{"id":31052,"date":"2023-05-06T21:46:55","date_gmt":"2023-05-06T14:46:55","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31052"},"modified":"2023-05-06T21:46:55","modified_gmt":"2023-05-06T14:46:55","slug":"phoi-hop-som-perampanel-trong-dieu-tri-dong-kinh-cuc-bo","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/phoi-hop-som-perampanel-trong-dieu-tri-dong-kinh-cuc-bo\/","title":{"rendered":"Ph\u1ed1i h\u1ee3p s\u1edbm perampanel trong \u0111i\u1ec1u tr\u1ecb \u0111\u00f4\u0323ng kinh c\u1ee5c b\u1ed9"},"content":{"rendered":"

\u0110\u00f4\u0323ng kinh\u00a0l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u1ea7n kinh m\u1ea1n t\u00ednh th\u01b0\u1eddng g\u1eb7p, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u1ecdi \u0111\u1ed9 tu\u1ed5i, gi\u1edbi t\u00ednh v\u00e0 d\u00e2n t\u1ed9c. \u0110\u1ed9ng kinh c\u0169ng g\u00e2y ra c\u00e1c \u1ea3nh h\u01b0\u1edfng v\u1ec1 t\u00e2m l\u00fd x\u00e3 h\u1ed9i l\u00e2u d\u00e0i. Do \u0111\u00f3, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb h\u1ebft c\u01a1n \u0111\u1ed9ng kinh<\/a> l\u00e0 quan tr\u1ecdng trong vi\u1ec7c \u0111\u01b0a ng\u01b0\u1eddi b\u1ec7nh tr\u1edf v\u1ec1 cu\u1ed9c s\u1ed1ng b\u00ecnh th\u01b0\u1eddng. Trong \u0111\u00f3, thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh l\u00e0 m\u1ed9t trong nh\u1eefng \u0111i\u1ec1u tr\u1ecb ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3 tr\u00ean 60% tr\u01b0\u1eddng h\u1ee3p \u0111\u1ed9ng kinh. Perampanel l\u00e0 m\u1ed9t thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh th\u1ebf h\u1ec7 m\u1edbi v\u1edbi c\u01a1 ch\u1ebf \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc th\u1ee5 th\u1ec3 \u03b1-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA) \u1edf m\u00e0ng sau xi-nap. Perampanel \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u00f3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p trong \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 trong nhi\u1ec1u nghi\u00ean c\u1ee9u tr\u00ean th\u1ebf gi\u1edbi. Nh\u00e2n hai tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 s\u1eed d\u1ee5ng perampanel t\u1ea1i ph\u00f2ng kh\u00e1m \u0110\u1ed9ng kinh, B\u1ec7nh vi\u1ec7n Nguy\u1ec5n Tri Ph\u01b0\u01a1ng, ch\u00fang t\u00f4i b\u00e0n lu\u1eadn v\u1ec1 s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p s\u1edbm perampanel v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 li\u00ean quan.<\/strong><\/p>\n

\"\u0110\u00f4\u0323ng
\u0110\u00f4\u0323ng kinh<\/figcaption><\/figure>\n

Ba\u0300i vi\u00ea\u0301t “Ph\u1ed1i h\u1ee3p s\u1edbm perampanel trong \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9: Kinh nghi\u1ec7m t\u1eeb c\u00e1c tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng” tri\u0301ch ngu\u00f4\u0300n t\u01b0\u0300 H\u00f4\u0323i Th\u00e2\u0300n kinh ho\u0323c Vi\u00ea\u0323t Nam.<\/strong><\/em><\/p>\n

Ta\u0301c gia\u0309: L\u00ea Th\u1ee5y Minh An1, V\u00f5 Th\u1ecb H\u1ea1nh Vi2, L\u00ea Qu\u1ef3nh Ng\u00e2n2<\/em><\/p>\n

B\u1ed9 m\u00f4n Th\u1ea7n kinh, \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c TP. H\u1ed3 Ch\u00ed Minh1<\/em><\/p>\n

Khoa Th\u1ea7n kinh, B\u1ec7nh vi\u1ec7n Nguy\u1ec5n Tri Ph\u01b0\u01a1ng2
\n<\/em><\/p>\n

1. Gi\u1edbi thi\u1ec7u v\u00ea\u0300 \u0110\u00f4\u0323ng kinh<\/strong><\/h2>\n

\u0110\u00f4\u0323ng kinh l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh l\u00fd th\u1ea7n kinh m\u1ea1n t\u00ednh th\u01b0\u1eddng g\u1eb7p nh\u1ea5t. Theo \u01b0\u1edbc t\u00ednh c\u1ee7a Li\u00ean h\u1ed9i Qu\u1ed1c t\u1ebf ch\u1ed1ng \u0110\u00f4\u0323ng kinh (ILAE) n\u0103m 1996, c\u00f3 kho\u1ea3ng 50 tri\u1ec7u ng\u01b0\u1eddi tr\u00ean th\u1ebf gi\u1edbi m\u1eafc c\u0103n b\u1ec7nh n\u00e0y v\u00e0 ch\u1ee7 y\u1ebfu s\u1ed1ng \u1edf c\u00e1c n\u01b0\u1edbc \u0111ang ph\u00e1t tri\u1ec3n, m\u1ed7i n\u0103m c\u00f3 kho\u1ea3ng 61,4\/100.000 tr\u01b0\u1eddng h\u1ee3p ph\u00e1t hi\u1ec7n \u0111\u00f4\u0323ng kinh m\u1edbi (1). T\u1ea1i Vi\u1ec7t Nam, \u0111\u00f4\u0323ng kinh \u1ea3nh h\u01b0\u1edfng 0,6 \u2013 1% d\u00e2n s\u1ed1, t\u1ef7 l\u1ec7 hi\u1ec7n m\u1eafc l\u00e0 4,4\/1.000 ng\u01b0\u1eddi (2). Tuy nhi\u00ean, kho\u1ea3ng tr\u1ed1ng \u0111i\u1ec1u tr\u1ecb t\u1ea1i Vi\u1ec7t Nam l\u00ean \u0111\u1ebfn 85% v\u00e0 tr\u1edf th\u00e0nh v\u1ea5n \u0111\u1ec1 \u0111\u00e1ng quan t\u00e2m (3). Thu\u1ed1c ch\u1ed1ng \u0111\u00f4\u0323ng kinh l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u1ed5 bi\u1ebfn. Trong \u0111\u00f3, Kwan v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 b\u00e1o c\u00e1o trong d\u00e2n s\u1ed1 \u0111\u1ed9ng kinh m\u1edbi ch\u1ea9n \u0111o\u00e1n, g\u1ea7n 50% ng\u01b0\u1eddi b\u1ec7nh \u0111\u00f4\u0323ng kinh ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c c\u01a1n \u0111\u1ed9ng kinh v\u1edbi thu\u1ed1c \u0111\u1ea7u ti\u00ean, th\u00eam 15% ki\u1ec3m so\u00e1t v\u1edbi thu\u1ed1c th\u1ee9 2 hay th\u1ee9 3 (4). Tuy nhi\u00ean hi\u1ec7u qu\u1ea3 ki\u1ec3m so\u00e1t c\u01a1n gi\u1ea3m h\u1eb3n khi ph\u1ed1i h\u1ee3p t\u1eeb thu\u1ed1c th\u1ee9 3 tr\u1edf l\u00ean. Perampanel (PER) l\u00e0 m\u1ed9t trong nh\u1eefng thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh th\u1ebf h\u1ec7 m\u1edbi v\u1edbi c\u01a1 ch\u1ebf kh\u00e1c bi\u1ec7t l\u00e0 ch\u1ea5t \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 \u03b1-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA) kh\u00f4ng c\u1ea1nh tranh, \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn tr\u00ean to\u00e0n c\u1ea7u nh\u01b0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p. Perampanel \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u00f3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p trong \u0111\u1ed9ng kinh to\u00e0n th\u1ec3 v\u00e0 \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 (5-7). Tuy nhi\u00ean, \u0111\u1ec3 t\u1ed1i \u01b0u h\u00f3a vi\u1ec7c \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh, vi\u1ec7c ph\u1ed1i h\u1ee3p s\u1edbm v\u1edbi PER l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 \u0111\u00e1ng \u0111\u01b0\u1ee3c quan t\u00e2m. Ch\u00fang t\u00f4i m\u00f4 t\u1ea3 hai tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 c\u00f3 s\u1eed d\u1ee5ng PER nh\u01b0 m\u1ed9t thu\u1ed1c ph\u1ed1i h\u1ee3p s\u1edbm.<\/p>\n

2. Tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng<\/strong><\/h2>\n

2.1. Tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng 1<\/strong><\/h3>\n

P.V l\u00e0 nam sinh 15 tu\u1ed5i, thu\u1eadn tay ph\u1ea3i \u0111\u1ebfn kh\u00e1m t\u1ea1i ph\u00f2ng kh\u00e1m \u0110\u00f4\u0323ng kinh, B\u1ec7nh vi\u1ec7n Nguy\u1ec5n Tri Ph\u01b0\u01a1ng t\u1eeb th\u00e1ng 11\/2019. Ng\u01b0\u1eddi b\u1ec7nh kh\u1edfi ph\u00e1t \u0111\u00f4\u0323ng kinh t\u1eeb n\u0103m 12 tu\u1ed5i. Tri\u1ec7u ch\u1ee9ng c\u01a1n th\u01b0\u1eddng x\u1ea3y ra v\u00e0o ban \u0111\u00eam, ng\u01b0\u1eddi b\u1ec7nh \u0111ang ng\u1ee7, \u0111\u1ed9t ng\u1ed9t th\u1ee9c gi\u1ea5c, c\u00f3 c\u1eed \u0111\u1ed9ng t\u1ef1 \u0111\u1ed9ng hai tay, sau \u0111\u00f3 c\u00f3 tri\u1ec7u ch\u1ee9ng xoay \u0111\u1ea7u m\u1eaft sang tr\u00e1i v\u00e0 chuy\u1ec3n th\u00e0nh co c\u1ee9ng co gi\u1eadt hai b\u00ean. Ng\u01b0\u1eddi b\u1ec7nh l\u00e0 con th\u1ee9 2 trong gia \u0111\u00ecnh, sinh th\u01b0\u1eddng, \u0111\u1ee7 th\u00e1ng, kh\u00f4ng ghi nh\u1eadn ti\u1ec1n c\u0103n b\u1ec7nh l\u00fd th\u1ea7n kinh nh\u01b0 s\u1ed1t co gi\u1eadt, nhi\u1ec5m tr\u00f9ng th\u1ea7n kinh, ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o; v\u00e0 c\u0169ng kh\u00f4ng ghi nh\u1eadn ti\u1ec1n s\u1eed gia \u0111\u00ecnh \u0111\u00f4\u0323ng kinh. C\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) s\u1ecd n\u00e3o ghi nh\u1eadn b\u00ecnh th\u01b0\u1eddng, \u0111i\u1ec7n n\u00e3o \u0111\u1ed3 (EEG) gi\u1ea5c ng\u1ee7 tr\u01b0a ghi nh\u1eadn gai \u2013 s\u00f3ng d\u1ea1ng \u0111\u1ed9ng kinh v\u00f9ng tr\u00e1n ph\u1ea3i (Fp2\/F8\/T2) (H\u00ecnh 1). X\u00e9t nghi\u1ec7m HLA-B1502 d\u01b0\u01a1ng t\u00ednh. D\u1ef1a v\u00e0o tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, h\u00ecnh \u1ea3nh h\u1ecdc v\u00e0 \u0111i\u1ec7n n\u00e3o \u0111\u1ed3, ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n l\u00e0 c\u01a1n \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 suy gi\u1ea3m \u00fd th\u1ee9c, kh\u1edfi ph\u00e1t v\u1eadn \u0111\u1ed9ng chuy\u1ec3n th\u00e0nh co c\u1ee9ng co gi\u1eadt hai b\u00ean. Ch\u1ea9n \u0111o\u00e1n theo h\u1ed9i ch\u1ee9ng \u0111\u00f4\u0323ng kinh ph\u00f9 h\u1ee3p v\u1edbi \u0110\u1ed9ng kinh th\u00f9y tr\u00e1n, v\u1edbi c\u0103n nguy\u00ean ch\u01b0a r\u00f5. Ng\u01b0\u1eddi b\u1ec7nh \u0111i\u1ec1u tr\u1ecb t\u1ea1i b\u1ec7nh vi\u1ec7n \u0111\u1ecba ph\u01b0\u01a1ng v\u1edbi levetiracetam (LEV) 1000mg\/ng\u00e0y v\u00e0 kh\u00f4ng c\u00f3 c\u01a1n trong v\u00f2ng 1 n\u0103m. Sau \u0111\u00f3, ng\u01b0\u1eddi b\u1ec7nh t\u00e1i ph\u00e1t c\u01a1n v\u1edbi t\u1ea7n s\u1ed1 1 c\u01a1n\/tu\u1ea7n. Ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c t\u0103ng li\u1ec1u d\u1ea7n levetiracetam \u0111\u1ebfn 2000 mg nh\u01b0ng t\u1ea7n s\u1ed1 c\u01a1n v\u1eabn kh\u00f4ng thay \u0111\u1ed5i. Topiramate (TPX) \u0111\u01b0\u1ee3c th\u00eam v\u00e0o v\u00e0 t\u0103ng d\u1ea7n \u0111\u1ebfn li\u1ec1u 200mg\/ng\u00e0y. Tuy t\u1ea7n s\u1ed1 c\u01a1n gi\u1ea3m c\u00f2n t\u1eeb 1 \u0111\u1ebfn 2 c\u01a1n\/th\u00e1ng nh\u01b0ng ng\u01b0\u1eddi b\u1ec7nh v\u1eabn kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng kh\u00f4ng c\u01a1n. L\u00fac n\u00e0y, ch\u00fang t\u00f4i quy\u1ebft \u0111\u1ecbnh s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p v\u1edbi perampanel (PER) v\u1edbi li\u1ec1u kh\u1edfi \u0111\u1ea7u l\u00e0 2mg. Sau 2 tu\u1ea7n s\u1eed d\u1ee5ng, ch\u00fang t\u00f4i d\u1ef1 t\u00ednh t\u0103ng li\u1ec1u PER th\u00e0nh 4mg nh\u01b0ng ng\u01b0\u1eddi th\u00e2n than phi\u1ec1n b\u00e9 d\u1ec5 n\u1ed5i n\u00f3ng, hay c\u00e1u g\u1eaft so v\u1edbi ng\u00e0y th\u01b0\u1eddng. Do \u0111\u00f3, PER \u0111\u01b0\u1ee3c d\u00f9ng ti\u1ebfp li\u1ec1u 2mg trong 2 tu\u1ea7n k\u1ebf ti\u1ebfp. Trong l\u1ea7n t\u00e1i kh\u00e1m ti\u1ebfp theo, khi c\u00e1c tri\u1ec7u ch\u1ee9ng c\u00e1u g\u1eaft \u0111\u00e3 thuy\u00ean gi\u1ea3m, ch\u00fang t\u00f4i t\u0103ng PER \u0111\u1ebfn li\u1ec1u 4mg. Hi\u1ec7n t\u1ea1i, ng\u01b0\u1eddi b\u1ec7nh ghi nh\u1eadn kh\u00f4ng c\u00f2n c\u01a1n \u0111\u1ed9ng kinh trong v\u00f2ng 6 th\u00e1ng v\u1edbi PER 4mg, TPX 200mg v\u00e0 k\u1ebf ho\u1ea1ch gi\u1ea3m d\u1ea7n v\u00e0 ng\u01b0ng LEV.<\/p>\n

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

H\u00ecnh 1. EEG ngo\u00e0i c\u01a1n v\u00f9ng tr\u00e1n ph\u1ea3i<\/p>\n

2.2. Tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng 2<\/strong><\/h3>\n

T.Q.K l\u00e0 sinh vi\u00ean nam, 22 tu\u1ed5i, thu\u1eadn tay ph\u1ea3i kh\u1edfi ph\u00e1t \u0111\u00f4\u0323ng kinh t\u1eeb n\u0103m 18 tu\u1ed5i. Tri\u1ec7u ch\u1ee9ng c\u01a1n kh\u1edfi ph\u00e1t v\u1edbi h\u00ecnh \u1ea3nh c\u00e1c h\u00ecnh tr\u00f2n hay tam gi\u00e1c m\u00e0u tr\u1eafng hay c\u00e1c ch\u1edbp s\u00e1ng nh\u1ecf xu\u1ea5t hi\u1ec7n g\u00f3c tr\u00e1i di chuy\u1ec3n sang b\u00ean ph\u1ea3i th\u1ecb tr\u01b0\u1eddng, c\u01a1n k\u00e9o d\u00e0i kho\u1ea3ng 10 \u0111\u1ebfn 20 gi\u00e2y, ng\u01b0\u1eddi b\u1ec7nh ho\u00e0n to\u00e0n t\u1ec9nh t\u00e1o trong c\u01a1n (H\u00ecnh 2). T\u1eeb 18 tu\u1ed5i \u0111\u1ebfn n\u0103m 20 tu\u1ed5i, ng\u01b0\u1eddi b\u1ec7nh c\u00f2n c\u00f3 c\u00e1c c\u01a1n kh\u1edfi ph\u00e1t t\u01b0\u01a1ng t\u1ef1 k\u00e8m theo c\u1eed \u0111\u1ed9ng xoay \u0111\u1ea7u m\u1eaft sang tr\u00e1i, lo\u1ea1i c\u01a1n n\u00e0y k\u1ebft th\u00fac khi ng\u01b0\u1eddi b\u1ec7nh \u0111i\u1ec1u tr\u1ecb v\u1edbi levetiracetam li\u1ec1u 1000mg\/ng\u00e0y. Ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ebfn kh\u00e1m t\u1ea1i ph\u00f2ng kh\u00e1m \u0110\u1ed9ng kinh v\u1edbi nh\u1eefng c\u01a1n c\u1ee5c b\u1ed9 c\u00f2n \u00fd th\u1ee9c kh\u1edfi ph\u00e1t b\u1eb1ng tri\u1ec7u ch\u1ee9ng gi\u00e1c quan (th\u1ecb gi\u00e1c), t\u1ea7n s\u1ed1 t\u1eeb 1 \u0111\u1ebfn 2 c\u01a1n m\u1ed7i ng\u00e0y, v\u00e0 \u0111ang s\u1eed d\u1ee5ng levetiracetam 1000mg\/ng\u00e0y. \u0110i\u1ec7n n\u00e3o \u0111\u1ed3 ghi nh\u1eadn h\u00ecnh \u1ea3nh gai \u2013 s\u00f3ng d\u1ea1ng \u0111\u1ed9ng kinh ngo\u00e0i c\u01a1n v\u00f9ng ch\u1ea9m ph\u1ea3i v\u1edbi ho\u1ea1t \u0111\u1ed9ng n\u1ec1n b\u00ecnh th\u01b0\u1eddng. MRI s\u1ecd n\u00e3o ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng. D\u1ef1a v\u00e0o tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, \u0111i\u1ec7n n\u00e3o v\u00e0 h\u00ecnh \u1ea3nh h\u1ecdc, ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n l\u00e0 \u0111\u1ed9ng kinh thu\u1ef3 ch\u1ea9m. V\u1ec1 c\u0103n nguy\u00ean v\u00e0 \u0111\u1ed9 tu\u1ed5i kh\u1edfi ph\u00e1t, h\u1ed9i ch\u1ee9ng \u0110\u1ed9ng kinh thu\u1ef3 ch\u1ea9m kh\u1edfi ph\u00e1t tr\u1ec5 th\u1ec3 Gastaut l\u00e0 m\u1ed9t ch\u1ea9n \u0111o\u00e1n c\u00f3 kh\u1ea3 n\u0103ng, v\u00e0 ph\u00e2n bi\u1ec7t v\u1edbi \u0110\u1ed9ng kinh thu\u1ef3 ch\u1ea9m v\u1edbi c\u0103n nguy\u00ean kh\u00f4ng r\u00f5. Ch\u00fang t\u00f4i ti\u1ebfn h\u00e0nh t\u0103ng d\u1ea7n li\u1ec1u levetiracetam \u0111\u1ebfn 2000mg\/ng\u00e0y. Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 gi\u1ea3m t\u1ea7n s\u1ed1 c\u01a1n c\u00f2n 2-3 c\u01a1n\/tu\u1ea7n. V\u1edbi d\u1ef1 \u0111\u1ecbnh ph\u1ed1i h\u1ee3p thu\u1ed1c, ng\u01b0\u1eddi b\u1ec7nh ki\u1ec3m tra gen HLA-B1502 v\u00e0 c\u00f3 k\u1ebft qu\u1ea3 d\u01b0\u01a1ng t\u00ednh. PER \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn l\u00e0 thu\u1ed1c ph\u1ed1i h\u1ee3p th\u1ee9 2 v\u1edbi li\u1ec1u kh\u1edfi \u0111\u1ea7u l\u00e0 2mg. Hi\u1ec7n t\u1ea1i, ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng c\u00f2n c\u01a1n \u0111\u1ed9ng kinh trong v\u00f2ng 6 th\u00e1ng v\u1edbi LEV 2000mg\/ng\u00e0y v\u00e0 PER 2mg\/ng\u00e0y.<\/p>\n

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

H\u00ecnh 2. H\u00ecnh v\u1ebd ng\u01b0\u1eddi b\u1ec7nh m\u00f4 t\u1ea3 tri\u1ec7u ch\u1ee9ng th\u1ecb gi\u00e1c trong c\u01a1n<\/p>\n

3. B\u00e0n lu\u1eadn v\u00ea\u0300 ph\u00f4\u0301i h\u01a1\u0323p s\u01a1\u0301m PER \u01a1\u0309 b\u00ea\u0323nh nh\u00e2n \u0110\u00f4\u0323ng kinh<\/strong><\/h2>\n

3.1. Hi\u1ec7u qu\u1ea3 ph\u1ed1i h\u1ee3p s\u1edbm PER<\/strong><\/h3>\n

Hai tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng ghi nh\u1eadn PER c\u00f3 hi\u1ec7u qu\u1ea3 ki\u1ec3m so\u00e1t c\u01a1n v\u1edbi vai tr\u00f2 thu\u1ed1c ph\u1ed1i h\u1ee3p th\u1ee9 2 v\u00e0 th\u1ee9 3 sau khi thu\u1ed1c \u0111\u1ea7u ti\u00ean th\u1ea5t b\u1ea1i trong \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 c\u00f3 v\u00e0 kh\u00f4ng chuy\u1ec3n th\u00e0nh co c\u1ee9ng co gi\u1eadt hai b\u00ean. \u0110i\u1ec1u n\u00e0y c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf c\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y. M\u1ed9t nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u quan s\u00e1t, \u0111a trung t\u00e2m t\u1ea1i T\u00e2y Ban Nha thu th\u1eadp 77 ng\u01b0\u1eddi b\u1ec7nh s\u1eed d\u1ee5ng PER nh\u01b0 m\u1ed9t thu\u1ed1c ph\u1ed1i h\u1ee3p s\u1edbm (thu\u1ed1c th\u1ee9 2 v\u00e0 th\u1ee9 3) sau khi th\u1ea5t b\u1ea1i v\u1edbi \u0111\u01a1n tr\u1ecb li\u1ec7u v\u00e0 theo d\u00f5i hi\u1ec7u qu\u1ea3 sau 3, 6 v\u00e0 12 th\u00e1ng (8). Sau 12 th\u00e1ng \u0111i\u1ec1u tr\u1ecb (li\u1ec1u trung b\u00ecnh 6 mg\/ng\u00e0y), 60% b\u1ec7nh nh\u00e2n (39\/65) gi\u1ea3m \u0111\u01b0\u1ee3c \u226550% t\u1ea7n su\u1ea5t co gi\u1eadt so v\u1edbi ban \u0111\u1ea7u. T\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng \u1edf th\u1eddi \u0111i\u1ec3m 12 th\u00e1ng cao h\u01a1n \u0111\u00e1ng k\u1ec3 khi PER \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 thu\u1ed1c th\u1ee9 2 sau th\u1ea5t b\u1ea1i \u0111\u01a1n tr\u1ecb li\u1ec7u (72,2%) so v\u1edbi khi PER \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o sau hai thu\u1ed1c (44,8%). M\u1ed9t nghi\u00ean c\u1ee9u nh\u00e3n m\u1edf v\u1ec1 hi\u1ec7u qu\u1ea3 v\u00e0 t\u00ednh an to\u00e0n c\u1ee7a perampanel nh\u01b0 l\u00e0 thu\u1ed1c ph\u1ed1i h\u1ee3p \u0111\u1ea7u ti\u00ean cho \u0111\u01a1n tr\u1ecb li\u1ec7u \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 chuy\u1ec3n th\u00e0nh co c\u1ee9ng co gi\u1eadt hai b\u00ean \u1edf H\u00e0n Qu\u1ed1c (N = 85) (9). T\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng 50% (gi\u1ea3m \u226550% t\u1ea7n su\u1ea5t co gi\u1eadt) \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf 80% b\u1ec7nh nh\u00e2n trong th\u1eddi gian duy tr\u00ec, v\u1edbi c\u00e1c c\u1ea3i thi\u1ec7n v\u1ec1 co gi\u1eadt \u0111\u01b0\u1ee3c th\u1ea5y \u1edf c\u1ea3 m\u1ee9c th\u1ea5p (4 v\u00e0 6 mg\/ng\u00e0y) v\u00e0 cao (8, 10, v\u00e0 12 mg\/ng\u00e0y). Ngo\u00e0i ra, c\u00e1c ph\u00e2n t\u00edch h\u1eadu ki\u1ec3m cho th\u1ea5y r\u1eb1ng khi ph\u00e2n t\u1ea7ng theo t\u1ed1c \u0111\u1ed9 t\u0103ng li\u1ec1u (ch\u1eadm: t\u0103ng li\u1ec1u \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong kho\u1ea3ng th\u1eddi gian \u22652 tu\u1ea7n; nhanh: th\u1ef1c hi\u1ec7n \u1edf kho\u1ea3ng th\u1eddi gian <2 tu\u1ea7n), t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n trong nh\u00f3m ch\u1eadm nh\u1eefng \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng 50%, 75% ho\u1eb7c 100% cao h\u01a1n v\u1ec1 s\u1ed1 l\u01b0\u1ee3ng so v\u1edbi nh\u1eefng ng\u01b0\u1eddi trong nh\u00f3m nhanh (l\u1ea7n l\u01b0\u1ee3t l\u00e0 83,1% so v\u1edbi 73,1%, 72,9% so v\u1edbi 69,2% v\u00e0 49,2% so v\u1edbi 42,3%). N\u0103m 2021, c\u00e1c t\u00e1c gi\u1ea3 \u0111\u00e3 \u0111\u0103ng t\u1ea3i k\u1ebft qu\u1ea3 k\u00e9o d\u00e0i 3 n\u0103m c\u1ee7a nghi\u00ean c\u1ee9u tr\u00ean (10). T\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng 50% \u1edf n\u0103m th\u1ee9 3 l\u00e0 84,8% v\u00e0 trong 3 n\u0103m l\u00e0 71,7%. T\u1ef7 l\u1ec7 duy tr\u00ec thu\u1ed1c trong m\u1ed9t, hai v\u00e0 ba n\u0103m t\u01b0\u01a1ng t\u1ef1 nhau (l\u1ea7n l\u01b0\u1ee3t l\u00e0 62,5%, 53,1%, v\u00e0 52,1%). Li\u1ec1u s\u1eed d\u1ee5ng c\u00f3 hi\u1ec7u qu\u1ea3 c\u1ee7a PER ghi nh\u1eadn 4-6mg trong c\u00e1c nghi\u00ean c\u1ee9u \u1edf ch\u00e2u \u00c1 c\u0169ng t\u01b0\u01a1ng t\u1ef1 li\u1ec1u thu\u1ed1c ch\u00fang t\u00f4i s\u1eed d\u1ee5ng trong 2 tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng. Trong th\u1eddi gian 3 n\u0103m m\u00e0 ng\u01b0\u1eddi b\u1ec7nh nh\u1eadn \u0111\u01b0\u1ee3c li\u1ec1u cu\u1ed1i c\u00f9ng c\u1ee7a PER \u1edf 4 mg\/ng\u00e0y, 87,5% ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 gi\u1ea3m 50% c\u01a1n co gi\u1eadt v\u00e0 45,8% b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 c\u01a1n (10). T\u1ef7 l\u1ec7 n\u00e0y cao h\u01a1n \u1edf ng\u01b0\u1eddi \u0111\u01b0\u1ee3c d\u00f9ng PER v\u1edbi li\u1ec1u 6 mg\/ng\u00e0y. Nh\u1eefng k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 c\u0169ng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong m\u1ed9t nghi\u00ean c\u1ee9u c\u1ee7a Nh\u1eadt B\u1ea3n, trong \u0111\u00f3 >50% b\u1ec7nh nh\u00e2n kh\u00f4ng c\u01a1n v\u1edbi li\u1ec1u PER t\u1ed1i thi\u1ec3u l\u00e0 2mg (11).<\/p>\n

3.2. T\u00e1c d\u1ee5ng ngo\u1ea1i \u00fd th\u01b0\u1eddng g\u1eb7p<\/h3>\n

Bu\u1ed3n ng\u1ee7, ch\u00f3ng m\u1eb7t, b\u1ee9t r\u1ee9t l\u00e0 nh\u1eefng t\u00e1c d\u1ee5ng th\u01b0\u1eddng g\u1eb7p khi s\u1eed d\u1ee5ng PER \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn trong c\u00e1c nghi\u00ean c\u1ee9u tr\u00ean (8-10). M\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng ngo\u1ea1i \u00fd v\u1ec1 t\u00e2m th\u1ea7n c\u0169ng \u0111\u01b0\u1ee3c ghi nh\u1eadn nh\u01b0 k\u00edch \u0111\u1ed9ng, b\u1ee9t r\u1ee9t nh\u01b0ng v\u1edbi t\u1ef7 l\u1ec7 th\u1ea5p. Nghi\u00ean c\u1ee9u cho th\u1ea5y c\u00e1c t\u00e1c d\u1ee5ng ngo\u1ea1i \u00fd n\u00e0y \u0111a s\u1ed1 \u1edf m\u1ee9c \u0111\u1ed9 nh\u1eb9 v\u00e0 trung b\u00ecnh, c\u00f3 th\u1ec3 ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c, ch\u1ec9 c\u00f3 r\u1ea5t \u00edt tr\u01b0\u1eddng h\u1ee3p ng\u01b0ng s\u1eed d\u1ee5ng PER do t\u00e1c d\u1ee5ng nghi\u00eam tr\u1ecdng. \u1ede tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng s\u1ed1 1, b\u00e9 trai xu\u1ea5t hi\u1ec7n d\u1ec5 c\u00e1u g\u1eaft trong th\u1eddi gian b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng PER. X\u00e9t th\u1ea5y ng\u01b0\u1eddi b\u1ec7nh ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c, ch\u00fang t\u00f4i quy\u1ebft \u0111\u1ecbnh k\u00e9o d\u00e0i th\u1eddi gian t\u0103ng li\u1ec1u PER trong v\u00f2ng 2 tu\u1ea7n th\u00e0nh 4 tu\u1ea7n. Sau \u0111\u00f3, ng\u01b0\u1eddi b\u1ec7nh dung n\u1ea1p v\u1edbi c\u00e1c t\u00e1c d\u1ee5ng ngo\u1ea1i \u00fd n\u00e0y n\u00ean ch\u00fang t\u00f4i t\u0103ng li\u1ec1u PER v\u00e0 ng\u01b0\u1eddi b\u1ec7nh dung n\u1ea1p \u0111\u01b0\u1ee3c li\u1ec1u ti\u1ebfp theo. T\u1ef7 l\u1ec7 duy tr\u00ec s\u1eed d\u1ee5ng PER c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o kh\u00e1 cao kho\u1ea3ng %. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 ti\u1ec1n c\u0103n r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n, r\u1ed1i lo\u1ea1n nh\u1eadn th\u1ee9c c\u1ea7n c\u1ea9n tr\u1ecdng trong vi\u1ec7c l\u1ef1a ch\u1ecdn PER.<\/p>\n

3.3. T\u1ed1i \u01b0u h\u00f3a vi\u1ec7c s\u1eed d\u1ee5ng PER<\/h3>\n

D\u1ef1a tr\u00ean kinh nghi\u1ec7m l\u00e2m s\u00e0ng v\u00e0 \u00fd ki\u1ebfn m\u1ed9t s\u1ed1 chuy\u00ean gia \u0111\u1ed9ng kinh, m\u1ed9t s\u1ed1 l\u1eddi khuy\u00ean \u0111\u01b0\u1ee3c \u0111\u01b0a ra \u0111\u1ec3 h\u01b0\u1edbng d\u1eabn ng\u01b0\u1eddi b\u1ec7nh s\u1eed d\u1ee5ng hi\u1ec7u qu\u1ea3 PER c\u0169ng nh\u01b0 x\u1eed tr\u00ed c\u00e1c t\u00e1c d\u1ee5ng ngo\u1ea1i \u00fd.
\n\u2022 Th\u00f4ng tin v\u00e0 gi\u1ea3i th\u00edch c\u00e1c t\u00e1c d\u1ee5ng ngo\u1ea1i \u00fd c\u00f9ng v\u1edbi l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng PER cho ng\u01b0\u1eddi b\u1ec7nh v\u00e0 th\u00e2n nh\u00e2n c\u0169ng nh\u01b0 c\u00e1ch theo d\u00f5i v\u00e0 b\u00e1o v\u1edbi b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb.
\n\u2022 H\u01b0\u1edbng d\u1eabn ng\u01b0\u1eddi b\u1ec7nh u\u1ed1ng v\u00e0o th\u1eddi gian chu\u1ea9n b\u1ecb \u0111i ng\u1ee7 (60-90 ph\u00fat), kh\u00f4ng n\u00ean u\u1ed1ng ngay tr\u01b0\u1edbc khi ng\u1ee7. \u0110i\u1ec1u n\u00e0y s\u1ebd gi\u00fap tr\u00e1nh t\u00e1c d\u1ee5ng bu\u1ed3n ng\u1ee7 v\u00e0 ch\u00f3ng m\u1eb7t v\u00e0o bu\u1ed5i s\u00e1ng.
\n\u2022 Kh\u1edfi \u0111\u1ea7u li\u1ec1u th\u1ea5p (1-2mg\/ng\u00e0y) v\u00e0 t\u0103ng li\u1ec1u ch\u1eadm sau m\u1ed7i 2 tu\u1ea7n.
\n\u2022 N\u1ebfu ng\u01b0\u1eddi b\u1ec7nh xu\u1ea5t hi\u1ec7n t\u00e1c d\u1ee5ng ngo\u1ea1i \u00fd, c\u00f3 th\u1ec3 k\u00e9o d\u00e0i th\u1eddi gian t\u0103ng li\u1ec1u (2-4 tu\u1ea7n). Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, c\u00f3 th\u1ec3 xem x\u00e9t gi\u1ea3m xu\u1ed1ng m\u1ed9t li\u1ec1u \u0111\u1ec3 t\u00e1c d\u1ee5ng ngo\u1ea1i \u00fd bi\u1ebfn m\u1ea5t v\u00e0 t\u0103ng d\u1ea7n li\u1ec1u tr\u1edf l\u1ea1i.<\/p>\n

4. K\u1ebft lu\u1eadn ph\u00f4\u0301i h\u01a1\u0323p PER \u01a1\u0309 b\u00ea\u0323nh nh\u00e2n \u0111\u00f4\u0323ng kinh<\/strong><\/h2>\n

PER v\u1edbi c\u01a1 ch\u1ebf kh\u00e1c bi\u1ec7t \u0111\u01b0\u1ee3c ghi nh\u1eadn c\u00f3 hi\u1ec7u qu\u1ea3 \u0111\u1ed1i v\u1edbi \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 c\u00f3 hay kh\u00f4ng chuy\u1ec3n th\u00e0nh co c\u1ee9ng co gi\u1eadt hai b\u00ean. Vi\u1ec7c ph\u1ed1i h\u1ee3p s\u1edbm PER nh\u1eb1m t\u1ed1i \u01b0u h\u00f3a \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh c\u1ea7n c\u00f3 s\u1ef1 h\u1ee3p t\u00e1c \u0111i\u1ec1u tr\u1ecb gi\u1eefa ng\u01b0\u1eddi b\u1ec7nh, th\u00e2n nh\u00e2n v\u00e0 b\u00e1c s\u0129 l\u00e2m s\u00e0ng.<\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o<\/strong><\/h2>\n

1. Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon CS, Dykeman J, et al. Prevalence and incidence of epilepsy: A systematic review and meta-analysis of international studies. Neurology. 2017;88(3):296-303.
\n2. Tuan NA, Cuong le Q, Allebeck P, Chuc NT, Persson HE, Tomson T. The prevalence of epilepsy in a rural district of Vietnam: a population-based study from the EPIBAVI project. Epilepsia. 2008;49(9):1634-7.
\n3. Tuan NA, Tomson T, Allebeck P, Chuc NT, Cuong le Q. The treatment gap of epilepsy in a rural district of Vietnam: a study from the EPIBAVI project. Epilepsia. 2009;50(10):2320-3.
\n4. Kwan P, Brodie MJ. Early identification of refractory epilepsy. New England Journal of Medicine. 2000;342(5):314-9.
\n5. French JA, Krauss GL, Wechsler RT, Wang X-F, DiVentura B, Brandt C, et al. Perampanel for tonic-clonic seizures in idiopathic generalized epilepsy: a randomized trial. Neurology. 2015;85(11):950-7.
\n6. Hwang SK, Lee YJ, Nam SO, Kim WS, Kim JS, Kim SJ, et al. Real-Life Effectiveness and Tolerability of Perampanel in Pediatric Patients Aged 4 Years or Older with Epilepsy: A Korean National Multicenter Study. J Clin Neurol. 2020;16(1):53-9.
\n7. Villanueva V, Montoya J, Castillo A, Mauri-Llerda J, Giner P, L\u00f3pez-Gonz\u00e1lez FJ, et al. Perampanel in routine clinical use in idiopathic generalized epilepsy: The 12-month GENERAL study. Epilepsia. 2018;59(9):1740-52.
\n8. Rodr\u00edguez-Osorio X, Lema-Facal T, Rubio-Naz\u00e1bal E, Castro-Vilanova MD, Pato-Pato A, Abella-Corral J, et al. Perampanel effectiveness and safety as early add-on treatment for focal-onset seizures: PEREAGAL study. Epilepsy Res. 2021;172:106570.
\n9. Kim JH, Kim DW, Lee SK, Seo DW, Lee JW, Park HJ, et al. First add-on perampanel for focal-onset seizures: An open-label, prospective study. Acta Neurol Scand. 2020;141(2):132-40.
\n10. Im K, Lee S-A, Kim JH, Kim DW, Lee SK, Seo DW, et al. Long-term efficacy and safety of perampanel as a first add-on therapy in patients with focal epilepsy: Three-year extension study. Epilepsy & Behavior. 2021;125:108407.
\n11. Takahashi S, Shimizu K, Inaji M, Hashimoto S, Yamamoto S, Maehara T. Effectiveness of perampanel as a first add-on antiepileptic drug for the treatment of partial epilepsy. Epilepsy Behav. 2019;100(Pt A):106492.<\/p>\n","protected":false},"excerpt":{"rendered":"

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