{"id":31132,"date":"2023-05-06T21:45:04","date_gmt":"2023-05-06T14:45:04","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31132"},"modified":"2023-05-06T21:45:04","modified_gmt":"2023-05-06T14:45:04","slug":"cac-con-dong-kinh-sau-dot-quy-post-stroke-epilepsies-pse","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/cac-con-dong-kinh-sau-dot-quy-post-stroke-epilepsies-pse\/","title":{"rendered":"C\u00e1c c\u01a1n \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 (Post -stroke epilepsies: PSE)"},"content":{"rendered":"

\u0110\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 (Post-stroke epilepsies – PSE) l\u00e0 m\u1ed9t lo\u1ea1i \u0111\u1ed9ng kinh<\/a> ph\u1ee9c t\u1ea1p x\u1ea3y ra sau khi b\u1ec7nh nh\u00e2n tr\u1ea3i qua \u0111\u1ed9t qu\u1ef5. S\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a PSE ph\u1ee5 thu\u1ed9c v\u00e0o nhi\u1ec1u y\u1ebfu t\u1ed1, bao g\u1ed3m v\u1ecb tr\u00ed v\u00e0 k\u00edch th\u01b0\u1edbc c\u1ee7a t\u1ed5n th\u01b0\u01a1ng do \u0111\u1ed9t qu\u1ef5 g\u00e2y ra, ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb v\u00e0 nguy c\u01a1 b\u1ec7nh t\u1eadt. PSE c\u00f3 th\u1ec3 x\u1ea3y ra trong v\u00f2ng v\u00e0i ng\u00e0y ho\u1eb7c th\u1eadm ch\u00ed m\u1ed9t n\u0103m sau \u0111\u1ed9t qu\u1ef5. N\u00f3 c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng c\u01a1n \u0111\u1ed9ng kinh kh\u00e1c nhau, t\u1eeb nh\u1eefng c\u01a1n \u0111\u01a1n gi\u1ea3n \u0111\u1ebfn nh\u1eefng c\u01a1n ph\u1ee9c t\u1ea1p v\u1edbi nhi\u1ec1u tri\u1ec7u ch\u1ee9ng. Nh\u1eefng c\u01a1n \u0111\u1ed9ng kinh n\u00e0y c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 g\u00e2y ra nhi\u1ec1u r\u1eafc r\u1ed1i trong vi\u1ec7c \u0111i\u1ec1u tr\u1ecb.<\/strong><\/p>\n

Ba\u0300i vi\u00ea\u0301t “C\u00e1c c\u01a1n \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 (Post -stroke epilepsies: PSE)” 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: Jallon Pierre Marie<\/strong><\/em>
\nVi\u1ec7n tr\u01b0\u1eddng Gen\u00e8ve Th\u1ee5y S\u0129<\/em>
\nNguy\u00ean Ch\u1ee7 t\u1ecbch Li\u00ean \u0111o\u00e0n \u0110\u1ed9ng kinh C\u1ed9ng H\u00f2a Ph\u00e1p<\/em>
\nNg\u01b0\u1eddi d\u1ecbch: Phan L\u1ec7 B\u00edch H\u01b0\u1eddng<\/strong><\/em><\/p>\n

1.\u00a0\u0110i\u0323nh nghi\u0303a va\u0300 ph\u00e2n loa\u0323i \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 PSE<\/strong><\/h2>\n

C\u00e1c c\u01a1n \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 ph\u1ea3i \u0111\u01b0\u1ee3c hi\u1ec3u \u0111\u00fang l\u00e0 c\u00e1c c\u01a1n \u0111\u1ed9ng kinh li\u00ean quan \u0111\u1ebfn \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o v\u00e0 \u0111\u1ed9t qu\u1ef5 nh\u1ed3i m\u00e1u n\u00e3o (bao g\u1ed3m c\u1ea3 nh\u1ed3i m\u00e1u \u0111\u1ed9ng m\u1ea1ch v\u00e0 nh\u1ed3i m\u00e1u t\u0129nh m\u1ea1ch) v\u00ec m\u1eb7c d\u00f9 l\u00e0 c\u00f3 t\u1eeb \u201csau \u0111\u1ed9t qu\u1ef5\u201d nh\u01b0ng PSE ph\u1ea3i \u0111\u01b0\u1ee3c hi\u1ec3u l\u00e0 bao g\u1ed3m c\u1ea3 hai t\u00ecnh hu\u1ed1ng \u0111i\u1ec7n l\u00e2m s\u00e0ng kh\u00e1c bi\u1ec7t nh\u01b0 sau:
\n\u2013 C\u01a1n \u0111\u1ed9ng kinh kh\u1edfi ph\u00e1t s\u1edbm, c\u00f2n g\u1ecdi l\u00e0 C\u01a0N S\u1edaM (crises precoces): l\u00e0 nh\u1eefng c\u01a1n \u0111\u1ed9ng kinh tri\u1ec7u ch\u1ee9ng c\u1ea5p t\u00ednh, g\u1ea7n s\u00e1t v\u1edbi th\u1eddi \u0111i\u1ec3m b\u1ecb \u0111\u1ed9t qu\u1ef5 v\u00e0 c\u00f3 th\u1ec3 t\u00e1i hi\u1ec7n ho\u1eb7c kh\u00f4ng t\u00e1i hi\u1ec7n l\u1ea1i sau giai \u0111o\u1ea1n c\u1ea5p c\u1ee7a \u0111\u1ed9t qu\u1ef5, hay c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 c\u01a1n c\u00f3 y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t.
\n\u2013 C\u01a1n \u0111\u1ed9ng kinh kh\u1edfi ph\u00e1t mu\u1ed9n, c\u00f2n g\u1ecdi l\u00e0 C\u01a0N MU\u1ed8N (crises tardives): l\u00e0 nh\u1eefng c\u01a1n \u0111\u1ed9ng kinh x\u1ea3y ra xa sau th\u1eddi \u0111i\u1ec3m \u0111\u1ed9t qu\u1ef5 c\u1ea5p v\u00e0 \u0111\u01b0\u1ee3c xem l\u00e0 nh\u1eefng c\u01a1n kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t, nh\u1eefng c\u01a1n lo\u1ea1i n\u00e0y c\u00f3 xu h\u01b0\u1edbng t\u00e1i ph\u00e1t c\u01a1n tr\u1edf th\u00e0nh \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 th\u1eadt s\u1ef1 (PSE).
\nTheo \u0111\u1ecbnh ngh\u0129a c\u1ee7a li\u00ean \u0111o\u00e0n \u0111\u1ed9ng kinh qu\u1ed1c t\u1ebf ILAE v\u1ec1 c\u00e1c c\u01a1n \u0111\u1ed9ng kinh li\u00ean quan \u0111\u1ebfn \u0111\u1ed9t qu\u1ef5, c\u01a1n s\u1edbm c\u00f3 th\u1ec3 x\u1ea3y ra ngay tr\u01b0\u1edbc th\u1eddi \u0111i\u1ec3m \u0111\u1ed9t qu\u1ef5, hay trong tu\u1ea7n l\u1ec5 \u0111\u1ea7u ti\u00ean c\u1ee7a \u0111\u1ed9t qu\u1ef5, c\u00f2n c\u00e1c c\u01a1n sau \u0111\u00f3 l\u00e0 c\u00e1c c\u01a1n mu\u1ed9n. Th\u00f4ng th\u01b0\u1eddng 70% c\u01a1n s\u1edbm x\u1ea3y ra trong 24h \u0111\u1ea7u c\u1ee7a \u0111\u1ed9t qu\u1ef5 v\u00e0 c\u01a1n mu\u1ed9n c\u00f3 th\u1ec3 m\u00e3i \u0111\u1ebfn 6 th\u00e1ng hay 1 n\u0103m sau \u0111\u1ed9t qu\u1ef5 m\u1edbi xu\u1ea5t hi\u1ec7n.<\/p>\n

2. Sinh b\u00ea\u0323nh ho\u0323c cu\u0309a \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 PSE<\/strong><\/h2>\n

\u0110\u00e2y l\u00e0 lo\u1ea1i \u0111\u1ed9ng kinh tri\u1ec7u ch\u1ee9ng do t\u1ed5n th\u01b0\u01a1ng c\u1ea5u tr\u00fac v\u00e0 chuy\u1ec3n h\u00f3a, c\u01a1 ch\u1ebf t\u01b0\u01a1ng \u0111\u1ed1i ph\u1ee9c t\u1ea1p v\u00e0 c\u00f3 nhi\u1ec1u gi\u1ea3 thi\u1ebft.<\/p>\n

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2.1. C\u00e1c c\u01a1n kh\u1edfi ph\u00e1t s\u1edbm<\/strong><\/h3>\n

C\u01a1n tri\u1ec7u ch\u1ee9ng c\u00f3 sinh b\u1ec7nh h\u1ecdc li\u00ean quan \u0111\u1ebfn.
\n\u2013 Ph\u00f9 \u0111\u1ed9c t\u1ebf b\u00e0o, gia t\u0103ng c\u00e1c y\u1ebfu t\u1ed1 k\u00edch th\u00edch c\u00f3 b\u1ea3n ch\u1ea5t l\u00e0 acid amin, suy gi\u1ea3m c\u00e1c c\u01a1 ch\u1ebf \u1ee9c ch\u1ebf t\u1ebf b\u00e0o th\u1ea7n kinh.
\n\u2013 Vai tr\u00f2 c\u1ee7a v\u00f9ng tranh t\u1ed1i tranh s\u00e1ng.
\n\u2013 Vai tr\u00f2 c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 n\u1ed9i t\u1ea1i ho\u1eb7c c\u00e1c t\u00e1c nh\u00e2n chuy\u1ec3n h\u00f3a do tu\u1ed5i, b\u1ec7nh chuy\u1ec3n h\u00f3a \u0111\u1ed3ng m\u1eafc.
\n\u2013 C\u00e1c s\u1ea3n ph\u1ea9m tho\u00e1i gi\u00e1ng c\u1ee7a Hemoglobin c\u00f3 t\u00ednh sinh \u0111\u1ed9ng kinh.<\/p>\n

2.2. C\u01a1n mu\u1ed9n<\/strong><\/h3>\n

\u2013 B\u1ec7nh sinh kh\u00e1 gi\u1ed1ng v\u1edbi nh\u1eefng c\u01a1n sau ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o.
\n\u2013 T\u1ea1i v\u00f9ng s\u1eb9o c\u1ee7a n\u00e3o: m\u1ea5t c\u00e1c ti\u1ec1n ch\u1ea5t c\u1ee7a h\u1ec7 Gabanergic.
\n\u2013 Bi\u1ebfn \u0111\u1ed5i c\u00e1c recepter Glutaminergic c\u1ee7a m\u00e0ng t\u1ebf b\u00e0o th\u1ea7n kinh.
\n\u2013 S\u1ef1 l\u1eafng \u0111\u1ecdng c\u00e1c hemosiderin.<\/p>\n

3. Di\u0323ch t\u00ea\u0303 ho\u0323c \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 PSE<\/strong><\/h2>\n

Theo Louis v\u00e0 McDowell (1967): PSE chi\u1ebfm 2.7% trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p NMN kh\u00f4ng do thuy\u00ean t\u1eafc.
\nTr\u00ean t\u1ea1p ch\u00ed Oxford Community Stroke Project: PSE chi\u1ebfm 6 % sau 1 n\u0103m v\u00e0 11 % sau 6 n\u0103m (Burn et al.1997).
\nTrong nhi\u1ec1u nghi\u00ean c\u1ee9u d\u1ecbch t\u1ec5 h\u1ecdc, PSE chi\u1ebfm kho\u1ea3ng 2,5% tr\u00ean t\u1ed5ng s\u1ed1 c\u00e1c cas \u0111\u1ed9t qu\u1ef5 n\u00f3i chung, trong \u0111\u00f3 nh\u1ed3i m\u00e1u n\u00e3o c\u00f3 kho\u1ea3ng 1,99% \u2013 2,1% cas m\u1eafc, v\u00e0 \u1edf xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd c\u00f3 kho\u1ea3ng 2,6-4,35%: Bladin (2000), Camilo and Goldstein (2004), Serafini et al (2015)\u2026
\nCon s\u1ed1 th\u1ed1ng k\u00ea lo\u1ea1i c\u01a1n kh\u1edfi ph\u00e1t s\u1edbm hay c\u01a1n c\u00f3 y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t v\u00e0 c\u01a1n mu\u1ed9n t\u1ee9c c\u01a1n kh\u00f4ng y\u1ebfu t\u1ed1 g\u00e2y n\u00ean, r\u1ea5t dao \u0111\u1ed9ng t\u1eeb 2-33% v\u00e0 3-67%.<\/p>\n

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Ph\u00e2n b\u1ed1 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 v\u00e0 t\u1ea7n su\u1ea5t c\u00e1c c\u01a1n tr\u00ean nh\u00f3m b\u1ec7nh nh\u00e2n tr\u00ean 65 tu\u1ed5i: c\u00f3 \u0111\u1ebfn 63% c\u00e1c c\u01a1n \u0111\u1ed9ng kinh \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i (t\u1eeb 65 tr\u1edf l\u00ean) li\u00ean quan \u0111\u1ebfn b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u n\u00e3o.<\/p>\n

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4. Ca\u0301c y\u00ea\u0301u t\u00f4\u0301 nguy c\u01a1 cu\u0309a \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 PSE<\/strong><\/h2>\n

C\u00f3 kh\u00e1 nhi\u1ec1u nghi\u00ean c\u1ee9u v\u1edbi s\u1ed1 l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n t\u01b0\u01a1ng \u0111\u1ed1i l\u1edbn cho th\u1ea5y \u0111\u1ed9 m\u1ea1nh c\u1ee7a m\u1ed1i t\u01b0\u01a1ng quan gi\u1eefa c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 v\u1edbi s\u1ef1 xu\u1ea5t hi\u1ec7n c\u00e1c c\u01a1n \u0111\u1ed9ng kinh li\u00ean quan \u0111\u1ebfn \u0111\u1ed9t qu\u1ef5.
\nFerlazzo et al. (2016): \u0110\u00e1nh gi\u00e1 h\u1ec7 th\u1ed1ng v\u00e0 ph\u00e2n t\u00edch g\u1ed9p c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5: 21 nghi\u00ean c\u1ee9u: 21548 BN \u0111\u1ed9t qu\u1ef5. 1411 b\u1ecb \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5. T\u1ef7 l\u1ec7 hi\u1ec7n m\u1eafc chung: 4.7%.
\nCarolina Ferreira-Atuesta et al. Annals Neurol. 2021. C\u00e1c c\u01a1n \u0111\u1ed9ng kinh sau nh\u1ed3i m\u00e1u n\u00e3o: 1 nghi\u00ean c\u1ee9u \u0111a trung t\u00e2m b\u1eaft c\u1eb7p (4229 BN). \u0110\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 chi\u1ebfm 6%.
\n\u2013 C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ed9c l\u1eadp \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00e1c nghi\u00ean c\u1ee9u ch\u1ec9 r\u00f5, bao g\u1ed3m:
\n+ \u0110\u1ed9 n\u1eb7ng c\u1ee7a \u0111\u1ed9t qu\u1ef5.
\n+ C\u00e1c t\u1ed5n th\u01b0\u01a1ng v\u00f9ng v\u1ecf n\u00e3o.
\n+ \u0110\u1ed9t qu\u1ef5 th\u1ec3 xu\u1ea5t huy\u1ebft n\u00e3o.
\n+ Nh\u1ed3i m\u00e1u n\u00e3o thu\u1ed9c tu\u1ea7n ho\u00e0n tr\u01b0\u1edbc.
\n+ \u0110\u1ed9t qu\u1ef5 \u1edf ng\u01b0\u1eddi tr\u1ebb.
\n+ C\u01a1n s\u1edbm l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a t\u00e1i l\u1eadp c\u00e1c c\u01a1n mu\u1ed9n.
\nTuy nhi\u00ean vai tr\u00f2 c\u1ee7a ti\u00eau s\u1ee3i huy\u1ebft, can thi\u1ec7p n\u1ed9i m\u1ea1ch, v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa c\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn vi\u1ec7c xu\u1ea5t hi\u1ec7n PSE hay kh\u00f4ng c\u00f2n ch\u1edd \u0111\u1ee3i \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u th\u00eam.<\/p>\n

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V\u1ec1 \u0111\u1eb7c \u0111i\u1ec3m h\u00ecnh \u1ea3nh h\u1ecdc s\u1ecd n\u00e3o c\u00f3 m\u1ed1i t\u01b0\u01a1ng quan v\u1edbi vi\u1ec7c xu\u1ea5t hi\u1ec7n PSE \u0111\u01b0\u1ee3c cho th\u1ea5y qua c\u00e1c ph\u00e2n t\u00edch d\u01b0\u1edbi nh\u00f3m c\u1ee7a c\u00e1c nghi\u00ean c\u1ee9u sau:<\/p>\n

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M\u1eb7t kh\u00e1c m\u1ed9t nghi\u00ean \u0111o\u00e0n h\u1ec7 \u0111\u01b0\u1ee3c \u0111\u0103ng tr\u00ean t\u1ea1p ch\u00ed Annals Neurol. 2021 c\u1ee7a Carolina Ferreira-Atuesta v\u00e0 c\u1ed9ng s\u1ef1 tr\u00ean 4229 b\u1ec7nh nh\u00e2n, tu\u1ed5i trung b\u00ecnh l\u00e0 71 v\u1edbi 57% l\u00e0 nam gi\u1edbi, cho th\u1ea5y:
\n\u2013 Nguy c\u01a1 b\u1ecb c\u00e1c c\u01a1n \u0111\u1ed9ng kinh tri\u1ec7u ch\u1ee9ng c\u1ea5p t\u00ednh cao h\u01a1n \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y \u1edf nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3:
\n\u0110\u1ed9t qu\u1ef5 n\u1eb7ng h\u01a1n,
\nNh\u1ed3i m\u00e1u v\u00f9ng ph\u00e2n b\u1ed1 \u0110M n\u00e3o sau,
\n\u0110\u1ed9t qu\u1ef5 do x\u01a1 v\u1eefa m\u1ea1ch m\u00e1u l\u1edbn.
\n\u0110\u1ed9t qu\u1ef5 do t\u1eafc m\u1ea1ch m\u00e1u nh\u1ecf c\u00f3 nguy c\u01a1 th\u1ea5p b\u1ecb c\u00e1c c\u01a1n \u0111\u1ed9ng kinh tri\u1ec7u ch\u1ee9ng c\u1ea5p t\u00ednh.
\nTrong s\u1ed1 BN c\u00f3 c\u01a1n tri\u1ec7u ch\u1ee9ng c\u1ea5p t\u00ednh, c\u00f3 6% sau n\u00e0y ph\u00e1t tri\u1ec3n th\u00e0nh \u0111\u1ed9ng kinh PSE.
\n\u2013 Ng\u01b0\u1ee3c l\u1ea1i, c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a c\u01a1n mu\u1ed9n l\u00e0:
\n\u0110\u00e3 c\u00f3 c\u00e1c c\u01a1n \u0111\u1ed9ng kinh tri\u1ec7u ch\u1ee9ng c\u1ea5p t\u00ednh,
\n\u0110\u1ed9t qu\u1ef5 n\u1eb7ng.
\nNh\u1ed3i m\u00e1u v\u00f9ng v\u1ecf n\u00e3o,
\nNh\u1ed3i m\u00e1u n\u00e3o do x\u01a1 v\u1eefa \u0110M l\u1edbn.
\nNh\u1eefng ph\u00e1t hi\u1ec7n tr\u00ean \u0111i\u1ec7n n\u00e3o \u0111\u1ed3 trong v\u00f2ng 7 ng\u00e0y sau kh\u1edfi ph\u00e1t \u0111\u1ed9t qu\u1ef5 l\u00e0 kh\u00f4ng li\u00ean quan m\u1ed9t c\u00e1ch \u0111\u1ed9c l\u1eadp v\u1edbi y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5. Do \u0111\u00f3 vi\u1ec7c \u0111o \u0111i\u1ec7n n\u00e3o th\u01b0\u1eddng qui hay t\u1ea7m so\u00e1t l\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft.
\nNgo\u00e0i ra, nghi\u00ean c\u1ee9u n\u00e0y c\u0169ng kh\u00f4ng t\u00ecm th\u1ea5y m\u1ed1i li\u00ean quan gi\u1eefa c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u00e1i th\u00f4ng n\u00f3i chung hay ti\u00eau s\u1ee3i huy\u1ebft t\u0129nh m\u1ea1ch hay l\u1ea5y huy\u1ebft kh\u1ed1i d\u1ee5ng c\u1ee5 v\u1edbi th\u1eddi \u0111i\u1ec3m b\u1ecb \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 hay v\u1edbi nguy c\u01a1 b\u1ecb c\u00e1c c\u01a1n \u0111\u1ed9ng kinh tri\u1ec7u ch\u1ee9ng c\u1ea5p t\u00ednh.<\/p>\n

5. Bi\u00ea\u0309u hi\u00ea\u0323n \u0111\u0103\u0323c tr\u01b0ng tr\u00ean l\u00e2m sa\u0300ng va\u0300 \u0111i\u00ea\u0323n na\u0303o cu\u0309a \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 PSE<\/strong><\/h2>\n

C\u00e1c lo\u1ea1i c\u01a1n PSE th\u01b0\u1eddng kh\u00e1 \u0111a d\u1ea1ng, \u0111\u1eb7c bi\u1ec7t c\u00e1c c\u01a1n th\u00f9y \u0111\u1ec9nh th\u01b0\u1eddng c\u00f3 \u00edt bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng (Pauci-symptomatic).<\/p>\n

5.1. C\u00e1c c\u01a1n \u0111\u1ed9ng kinh x\u1ea3y ra tr\u01b0\u1edbc \u0111\u1ed9t qu\u1ef5 (Pre-cursive seizures)<\/h3>\n

L\u00e0 c\u00e1c c\u01a1n x\u1ea3y ra ngay tr\u01b0\u1edbc th\u1eddi \u0111i\u1ec3m \u0111\u1ed9t qu\u1ef5. Theo m\u1ed9t nghi\u00ean c\u1ee9u \u1edf Th\u1ee5y \u0110i\u1ec3n (Zelano v\u00e0 c\u1ed9ng s\u1ef1, 2017), c\u00f3 1,48% c\u00e1c BN trong s\u1ed1 n\u00e0y \u0111\u00e3 t\u1eebng c\u00f3 b\u1ec7nh \u0111\u1ed9ng kinh hay \u0111\u00e3 t\u1eebng b\u1ecb 1 c\u01a1n co gi\u1eadt ki\u1ec3u \u0111\u1ed9ng kinh trong v\u00f2ng 10 n\u0103m v\u1ec1 tr\u01b0\u1edbc. C\u1ea7n ph\u1ea3i ch\u00fa \u00fd r\u1eb1ng 5-20% c\u00e1c BN h\u01a1n 60 tu\u1ed5i, \u0111\u1ed9t ng\u1ed9t c\u00f3 c\u01a1n co gi\u1eadt ki\u1ec3u \u0111\u1ed9ng kinh c\u00f3 th\u1ec3 l\u00e0 \u0111i\u1ec1m b\u00e1o tr\u01b0\u1edbc c\u1ee7a c\u01a1n \u0111\u1ed9t qu\u1ef5 c\u1ea5p ngay sau \u0111\u00f3. \u1ede c\u00e1c b\u1ec7nh nh\u00e2n tr\u1ebb h\u01a1n, nh\u1ea5t l\u00e0 b\u1ec7nh nh\u00e2n n\u1eef \u0111ang u\u1ed1ng thu\u1ed1c ng\u1eeba thai, c\u01a1n \u0111\u1ed9ng kinh x\u1ea3y ra tr\u01b0\u1edbc tri\u1ec7u ch\u1ee9ng \u0111\u1ed9t qu\u1ef5 n\u00ean \u0111\u01b0\u1ee3c ngh\u0129 \u0111\u1ebfn m\u1ed9t tr\u01b0\u1eddng h\u1ee3p huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch n\u1ed9i s\u1ecd.<\/p>\n

5.2. Tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh<\/h3>\n

Chi\u1ebfm 1% trong s\u1ed1 t\u1ea5t c\u1ea3 c\u00e1c BN b\u1ecb b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u n\u00e3o. Tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh chi\u1ebfm 5-19% c\u00e1c c\u01a1n \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 v\u00e0 th\u01b0\u1eddng n\u1eb1m trong nh\u00f3m c\u01a1n s\u1edbm (c\u01a1n c\u00f3 y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t). Tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh trong \u0111\u1ed9t qu\u1ef5 c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n co gi\u1eadt, ch\u1ec9 l\u00e0 tr\u1ea1ng th\u00e1i l\u00fa l\u1eabn n\u00ean d\u1ec5 b\u1ecb b\u1ecf s\u00f3t. T\u1ef7 l\u1ec7 t\u1eed vong c\u1ee7a BN b\u1ecb tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh kh\u00f4ng co gi\u1eadt sau \u0111\u1ed9t qu\u1ef5 chi\u1ebfm 30-53%. V\u1ea5n \u0111\u1ec1 n\u00e0y n\u00f3i l\u00ean vai tr\u00f2 quan tr\u1ecdng c\u1ee7a m\u00e1y \u0111i\u1ec7n n\u00e3o di \u0111\u1ed9ng cho ICU v\u00e0 n\u1ebfu ngh\u0129 \u0111\u1ebfn t\u00ecnh tr\u1ea1ng r\u1ed1i lo\u1ea1n tri gi\u00e1c l\u00e0 do tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh sau khi \u0111\u00e3 lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c th\u00ec test Diazepam s\u1ebd gi\u00fap \u00edch cho ch\u1ea9n \u0111o\u00e1n.
\nTheo Rumbach v\u00e0 c\u1ed9ng s\u1ef1 n\u0103m 2000, trong 3205 BN b\u1ecb \u0111\u1ed9t qu\u1ef5 l\u1ea7n \u0111\u1ea7u, c\u00f3 159 BN b\u1ecb c\u00e1c c\u01a1n \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5, tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf 31 BN (19%), c\u00f3 17 BN xu\u1ea5t hi\u1ec7n tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh nh\u01b0 l\u00e0 tri\u1ec7u ch\u1ee9ng kh\u1edfi \u0111\u1ea7u sau \u0111\u00f3 m\u1edbi ph\u00e1t hi\u1ec7n c\u00f3 \u0111\u1ed9t qu\u1ef5 v\u00e0 c\u00f3 4 BN kh\u00e1c th\u00ec khi \u0111\u1ed9t qu\u1ef5 b\u1eaft \u0111\u1ea7u c\u0169ng c\u00f9ng l\u00fac c\u00f3 tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh.
\n\u1ede c\u00e1c BN c\u00f2n l\u1ea1i, tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh xu\u1ea5t hi\u1ec7n sau 1 hay nhi\u1ec1u c\u01a1n \u0111\u1ed9ng kinh \u0111i tr\u01b0\u1edbc. Trong nghi\u00ean c\u1ee9u c\u00f3 15 BN t\u1eed vong, trong \u0111\u00f3 t\u1eed vong li\u00ean quan tr\u1ef1c ti\u1ebfp \u0111\u1ebfn tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh x\u1ea3y ra \u1edf 5 BN.
\nM\u1eb7c d\u00f9 ti\u00ean l\u01b0\u1ee3ng t\u1ee9c th\u1eddi c\u1ee7a c\u00e1c BN b\u1ecb tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh th\u00ec k\u00e9m, nh\u01b0ng tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh trong PSE ch\u1ec9 l\u00e0 d\u1ea5u hi\u1ec7u tri\u1ec7u ch\u1ee9ng c\u1ea5p t\u00ednh ch\u1ee9 kh\u00f4ng ph\u1ea3i l\u00e0 y\u1ebfu t\u1ed1 c\u1ea7n thi\u1ebft d\u1ef1 \u0111o\u00e1n cho \u0111\u1ed9ng kinh sau n\u00e0y.<\/p>\n

5.3. T\u00ecnh tr\u1ea1ng l\u00fa l\u1eabn k\u00e8m c\u00e1c ho\u1ea1t \u0111\u1ed9ng k\u1ecbch ph\u00e1t m\u1ed9t b\u00ean b\u00e1n c\u1ea7u ki\u1ec3u \u0111\u1ed9ng kinh tr\u00ean \u0111i\u1ec7n n\u00e3o \u0111\u1ed3 (\u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 Periodic lateralized epileptiform discharges phus: PLEDs +)<\/h3>\n

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

V\u1edbi thu\u1eadt ng\u1eef m\u1edbi PLEDs c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 LPDs (Lareralized Periodic Discharges)
\nCas l\u00e2m s\u00e0ng minh h\u1ecda:
\nBN n\u1eef 62 tu\u1ed5i, nghi\u1ec7n r\u01b0\u1ee3u. \u0110\u1ed9t ng\u1ed9t c\u00f3 v\u00e0i c\u01a1n \u0111\u1ed9ng kinh co c\u1ee9ng \u2013 co gi\u1eadt to\u00e0n th\u1ec3 x\u1ea3y ra trong b\u1ed1i c\u1ea3nh cai r\u01b0\u1ee3u. Nh\u1eadp vi\u1ec7n v\u00ec m\u1ea5t ng\u00f4n ng\u1eef \u201cjargon\u201d. Kh\u00e1m c\u00f3 b\u00e1n manh \u0111\u1ed3ng danh ph\u1ea3i. H\u00ecnh \u1ea3nh h\u1ecdc cho th\u1ea5y<\/p>\n

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

\u0110i\u1ec7n n\u00e3o \u0111\u1ed3 c\u1ee7a b\u1ec7nh nh\u00e2n nh\u01b0 sau:<\/p>\n

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

5.4. C\u00e1c c\u01a1n \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 v\u1eadn \u0111\u1ed9ng \u1ee9c ch\u1ebf: <\/strong><\/h3>\n

Tri\u1ec7u ch\u1ee9ng m\u1ea5t v\u1eadn \u0111\u1ed9ng (tri\u1ec7u ch\u1ee9ng \u00e2m t\u00ednh) r\u1ea5t d\u1ec5 nh\u1ea7m l\u1eabn v\u1edbi c\u01a1n TIA. \u0110\u00f4i khi ph\u1ea3i ph\u00e2n bi\u1ec7t nh\u1edd v\u00e0o \u0111i\u1ec7n n\u00e3o \u0111\u1ed3. C\u00f3 c\u00e1c ki\u1ec3u bi\u1ec3u hi\u1ec7n sau:
\n\u2013 Khi\u1ebfm khuy\u1ebft v\u1eadn \u0111\u1ed9ng c\u1ee5c b\u1ed9 \u0111\u01a1n \u0111\u1ed9c l\u1eb7p \u0111i l\u1eb7p l\u1ea1i v\u00e0 c\u00f3 t\u00ednh \u0111\u1ecbnh h\u00ecnh.
\n\u2013 Khi\u1ebfm khuy\u1ebft v\u1eadn \u0111\u1ed9ng c\u1ee5c b\u1ed9 \u0111\u01a1n \u0111\u1ed9c \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y tr\u01b0\u1edbc khi c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n co gi\u1eadt.
\n\u2013 Khi\u1ebfm khuy\u1ebft v\u1eadn \u0111\u1ed9ng c\u1ee5c b\u1ed9 k\u00e8m bi\u1ec3u hi\u1ec7n co gi\u1eadt \u1edf \u0111\u1ed1i b\u00ean
\nC\u00e1c khi\u1ebfm khuy\u1ebft v\u1eadn \u0111\u1ed9ng \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y lu\u00f4n lu\u00f4n k\u00e8m v\u1edbi c\u00e1c ph\u00f3ng l\u1ef1c tr\u00ean EEG.
\n\u0110\u1ed9ng kinh ki\u1ec3u n\u00e0y \u00e1p \u1ee9ng t\u1ed1t v\u1edbi c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh h\u1ecd Benzodiazepin.
\nN\u1ebfu th\u1eddi gian c\u1ee7a c\u01a1n d\u00e0i t\u1eeb 2-30\u2019 l\u00e0 \u0111\u01b0\u1ee3c xem nh\u01b0 tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh (Smith et al.).
\nLo\u1ea1i \u0111\u1ed9ng kinh ki\u1ec3u n\u00e0y th\u01b0\u1eddng do c\u00e1c nguy\u00ean nh\u00e2n: U v\u00e0 \u0111\u1ed9t qu\u1ef5, x\u01a1 h\u1ea3i m\u00e3 (23%), c\u0103n nguy\u00ean \u1ea9n (14%, tr\u1ebb em).
\nC\u00e1c c\u01a1n \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 v\u1eadn \u0111\u1ed9ng \u1ee9c ch\u1ebf \u0111\u01b0\u1ee3c ngh\u0129 \u0111\u1ebfn khi kh\u00f4ng c\u00f3 b\u1ea5t th\u01b0\u1eddng th\u1ea7n kinh kh\u00e1c ho\u1eb7c b\u1ed1i c\u1ea3nh l\u00e2m s\u00e0ng kh\u00e1c c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch cho khi\u1ebfm khuy\u1ebft v\u1eadn \u0111\u1ed9ng n\u00e0y.
\nC\u1ea7n ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi: li\u1ec7t Todd, TIA, nh\u1eefng b\u1ec7nh l\u00fd t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh kh\u00e1c ho\u1eb7c c\u01a1n t\u00e2m th\u1ea7n.
\n\u0110\u00e2y l\u00e0 \u0111i\u1ec7n n\u00e3o c\u1ee7a 1 b\u1ec7nh nh\u00e2n c\u00f3 c\u01a1n \u1ee9c ch\u1ebf v\u1eadn \u0111\u1ed9ng sau \u0111\u1ed9t qu\u1ef5<\/em><\/p>\n

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

V\u00e0 h\u00ecnh \u1ea3nh h\u1ecdc c\u1ee7a c\u00f9ng b\u1ec7nh nh\u00e2n \u0111\u00f3:<\/p>\n

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

5.5. C\u01a1n \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 v\u1eadn \u0111\u1ed9ng k\u00e9o d\u00e0i do t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft kh\u00f4ng nhi\u1ec5m ceton.<\/strong><\/h3>\n

Theo b\u00e1o c\u00e1o c\u1ee7a Maccario et al n\u0103m 1965 c\u00f3 7 cases. Harden v\u00e0 c\u1ed9ng s\u1ef1 (1991), Moien-Afshari (2005) c\u0169ng m\u00f4 t\u1ea3 c\u00e1c c\u01a1n \u0111\u1ed9ng kinh thu\u1ef3 ch\u1ea9m \u1edf BN t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft kh\u00f4ng nhi\u1ec5m ceton. Hennis v\u00e0 c\u1ed9ng s\u1ef1 (1991) v\u00e0 Lammouchi (2004) th\u00ec cho r\u1eb1ng \u0111\u00f4i khi ph\u00e1t hi\u1ec7n c\u01a1n ki\u1ec3u n\u00e0y l\u00e0 g\u1ee3i \u00fd c\u00f3 t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng m\u1edbi m\u1eafc ho\u1eb7c kh\u00f4ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb.
\nC\u00e1c c\u01a1n co gi\u1eadt do t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n kh\u00e1c nhau nh\u01b0:
\n\u2013 C\u00e1c c\u01a1n \u0111\u1ed9ng kinh v\u1eadn \u0111\u1ed9ng: Chi\u1ebfm t\u1ef7 l\u1ec7 75-86%, th\u01b0\u1eddng l\u00e0 c\u1ee5c b\u1ed9, hi\u1ebfm khi l\u00e0 c\u00e1c c\u01a1n \u0111\u1ed9ng kinh co c\u1ee9ng co gi\u1eadt to\u00e0n th\u1ec3.
\n\u2013 Tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 v\u1eadn \u0111\u1ed9ng.
\n\u2013 C\u01a1n ng\u01b0ng n\u00f3i.
\n\u2013 C\u01a1n b\u00e1n manh \u0111\u1ed3ng danh.
\n\u2013 C\u01a1n \u1ea3o gi\u00e1c th\u1ecb gi\u00e1c (7%) hay m\u00f9 v\u1ecf n\u00e3o.
\n\u2013 C\u01a1n \u0111\u1ed9ng kinh xoay ng\u01b0\u1eddi l\u1eb7p l\u1ea1i: BN xoay tr\u00f2n nh\u01b0 \u0111\u00e8n c\u00f9 trong c\u01a1n.
\nC\u00e1c c\u01a1n \u0111\u1ed9ng kinh xoay tr\u00f2n l\u1eb7p \u0111i l\u1eb7p l\u1ea1i c\u1ea5p t\u00ednh l\u00e0 1 bi\u1ec3u hi\u1ec7n kh\u00e1 \u0111\u1eb7c tr\u01b0ng c\u1ee7a t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft kh\u00f4ng nhi\u1ec5m ceton (Taieb-Dogui T, Harzallah MS, Khlifa K, Dogui M, Ben Ammou S, Jallon P. Neurophysiol Clin. 2002;32:254-7)
\n\u2013 M\u00faa gi\u1eadt hay m\u00faa vung n\u1eeda ng\u01b0\u1eddi hay th\u1eadm ch\u00ed l\u00e0 hi\u1ebfm g\u1eb7p c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n t\u00ecnh tr\u1ea1ng m\u00faa vung c\u1ea3 2 b\u00ean.
\nC\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ea5p t\u00ednh th\u01b0\u1eddng nh\u1ea5t l\u00e0 x\u1ea3y ra t\u1ef1 ph\u00e1t nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c k\u00edch g\u1ee3i b\u1eb1ng s\u1ef1 di chuy\u1ec3n, nhi\u1ec5m tr\u00f9ng hay kh\u00e1c y\u1ebfu t\u1ed1 l\u00e0m x\u00e1o tr\u1ed9n t\u00ecnh tr\u1ea1ng \u0111ang \u1ed5n \u0111\u1ecbnh c\u1ee7a b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/p>\n

5.6. C\u01a1n \u0111\u1ed9ng kinh trong huy\u1ebft kh\u1ed1i TM n\u00e3o (CVST)<\/strong><\/h3>\n

* Hay l\u00e0 c\u00e1c c\u01a1n s\u1edbm (Precot) chi\u1ebfm t\u1edbi 39.3%, l\u00e0 c\u00e1c c\u01a1n \u0111\u1ed9ng kinh x\u1ea3y ra tr\u01b0\u1edbc c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c c\u1ee7a CVST
\nC\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ed9c l\u1eadp c\u1ee7a c\u01a1n bao g\u1ed3m:
\n\u2013 T\u1ed5n th\u01b0\u01a1ng tr\u00ean l\u1ec1u, huy\u1ebft kh\u1ed1i TM v\u1ecf n\u00e3o.
\n\u2013 Huy\u1ebft kh\u1ed1i xoang d\u1ecdc tr\u00ean.
\n\u2013 Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch n\u00e3o h\u1eadu s\u1ea3n.
\n* C\u00e1c c\u01a1n \u0111\u1ed9ng kinh x\u1ea3y ra trong v\u00f2ng 2 tu\u1ea7n c\u1ee7a CVST chi\u1ebfm 6.9%, v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 sau:
\n\u2013 T\u1ed5n th\u01b0\u01a1ng tr\u00ean l\u1ec1u v\u00e0 \u0111\u00e3 c\u00f3 c\u00e1c c\u01a1n \u0111\u1ed9ng kinh trong ti\u1ec1n s\u1eed.
\n\u2013 C\u00e1c BN b\u1ecb t\u1ed5n th\u01b0\u01a1ng tr\u00ean l\u1ec1u v\u00e0 \u0111\u00e3 c\u00f3 c\u01a1n s\u1edbm. Tr\u01b0\u1eddng h\u1ee3p n\u00e0y c\u01a1n \u0111\u1ed9ng kinh s\u1ebd gi\u1ea3m \u0111\u00e1ng k\u1ec3 khi d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh d\u1ef1 ph\u00f2ng.<\/p>\n

6. \u0110i\u00ea\u0300u tri\u0323 \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 PSE<\/strong><\/h2>\n

Nguy c\u01a1 c\u1ee7a c\u00e1c c\u01a1n \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 t\u01b0\u01a1ng \u0111\u1ed1i th\u1ea5p, d\u1ef1 ph\u00f2ng nguy\u00ean ph\u00e1t khi ch\u01b0a c\u00f3 c\u01a1n kh\u00f4ng \u0111\u01b0\u1ee3c coi l\u00e0 th\u00edch h\u1ee3p ngo\u00e0i tr\u1eeb tr\u01b0\u1eddng h\u1ee3p c\u00f3 xu\u1ea5t huy\u1ebft n\u00e3o th\u00f9y l\u1edbn.
\nC\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i: Gabapentin, Lamotrigine hay Levetiracetam, trong \u0111\u00f3 Levetiracetam c\u00f3 khuynh h\u01b0\u1edbng \u0111\u01b0\u1ee3c ch\u1ecdn l\u1ef1a nhi\u1ec1u h\u01a1n. B\u00ean c\u1ea1nh \u0111\u00f3 n\u00ean tr\u00e1nh d\u00f9ng Carbamazepine v\u00e0 nh\u1ea5t l\u00e0 Oxcarbamazepine.<\/p>\n

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

\u0110i\u1ec1u tr\u1ecb tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh theo ph\u00e1c \u0111\u1ed3 c\u1ee7a tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh. \u0110\u1ed1i v\u1edbi tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh trong c\u00e1c t\u00ecnh hu\u1ed1ng r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a v\u00e0 c\u00e1c c\u01a1n co gi\u1eadt c\u1ea5p t\u00ednh c\u00f3 y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t kh\u00f4ng c\u1ea7n thi\u1ebft ph\u1ea3i duy tr\u00ec thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh l\u00e2u d\u00e0i.
\nT\u00d3M L\u1ea0I: C\u00e1c c\u01a1n \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 (PSE) chi\u1ebfm t\u1ea7n su\u1ea5t t\u1eeb 2-6%. Ph\u1ea7n l\u1edbn c\u00e1c c\u01a1n x\u1ea3y ra trong v\u00f2ng 24h \u0111\u1ea7u c\u1ee7a \u0111\u1ed9t qu\u1ef5 v\u00e0 \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 c\u01a1n tri\u1ec7u ch\u1ee9ng c\u1ea5p t\u00ednh, v\u00e0 tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh c\u0169ng l\u00e0 bi\u1ec3u hi\u1ec7n th\u01b0\u1eddng g\u1eb7p. PSE gi\u1ea3i th\u00edch s\u1ef1 gia t\u0103ng t\u1ea7n su\u1ea5t \u0111\u1ed9ng kinh \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i. Tri\u1ec7u ch\u1ee9ng c\u1ee7a PSE r\u1ea5t \u0111a d\u1ea1ng v\u00e0 \u0111\u00f4i khi kh\u00f3 nh\u1eadn bi\u1ebft tr\u00ean l\u00e2m s\u00e0ng, \u0111i\u1ec7n n\u00e3o \u0111\u1ed3 n\u1ebfu \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u00fang th\u1eddi \u0111i\u1ec3m v\u00e0 k\u0129 thu\u1eadt \u0111o t\u1ed1t s\u1ebd gi\u00fap \u00edch nhi\u1ec1u cho ch\u1ea9n \u0111o\u00e1n. Trong nh\u00f3m c\u01a1n s\u1edbm c\u1ea7n ch\u00fa \u00fd c\u00e1c c\u01a1n c\u00f3 th\u1ec3 \u0111\u1ebfn tr\u01b0\u1edbc th\u1eddi \u0111i\u1ec3m \u0111\u1ed9t qu\u1ef5 v\u00e0 c\u00f3 th\u1ec3 c\u1ea3nh b\u00e1o tr\u01b0\u1eddng h\u1ee3p huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch v\u1ecf n\u00e3o. C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a PSE \u0111\u00e3 \u0111\u01b0\u1ee3c bi\u1ebft r\u00f5 g\u1ed3m: \u0110\u1ed9t qu\u1ef5 ng\u01b0\u1eddi tr\u1ebb, xu\u1ea5t huy\u1ebft n\u00e3o th\u00f9y l\u1edbn, t\u1ed5n th\u01b0\u01a1ng r\u1ed9ng v\u00f9ng v\u1ecf, v\u00e0 s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a c\u01a1n s\u1edbm l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a c\u01a1n mu\u1ed9n. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb PSE c\u00f3 \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi c\u00e1c thu\u1ed1c \u0111\u1ed9ng kinh th\u1ebf h\u1ec7 m\u1edbi v\u00e0 \u00edt t\u00e1c d\u1ee5ng ph\u1ee5. Ch\u01b0a c\u00f3 t\u00e0i li\u1ec7u n\u00e0o ch\u1ee9ng minh \u0111\u01b0\u1ee3c s\u1ef1 c\u1ea7n thi\u1ebft ph\u1ea3i cho thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh ph\u00f2ng ng\u1eeba khi \u0111\u1ed9t qu\u1ef5.<\/p>\n

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

1. Anna Serafini 1, Gian Luigi Gigli, Giorgia Gregoraci, Francesco Janes, Iacopo Cancelli, Stefano Novello, Mariarosaria Valente. Are Early Seizures Predictive of Epilepsy after a Stroke? Results of a Population-Based Study. Neuroepidemiology. 2015;45(1):50-8.
\n2. Camilo O, Goldstein LB. Seizures and epilepsy after ischemic stroke. Stroke. 2004 Jul;35(7):1769-75.
\n3. Carolina Ferreira-Atuesta et al. Seizures after Ischemic Stroke: A Matched Multicenter Study. Annals Neurol. 2021
\n4. Ferreira-Atuesta C, D\u00f6hler N, Erd\u00e9lyi-Canavese B, Felbecker A, Seizures after Ischemic Stroke: A Matched Multicenter Study. Ann Neurol. 2021 Nov;90(5):808-820.
\n5. Ferlazzo E, Gasparini S, Beghi E, Sueri C, Russo E, Leo A, Labate A, Gambardella A, Belcastro V, Striano P, Paciaroni M, Pisani LR, Aguglia U; Epilepsy Study Group of the Italian Neurological Society.Epilepsy in cerebrovascular diseases: Review of experimental and clinical data with meta-analysis of risk factors. Epilepsia. 2016 Aug;57(8):1205-14.
\n6. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, Engel J Jr, Forsgren L, French JA, Glynn M, Hesdorffer DC, Lee BI, Mathern GW, Mosh\u00e9 SL, Perucca E, Scheffer IE, Tomson T, Watanabe M, Wiebe S. ILAE official report: a practical clinical definition of epilepsy. .Epilepsia2014 Apr;55(4):475-82.
\n7. Hennis A, Corbin D, Fraser H.J, Focal seizures and non-ketotic\u2002hyperglycaemia. Neurol Neurosurg Psychiatry. 1992 Mar;55(3):195-7
\n8. Lammouchi T, Zoghlami F, Ben Slamia L, Grira M, Harzallah MS, Benammou S. Epileptic seizures in non-ketotic hyperglycemia. Neurophysiol Clin. 2004 Oct;34(3-4):183-7.
\n9. Louis S, McDowell F. Epileptic seizures in non-embolic cerebral infarction. Am Neurol Assoc, 1967;92:260-1.
\n10. Maccario M, Messis CP, Vastola EF. Focal seizure as a manifestation of hyperglycemia without ketoacidosis. A report of seven cases with review of the literature. Neurology. 1965 mar;15:195-206.
\n11. Harden CL, Rosenbaum DH, Daras M. Hyperglycemia presenting with occipital seizures. Epilepsia. 1991 Mar-Apr;32(2):215-20
\n12. Moien-Afshari F, T\u00e9llez-Zenteno JF. Occipital seizures induced by hyperglycemia: a case report and review of literature. Seizure. 2009 Jun;18(5):382-5.
\n13. Rumbach L, Berges S, Moulin T, Berger E, Tatu L, Sablot D, Challier B. Seizures and epilepsy following strokes: recurrence factors. Eur Neurol. 2000;43(1):3-8.
\n14. Taieb-Dogui T, Harzallah MS, Khlifa K, Dogui M, Ben Ammou S, Jallon P. Acute repetitive giratory seizures as a manifestation of nonketotic hyperglycemia. Neurophysiol Clin. 2002 Sep;32(4):254-7
\n15. Tanaka T, Ihara M. Post-stroke epilepsy. Neurochem Int. 2017 Jul;107:219-228.
\n16. Zelano J, Larsson D, Kumlien E, \u00c5sberg S. Pre-stroke seizures: A nationwide register-based investigation. Seizure. 2017 Jul;49:25-29.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u0110\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 (Post-stroke epilepsies – PSE) l\u00e0 m\u1ed9t lo\u1ea1i \u0111\u1ed9ng kinh ph\u1ee9c t\u1ea1p x\u1ea3y ra sau khi b\u1ec7nh nh\u00e2n tr\u1ea3i qua \u0111\u1ed9t qu\u1ef5. S\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a PSE ph\u1ee5 thu\u1ed9c v\u00e0o nhi\u1ec1u y\u1ebfu t\u1ed1, bao g\u1ed3m v\u1ecb tr\u00ed v\u00e0 k\u00edch th\u01b0\u1edbc c\u1ee7a t\u1ed5n th\u01b0\u01a1ng do \u0111\u1ed9t qu\u1ef5 g\u00e2y ra, ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u […]<\/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":"\nC\u00e1c c\u01a1n \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 (Post -stroke epilepsies: PSE)<\/title>\n<meta name=\"description\" content=\"\u0110\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 (Post-stroke epilepsies - PSE) l\u00e0 m\u1ed9t lo\u1ea1i \u0111\u1ed9ng kinh ph\u1ee9c t\u1ea1p x\u1ea3y ra sau khi b\u1ec7nh nh\u00e2n tr\u1ea3i qua \u0111\u1ed9t qu\u1ef5.\" \/>\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=\"C\u00e1c c\u01a1n \u0111\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 (Post -stroke epilepsies: PSE)\" \/>\n<meta property=\"og:description\" content=\"\u0110\u1ed9ng kinh sau \u0111\u1ed9t qu\u1ef5 (Post-stroke epilepsies - 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