\u1ea3 d\u01b0\u1ee3c v\u1ec1 riluzole, davunetide, waveglusib, sodium valproate v\u00e0 rasagiline cho th\u1ea5y kh\u00f4ng c\u00f3 t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn c\u00e1c ti\u00eau ch\u00ed ch\u00ednh theo d\u00f5i s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh v\u00e0 thi\u1ebfu b\u1eb1ng ch\u1ee9ng cho th\u1ea5y c\u00e1c t\u00e1c nh\u00e2n c\u00f3 t\u00e1c d\u1ee5ng d\u1ef1 ki\u1ebfn th\u00f4ng qua c\u00e1c c\u01a1 ch\u1ebf l\u00fd thuy\u1ebft.
\nC\u00e1c nghi\u00ean c\u1ee9u hi\u1ec7n t\u1ea1i v\u1ec1 li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n t\u1eadp trung v\u00e0o tau bao g\u1ed3m TPI-287 (ch\u1ea5t \u1ed5n \u0111\u1ecbnh vi \u1ed1ng), C2N-8E12\/ABBV-8E12 v\u00e0 BMS-986168\/BIIB092 (c\u00e1c kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng ch\u1ed1ng tau v\u00e0 salsalate, ch\u1ea5t \u1ee9c ch\u1ebf acetyl h\u00f3a tau). C\u00e1c ch\u1ea5t \u1ed5n \u0111\u1ecbnh vi \u1ed1ng \u0111\u01b0\u1ee3c hy v\u1ecdng s\u1ebd b\u00f9 \u0111\u1eafp cho r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng vi \u1ed1ng li\u00ean quan \u0111\u1ebfn m\u1ea5t ch\u1ee9c n\u0103ng tau; c\u00e1c kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng ch\u1ed1ng tau \u0111\u01b0\u1ee3c hy v\u1ecdng s\u1ebd ng\u0103n c\u1ea3n s\u1ef1 l\u00e2y lan c\u1ee7a tau g\u00e2y b\u1ec7nh, v\u00e0 c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf acetyl h\u00f3a tau \u0111\u01b0\u1ee3c hy v\u1ecdng s\u1ebd \u1ee9c ch\u1ebf s\u1ef1 acetyl h\u00f3a c\u1ee7a tau h\u00f2a tan v\u00e0 do \u0111\u00f3 h\u1ea1n ch\u1ebf s\u1ef1 t\u0103ng phosphoryl h\u00f3a.<\/p>\n

10. Ti\u1ebfn tri\u1ec3n v\u00e0 ti\u00ean l\u01b0\u1ee3ng\u00a0<\/strong><\/h2>\n

Li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n ti\u1ebfn tri\u1ec3n nhanh v\u00e0 kh\u00f4ng ng\u1eebng. H\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n tr\u1edf n\u00ean ph\u1ee5 thu\u1ed9c v\u00e0o s\u1ef1 ch\u0103m s\u00f3c trong v\u00f2ng 3 ho\u1eb7c 4 n\u0103m k\u1ec3 t\u1eeb khi kh\u1edfi ph\u00e1t. T\u1eed vong trung b\u00ecnh t\u1eeb 6 \u0111\u1ebfn 9 n\u0103m sau khi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n.<\/p>\n

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

1. Steele J.C., Richardson J.C., v\u00e0 Olszewski J. (1964). Progressive supranuclear palsy: a heterogeneous degeneration involving the brain stem, basal ganglia and cerebellum with vertical gaze and pseudobulbar palsy, nuchal dystonia and dementia. Archives of neurology, 10(4), 333\u2013359.
\n2. Schrag A., Ben-Shlomo Y., v\u00e0 Quinn N.P. (1999). Prevalence of progressive supranuclear palsy and multiple system atrophy: a cross-sectional study. Lancet, 354(9192), 1771\u20131775.
\n3. Respondek G., Stamelou M., Kurz C. v\u00e0 c\u1ed9ng s\u1ef1. (2014). The phenotypic spectrum of progressive supranuclear palsy: a retrospective multicenter study of 100 definite cases. Mov Disord, 29(14), 1758\u20131766.
\n4. Pittman A.M., Myers A.J., Duckworth J. v\u00e0 c\u1ed9ng s\u1ef1. (2004). The structure of the tau haplotype in controls and in progressive supranuclear palsy. Hum Mol Genet, 13(12), 1267\u20131274.
\n5. Kovacs G.G. (2015). Invited review: Neuropathology of tauopathies: principles and practice. Neuropathol Appl Neurobiol, 41(1), 3\u201323.
\n6. Agarwal S. v\u00e0 Gilbert R. (2022). Progressive Supranuclear Palsy. StatPearls. StatPearls Publishing, Treasure Island (FL).
\n7. Massey L.A., Micallef C., Paviour D.C. v\u00e0 c\u1ed9ng s\u1ef1. (2012). Conventional magnetic resonance imaging in confirmed progressive supranuclear palsy and multiple system atrophy. Movement disorders, 27(14), 1754\u20131762.
\n8. Saeed U., Lang A.E., v\u00e0 Masellis M. (2020). Neuroimaging Advances in Parkinson\u2019s Disease and Atypical Parkinsonian Syndromes. Front Neurol, 11, 572976.
\n9. Giagkou N., H\u00f6glinger G.U., v\u00e0 Stamelou M. (2019). Progressive supranuclear palsy. International review of neurobiology, 149, 49\u201386.
\n10. Rojas J.C., Bang J., Lobach I.V. v\u00e0 c\u1ed9ng s\u1ef1. (2018). CSF neurofilament light chain and phosphorylated tau 181 predict disease progression in PSP. Neurology, 90(4), e273\u2013e281.
\n11. H\u00f6glinger G.U., Respondek G., Stamelou M. v\u00e0 c\u1ed9ng s\u1ef1. (2017). Clinical diagnosis of progressive supranuclear palsy: The movement disorder society criteria. Mov Disord, 32(6), 853\u2013864.<\/p>\n","protected":false},"excerpt":{"rendered":"

Li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n (PSP \u2013 Progressive supranuclear palsy) l\u00e0 b\u1ec7nh l\u00fd tho\u00e1i h\u00f3a th\u1ea7n kinh ph\u1ed5 bi\u1ebfn nh\u1ea5t trong nh\u00f3m h\u1ed9i ch\u1ee9ng Parkinson kh\u00f4ng \u0111i\u1ec3n h\u00ecnh. C\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng \u0111\u1eb7c tr\u01b0ng c\u1ee7a b\u1ec7nh g\u1ed3m li\u1ec7t li\u1ebfc d\u1ecdc, m\u1ea5t \u1ed5n \u0111\u1ecbnh t\u01b0 th\u1ebf v\u1edbi t\u00ecnh tr\u1ea1ng ng\u00e3 t\u00e1i di\u1ec5n kh\u00f4ng r\u00f5 nguy\u00ean […]<\/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":"\nT\u1ed5ng quan li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n - Vinmec<\/title>\n<meta name=\"description\" content=\"Li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n l\u00e0 b\u1ec7nh l\u00fd tho\u00e1i h\u00f3a th\u1ea7n kinh ph\u1ed5 bi\u1ebfn nh\u1ea5t trong nh\u00f3m h\u1ed9i ch\u1ee9ng Parkinson kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.\" \/>\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=\"T\u1ed5ng quan li\u1ec7t tr\u00ean nh\u00e2n ti\u1ebfn tri\u1ec3n - 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