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Ho Huu That, MD Pham Ngoc Thach University of Medicine 5/4/2019  Co giật – Convulsion  Cơn động kinh – Seizure  Động kinh – Epilepsy  Convulsive/Non convulsive Seizure Convulsive/Non  Epileptic/Non epileptic Seizure Epileptic/Non 5/4/2019 5/4/2019 ILAE - 2014  Có phải động kinh (seizure) hay không? không ? Phân loại động kinh  Nguyên nhân seizure?  Epilepsy (unprovoked seizure) Non Epilepsy  Non  (provoked seizure) Nguyên nhân epilepsy? (Các hội chứng động kinh kinh:: epileptic syndromes) 5/4/2019 ILAE - 2016 5/4/2019 ĐK toàn thể ĐK cục Vơ (Idiopathic) •Childhood Absence Epilepsy (CAE) •Juvenile Absence Epilepsy (JAE) •Juvenile Myoclonic Epilepsy (JME) •Epilepsy with GTCS alone (EGTCS) Panayitopoulos Syndrome Khơng vơ (Nonidiopathic) •Lennox Gastaut Syndrome •West Syndrome •Dravet Syndrome… Symtomatic epilepsy: •Brain tumor •Poststroke •Post Head Trauma 5/4/2019 5/4/2019 5/4/2019 5/4/2019 10  Hạn chế phóng điện neuron cách ức chế kênh Na+ 5/4/2019 Pharmacotherapy of the epilepsies - Goodman & Gilman's The pharmacological Basis of Therapeutics 2011 11  Gia tăng ức chế qua synapse chất dẫn truyền thần kinh GABA GABA 5/4/2019 Pharmacotherapy of the epilepsies - Goodman & Gilman's The pharmacological Basis of Therapeutics 2011 12 Ức  chế Ca2+ kênh hoạt hóa điện (voltage-(voltage activated Ca2+ channels) channels) 5/4/2019 Pharmacotherapy of the epilepsies - Goodman & Gilman's The pharmacological Basis of Therapeutics 2011 13 Mechnism Na+ channel modulators Drugs PHT, CBZ, OxCBZ, LTG, TPM, VPA GABAA receptor BZDs, PB, TPM, CBZ, allosteric OxCBZ modulators Ca2+ channel blockers 5/4/2019 ESM, VPA, LTG Consequences of action block action potential propagation stabilize neuronal membranes  neurotransmitter release, focal firing, and seizure spread  membrane hyperpolarization and seizure threshold  focal firing  neurotransmitter release  slow-depolarization and spike-wave discharges Pharmacotherapy of the epilepsies - Goodman & Gilman's The pharmacological Basis of Therapeutics 2011 14 5/4/2019 15 5/4/2019 16 5/4/2019 17 5/4/2019 18 5/4/2019 19 5/4/2019 20 5/4/2019 21 Goodman & Gilman's The pharmacological Basis of Therapeutics 2011 Novel oral anticoagulant management issues for the stroke clinician International Journal of Stroke 2016 ILAE Treatment Guidelines – Epilepsia 2006 Incidence and associations of poststroke epilepsy – the prospective south London stroke register In stroke 2013 Adams and Victor’s Principles of Neurology (2014 2014)) Cerebrovascular diseases, 10th edition, McGraw McGraw Hill, New York York 5/4/2019 Clinical Neuroanatomy 27th edition, McGraw McGraw Hill, New York, 2013 2013 22