Yav dhau los, qaug dab peg hu ua kab mob los yog mob vwm, thiab cov neeg uas muaj nws tau raug thuam, uas yog, lawv tau raug kev puas siab puas ntsws hauv zej zog, thiab feem ntau tsis zoo. Txawm tias nyob hauv peb lub hnub nyoog, hauv qee lub tebchaws, cov tib neeg uas kuaj pom tias muaj kab mob vwm lossis mob vwm tsis raug tso cai ua haujlwm hauv ntau txoj haujlwm, tsav tsheb, thiab koom nrog qee yam kev lom zem, xws li dhia dej.
Muaj ib qho kev xav ntawm cov neeg tias qhov mob qaug dab peg yuav tsum zoo li qhov no: tus neeg mob poob rau hauv av, pib convulse, npuas tshwm los ntawm nws lub qhov ncauj. Yog hais tias ib tug neeg tau npog nrog ib daim ntaub tsaus rau lub sijhawm no, qhov kev tawm tsam dhau mus, thiab tus neeg mob pw tsaug zog. Qhov tseeb, qaug dab peg tuaj yeem tshwm sim nws tus kheej hauv ntau txoj kev, thiab nws raug kho hauv cov chaw kho mob tshwj xeeb. Ib qho zoo tshaj plaws nyob rau hauv Russia yog lub tsev kho mob Bekhterev, uas siv cov txheej txheem niaj hnub ntawm kev kuaj mob thiab kev kho mob. Hais txog focal epilepsy nyob rau hauv cov neeg mob thiab lawv cov txheeb ze, muaj ntau ntauCov lus nug: nws tuaj qhov twg, nws tau txais txiaj ntsig, puas yog kis tau, vim li cas cov me nyuam yaus raug kev txom nyem los ntawm qaug dab peg, puas tuaj yeem kho tau tag nrho, nws yog dab tsi, nws yuav ua li cas rau lub neej thiab ntau yam ntxiv. Hauv tsab xov xwm no peb yuav sim muab cov ncauj lus kom ntxaws txog tus kab mob no.
Epilepsy is…
Pib nrog, cia peb piav qhia seb hom mob no yog dab tsi - focal epilepsy. Nyob rau hauv tib neeg lub paj hlwb muaj microscopically me me structural thiab functional formations hu ua neurons. Lawv cov qauv tshwj xeeb tso cai rau lawv khaws thiab xa cov ntaub ntawv los ntawm lwm cov chav nyob, nrog rau cov leeg thiab cov qog. Qhov tseeb, ib qho kev tshwm sim ntawm lub cev yog txiav txim los ntawm tus cwj pwm ntawm cov khoom me me no. Muaj ntau tshaj 65 billion ntawm lawv nyob rau hauv tib neeg lub hlwb. Muaj ntau ntawm lawv intertwined nrog ib leeg thiab tsim lub thiaj li hu ua neural network. Figuratively, lawv tuaj yeem sawv cev ua ib hom kev sib koom tes zoo uas nyob raws li nws txoj cai. Epileptic qaug dab peg tshwm sim thaum tam sim (paroxysmal) hluav taws xob tawm hauv cov neurons, cuam tshuam lawv txoj haujlwm. Qhov no tuaj yeem tshwm sim hauv ntau yam kab mob, feem ntau cuam tshuam nrog neuroses ntawm ntau yam etiologies. Muaj focal epilepsy thiab generalized. Lo lus "focal" los ntawm Latin "focus". Epilepsy yog suav hais tias yog focal thaum lub excitation ntawm neurons yog teem rau hauv ib qho chaw (focus) los yog, hais lus yooj yim, muaj qhov txhab nyob rau hauv ib qho chaw ntawm lub hlwb. Epilepsy raug suav hais tias yog generalized (general) thaum qhov mob tshwm sim tam sim ntawdob lub hemispheres ntawm lub hlwb, lossis, tau tshwm sim hauv ib qho chaw, kis mus rau tag nrho lub hlwb.
Kev faib tawm
Hauv xyoo 1989, qhov kev faib tawm yav dhau los ntawm focal epilepsy thiab nws cov tsos mob tau hloov kho. Tam sim no, nyob rau hauv lub moj khaum ntawm no pathology, cov tsos mob nram qab no txawv:
1. Idiopathic.
2. Symptomatic.
3. Cryptogenic.
Nyob rau hauv daim ntawv dav dav, cov tsos mob ntawm idiopathic thiab cov tsos mob qaug dab peg yog qhov txawv.
Tseem muaj ntau yam xwm txheej uas muaj ob qho tib si focal thiab generalized nta.
Idiopathic focal epilepsy
Hom kab mob no txhim kho thaum cov neurons ntawm lub hlwb pib ua haujlwm ntau dua li qhov tsim nyog. Nyob rau hauv cov ntaub ntawv no, ib tug thiaj li hu ua epileptic tsom xam yog tsim, nyob rau hauv uas cov hluav taws xob tawm ntau dhau yog generated, tab sis tus neeg mob tsis muaj structural hlwb txhab. Thaum xub thawj, lub cev, teb rau qhov no, tsim ib hom kev tiv thaiv ncej nyob ib ncig ntawm lub tsom. Thaum cov kev tso tawm tau txais kev siv zog uas tso cai rau lawv tawg tawm ntawm nws, ib tus neeg muaj qaug dab peg. Qhov ua rau ntawm idiopathic epilepsy nyob rau hauv feem ntau ntawm cov neeg mob yog ib tug congenital mutation nyob rau hauv cov noob, yog li nws yuav ua tau los ntawm noob neej. Cov kab mob no tuaj yeem tshwm sim rau txhua lub hnub nyoog, tab sis feem ntau nws thawj cov cim qhia tau pom hauv cov menyuam yaus. Nrog rau kev nkag mus rau cov kws kho mob raws sij hawm, tus kab mob tuaj yeem raug tshem tawm, thiab tsis muaj kev kho kom raug, cov neeg mob pib hloov cov txheej txheem ntawm lub paj hlwb hemispheres, uas ua rau muaj ntau yam kev puas hlwb.tus cwj pwm, nrog rau kev puas siab puas ntsws. Epilepsy nyob rau hauv cov me nyuam yog benign vim tsis muaj kev hem thawj rau lub neej. Nws raug cais raws li qhov chaw ntawm lub hom phiaj ntawm cov neurons nquag thiab tshwm sim:
- temporal;
- occipital;
- kev nyeem ntawv mob vwm.
Cov tsos mob thiab chaw kho mob ntawm lub cev nqaij daim tawv nqaij tawv nqaij
Raws li lub npe txhais tau hais tias, hom kab mob no tau kuaj pom yog tias qhov ua kom pom tseeb ntawm cov neurons nquag nquag nyob hauv cov tuam tsev. Focal temporal lobe epilepsy tuaj yeem tshwm sim rau menyuam yaus vim li cas hauv qab no:
- perinatal (birth) kev raug mob;
- tsis muaj oxygen hauv cov ntshav (hypoxemia) vim muaj ntau yam laj thawj, ib qho ntawm fetal asphyxia thaum yug menyuam;
- post-traumatic gliosis hauv thaj tsam ntawm lub cev.
Hauv cov neeg laus, pathology tuaj yeem txhim kho rau cov laj thawj hauv qab no:
- kev cuam tshuam hauv cov hlab ntsha hlwb;
- cerebral infarction;
- kev raug mob.
Nrog rau cov kab mob no, kev qaug dab peg dhau mus yam tsis muaj kev nco qab, thiab nws cov precursors (aura) tuaj yeem lossis tsis tuaj. Cov neeg mob yuav hnov zoo, gustatory lossis pom kev pom, kiv taub hau, qee zaum mob hauv lub peritoneum, xeev siab, tsis xis nyob hauv lub plawv, ua tsis taus pa, ua daus no, arrhythmia, ntshai, xav txog kev hloov lub sijhawm, kev xav ntawm tus kheej lub cev.
Yog hais tias qhov excitation ntawm neurons tawm ntawm qhov chaw tsom mus thiab kis mus rau ob lub hemispheres ntawm lub hlwb, uas yog, qaug dab peg los ntawm focal hla mus rau.generalized, qaug dab peg tuaj yeem dhau los ntawm kev tsis nco qab, kev nco tsis zoo, poob, tab sis tsis muaj convulsions. Tsis tas li ntawd nyob rau theem ntawm tus kab mob no, cov neeg mob yuav muaj kev rov ua dua - npuaj tes, khawb, quaj qw, rov ua qee lub suab, blinking.
Nrog rau kev loj hlob ntawm lub cev nqaij daim tawv nqaij ntuag, qaug dab peg tau pom, uas yog hu ua Secondary generalized. Lawv yog cov yam ntxwv los ntawm kev tsis nco qab, poob ntawm tus neeg mob, convulsions nyob rau hauv tej nqaij.
Cov tshuaj tseem ceeb rau kev mob vwm ntawm daim ntawv no yog cov tshuaj "Carbamazepine", thiab yog tias tsis muaj txiaj ntsig, kev kho mob hloov pauv tau ua tiav. Hauv qhov xwm txheej hnyav heev, kev phais raug qhia.
Chaw kho mob thiab cov tsos mob ntawm occipital epilepsy
Cov kab mob no tseem suav tias yog qhov tsis zoo thiab tshwm sim rau txhua lub hnub nyoog, tab sis hauv 76% ntawm cov xwm txheej nws tshwm sim tau sau tseg hauv cov menyuam yaus hnub nyoog 3 txog 6 xyoo. Occipital focal epilepsy nyob rau hauv cov menyuam yaus yog tus cwj pwm los ntawm qhov tseeb tias qaug dab peg nrog nws tuaj yeem tshwm sim nrog qhov sib txawv loj thiab luv luv (li 10 feeb) lossis ntev (ntau tshaj 30 feeb, qee zaum ob peb teev).
Kwv yees li ntawm 10% ntawm cov neeg mob tsuas muaj cov kab mob tsis zoo (xws li xeev siab, feem ntau xaus nrog ntuav, mob taub hau, tsis xis nyob, qaug zog, tawm hws ntau, pallor, lossis, qhov sib txawv, reddening ntawm daim tawv nqaij, hnoos, mob plawv, myiasis, mydriasis, urinary incontinence, kub taub hau).
Kwv yees li 80% ntawm cov neeg mob muaj kev sib txawv (tsis raugposition) qhov muag. Feem ntau, tus menyuam ntsia deb.
26% ntawm cov ntaub ntawv tshaj tawm muaj hemiclonia (cov leeg leeg tsis sib xws).
Thiab thaum kawg, hauv 90% ntawm cov neeg mob, cov tsos mob tshwm sim tuaj yeem nrog los ntawm kev tsis nco qab.
1/5 cov menyuam yaus tuaj yeem hnov qab, Jacksonian taug kev, thiab qee tus tuaj yeem pom qhov muag tsis pom lossis pom qhov tsis txaus ntseeg.
Thaum kawg ntawm kev tawm tsam, tus menyuam zoo li qub, tsis muaj cov tsos mob ntawm lub paj hlwb thiab teeb meem kev txawj ntse.
Lub sijhawm qaug dab peg thiab cov tsos mob ntawm tus kheej txaus ntshai heev rau cov niam txiv uas xav tias tus menyuam yuav tuag. Txawm li cas los xij, kev pab nrog kev qaug dab peg ntawm lub sijhawm luv tsis tas yuav tsum tau ua. Yog tias qhov kev tawm tsam nrog occipital qaug dab peg ntev ntev thiab muaj cov tsos mob tshwm sim, kev saib xyuas xwm txheej ceev tau muab, suav nrog kev txhaj tshuaj ntawm cov tshuaj benzodiazepines. Yog hais tias tus me nyuam muaj qaug dab peg, kev kho mob prophylactic nrog Carbamazepine yog ua tiav.
Pib nyeem ntawv qaug dab peg
Qhov tshwm sim tsis tshua muaj tshwm sim ntawm tus kab mob, tshwm sim hauv cov tub hluas piv rau cov ntxhais hauv qhov piv ntawm 2: 1. Hom kab mob vwm no tshwm sim thaum muaj hnub nyoog kawm ntawv. Kev qaug dab peg pib nrog trembling ntawm lub puab tsaig, twitching ntawm cov leeg ntawm lub puab tsaig sab qis, tsis tshua muaj kev ua pa nyuaj, kev hnov lus txawv txav thaum nyeem ntawv, tshwj xeeb tshaj yog tias nws ua kom nrov nrov. Thaum thawj harbiners tshwm sim, tus menyuam yuav tsum tsis txhob nyeem ntawv, txwv tsis pub qhov kev tawm tsam tuaj yeem ua rau qaug dab peg. Ib txhianiam txiv, thiab cov xib fwb, ib yam nkaus, tsis txhob coj tus mob no ntawm tus me nyuam tiag, txawm li cas los xij, kev nyeem ntawv qaug dab peg yuav tsum tau kho, vim tias yav tom ntej kev tawm tsam yuav pib tshwm sim thaum ua si, thaum tham lossis noj mov. Cov tshuaj tseem ceeb rau hom mob vwm no yog Valproate. Cov kws kho mob kuj tseem yuav sau tshuaj Flunarizine thiab Clonazepam.
Symptomatic focal epilepsy
Cov kab mob no tau kuaj pom thaum muaj kev cuam tshuam ntawm lub paj hlwb cortex, qhov ua rau muaj kev ntseeg siab. Symptomatic epilepsy yog sau rau cov neeg laus thiab cov me nyuam uas muaj kwv yees li tib zaus. Cov laj thawj rau nws qhov tshwm sim tuaj yeem yog:
- mob hlwb raug mob ntawm ib qho etiology;
- kab mob sib kis;
- kab mob kis;
- ncauj tsev menyuam vascular dysplasia;
- mob ntshav siab;
- osteochondrosis ntawm tus txha caj qaum;
- tsis zoo ntawm lub paj hlwb;
- oxygen starvation (asphyxia);
- ntau yam mob ntawm lub cev sab hauv;
- kev raug mob hauv cov menyuam yug tshiab.
Cov tsos mob qaug dab peg tuaj yeem tshwm sim nws tus kheej txawm tias ntau xyoo tom qab raug mob lossis mob.
Kev faib tawm ntawm cov tsos mob qaug dab peg
Nyob rau hauv cov kab mob no, plaub daim ntawv yog qhov txawv, nyob ntawm qhov chaw ntawm kev hloov pauv:
- temporal;
- parietal;
- occipital;
- ntev.
Kuj nyob rau hauv pab pawg no, Kozhevnikovsky syndrome yog qhov txawv (hmoov thiab mob vwm ib txhij)thiab ib qho mob uas ua rau qaug dab peg qaug dab peg tshwm sim los ntawm qee qhov kev txhawb nqa sab nraud, xws li tom qab sawv ntxov.
Timporal symptomatic epilepsy yog tus cwj pwm los ntawm qhov tsis hnov lus tsis zoo, kev xav tsis zoo, thiab tus cwj pwm coj cwj pwm.
Thaum frontal feem ntau pom muaj teeb meem hais lus, nco tsis tau, ceev wits thiab lwm yam kev txawj ntse sib txawv ntawm cov hnub nyoog.
Occipital epilepsy entails qhov muag tsis pom kev, qaug zog, ua haujlwm tsis zoo ntawm kev txav.
Lub parietal muaj nyob rau hauv nws cov cuab tam convulsions, paresis, impaired motor functions.
Kev qaug dab peg hauv cov tsos mob tuaj yeem ua tau yooj yim (me me autonomic, lub cev muaj zog thiab kev hnov lus txawv txav thaum lub siab ua haujlwm), complex (tsis nco qab thiab kev ua haujlwm ntawm cov kab mob hauv nruab nrog cev) thiab thib ob generalized (tsis nco qab, convulsions, loj autonomic teeb meem.).
Yog tias koj muaj cov tsos mob ntawm tus mob vwm, koj yuav tsum hu rau tus kws kho mob hlwb lossis kws kho hlwb hauv koj lub tsev kho mob. Lub koob npe nrov zoo yog nyiam los ntawm Bekhterev Clinic nyob rau hauv St. Petersburg, qhov twg, nrog rau lwm tus, muaj ib tug department ntawm neurology thiab me nyuam puas hlwb. Muaj lub hauv paus kev kuaj mob niaj hnub no, biochemical, hormonal, kev tshawb fawb txog cov khoom siv dav dav tau txiav txim siab, kev soj ntsuam tshuaj tau ua, kev kuaj mob ua haujlwm, ultrasound, ECG, kuaj vascular yog ua tiav.
Cryptogenic focal epilepsy
Lo lus "cryptogenic" yog los ntawm Greek "kryfto", uas txhais tau tias " zais", " zais". Kev kuaj mob"cryptogenic epilepsy" raug kuaj pom thaum tus kab mob tsis tuaj yeem txheeb xyuas tau. Feem ntau, qhov no pathology tau pom nyob rau hauv cov neeg laus dua 16 xyoo. Tej yam tshwm sim muaj xws li ntau yam kev raug mob taub hau, qog nqaij hlav, ntau yam kab mob, thiab kab mob plawv. Kev tsis paub meej txog tus kab mob ua rau nws nyuaj rau kev kho. Nyob rau hauv cov ntaub ntawv no, yog hais tias ua tau, nws yog advisable mus cuag lub hauv paus tsev kho mob, qhov twg muaj ib tug kuaj mob lub hauv paus nrog niaj hnub advanced cov cuab yeej, piv txwv li, lub koom haum ntawm lub hlwb (St. Petersburg). Ntawm no, cov kws paub txog kev paub dhau los ua qhov kev kawm qib siab ntawm cov hlab ntsha hauv cheeb tsam lub taub hau, electroencephalography, electroneuromyography, kev tshawb fawb ntawm lub hlwb muaj peev xwm thiab ntau yam kev kuaj biochemical thiab kuaj.
Daim duab kho mob ntawm qaug dab peg hauv cryptogenic qaug dab peg tuaj yeem sib txawv heev. Kev qaug dab peg hauv cov kab mob no tau pom nrog thiab tsis muaj kev nco qab, nrog cov tsos mob ntawm kev tsis txaus ntseeg, convulsions lossis tsis muaj lawv, qaug dab peg ntawm qhov sib txawv thiab lub sijhawm, lossis tsuas yog me me lub cev muaj zog thiab / lossis kev puas siab puas ntsws.
Raws li kev tsom xam ntawm kev ua kom pom tseeb ntawm cov neurons overexcited, cov ntaub ntawv hauv qab no yog qhov txawv:
- nyob rau hauv txoj cai hemisphere;
- nyob rau sab laug hemisphere;
- hauv lub hlwb sib sib zog nqus ntu;
- cryptogenic focal frontal lobe mob vwm.
Tsis tas li, cryptogenic qaug dab peg tuaj yeem nrog Lennox-Gastaut syndrome. Nws tau pom ntau zaus hauv cov tub hluas hnub nyoog 4 txog 6 xyoos thiab muaj kev tsis txaus ntseeg shuddering, poob ntawm cov leeg nqaij, ntog thiab tsis nco qab.
Kev kho mob
Kev pab thawj zaug rau kev qaug dab peg yuav tsum tau muab los ntawm cov txheeb ze thiab lwm tus uas nws qhov muag tshwm sim. Yuav ua li cas? Lub algorithm yog raws li nram no:
- tiv thaiv tus neeg mob ntawm cov khoom txaus ntshai kom nws tsis txhob raug mob;
- yog tus neeg poob lawm, muab tej yam mos tso rau hauv nws lub taub hau;
- xoos fasteners (khawm, zipper) ntawm caj dab thiab hauv siab;
- tom qab tus neeg mob tuaj rau nws lub siab, kho nws qhov txhab, yog tias muaj;
- hu lub tsheb thauj neeg mob.
Yuav ua li cas tsis ua:
- tuav tus txiv neej chim;
- qhib tus neeg mob cov hniav;
- sim muab dej los yog tshuaj rau nws.
Kev kho mob qaug dab peg yog ua tiav tom qab tsim qhov ua rau ntawm tus kab mob thiab kev kuaj mob kom raug, yog li ntawd, yog tias ua tau, nws raug nquahu kom hu rau cov chaw kho mob tshwj xeeb, piv txwv li, Lub Tsev Kho Mob hlwb (St. Petersburg), Lub Tsev Kho Mob. rau Restorative Neurology (Moscow) thiab lwm lub tsev kho mob tshwj xeeb uas muaj cov kws kho mob vwm.
Epilepsy kho tau ntau txoj hauv kev:
- txo qis zaus thiab lub sijhawm ntawm qaug dab peg;
- tiv thaiv kev qaug dab peg tshiab;
- pab mob;
- mus txog lub xeev tus neeg mob, uas tuaj yeem tso tseg tau tshuaj.
Qee zaum, yuav tsum tau siv cov kev kho mob tshwj xeeb hauv cov chaw kho mob hlwb tshwj xeeb. Cov kev kho mob muaj xws li tshuaj, noj zaub mov, osteopathy, Voight Method thiab, nyob rau hauv cov teeb meem nyuaj, phais.
