Bnh Parkinson

(Parkinson's disease)

Bc s Nguyn Xun Cm bin son O.B.E.

Hi Tm Thn Vit Nam Serving the mental health needs & promoting wellbeing of people from Vietnam

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Bnh Parkinson Ra ng, thnh thong bn c th gp mt ngi ln tui, v mt ng ngc km thn sc, dng i li c mt s nt c bit khc thng: hai chn bc lp xp, hai tay thng ng t a ti a lui, thn hnh hi nghing v pha trc. Phn chc l ngi mc phi bnh Parkinson, tn v bc s Anh m t cc triu chng vo hai th k trc y. Nguyn do ca bnh Parkinson cha c r lm. Ngi ta ch bit l trn phng din bnh l c s thoi ha, h hi ca mt b phn nm su trong no, bn trn cung no, gi l hch y no (basal ganglia). Hch tit ra mt cht truyn dn thn kinh (neurotransmitter) tn l Dopamine; cn ti sao hch ny v gi b thoi ha, n nay vn cha c li gii thch tha ng, mc du mi trng c cho l mt yu t gy bnh quan trng.

Trong no cn c mt cht truyn dn thn kinh khc, l Acytylcholine. Dopamine v Acetylcholine hot ng st cnh v qun bnh vi nhau, iu ha cc tn hiu t v no xung ty sng ri ra c bp. Nh th c ng ca chng ta c s phi hp nhp nhng v uyn chuyn. Thiu Dopamine, c bp khng cn c kim sot na, nn lc no cng vo tnh trng trng cng khin c ng gim bt i v thm nhiu kh khn hn.

Hnh no b dc

Cung no

Hch y no

V no

1

C mt s bnh trng vi triu chng ging nh bnh Parkinson, ting Anh gi l Parkinsonism, nguyn do c bit r hn: Ph chng ca cc thuc cha bnh tm thn loi Butyrophenone,

Phenothiazine. Cht c lm h hi hch y, v d Manganese Bnh do siu khun gy ra: Japanese B encephalitis (nm 2000

Vit Nam xy ra bnh dch ny), Encephalitis lethargica. Chn thng s no lin tc, thng xy ra cho cc v s quyn

Anh, in hnh l nh v ch hng nng Muhammad Ali. Thoi ha tng qut ca nhiu b phn trong c th. Bnh Wilson do cht ng c nhiu trong mu, lm thoi ha hch

y no v h gan; bnh Huntington. Bnh giang mai xm nhp vo h thn kinh (neurosyphilis). U bu no b. Triu Chng

Bnh Parkinson xy ra thng t 50 tui tr ln v cho c hai phi, nam nhiu hn n. Nhng khi cc triu chng y , vic nh bnh r rng ri, th thng k cho bit l c n 10% ngi di 40 tui mc phi. Hin nay ti VQ Anh c khong 200,000 bnh nhn

Dopamine Acytylcholine Acytylcholine Dopamine

Hch y no bnh thng

Hch y no thoi

ha

Ty sng Ty sng

Trng lc c bp bnh thng

y Dopamine

Trng lc c bp tng cao

Thiu Dopamine

2

Parkinson, mi nm thm 15,000 trng hp mi c ghi nhn. Cc triu chng bt u xy ra sau khi hch y no b thoi ha v lng Dopamine gim mt i 80%. Thot tin, nu ngi nh tinh mt cht s nhn thy c s khc thng trn nt mt bnh nhn. H lm nh th lnh lng trc chuyn vui bun, l v cc c bp trn mt khng cn nhy cm nh trc na, mt i kh nng biu l phn tnh cm ca con ngi. K n l khi vit th tay hi run, nt ch cng ngy cng nh, nht l cui hng. Nhai, nut c phn kh khn hn, b tiu ha mt dn hiu nng nn bnh nhn hay b to bn. H cng t ng v m, ban ngy l mt mi, d tr nn cau c gt gng. Khi bnh pht trin nhiu ri th cc triu chng cng l r: Run y l mt triu chng chnh, th hin nhiu nht l tay v bn tay, i khi c chn, mm v li na. Ban u run mt bn, sau l c hai bn, run nhiu lc bnh nhn ngi im v bt i khi h lm mt cng vic no . Cc ngn tay khp vo dui ra lin tc, ngn ci mn m hai ngn tr v gia ging nh ang vn thuc ht. t c ng Pht trin dn dn, to kh khn cho bnh nhn khi mun lm mt ng tc thng thng. Cc cng vic cn n bn tay kh thc hin c, v d nh gi nt o, cm bt vit. Cng tay chn (rigidity) T chi cng khi co vo, nht l chi trn. Chn v thn mnh thng , hi nghing v pha trc. Ngoi vic i ng c nhng nt c bit k trn, bnh nhn pht m nhanh nhng khng r rng, mm chy nc di lng thng, da tit ra cht nhn. Kh nng v nhn thc nh tp trung t tng, s phn on, tr nh, tr thng minh khng b nh hng nhiu.

3

Trong phn th nghim lm sng, bc s s cho th mu v bnh giang mai, tm lng cht ng trong mu v nc tiu, lm scan no b nu bnh nhn di 50 tui v triu chng ch xy ra mt na ngi m thi. Cha Tr

iu cn bit l bnh Parkinson khng th cha tuyt cn c. Ty theo tnh trng nng nh, tui ca ngi bnh m s iu tr c khc nhau. Dc phm Cc loi thuc gm c: Levodopa: y l thuc cng hiu nht hin nay, em li phm

cht tt v cuc sng cho a s bnh nhn. iu bt li l mt thi gian sau, thuc mt dn hiu lc, li gy ra mt s ph chng: c ng bt thng (dyskinesia) nh cn cht hm rng, mm nhai v nut lin tc, ma may tay chn, co git c bp; l m, cm xc thay i tng lc.

Thuc c tc dng nh Dopamine (Dopamine agonist) gm c Bromocriptine, Cabergoline, Pergolide, Ropinirole.

Thuc khng choline (anticholinergics) lm gim bt nh hng ca ha cht acetylcholine trong no: Benztropine, Orphenadrine, Procyclidine.

Thuc ngn chn Comt (Comt inhibitors): Tolcapone, c th dng chung vi Levodopa.

Selegiline lm chm s chuyn ha ca cht Dopamine trong no. Gii phu Gn y, vi nhng k thut mi, gii phu c ch trng tr li: Dng vi in cc ph hy mt ch nht nh ca hch y no,

gip cho bnh nhn chu c liu Levodopa cao hn. Kch thch su trong no: Thay v ph hy hch y no, phng

php ny dng mt in cc cm vo v ni vi mt my gy

4

nhp bn ngoi kim sot. Cng hiu ca loi kch thch ny l tr c chng run v t c ng.

Ghp t bo ca phi thai sn xut dopamine vo hch y no, c nhiu trin vng tt.

Tin liu bnh

Ty theo bnh trng xy ra la tui no. Nu cn tr m mc phi, bnh s tin trin dn dn, tui i c th gim i v cc bin chng xy ra do nm mt ch t vn ng, do b ng t gy xng. T 70 tui tr ln m l vng vo, bnh c v khng tin trin nng hn, tui th v th m khng thay i: tuy nhin c mt s c s b bnh gi ln (senile dementia). C mt s iu cn bit: Khng c bnh Parkinson no ging bnh no, ngi ny ch c

mt triu chng, ngi khc c y triu chng cng lc. Cch iu tr c tnh cch ring bit tng trng hp, v loi

thuc cng nh liu lng. L qun ung thuc mt ln trong ngy th ng ung gp i

liu ln k. Nn hi kin bc s nu thy chng mt (c th v huyt p h

thp) hoc nhng ph chng khc. Ti liu tham kho: Davidson's Textbook of Medicine, 1997 Y t Nguyt san, 10-99 The Drug Treatment of Parkinson's Disease, 6-98 Medical briefing, Dr Thomas Stuttaford, 2-01

5

- Parkinson Disease

(Parkinsons Disease)

(basal ganglia) (Doparmine)

(acetylcholine)

Parkinsonism

Butyrophenone, Phenothiazine

(manganese) 2000

6

Encephalitis lethargica

Muhammad Ali (Wilson)

(Huntingtons disease) (neurosyphilis)

50 10 40 20 15,000 80

7

50

Levodopa:

(dyskinesia)

(Doparmine agonist) Bromocriptine, Cabergoline, Pergolide, Ropinirole.

(anticholinergics) Benztropine, Orphenadrine, Procyclidine

8

COMT (Comt inhibitors) Tolcapone Levodopa

Selegiline

Levopoda

70

(senile dementia)

()

9

This Booklet is published with the support of:

Department of Health

City Bridge Trust

SLaM NHS Trust

Big Lottery Fund

City Parochial Foundation

Hi Tm Thn Vit Nam Serving the mental health needs & promoting wellbeing of people from Vietnam

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