epilepsy (1)

∫∑∑Ë’ 8 ·π«∑“ß°“√∫√À‘ “√¬“°π— ™—° ·π«∑“ß°“√∫√À‘ “√¬“°π— ™°— ¡’À≈°— °“√ ¥—ßπ’È 1. μâÕß·πà„®«à“ºŸâªÉ«¬¡’Õ“°“√¢Õß‚√§≈¡™—°®√‘ß „πºâŸªÉ«¬∑’Ë¡’Õ“°“√‡°√Áß °√–μÿ° μ—«‡¢’¬«À√◊Õ ¡’Õÿ®®“√–ªí  “«–√“¥ ¡’Õ“°“√´È”Ê °—πÀ≈“¬§√—Èß ‰¡à¡’ªí≠À“„π°“√«‘π‘®©—¬ ·μà„π∫“ß√“¬∑’Ë·æ∑¬å¬—߉¡à¡—Ëπ„®«à“ Õ“°“√∑’˺ŸâªÉ«¬‡≈à“¡“π—Èπ‡ªìπÕ“°“√¢Õß‚√§≈¡™—° §«√æ‘®“√≥“Õ¬à“ß√Õ∫§Õ∫°àÕπ∑’Ë®–‡√‘Ë¡¬“°—π™—°„Àâ°—∫ºâŸªÉ«¬ (∫∑∑’Ë 5 ·ºπ¿Ÿ¡‘∑’Ë 2, 3) 2. ‡≈◊Õ°„™â„Àâ‡À¡“– ¡°—∫™π‘¥¢ÕßÕ“°“√™—° (μ“√“ß∑’Ë 5) ‚¥¬‡≈◊Õ°°≈ÿ࡬“À≈—°°àÕπ∑’Ë®–„™â°≈ÿà¡ ¬“√ÕßÀ√◊Õ¬“‡ √‘¡ ∂⓺ŸâªÉ«¬¡’Õ“°“√™—°À≈“¬™π‘¥√à«¡°—π„Àâ‡≈◊Õ°„™â¬“∑’ËÕÕ°ƒ∑∏‘ϧ√Õ∫§≈ÿ¡‰¥â°«â“ß (broad spectrum AEDs) 3. °“√‡√¡Ë‘ ·≈–°“√ª√∫— ¬“°π— ™—° 3.1 ‡√¡Ë‘ μπâ ¥«â ¬¬“°π— ™°— ™π¥‘ ‡¥¬’ « (monotherapy) ºªâŸ «É ¬√Õâ ¬≈– 60-70 Õ“°“√™°— ®–μÕ∫ πÕß¥μ’ Õà °“√ „™â¬“°—π™—°‡æ’¬ß™π‘¥‡¥’¬« ª√–‚¬™πå¢Õß°“√√—°…“¥â«¬¬“™π‘¥‡¥’¬«π—Èπ πÕ°®“°®–¡’Õ“°“√¢â“߇§’¬ß·≈–ªØ‘°‘√‘¬“ √–À«à“߬“ (drug interaction) πâÕ¬°«à“°“√√—∫ª√–∑“π¬“À≈“¬™π‘¥æ√âÕ¡°—π·≈â« ºŸâªÉ«¬¬—ß “¡“√∂√—∫ª√–∑“𠬓°—π™—°‰¥âμàÕ‡π◊ËÕß·≈– ¡Ë”‡ ¡Õ¥’°«à“ ·≈–‡ ’¬§à“„™â®à“¬πâÕ¬°«à“ 3.2 °“√ª√—∫¬“°—π™—° „π√–¬–‡√‘Ë¡μâπ¢Õß°“√√—°…“ §«√‡√‘Ë¡¬“°—π™—°„π¢π“¥μË” ‡æ◊ËÕ„ÀâºâŸªÉ«¬ ª√—∫ ¿“æ√à“ß°“¬‡æ◊ËÕ∑πμàÕº≈¢â“߇§’¬ß∑’Ëæ∫‰¥â„𬓰—π™—°∑—Ë«‰ª ‡™àπ Õ“°“√ßà«ß´÷¡ ‡¥‘π‡´ À≈—ß®“°π—Èπ§àÕ¬Ê ‡æ‘Ë¡¢π“¥¢Õ߬“°—π™—°¢÷Èπ ®π°√–∑—Ëߧÿ¡Õ“°“√™—°‰¥â ‚¥¬‰¡à¡’Õ“°“√¢â“߇§’¬ß (maximal tolerated dose) ¢π“¥¢Õß ¬“°—π™—°æ◊Èπ∞“π· ¥ß„πμ“√“ß∑’Ë 6 °“√‡√‘Ë¡„À⬓°—π™—°∑“ߪ“°¢π“¥ Ÿß (oral loading dose) π—Èπ‰¡à¡’À≈—°∞“π ∑“ß«‘™“°“√™—¥‡®π ∂â“ ß —¬«à“ºâŸªÉ«¬¡’‚Õ°“ ‡°‘¥Õ“°“√™—°μàÕ‡π◊ËÕß (status epilepticus) „Àℙ⬓°—π™—°∑“ß À≈Õ¥‡≈◊Õ¥¥” (∫∑∑’Ë 7) 4. °“√√—∫ª√–∑“𬓰𗠙—°∑Èß— „π‡¥Á°·≈–º„⟠À≠৫√®–¡§’ «“¡μÕà ‡πÕ◊Ë ß·≈– ¡Ë”‡ ¡Õ √—∫ª√–∑“𬓮π°«à“®–§ÿ¡Õ“°“√™—°‰¥âÕ¬à“ßπâÕ¬ 2 ªï ®÷ßæ‘®“√≥“≈¥¬“≈ßÕ¬à“ß™â“Ê (Àπâ“ 49) ·π«∑“ß°“√√—°…“ 41 ‚√§≈¡™°—

μ“√“ß∑’Ë 5 °“√‡≈Õ◊ °„™â¬“°π— ™°— μ“¡™π‘¥¢ÕßÕ“°“√™—° ¬“∑‡Ë’ ≈Õ◊ °„™â ™π¥‘ ¢ÕßÕ“°“√™°— ¬“À≈°— ¬“√Õß (¬“‡ √‘¡) Absence Myoclonic, atonic, tonic ∫≠— ™’¬“ ° ∫—≠™¬’ “ ß ‰¡àÕ¬àŸ„π∫—≠™’ ¬“À≈°— ·Ààß™“μ‘ Generalized tonic clonic Sodium valproate Lamotrigineß Clonazepam¢ Partial Sodium valproate Topiramate*ß Infantile spasms Lamotrigine*ß Clonazepam¢ Nitrazepam Phenobarbital Lamotrigineß Oxcarbazepine Levetiracetam Sodium valproate Topiramateß Clonazepam¢ Phenytoin Clobazam Carbamazepine Carbamazepine Lamotrigineß Levetiracetam Gabapentinß Phenytoin Topiramateß Oxcarbazepine Clonazepam¢ Sodium valproate Clobazam Phenobarbital Vigabatrinß Sodium valproate Nitrazepamß Clonazepam¢ Clobazam Topiramateß * „™ â ”À√∫— √°— …“ Lennox-Gastaut Syndrome „π‡¥°Á ∫—≠™’¬àÕ¬ ° ¢ § ß ·≈– ® μ“¡∫—≠™’¬“À≈—°·Ààß™“μ‘ 2547 (¿“§ºπ«°) 42 ·π«∑“ß°“√√°— …“ ‚√§≈¡™°—

μ“√“ß∑’Ë 6 ¢Õâ ¡Ÿ≈· ¥ß¢π“¥¢Õ߬“°π— ™°— ∑Ë’„™°â π— ∫àÕ¬Ê Drug Adult initial Ped initial dose Dosing regimen Adult escalation Ped escalation Adult usual Ped usual dose Time to steady dose (mg/day) (mg/kg/day) dose (mg/day) (mg/kg/day) state (day) Carbamazepine 200 10-15 bid-tid 200 mg/wk 5mg/kg/wk 600-1200 10-30 3-4 Gabapentin 300 10 tid-qid 300 mg/day 30-100 1-2 Lamotrigine * ** bid *** 300 mg/d 900-3600 && 3-10 Levetiracetam 500 10 bid 500 mg/wk 20-80 2 Sodium valproate 500-1000 15-20 (10) bid-tid 250 mg/wk **** & 30-80 2 Oxcarbazepine 150-300 10 bid 300 mg/wk 20-50 2 Phenobarbital 60-90 3-5 (4) od-bid 30 mg/4wk 10mg/kg/wk 1000-3000 3-5 15-20 Phenytoin 200-300 5 od-bid 50-100 mg/wk 5-8 15-20 Topiramate 25-50 1 bid 25 mg/wk 5-10mg/kg/wk 1000-3000 5-9 3-5 Vigabatrin 500-1000 40-50 bid 500 mg/wk 100-150 2 10mg/kg/wk 600-2400 1-2mg/kg/2wk 90-120 1-2mg/kg/2wk 300-500 1mg/kg/wk 200-400 10-20mg/kg/wk 2000-4000 ·π«∑“ß°“√√—°…“ * 25 mg/day monotherapy, 25 mg/alternate day with VPA, 50 mg/day with inducer ‚√§≈¡™°— ** 0.5 mg/kg/day monotherapy, 0.1-0.3 mg/kg/day with VPA, 1 mg/kg/day with inducer *** 25 mg/wk monotherapy, slowly titration with VPA, 50 mg/wk with inducer **** 0.5 mg/kd/2wk monotherpy, 0.1-0.3 mg/kg/2wk with VPA, 1 mg/kg/d with inducer & 150-400 mg/day monotherapy, 100-300 mg/kg/day with VPA, 200-800 mg/kg/day with inducer && 10 mg/kg/day monotherapy, 5 mg/kg/day with VPA, 15 mg/kg/day with inducer 43

μ“√“ß∑Ë’ 7 ¢âÕ¡Ÿ≈∑“߇¿ —™®≈π»“ μ√å¢Õ߬“°π— ™—° Drug Route of Half life (hr) Therapeutic Protein binding elimination (Adult) (Ped) range (μg/ml) (%) Carbamazepine Hepatic 14-27 14-27 (children) 4-12 75 8-28 (neonates) Gabapentin Renal 5-7 ·ª√μ“¡Õ“¬ÿ * * 0 Lamotrigine Hepatic Levetiracetam Renal 15-30 ·ª√μ“¡Õ“¬ÿ * * 55 Sodium valproate Hepatic Oxcarbazepine Hepatic 7-8 ·ª√μ“¡Õ“¬ÿ * * <10 6-15 8-15 50-150 80-95 8-10 hr ·ª√μ“¡Õ“¬ÿ * * 40 (MHD*) Phenobarbital Hepatic 40-136 37-73 10-40 40-60 Phenytoin Hepatic 12-36 5-14 (children) 10-20 69-96 10-60 (neonates) Topiramate Renal (70%) 20-30 ·ª√μ“¡Õ“¬ÿ * * 15 Vigabatrin Renal 5-7 ·ª√μ“¡Õ“¬ÿ * * 0 * MHD : monohydroxy derivative ** ‰¡à¡’§«“¡®”‡ªìπ∑“ߧ≈‘π‘° ¬—߉¡à “¡“√∂μ√«®‰¥â„πª√–‡∑»‰∑¬ 5. ∫√À‘ “√¬“°—π™—°μ“¡§ÿ≥ ¡∫μ— ‘∑“߇¿ ™— «‘∑¬“ (μ“√“ß∑’Ë 7) 5.1 §“à §√ß÷Ë ™«’ μ‘ ¬“ (half life, T 1/2 ) ¬“∑¡’Ë ’ T 1/2  π—È ‰¥·â °à carbamazepine, sodium valproate §«√„À«â π— ≈– 2-3 §√—Èß ∂â“ T 1/2 π“πμ—Èß·μà 24 ™—Ë«‚¡ß¢÷Èπ‰ª ‰¥â·°à phenytoin, phenobarbital  “¡“√∂„À≥⫗π≈– 1 §√—Èß „πºâŸ„À≠à ‡ªìπμâπ 5.2 Steady state §◊Õ√–¬–‡«≈“∑’ˬ“‰¥â√–¥—∫§ß∑’Ë„π‡≈◊Õ¥ À≈—ß®“°‰¥â√—∫¬“‡¢â“ àŸ√à“ß°“¬ „π°“√∫√‘À“√ ¬“∑“ߪ“°√–¬–‡«≈“∂÷ß steady state ®–π“πª√–¡“≥ 5 ‡∑à“¢Õß T 1/2 °“√ª√–‡¡‘πº≈°“√§«∫§ÿ¡Õ“°“√™—° √«¡∑—Èß°“√‡®“–√–¥—∫¬“„π‡≈◊Õ¥ §«√°√–∑”‡¡◊ËÕ¬“∂÷ß steady state ·≈â« °“√∑’Ë®–ª√–‡¡‘π«à“¬“°—π™—°™π‘¥„¥™π‘¥Àπ÷Ë߉¥âº≈À√◊Õ‰¡à ®”‡ªìπμâÕß„À⬓°—π™—°™π‘¥π—Èπ„π¢π“¥∑’Ë ‡À¡“– ¡‡ªìπ√–¬–‡«≈“∑’Ëπ“π‡æ’¬ßæÕ 6. °“√‡≈◊Õ°„™â preparation ¢Õ߬“ ¬“·μà≈–™π‘¥ ‡™à𠬓‡¡Á¥ πÈ” ·§ª´Ÿ≈ À√◊Õ¬“™π‘¥‡¥’¬«°—π ·μàμà“ß∫√‘…—∑μâÕߧ”π÷ß∂÷ß bioavailability ∑’ËÕ“®®–·μ°μà“ß°—π‰¥â¡“° °“√‡ª≈’ˬπ™π‘¥¢Õß preparation ¢Õ߬“™π‘¥ ‡¥’¬«°—π„πºâŸªÉ«¬∑’˧«∫§ÿ¡Õ“°“√™—°‰¥â·≈â«Õ“®∑”„À⧫∫§ÿ¡Õ“°“√™—°‰¡à‰¥â À√◊Õ‡°‘¥º≈¢â“߇§’¬ß¡“°¢÷Èπ°«à“‡¥‘¡ ∂“â ®”‡ªπì μÕâ ߇ª≈¬Ë’ π preparation ¬“Õ“®μÕâ ߪ√∫— ¢π“¥·≈–«∏‘ „’ ™â ‰¡§à «√‡ª≈¬Ë’ π°≈∫— ‰ª¡“ 44 ·π«∑“ß°“√√—°…“ ‚√§≈¡™°—

¢âÕ§«√√–«—ß ”À√—∫°“√„Àâ phenytoin §◊Õ ∂â“®”‡ªìπμâÕß„À⬓∑“ß “¬¬“ß (nasogastric tube) §«√„À⬓ „π√ªŸ ·∫∫‡¡Á¥ (infatab) ‰¡à§«√„™â„π√Ÿª·∫∫·§ª´Ÿ≈À√◊Õ·§ª´’≈ ´÷Ëß®–„Àâ√–¥—∫¬“μË”°«à“√ªŸ ·∫∫·√° ·≈–§«√·∫àß „À⇪ìπ 3 ‡«≈“ Àà“ß®“°Õ“À“√ 2 ™—Ë«‚¡ß ¬“°—π™—°∑’Ë controlled or sustained release ‰¡à§«√π”¡“∫¥ ‡æ√“–®–∑”„À⇠’¬§ÿ≥ ¡∫—μ‘¢Õ߬“ ·≈–®– ÕÕ°ƒ∑∏‘Ï„π√Ÿª·∫∫¢Õ߬“ª°μ‘ 7. °“√μ√«®√–¥—∫¬“°—π™°— „π‡≈Õ◊ ¥ ∑”‡¡◊ËÕ¡’¢âÕ∫àß™’È (μ“√“ß∑’Ë 8) μ“√“ß∑Ë’ 8 ¢âÕ∫àß™¢È’ Õß°“√ àßμ√«®√–¥∫— ¬“°—π™°— „π‡≈◊Õ¥ 1. „™âª√–°Õ∫°—∫Õ“°“√‡æ◊ËÕª√–‡¡‘π«à“¬“°—π™—°π—Èπ§«∫§ÿ¡Õ“°“√™—°‰¡à‰¥â 2. ‡æ◊ËÕ„™âª√–°Õ∫°—∫Õ“°“√º‘¥ª°μ‘∑“ߧ≈‘π‘°∑’ËÕ“®®–‡°‘¥®“°√–¥—∫¬“°—π™—° ßŸ ‡°‘π 3. ‡ΩÑ“¥Ÿ√–¥—∫¬“„πºâŸªÉ«¬∑’ˉ¥â√—∫¬“À≈“¬™π‘¥ ∑’ËÕ“®®–‡°‘¥ªØ‘°‘√‘¬“√–À«à“߬“ 4. ‡ΩÑ“¥√Ÿ –¥—∫¬“°—π™—°„π¿“«–∑’Ë¡’°“√‡ª≈’ˬπ·ª≈ß√–¥—∫‚ª√μ’π„π‡≈◊Õ¥ ‡™àπ °“√μ—Èߧ√√¿å ‚√§μ—∫ ‚√§‰μ ‡ªìπμâπ 5. ‡æ◊ËÕª√–‡¡‘π¥Ÿ§«“¡ ¡Ë”‡ ¡Õ„π°“√√—∫ª√–∑“π¬“¢ÕߺŸâªÉ«¬ ¬“°—π™—°‡°◊Õ∫∑ÿ°™π‘¥¡’ dose-response relationship π—Ëπ§◊Õ√–¥—∫¬“¬‘Ëß Ÿß ª√– ‘∑∏‘¿“æ„π°“√ªÑÕß°—π Õ“°“√™—°¬‘Ëߥ’ ∂⓺⟪ɫ¬¬—ß¡’Õ“°“√™—°´È” §«√‡æ‘Ë¡¢π“¥¢Õ߬“®π‰¥â√–¥—∫¬“„π upper level À√◊Õ sub-toxic level „π therapeutic range ¢Õ߬“°π— ™°— ππÈ— Therapeutic range À¡“¬∂÷ß ™à«ß¢Õß√–¥—∫¬“∑’Ë “¡“√∂§«∫§ÿ¡Õ“°“√™—°‰¥â ·≈–∂ⓠߟ °«à“π’È®–∑”„À⇰‘¥ Õ“°“√¢â“߇§’¬ßÕ—π‰¡àæ÷ߪ√– ß§å Therapeutic range (μ“√“ß∑’Ë 7) ¡’§«“¡·μ°μà“ß°—π¡“°„π·μà≈–§π ºŸâªÉ«¬∑’Ë¡’√–¥—∫¬“ ßŸ °«à“√–¥—∫ upper limit ¢Õß therapeutic range ∑’Ë»÷°…“®“°§π°≈ÿà¡Àπ÷Ëß Õ“®‰¡à¡’Õ“°“√‡ªìπæ‘… ·≈–‰¡à®”‡ªìπμâÕß≈¥¢π“¥¬“≈ß∂â“ ¬“§«∫§ÿ¡Õ“°“√™—°‰¥â¥’ ¢≥–‡¥’¬«°—πºŸâªÉ«¬∑’Ë¡’√–¥—∫¬“μË”°«à“ lower limit ¢Õß therapeutic range Õ“® “¡“√∂ §«∫§ÿ¡Õ“°“√™—°‰¥â‚¥¬‰¡à®”‡ªìπμâÕ߇æ‘Ë¡¬“ °“√√—°…“§«√Õ“»—¬Õ“°“√∑“ߧ≈‘π‘°‡ªìπÀ≈—°‚¥¬¥Ÿ®“°Õ“°“√™—° ·≈–‡ΩÑ“¥ÕŸ “°“√‡ªìπæ‘…®“°¬“ ·≈–„À⧫“¡ ”§—≠°—∫§à“√–¥—∫¬“„π‡≈◊Õ¥‡ªìπ√Õß °“√«—¥√–¥—∫¬“°—π™—°„π‡≈◊Õ¥ ª°μ‘®–«—¥‡ªìπ total level ´÷Ëß®–√«¡∑—Èß à«π¬“°—π™—°∑’Ë®—∫°—∫‚ª√μ’π·≈– ¬“∑’ˇªìπÕ‘ √– °“√‡®“–À“√–¥—∫¬“§«√∑”„πμÕπ‡™â“°àÕπ°‘π¬“¡◊ÈÕ·√° (trough level) „π°√≥’∑’Ë¡’°“√‡ª≈’ˬπ·ª≈ß √–¥—∫‚ª√μ’π„π‡≈◊Õ¥À√◊ժؑ°‘√‘¬“√–À«à“߬“ (drug interaction) ∑’ˇ°‘¥°“√·¬àß®—∫‚ª√μ’π ®”‡ªìπμâÕ߇®“–À“ free drug level °“√«—¥√–¥—∫¬“πÕ°®“°®–™à«¬„π°“√ª√—∫¢π“¥¢Õ߬“·≈⫬—ߙ૬∫Õ°∂÷ß §«“¡ ¡Ë”‡ ¡Õ „π°“√√∫— ª√–∑“𬓠(compliance) ¢ÕߺªŸâ «É ¬ 8. ª√–‡¡‘πª√– ‘∑∏‘¿“æ¢Õ߬“ (efficacy) ª√–‡¡‘π‰¥â®“° °“√μÕ∫ πÕßμàÕ¬“°—π™—°¢Õߺ⟪ɫ¬ ·æ∑¬å§«√·π–π”„ÀâºâŸªÉ«¬∫—π∑÷°®”π«π§√—ÈߢÕß°“√™—° §«“¡√ÿπ·√ß ‡«≈“ ·≈–√Ÿª·∫∫¢Õß°“√™—°‡æ◊ËÕª√–°Õ∫ °“√√—°…“ ‚¥¬∑—Ë«‰ª‡ªÑ“À¡“¬¢Õß°“√√—°…“ §◊Õ‰¡à¡’Õ“°“√™—°‡≈¬ (seizure free) ‚¥¬®–欓¬“¡§«∫§ÿ¡Õ“°“√™—° „À≥â‡√Á«∑’Ë ÿ¥ ·π«∑“ß°“√√—°…“ 45 ‚√§≈¡™°—

°“√ª√–‡¡‘𧫓¡√ÿπ·√ߢÕßÕ“°“√™—°„Àâª√–‡¡‘π ‘ËßμàÕ‰ªπ’È ‰¥â·°à §«“¡∂’Ë¢Õß°“√™—° √–¬–‡«≈“¢Õß Õ“°“√™—° √–¬–‡«≈“‰¡à√⟠÷°μ—«À≈—ß™—° §«“¡∂’Ë·≈–§«“¡√ÿπ·√ߢÕßÕÿ∫—쑇Àμÿ®“°°“√™—° „π°√≥’∑’ˇÀ≈◊Õ‡æ’¬ß aura ∑’ˉ¡à¡’Õ“°“√∑“ß motor ¡—°‰¡à¡’§«“¡®”‡ªìπμâÕߧ«∫§ÿ¡„ÀâÀ“¬À¡¥ ‡æ√“– aura ¡—°®–‰¡à§àÕ¬μÕ∫ πÕßμàÕ ¬“°—π™—° πÕ°®“°π§È’ «√¡°’ “√ª√–‡¡π‘ º≈°“√√°— …“‚¥¬√«¡ (global assessment) ‡ªπì °“√¥ªŸ √– ∑‘ ∏º‘ ≈ (effectiveness) ¢Õ߬“√–À«“à ß°“√§«∫§¡ÿ Õ“°“√™°— °∫— Õ“°“√¢“â ߇§¬’ ß∑‡Ë’ °¥‘ ¢πÈ÷ μÕà §≥ÿ ¿“晫’ μ‘ ·≈– ¿“«–∑“ß®μ‘  ß— §¡(psychosocial) ¢ÕߺŸâªÉ«¬ μ≈Õ¥®π§à“√—°…“·≈–‡»√…∞“π– ´÷Ëߪ√–‡¡‘π‚¥¬ºâŸ√—°…“ √à«¡°—∫ºŸâªÉ«¬·≈–§√Õ∫§√—«¢Õߺ⟪ɫ¬ μ“√“ß∑’Ë 9 Õ“°“√‰¡àæß÷ ª√– ß§®å “°¬“ (adverse reaction) ™Õ◊Ë ¬“ º≈¢â“߇§’¬ß∑Ë’æ∫∫àÕ¬ º≈¢“â ߇§¬’ ß∑’æË ∫‰¡à∫àÕ¬·μÕà “®√πÿ ·√ß Carbamazepine §≈◊Ëπ‰ â ´÷¡ ‡¥‘π‡´ ‡ÀÁπ¿“æ´âÕπ ºπ◊Ë Stevens-Johnson syndrome, SIADH, aplastic anemia μ∫— Õ°— ‡ ∫ ‡¡¥Á ‡≈Õ◊ ¥¢“«μ”Ë Clonazepam ÕÕà π‡æ≈¬’ ß«à ß hypotonia æƒμ°‘ √√¡ °¥°“√À“¬„® (∂“â „™¬â “©¥’ ) ‡ª≈’ˬπ·ª≈ßπÈ”≈“¬·≈–‡ ¡À–¡“° Gabapentin ßà«ßπÕπ ´÷¡ ‡«’¬π»’√…– ¡—°‰¡à§àÕ¬æ∫ Lamotrigine ¡÷πßß ‡ÀÁπ¿“æ´âÕ𠇥‘π‡´ ºπ◊Ë Stevens-Johnson syndrome Levetiracetam ´÷¡ ¡÷πßß ¡—°‰¡à§àÕ¬¡’ Sodium valproate ¡Õ◊  π—Ë §≈π◊Ë ‰ â Õ“‡®¬’ π hyperammonemia μ—∫Õ—°‡ ∫, μ—∫ÕàÕπÕ—°‡ ∫ ª«¥∑âÕß º¡√à«ß πÈ”Àπ—°‡æ‘Ë¡ hyperammonemia Nitrazepam Hypotonia ß«à ß´¡÷ ‡ ¡À– π”È ≈“¬¡“° ¡°— ‰¡§à Õà ¬æ∫ ÕàÕπ‡æ≈’¬ Oxcarbazepine ¡÷πßß ßà«ß´÷¡ ‡¥‘π‡´ Hyponatremia Phenobarbital ‡¥Á°-´ÿ°´π‰¡àÕ¬Ÿà ÿ¢ æƒμ‘°√√¡‡ª≈’ˬπ·ª≈ß ºπ◊Ë Stevens-Johnson syndrome, °â“«√â“« serum sickness ºŸâ„À≠à ßà«ß´÷¡ ÕàÕπ‡æ≈’¬ ∫ÿ§≈‘°¿“懪≈’ˬπ·ª≈ß ‡§√’¬¥ Phenytoin μ“°√–μÿ° nystagmus ‡«’¬π»’√…– ºπ◊Ë Stevens-Johnson syndrome ‡ÀÁπ¿“æ´âÕπ ´÷¡ ‡¥‘π‡´ §≈◊Ëπ‰ â Õ“‡®’¬π μ—∫Õ°— ‡ ∫ ·§≈‡´¬’ ¡μ”Ë choreo-athetosis ‡Àß◊Õ°∫«¡ Àπâ“À¬“∫ hersutism  ‘«‡æ‘Ë¡¢÷Èπ ‰¢âμàÕ¡πÈ”‡À≈◊Õß‚μ∑—Ë«‰ª ‡ âπª√– “∑Õ—°‡ ∫ megaloblastic anemia (folate deficiency) Topiramate ¡÷πßß ‡¥‘π‡´ §«“¡§‘¥‡™◊ËÕߙⓠ§«“¡º‘¥ª°μ‘ π‘Ë«„π‰μ μâÕÀ‘π ‡Àß◊ËÕÕÕ°πâÕ¬ ∑“ß°“√楟 πÈ”Àπ—°≈¥ Vigabatrin ¡÷πßß ßà«ß´÷¡ §«“¡º‘¥ª°μ‘∑“ß≈“π “¬μ“ 46 ·π«∑“ß°“√√°— …“ ‚√§≈¡™°—

9. ‡ΩÑ“¥ŸÕ“°“√‰¡àæ÷ߪ√– ß§å®“°¬“ (adverse reaction) (μ“√“ß∑’Ë 9) Õ“°“√¢â“߇§’¬ß¢Õ߬“°—π™—° Õ“®·∫àßÕÕ°‰¥â‡ªìπ 3 ª√–‡¿∑ §◊Õ °. Õ“°“√‡ªìπæ‘… (toxicity) ‡°‘¥¢÷Èπ„πºâŸªÉ«¬∑ÿ°§πÀ“°‰¥â√—∫¬“„π¢π“¥∑’Ë Ÿß‡°‘π‰ª Õ“®·μ°μà“ß°—π „𧫓¡‰«¢Õß°“√‡°‘¥Õ“°“√ Õ“°“√®–À“¬‰ª‰¥â‡¡◊ËÕ≈¥¬“≈ß ·≈–‰¡à¡’§«“¡®”‡ªìπμâÕ߇ª≈’ˬπ™π‘¥¬“°—π™—° ∂ⓧ«∫§ÿ¡‰¥â ¢. Õ“°“√·æâ (idiosyncrasy) ‡°‘¥¢÷Èπ„πºŸâªÉ«¬∫“ߧπ ´÷Ë߉¡à “¡“√∂§“¥°“√≥剥â μ—«Õ¬à“߇™àπ º◊Ëπ ¡—°‡°‘¥‡¡◊ËÕ‡√‘Ë¡„™â¬“‰¡àπ“π‚¥¬‡©æ“–¿“¬„π 3  —ª¥“Àå·√° ‡¡◊ËÕ‡°‘¥¢÷Èπ·≈â«®”‡ªìπμâÕßÀ¬ÿ¥¬“∑—π∑’ ·≈– ‰¡§à «√‡√¡Ë‘ ¬“°π— ™°— ™π¥‘ „À¡®à π°«“à ºπË◊ À“¬ À“°¡Õ’ “°“√™°— ´”È √–À«“à ßπ§È’ «√殑 “√≥“°“√„™¬â “°≈¡àÿ benzodiazepine ‡ªìπ°“√™—Ë«§√“« §. Õ“°“√¢â“߇§’¬ßμàÕ∑“√°„π§√√¿å (teratogenicity) ‡°‘¥‰¥â„π¡“√¥“∑’Ë„™â¬“°—π™—°∫“ß™π‘¥ À√◊Õ¡’ ¿“«–¢“¥ “√‚ø‡≈μ (¿“§ºπ«°) 10. °“√‡ª≈Ë’¬π™π‘¥¢Õ߬“°—π™—° ‡¡◊ËÕ„Àâ°“√√—°…“¥â«¬¬“°—π™—°μ—«·√°‰ª√–¬–Àπ÷Ëß·≈â« ºâŸªÉ«¬¬—ߧߡ’ Õ“°“√™—°Õ¬Ÿà§«√§”π÷ß∂÷ß “‡Àμÿ·≈–ªí®®—¬μà“ßÊ ∑’Ë∑”„À⧫∫§ÿ¡Õ“°“√™—°‰¡à‰¥â°àÕπ ‰¥â·°à - «‘π‘®©—¬º‘¥ ‚¥¬‡©æ“–Õ“°“√º‘¥ª°μ‘∑’ˇ°‘¥‡ªìπæ—°Ê (paroxysmal disorders) ‡™àπ syncope, tics, abnormal movements, breath holding spell, hyperventilation syndrome ‡ªπì μπâ (∫∑∑’Ë 4) - ¡’ “‡Àμÿ∑’ˬ—߉¡à‰¥â√—∫°“√√—°…“ ‡™àπ ¡’°âÕπ‡π◊ÈÕßÕ° À√◊Õ¡’√Õ¬‚√§¢Õß ¡Õß´÷Ëß¡—°‰¡à§àÕ¬μÕ∫ πÕß μàÕ°“√„™â¬“ - „À⬓∑’ˉ¡à‡À¡“– ¡°—∫Õ“°“√™—°¢Õߺ⟪ɫ¬ ‡™àπ ºâŸªÉ«¬∑’Ë¡’Õ“°“√™—°·∫∫‡À¡àÕ∑’ˇªìπ™π‘¥ absence seizure ·μà„À⬓°—π™—° carbamazepine À√◊Õ phenytoin ´÷Ë߬“∑—Èß Õß™π‘¥π’ȉ¡à “¡“√∂§«∫§ÿ¡Õ“°“√™—°™π‘¥π’ȉ¥â §«√‡ª≈¬Ë’ π„À‡â ªπì sodium valproate - °‘𬓉¡à ¡Ë”‡ ¡Õ ∑”„Àâ√–¥—∫¬“°—π™—°‰¡à‡æ’¬ßæÕμàÕ°“√ªÑÕß°—πÕ“°“√™—° - ¢π“¥¬“∑’Ë„™âÕ“®®–¬—߉¡à‡æ’¬ßæÕ ∂⓺ŸâªÉ«¬¬—߉¡à¡’Õ“°“√¢â“߇§’¬ß®“°¬“ §«√®–‡æ‘Ë¡¢π“¥¢Õß ¬“®π∂÷ߢπ“¥∑’Ë·π–π” À√◊Õ®π‡√‘Ë¡¡’Õ“°“√¢â“߇§’¬ß‡°‘¥¢÷Èπ ∂â“Õ¬àŸ„π ∂“π∑’Ë∑’Ë “¡“√∂μ√«®√–¥—∫¬“‰¥â §«√μ√«® √–¥—∫¬“°àÕπ®–‡ª≈’ˬπ™π‘¥¢Õ߬“ - ¡’ªí®®—¬°√–μÿâπ„À⇰‘¥Õ“°“√™—° ‡™àπ °“√Õ¥πÕπ ¿“«–‡§√’¬¥ ´÷Ëß„πºŸâªÉ«¬∫“ß√“¬∂Ⓣ¡àÀ≈’°‡≈’Ë¬ß  ‘Ëß°√–μÿâπ‡À≈à“π’È ∂÷ß·¡â®–°‘𬓰—π™—° ¡Ë”‡ ¡Õ°Á¬—ß¡’Õ“°“√™—°‡°‘¥¢÷Èπ‰¥â ∂â“Õ“°“√™—°¢Õߺ⟪ɫ¬π—Èπ¬—ߧ«∫§ÿ¡‰¡à‰¥â ·¡â«à“®–‰¥â°”®—¥ “‡Àμÿ·≈–ªí®®—¬¥—ß°≈à“«¢â“ßμâπ·≈â« §«√æ‘®“√≥“‡ª≈’Ë¬π¬“°—π™—°™π‘¥„À¡à ´÷ËßÕ“®®–∑”‰¥â‚¥¬ - ‡ª≈’Ë¬π¬“‡ªì𬓙π‘¥∑’Ë Õß ∑’ˬ—ߧ߇ªìπ first line drug  ”À√—∫Õ“°“√™—°™π‘¥π—ÈπÊ °àÕπ ´÷ËßÕ“®®–¡’ À≈“¬«‘∏’ «‘∏’∑’Ëπ‘¬¡ªØ‘∫—μ‘ ‰¥â·°à «∏‘ ∑’ Ë’ 1 „À⬓°—π™—°™π‘¥∑’Ë 2 æ√âÕ¡°—∫¬“°—π™—°™π‘¥·√° ®π§«∫§ÿ¡Õ“°“√™—°‰¥â¥’·≈â« ®÷ßæ‘®“√≥“ ≈¥¢π“¥¬“°π— ™°— ™π¥‘ ·√°≈ßÕ¬“à ß™“â Ê ¢Õâ ¥¢’ Õß°“√ªØ∫‘ μ— ·‘ ∫∫π§È’ Õ◊ ºªŸâ «É ¬¬ß— §ß¡√’ –¥∫— ¬“Õ¬„Ÿà π therapeutic range ·μÕà “®®–¡ª’ ≠í À“‡√ÕË◊ ß drug interaction «∏‘ ∑’ Ë’ 2 ≈¥¬“™π‘¥·√°≈ß™â“Ê „π¢≥–∑’˪√—∫¬“°—π™—°™π‘¥∑’Ë Õߢ÷Èπ®π°√–∑—Ëß∂÷ß√–¥—∫∑’˧‘¥«à“ §«∫§ÿ¡Õ“°“√™—°‰¥â ¢âÕ¥’¢Õß°“√ªØ‘∫—쑇™àππ’ȧ◊Õ ®–‰¡à§àÕ¬¡’ªí≠À“„π‡√◊ËÕß drug interaction ·μ৫√√–«—ßÕ“°“√™—° ∑’ËÕ“®®–‡°‘¥¢÷Èπ∫àÕ¬„π¢≥–∑’˪√—∫‡ª≈’Ë¬π¬“ ·π«∑“ß°“√√—°…“ 47 ‚√§≈¡™°—

- „π°√≥’∑’˺⟪ɫ¬¬—ß¡’Õ“°“√™—°‡¡◊ËÕ‡ª≈’ˬπ™π‘¥¢Õ߬“°—π™—°„π first line drug ‰ª·≈â« °“√√—°…“ ¢—ÈπμàÕ‰ª§◊Õ °“√„™â combination ¢Õß first line drug À√◊ÕÕ“®®–æ‘®“√≥“°“√„™â first line drug √à«¡°—∫°“√„™â second line drug °√≥π’ §È’ «√®–∑”‡¡ÕË◊ ®”‡ªπì ‡∑“à ππÈ— ‡πÕË◊ ß®“°®–¡ª’ ≠í À“ drug interaction ‰¥ â ߟ °«“à monotherapy 11. √–«ß— ªØ°‘ √‘ ¬‘ “√–À«“à ߬“ (drug interaction) ‡¡◊ËÕ„™â¬“°—π™—°√à«¡°—π¡“°°«à“ 1 ™π‘¥¢÷Èπ‰ª À√◊Õ√à«¡°—∫ ¬“Õ◊ËπÕ“®∑”„Àâ√–¥—∫¬“‡ª≈’ˬπ·ª≈ß °àÕ„À⇰‘¥Õ“°“√™—° À√◊Õ‡°‘¥Õ“°“√¢â“߇§’¬ß‰¥â (μ“√“ß∑’Ë 10, 11) μ“√“ß∑’Ë 10 ªØ°‘ √‘ ¬‘ “√–À«“à ߬“°π— ™°— °∫— ¬“Õπ◊Ë Ê ¬“°π— ™°— ´÷Ë߇¡◊ÕË „™√â «à ¡°—π·≈«â ¡—°∑”„À√â –¥∫— ¬“ÕËπ◊ ≈¥≈ß Carbamazepine Phenobarbital Phenytoin ¬“°—π™—°´ß÷Ë ‡¡Ë◊Õ„™â√à«¡°π— ·≈â«¡—°∑”„Àâ√–¥∫— ¬“ÕπË◊ ‡æ‘Ë¡¢π÷È Sodium valproate ¬“Õ◊πË ∑¡Ë’ —°∑”„Àâ√–¥—∫¬“°—π™—°≈¥≈ß Alcohol Nicotine Oral contraceptives Steroid Phenothiazine Rifampicin ¬“Õπ◊Ë ∑Ë’¡—°∑”„À√â –¥—∫¬“°—π™°— ‡æ¡Ë‘ ¢È÷π Allopurinol Chloramphenical Cimetidine Coumadins Diltiazem ·≈– Ca-channel blocker Õπ◊Ë Ê Disulfiram Erythromycin Isoniazid Para-aminosalicylic acid Propranolol Propoxyphene Sulfa groups 48 ·π«∑“ß°“√√°— …“ ‚√§≈¡™°—

μ“√“ß∑Ë’ 11 ªØ°‘ √‘ ¬‘ “√–À«“à ߬“°π— ™°— (AED interaction) Drug Effect on other drugs Carbamazepine ↑ phenobarbital Gabapentin ↓ sodium valproate, topiramate Lamotrigine ↑↓ phenytoin Sodium valproate Phenobarbital None Phenytoin Topiramate None ↑ phenytoin (free), phenobarbital, 10,11-epoxide of carbamazepine ↓ phenytoin (total), carbamazepine ↓ carbamazepine, sodium valproate ↑↓ phenytoin ↓ carbamazepine, sodium valproate ↑ phenobarbital ↑ phenytoin ↓ sodium valproate 12. ·π«∑“ß°“√À¬ÿ¥¬“°π— ™°—  à«π„À≠à¢ÕߺŸâªÉ«¬∑’ˉ¡à¡’Õ“°“√™—°‡ªìπ√–¬–‡«≈“π“π‰¡àπâÕ¬°«à“ 2 ªï ®– “¡“√∂À¬ÿ¥√—∫ª√–∑“𬓠°—π™—°‰¥â Õ¬à“߉√°Áμ“¡ºâŸªÉ«¬®”π«πÀπ÷ËßÕ“®‡°‘¥°“√™—°´È”À≈—ßÀ¬ÿ¥¬“ ‚¥¬‡©æ“–„π√–¬–‡«≈“Àπ÷Ëß∂÷ß Õߪï·√° ∑’ËÀ¬ÿ¥¬“ À√◊ÕÕ“®®–‡°‘¥¢÷Èπ‡¡◊ËÕ„¥°Á‰¥â·¡â‚Õ°“ ®–≈¥≈߉ª‡√◊ËÕ¬Ê °Áμ“¡ °“√™—°´È”π—ÈπÕ“®°àÕ„À⇰‘¥º≈‡ ’¬¢÷È𠇙àπ Õ“®‡°‘¥Õÿ∫—쑇Àμÿ®“°°“√™—° ‡ªìπμâπ ¥—ßπ—Èπ°“√À¬ÿ¥¬“°—π™—°®÷ߧ«√„ÀâºâŸªÉ«¬·≈–≠“μ‘√à«¡„π°“√μ—¥ ‘π„® ‚¥¬æ‘®“√≥“ªí®®—¬μà“ßÊ „π°“√欓°√≥å‚Õ°“ ‡°‘¥Õ“°“√™—°´È” ·≈–«“ß·π«∑“ߪÑÕß°—π·≈–·°â‰¢º≈μà“ßÊ ∑’ËÕ“®®–‡°‘¥¢÷ÈπÀ“°™—°´È” √«¡∑—Èßæ‘®“√≥“«‘∏’°“√À¬ÿ¥¬“√à«¡°—π «‘∏’≈¥¬“°π— ™—° §«√≈¥¢π“¥≈ߧ√—Èß≈–πâÕ¬Ê „π√–¬–‡«≈“∑’ˇÀ¡“– ¡‚¥¬¬÷¥À≈—°°“√μàÕ‰ªπ’È - „Àâ≈¥¢π“¥¬“°—π™—°≈ßÕ¬à“ß™â“Ê ∑ÿ° 4-8  —ª¥“ÀåμàÕ¬“°—π™—°Àπ÷Ëß™π‘¥μàÕ§√—Èß ®π°«à“®–À¡¥ - °√≥’∑’Ë√—∫ª√–∑“𬓰—π™—°À≈“¬™π‘¥ ·π–π”„ÀâÀ¬ÿ¥¬“°—π™—°∑’≈–™π‘¥ ‚¥¬¡’·π«∑“ߪؑ∫—μ‘¥—ßπ’È 1. À¬ÿ¥¬“‡ √‘¡°àÕπ¬“À≈—° 2. ¬“∑’Ë¡’º≈¢â“߇§’¬ß Ÿß°àÕπ 3. ¬“∑’Ë¡’√“§“·æß - À“°‡°‘¥Õ“°“√™—°√–À«à“ß≈¥¬“À√◊ÕÀ¬ÿ¥¬“ §«√æ‘®“√≥“‡≈◊Õ°¬“‡¥‘¡∑’ˇ§¬„™â‰¥âº≈„π¢π“¥μË” ÿ¥ °àÕπ„π™à«ß∑’Ë≈¥À√◊ÕÀ¬ÿ¥¬“°—π™—° ·π«∑“ß°“√√—°…“ 49 ‚√§≈¡™°—

ª®í ®¬— ∑Ë’™«à ¬„π°“√欓°√≥å‚Õ°“ ‡°‘¥™°— ´È”À≈ß— À¬¥ÿ ¬“°π— ™°— ‰¥â·°à 1. ª√–‡¿∑¢Õß°≈ÿà¡Õ“°“√™—°∑’ËÕ“®‡ªìπªí®®—¬„π°“√欓°√≥å‚Õ°“ ™—°´È” ‰¥â·°à 1.1 ‚√§≈¡™—°™π‘¥∑’Ë¡’‚Õ°“ ‡°‘¥™—°´È”¡“° ‰¥â·°à Juvenile myoclonic epilepsy, Lennox-Gastaut syndrome ‡ªπì μπâ 1.2 ‚√§≈¡™°— ™π¥‘ ∑¡’Ë ‚’ Õ°“ À“¬¢“¥ ßŸ ‰¥·â °à Benign rolandic epilepsy (Benign childhood epilepsy with centro-temporal spike) 2.  “‡Àμÿ¢Õß‚√§≈¡™—° ‚√§≈¡™—°∑’Ë∑√“∫ “‡Àμÿ (remote symptomatic epilepsy) ¡’‚Õ°“ ™—°´È”‰¥â ¡“°°«“à ™π¥‘ ∑‰Ë’ ¡∑à √“∫ “‡Àμÿ (cryptogenic epilepsy) 3. §«“¡º‘¥ª°μ‘¢Õߧ≈◊Ëπ‰øøÑ“ ¡Õß ºŸâªÉ«¬∑’Ë¡’§≈◊Ëπ‰øøÑ“ ¡Õߺ‘¥ª°μ‘¡’§«“¡‡ ’ˬ߇°‘¥™—°´È”¡“°°«à“ ºŸâªÉ«¬∑’Ë¡’§≈◊Ëπ‰øøÑ“ ¡Õߪ°μ‘ 4. Õ“¬ÿ∑’ˇ√‘Ë¡‡°‘¥‚√§≈¡™—° º≈°“√»÷°…“ à«π„À≠àæ∫«à“‚√§≈¡™—°∑’ˇ√‘Ë¡‡°‘¥„π«—¬√ÿàπ¡’‚Õ°“ ‡°‘¥°“√™—°´È” ¡“°∑’Ë ÿ¥ „π¢≥–∑’Ë‚√§≈¡™—°∑’ˇ√‘Ë¡¢÷Èπ„π«—¬‡¥Á°¡’‚Õ°“ À“¬¢“¥‰¥â¡“°∑’Ë ÿ¥ ªí®®—¬„π°“√欓°√≥套߰≈à“«¡’πÈ”Àπ—°‰¡à‡∑à“°—π ªí®®—¬∑’Ë¡’§«“¡‡ ’ˬߡ“° ‰¥â·°à ª√–‡¿∑¢Õß‚√§ ≈¡™—°·≈–‚√§≈¡™—°∑’Ë¡’ “‡Àμÿ ¬‘Ëß¡’ªí®®—¬‡ ’ˬߡ“°‡∑à“„¥¬‘Ëß¡’‚Õ°“ ™—°´È”¡“°¢÷Èπ‡∑à“π—Èπ  ”À√—∫ªí®®—¬μà“ßÊ ∑’Ë —¡æ—π∏å°—∫§«“¡√ÿπ·√ߢÕß‚√§≈¡™—° ‰¥â·°à ª√–«—쑇§¬¡’ status epilepticus √–¬–‡«≈“∑’Ë¡’Õ“°“√™—° ®”π«π¢ÕßÕ“°“√™—°∑—ÈßÀ¡¥°àÕπÀ¬ÿ¥¬“ √–¬–‡«≈“∑’ˇ√‘Ë¡¬“®π°√–∑—Ëߪ≈Õ¥®“°°“√™—° ª√–«—쑇§¬™—°´È”À≈—ßÀ¬ÿ¥¬“ ª√–«—쑇§¬‰¡àμÕ∫ πÕßμàÕ¬“°—π™—°™π‘¥μà“ßÊ μâÕß„™â¬“°—π™—°¡“°°«à“Àπ÷Ëß™π‘¥ ªí®®—¬‡À≈à“π’Ȭ—߉¡à “¡“√∂ √ÿª‰¥â·πàπÕπ«à“‡ªìπªí®®—¬‡ ’ˬßμàÕ°“√‡°‘¥™—°´È”À≈—ßÀ¬ÿ¥¬“ À“°ºâŸªÉ«¬‰¡à¡’Õ“°“√™—°μ‘¥μàÕ°—π 5 ªïÀ≈—ßÀ¬ÿ¥¬“ „Àâ∂◊Õ«à“À“¬¢“¥®“°‚√§≈¡™—° 50 ·π«∑“ß°“√√—°…“ ‚√§≈¡™°—

∫∑∑’Ë 9 ·π«∑“ß°“√ªØ∫‘ —μ‘„π°“√¥·Ÿ ≈‡¥Á° ∑Ë¡’ Õ’ “°“√™—°®“°‰¢â ‡¥Á°∑’Ë¡’‰¢â·≈â«¡’Õ“°“√™—° Õ“®‡°‘¥®“° “‡Àμÿ„À≠àÊ ‰¥âÀ≈“¬ “‡Àμÿ ‡™àπ 1. Õ“°“√™—°∑’ˇ°‘¥®“°‰¢â Ÿß (febrile seizure) ‚¥¬¡’ “‡Àμÿ¢Õ߉¢â‡°‘¥®“°°“√μ‘¥‡™◊ÈÕ∑’Ë à«πÕ◊Ëπ¢Õß√à“ß°“¬ ¿“¬πÕ°√–∫∫ª√– “∑ 2. Õ“°“√™°— ∑‡’Ë °¥‘ „πºªâŸ «É ¬∑¡’Ë °’ “√쥑 ‡™Õ◊È ¿“¬„π√–∫∫ª√– “∑‡™πà ‡ªπì ‡¬Õ◊Ë À¡ÿâ  ¡ÕßÕ°— ‡ ∫À√Õ◊  ¡ÕßÕ°— ‡ ∫ 3. §«“¡º‘¥ª°μ‘∑“ß metabolic ‚¥¬¡’Õ“°“√‰¢â√à«¡¥â«¬ ‡™à𠧫“¡º‘¥ª°μ‘¢Õß ¡¥ÿ≈¢Õ߇°≈◊Õ·√à √–¥—∫ πÈ”μ“≈„π‡≈◊Õ¥μË” √–¥—∫·§≈‡´’¬¡ À√◊Õ·¡°π’‡´’¬¡„π‡≈◊Õ¥μË” √«¡∑—ÈߺŸâªÉ«¬∑’ˇªìπ toxic encephalopathy ®“° “‡Àμÿμà“ßÊ 4. ‡ªìπÕ“°“√· ¥ß§√—Èß·√°¢Õߺ⟪ɫ¬‚√§≈¡™—° ‚¥¬¡’‰¢â‡ªìπªí®®—¬°√–μÿâ𠧔®”°¥— §«“¡¢ÕßÕ“°“√™°— ∑‡Ë’ °¥‘ ®“°‰¢â Ÿß (Febrile seizure) Õ“°“√™—°∑’ˇ°‘¥®“°‰¢â Ÿß ‡°‘¥„π‡¥Á°Õ“¬ÿ√–À«à“ß 6 ‡¥◊Õπ ∂÷ß 5 ªï  à«π„À≠àæ∫„πÕ“¬ÿ√–À«à“ß 1-3 ªï ·≈– “‡Àμÿ¢Õ߉¢âμâÕ߉¡à‰¥â‡°‘¥®“°°“√μ‘¥‡™◊ÈÕ¢Õß√–∫∫ª√– “∑°≈“ß À√◊Õ®“°§«“¡º‘¥ª°μ‘¢Õß ¡¥ÿ≈ ‡°≈◊Õ·√à„¥Ê À√◊Õ “‡ÀμÿÕ◊Ëπ∑’Ë∑”„À⇰‘¥Õ“°“√™—°‰¥â Õ“°“√™—°¡—°‡°‘¥¢÷Èπ¿“¬„π 24 ™—Ë«‚¡ß·√°¢Õ߉¢â ®”·π° ÕÕ°‰¥â‡ªìπ 1. Simple febrile seizure À¡“¬∂÷ß Õ“°“√™—°∑’ˇªìπ·∫∫ generalized seizure (generalize tonic clonic À√◊Õ generalized tonic) ‡°‘¥¢÷Èπ‡ªìπ™à«ß —Èπ‰¡à‡°‘π 15 π“∑’ ( à«π„À≠à‰¡à‡°‘π 5 π“∑’) ‰¡à¡’§«“¡º‘¥ª°μ‘¢Õß°“√μ√«® ∑“ß√–∫∫ª√– “∑À≈—ßÕ“°“√™—°·≈–‰¡à¡’Õ“°“√™—°´È”„π 24 ™—Ë«‚¡ß 2. Complex febrile seizure À¡“¬∂÷ßÕ“°“√™—°√à«¡°—∫‰¢â ‚¥¬∑’ËÕ“°“√™—°π—ÈπÕ“®‡°‘¥‡©æ“–∑’ËÀ√◊Õ‡ªìπ Õ“°“√™—°∑’Ë¡’√–¬–‡«≈“π“π°«à“ 15 π“∑’ À√◊Õ¡’§«“¡º‘¥ª°μ‘√–∫∫ª√– “∑¡“°àÕπÀ√◊Õ‡°‘¥¢÷Èπμ“¡¡“¿“¬À≈—ß Õ“°“√™—° À√◊Õ‡ªìπÕ“°“√™—°∑’ˇ°‘¥´È”„π 24 ™—Ë«‚¡ß √–∫“¥«‘∑¬“ °“√™—°∑’ˇ°‘¥®“°‰¢â‡ªìπªí≠À“∑’Ëæ∫‰¥â∫àÕ¬„π‡¥Á° ®“°°“√»÷°…“„πμà“ߪ√–‡∑»æ∫«à“¡’Õÿ∫—μ‘°“√≥å√âÕ¬≈– 2-5 „π°≈¡àÿ ª√–™“™π°Õà 𫬗 ‡√¬’ π ·π«∑“ß°“√√—°…“ 51 ‚√§≈¡™°—

欓∏°‘ ”‡π‘¥ ªí®®ÿ∫—ππ’Ȭ—߉¡à‰¥â¢âÕ √ÿª·πàπÕπ‡°’Ë¬«°—∫°≈‰°‡©æ“–¢ÕßÕ“°“√™—°®“°‰¢â ¡’¢âÕ¡Ÿ≈¬◊π¬—π«à“¡’§«“¡ ‡°’ˬ«¢âÕß°—∫æ—π∏ÿ°√√¡ ∑—Èßπ’ȇ¥Á°∑’ˇ°‘¥„π§√Õ∫§√—«∑’Ë¡’ª√–«—μ‘¡’Õ“°“√™—°®“°‰¢â ®–¡’‚Õ°“ ™—°®“°‰¢â¡“°°«à“ ‡¥°Á ∑‰Ë’ ¡¡à ª’ √–«μ— §‘ √Õ∫§√«— ·≈–æ∫«“à  ∫◊ ∑Õ¥∑“ßæπ— ∏°ÿ √√¡‡ªπì ·∫∫ multifactorial À√Õ◊ autosomal dominant 欓°√≥å‚√§ Õ—πμ√“¬∑’ˇ°‘¥®“°°“√™—°®“°‰¢â ŸßπâÕ¬¡“° ·≈–‰¡à∑”„À⇰‘¥ ¡Õßæ‘°“√À√◊Õ‡ ’¬ cognitive function ¿“¬À≈—ßÕ“°“√™—° ∂÷ß·¡â®–‡ªìπ febrile status epilepticus §«“¡ “¡“√∂„π°“√‡√’¬π æƒμ‘°√√¡ ·≈–‡™“«åªí≠≠“ (IQ) ‰¡à·μ°μà“ß®“°‡¥Á°∑’ˉ¡à‡§¬¡’Õ“°“√™—°®“°‰¢â¡“°àÕπ ·≈–æ—≤π“°“√¢Õ߇¥Á°°Á‰¡à·μ°μà“ß®“°æ’ËπâÕß∑’ˉ¡à¡’ Õ“°“√™—°®“°‰¢â Õ“°“√™°— ®“°‰¢‡â °¥‘ ´È”‰¥â ª√–¡“≥√Õâ ¬≈– 30-40 ¢Õ߇¥°Á ∑™’Ë °— ®“°‰¢§â √ß—È ·√° ·≈–ª√–¡“≥√Õâ ¬≈– 10 ‡∑“à ππ—È ∑’Ë®–‡°‘¥Õ“°“√™—°´È”‡°‘π 3 §√—Èß ªí®®—¬‡ ’ˬß∑’Ëæ∫«à“‡°’ˬ«¢âÕß°—∫°“√‡°‘¥Õ“°“√™—°´È”®“°‰¢â∑’Ë ”§—≠ §◊Õ 1. °“√¡’ª√–«—μ‘™—°®“°‰¢â Ÿß„π§√Õ∫§√—« 2. ™—°®“°‰¢â ßŸ §√—Èß·√°°àÕπÕ“¬ÿ 18 ‡¥◊Õπ ®–¡’§«“¡‡ ’ˬ߇√◊ËÕß°“√™—°´È”‡æ‘Ë¡¡“°¢÷Èπ∂÷ß√âÕ¬≈– 50 3. Õ“°“√™—°‡°‘¥À≈—ß®“°‡√‘Ë¡¡’‰¢â„π√–¬–∑’Ë —Èπ¡“° ‡™àπ ™—°¿“¬„π™—Ë«‚¡ß·√°¢Õ߉¢â ®–‡°‘¥™—°´È” ‰¥â∫àÕ¬°«à“°≈ÿà¡¡’‰¢â ŸßÕ¬àŸπ“π 4. Õ“°“√™—°∑’ˉ¢â‰¡à Ÿß¡“° À√◊Õ°“√¡’‰¢â∫àÕ¬Ê À≈—ß®“°∑’Ë¡’Õ“°“√™—°®“°‰¢â§√—Èß·√° °Á®–¡’‚Õ°“ ‡ ’ˬßμàÕ °“√‡°‘¥™—°´È”¡“°¢÷Èπ ®“°°“√»÷°…“æ∫«à“∂â“¡’ªí®®—¬‡ ’ˬßÀ≈“¬ª√–°“√®–¬‘Ëß¡’‚Õ°“ ∑’Ë®–‡°‘¥Õ“°“√™—°´È” ‡¥Á°∑’ˉ¡à¡’ªí®®—¬ ‡ ¬Ë’ ß®–¡‚’ Õ°“ ™°— ´”È ‡æ¬’ ß√Õâ ¬≈– 10-15 ‡∑“à ππÈ— Complex febrile seizure ·≈– febrile status epilepticus „π‡¥Á°∑’˪°μ‘¥’¡“°àÕπ∑’Ë®–‡°‘¥Õ“°“√™—°®“°‰¢â ‰¡à∑”„À⇰‘¥°“√™—°´È”¡“°°«à“ simple febrile seizure °“√‡°¥‘ ‡ªπì ‚√§≈¡™—°¿“¬À≈—ß∑’¡Ë ’Õ“°“√™—°®“°‰¢â ‡¥Á°ª°μ‘∑’Ë™—°®“°‰¢â Ÿß¡’‚Õ°“ ‡°‘¥‡ªìπ‚√§≈¡™—°¿“¬À≈—ß √âÕ¬≈– 1-3 ‚¥¬¡’ªí®®—¬‡ ’ˬßμàÕ‰ªπ’È 1. °“√¡’ª√–«—쑧√Õ∫§√—«‡ªìπ‚√§≈¡™—°‚¥¬‰¡à∑√“∫ “‡Àμÿ 2. °“√¡’§«“¡º‘¥ª°μ‘¢Õß√–∫∫ª√– “∑°àÕπÀ√◊ÕÀ≈—߇°‘¥¡’Õ“°“√™—°®“°‰¢â 3. ‡¥Á°∑’Ë¡’Õ“°“√™—°®“°‰¢â´÷Ëß®—¥Õ¬Ÿà„π°≈ÿà¡ complex febrile seizure °“√¥·Ÿ ≈ºªâŸ É«¬∑’¡Ë ’Õ“°“√™°— ®“°‰¢â ßŸ §√È—ß·√° 1. „π°√≥’∑’ˇ¥Á°°”≈—ß¡’Õ“°“√™—°Õ¬àŸ„Àâ°“√√—°…“‡∫◊ÈÕßμâπ‡™àπ‡¥’¬«°—∫°“√™—°∑’ˇ°‘¥∑—Ë«Ê ‰ª §◊Õ§≈“¬ ‡ ◊ÈÕºâ“∑’Ë√—¥ÕÕ°®“°μ—«‡¥Á° ®—∫πÕπμ–·§ß„Àâ»’√…–μË”‡æ◊ËÕ‰¡à„Àâ ”≈—°‡ ¡À–‡¢â“ªÕ¥ ·≈–¥Ÿ∑“߇¥‘πÀ“¬„®„À⥒ ‚¥¬‰¡àμâÕß„™â«— ¥ÿ„¥Ê ß—¥ª“°À√◊Õ„À⬓∑“ߪ“° „π‡«≈“‡¥’¬«°—π√’∫‡™Á¥μ—«‡æ◊ËÕ∑”„À≢â≈¥≈ß‚¥¬‡√Á« ‚¥¬°“√ „™âºâ“™ÿ∫πÈ”ª√–ª“ (¿“§ºπ«° Àπâ“ 62) ‡¡◊ËÕ¡’Õ“°“√™—°π“π (‡™àπ‡°‘π 5 π“∑’) ‡μ√’¬¡¬“ diazepam ‡æ◊ËÕ√–ß—∫ Õ“°“√™—°‚¥¬„Àâ∑“ßÀ≈Õ¥‡≈◊Õ¥¥” (0.2-0.3 ¡‘≈≈‘°√—¡/°°. μàÕ§√—Èß) À√◊Õ∑“ß∑«“√Àπ—° (0.5 ¡‘≈≈‘°√—¡/°°. μàÕ§√—Èß) 52 ·π«∑“ß°“√√°— …“ ‚√§≈¡™°—

·μà‰¡à‡°‘π 10 ¡‘≈≈‘°√—¡μàÕ§√—Èß „Àâ´È”‰¥â∑ÿ° 6-8 ™—Ë«‚¡ß ∂â“®”‡ªìπ „π°√≥’∑’Ë™—°´È”„π‡«≈“πâÕ¬°«à“ 6 ™—Ë«‚¡ß  “¡“√∂ „À⬓´È”‰¥â ·μàμâÕߥŸ·≈Õ¬à“ß„°≈♑¥‚¥¬‡©æ“–°“√¥Ÿ·≈≈¥‰¢â„À≥âº≈ ∂â“™—°∂’Ë¡“°„Àâæ‘®“√≥“°“√√—°…“·∫∫ status epilepticus (∫∑∑’Ë 7) 2. ‡¡◊ËÕÀ¬ÿ¥™—°√’∫´—°ª√–«—쑇æ‘Ë¡‡μ‘¡ ·≈–μ√«®ª√–‡¡‘π√à“ß°“¬∑—Èß√–∫∫∑—Ë«‰ª ·≈–√–∫∫ª√– “∑‡æ◊ËÕÀ“  “‡Àμÿ¢Õ߉¢â 3. ·π–π”„Àâμ√«®«‘‡§√“–ÀåπÈ”‰¢ —πÀ≈—ß∑ÿ°√“¬„π‡¥Á°‡≈Á° (Õ“¬ÿμË”°«à“ 18 ‡¥◊Õπ) ∂Ⓣ¡à¡’¢âÕÀâ“¡ ‡æ√“–Õ“°“√· ¥ß∑’Ë®–∫àß∫Õ°∂÷ß°“√μ‘¥‡™◊ÈÕ¢Õß√–∫∫ª√– “∑„π√–¬–·√°¢Õ߇¥Á°‡≈Á°Õ“®‰¡à™—¥‡®π  ”À√—∫‡¥Á°∑’ËÕ“¬ÿ¡“°°«à“ 18 ‡¥◊Õπ ∂⓺Ÿâμ√«®ª√–‡¡‘π·≈–¡—Ëπ„®«à“ °“√™—°π—Èπ‰¡à‰¥â‡°‘¥®“°°“√μ‘¥‡™◊ÈÕ ¢Õß√–∫∫ª√– “∑ °“√μ√«®«‘‡§√“–ÀåπÈ”‰¢ —πÀ≈—ßÕ“®‰¡à®”‡ªìπ‚¥¬æ‘®“√≥“‡ªìπ√“¬Ê ‰ª ´÷Ëß„π°√≥’π’ȧ«√®– μâÕß¡’°“√ª√–‡¡‘πºŸâªÉ«¬´È”Õ¬à“ß„°≈♑¥ °≈à“«§◊Õ∂⓬—ߧߡ’‰¢âÕ¬àŸ√à«¡°—∫¡’Õ“°“√À√◊ÕÕ“°“√· ¥ß∑’Ë ß —¬«à“ ®–¡’°“√μ‘¥‡™◊ÈÕ¢Õß√–∫∫ª√– “∑ ‰¥â·°à Õ“°“√´÷¡ Õ“‡®’¬π ‰¡à¥Ÿ¥π¡ ßÕ·ß ‰¡à‡≈àπμ“¡ª°μ‘ ¡’Õ“°“√™—°´È” μ√«®√à“ß°“¬¡’Õ“°“√· ¥ß«à“¡’§«“¡º‘¥ª°μ‘¢Õß√–∫∫ª√– “∑ ‰¥â·°à °√–À¡àÕ¡Àπâ“‚ªÉßμ÷ß §Õ·¢Áß positive Brudzinskiûs À√Õ◊ Kernig sign ·π–π”„Àμâ √«®«‡‘ §√“–Àπå ”È ‰¢ π— À≈ß— ‚¥¬‡√«Á 4. °“√μ√«®‡≈◊Õ¥‡æ◊ËÕÀ“§«“¡º‘¥ª°μ‘∑“ß metabolic (blood sugar, electrolytes, calcium, ·≈– magnesium) §«√∑”‡©æ“–„π√“¬∑’Ë¡’Õ“°“√™—°´È”À√◊Õ¡’Õ“°“√´÷¡ À√◊Õ¡’¢âÕ∫àß™’È ‡™àπ °‘π‰¡à‰¥â Õ“‡®’¬π ‡ªìπμâπ „π°√≥’∑’Ëμ√«®«‘‡§√“–ÀåπÈ”‰¢ —πÀ≈—ßμâÕßμ√«® blood sugar ‡æ◊ËÕ‡ª√’¬∫‡∑’¬∫ 5. ¬—߉¡à®”‡ªìπ∑’Ë®–μâÕß∑”°“√μ√«®§≈◊Ëπ‰øøÑ“ ¡Õß ¬°‡«âπ„π°√≥’∑’Ë¡’ª√–«—μ‘‚√§≈¡™—°„π§√Õ∫§√—« ·≈–¡°’ “√™°— ´”È ¿“¬À≈ß— (recurrence) 6. ‰¡à®”‡ªìπμâÕßμ√«®∑“ß√—ß ’«‘∑¬“¢Õß ¡Õß ‡™àπ ‡Õ°´‡√¬å°–‚À≈°»’√…– ·≈– CT scan 7. μ√«®·≈–√—°…“ “‡Àμÿ∑’Ë∑”„À⇰‘¥¡’Õ“°“√‰¢â 8. °“√√—°…“¿“¬À≈—ßÕ“°“√™—°‰¡à®”‡ªìπμâÕß„À⬓°—π™—°‡æ‘Ë¡‡μ‘¡ ¥Ÿ·≈‡¡◊ËÕ¡’‰¢â ¥â«¬°“√√’∫√—°…“ “‡Àμÿ „À⬓≈¥‰¢â ‡™Á¥μ—«·≈–„ÀâπȔլà“߇撬ßæÕ ¡Ë”‡ ¡Õ °“√·π–π”ºªŸâ °§√Õß 1. Õ∏∫‘ “¬„Àºâ ªŸâ °§√Õ߇¢“â „®«“à Õ“°“√™°— ®“°‰¢â „π™«à ߇«≈“ πÈ— Ê ®–‰¡°à Õà „À‡â °¥‘ Õπ— μ√“¬μÕà √–∫∫ª√– “∑ ·≈–μâÕß·π–π”ºâŸª°§√Õß„Àâ¡’∑—°…–„π°“√¥Ÿ·≈‡∫◊ÈÕßμâπ∑’Ë∂Ÿ°μâÕß∂â“¡’Õ“°“√‰¢â§√—ÈßμàÕ‰ª‚¥¬„Àâ°“√¥Ÿ·≈„°≈♑¥ μ—Èß·μà‡√‘Ë¡¡’‰¢â ¥â«¬°“√„À⬓≈¥‰¢â À¡—Ëπ‡™Á¥μ—«≈¥‰¢â (¿“§ºπ«°Àπâ“ 62) ‡¡◊ËÕ‰¢â¡’·π«‚πâ¡®– Ÿß¡“° §«√¥◊Ë¡πÈ” „Àâ‡æ’¬ßæÕ μ—Èß·μà√–¬–·√° æ√âÕ¡°—∫𔇥Á°‰ªæ∫·æ∑¬å‡æ◊ËÕμ√«®√—°…“ “‡Àμÿ¢Õ߉¢â 2. „À⧔·π–π”„π°“√¥Ÿ·≈‡∫◊ÈÕßμâπ°√≥’∑’ˇ¥Á°°”≈—ß¡’Õ“°“√™—°‡™àπ‡¥’¬«°—∫°“√™—°∑’ˇ°‘¥∑—Ë«Ê ‰ª §◊Õ §≈“¬‡ ◊ÈÕºâ“∑’Ë√—¥ÕÕ°®“°μ—«‡¥Á° ®—∫πÕπμ–·§ß„Àâ»’√…–μË”‡æ◊ËÕ‰¡à„Àâ  ”≈—°‡ ¡À–‡¢â“ªÕ¥ ·≈–¥Ÿ∑“߇¥‘πÀ“¬„® „À⥒‚¥¬‰¡àμâÕß„™â«— ¥ÿ„¥Ê ß—¥ª“°À√◊Õ„À⬓∑“ߪ“° „π‡«≈“‡¥’¬«°—π√’∫‡™Á¥μ—«‡æ◊ËÕ∑”„À≢â≈¥≈ß‚¥¬‡√Á« ‚¥¬°“√ „™âºâ“™ÿ∫πÈ”ª√–ª“ ‡¡◊ËÕ¡’Õ“°“√™—°π“π (‡™àπ‡°‘π 5 π“∑’) „Àâπ” àß‚√ß欓∫“≈ °“√¥·Ÿ ≈ºâŸª«É ¬∑’¡Ë Õ’ “°“√™—°®“°‰¢â¡“°°«“à 1 §√È—ß Recurrent simple febrile seizure ¥Ÿ·≈‡™àπ‡¥’¬«°—∫∑’Ë¡’Õ“°“√™—°®“°‰¢â§√—Èß·√° ¬°‡«âπ‡√◊ËÕß°“√μ√«® πÈ”‰¢ —πÀ≈—ß ·≈–μ√«®‡≈◊Õ¥À“§«“¡º‘¥ª°μ‘∑“ß metabolic μà“ßÊ §«√®–∑”‡©æ“–„π√“¬∑’Ë¡’¢âÕ∫àß™’È ·π«∑“ß°“√√—°…“ 53 ‚√§≈¡™°—

Recurrent complex febrile seizure „πºŸâªÉ«¬∑’Ë™—° focal À√◊Õμ√«®√à“ß°“¬¡’ neurological deficit §«√æ‘®“√≥“μ√«®§≈◊Ëπ‰øøÑ“ ¡Õß À“°Õ∏‘∫“¬„ÀâºâŸª°§√Õß∑√“∫¢âÕ¡Ÿ≈μ“¡∑’Ë°≈à“«¢â“ßμâπ·≈â« ·μàºâŸª°§√Õ߬—ߧ߫‘μ°°—ß«≈·≈–‰¡à¡—Ëπ„® „π°“√¥Ÿ·≈‡¡◊ËÕ¡’‰¢â Õ“®®–„À⬓ªÑÕß°—πÕ“°“√™—°‡ªìπ§√—Èߧ√“«„π™à«ß¡’‰¢â¢÷Èπ ‰¥â·°à diazepam ™π‘¥√—∫ª√–∑“π ¢π“¥ 0.75-1 ¡‘≈≈‘°√—¡/°°./«—π ·∫àß„Àâ∑ÿ° 6-8 ™—Ë«‚¡ß „π 24 ™—Ë«‚¡ß·√°¢Õ߉¢â‡∑à“π—Èπ ∑—Èßπ’ÈμâÕߥ·Ÿ ≈‡√◊ËÕß°“√≈¥‰¢â √à«¡¥â«¬ ‰¡à·π–π”„Àâ„™â phenobarbital ·≈– sodium valproate „π°“√ªÑÕß°—πÕ“°“√™—°´È”∑’ˇ°‘¥®“°‰¢â ·¡â¢âÕ¡Ÿ≈ ∑“ß«‘™“°“√‰¥â· ¥ß«à“ ¬“∑—Èß Õß™π‘¥ Õ“®®–≈¥Õ“°“√™—°´È”®“°‰¢â‰¥â ·μà¡’º≈¢â“߇§’¬ßμàÕ‡¥Á° ·≈–¬—߉¡à  “¡“√∂ªÑÕß°—π°“√‡°‘¥‚√§≈¡™—°„π¿“¬À≈—ß 54 ·π«∑“ß°“√√°— …“ ‚√§≈¡™°—

∫∑∑’Ë 10 Infantile spasms & West syndrome Infantile spasms §◊ÕÕ“°“√™—°∑’Ë¡’≈—°…≥–º«“‡ªìπ™ÿ¥Ê æ∫‰¥â‡©æ“–„π∑“√°·≈–‡¥Á°‡≈Á° ‰¡àæ∫„π‡¥Á°‚μ ·≈–ºâŸ„À≠à Õ“®®–¡’ “‡Àμÿ‡©æ“–À√◊Õ‰¡à¡’ “‡Àμÿ·πà™—¥ ¡—°‰¡àμÕ∫ πÕßμàÕ°“√√—°…“ ºâŸªÉ«¬ à«π„À≠à¡’§«“¡ º‘¥ª°μ‘¢Õß√–∫∫ª√– “∑√ÿπ·√ß West syndrome ‡ªìπ°≈ÿà¡Õ“°“√™—°∑’Ë¡’Õߧåª√–°Õ∫ 3 ª√–°“√ ‰¥â·°à 1. Õ“°“√™—°≈—°…≥–·∫∫ infantile spasms 2. æ—≤π“°“√™â“ 3. §≈π◊Ë ‰øø“Ñ  ¡Õß∑‡’Ë ªπì ·∫∫ hypsarrhythmia ªí®®ÿ∫—π‰¥â¡’§«“¡æ¬“¬“¡∑’Ë®–¡’°“√°”Àπ¥·π«∑“ß„π°“√«‘π‘®©—¬Õ“°“√™—°·∫∫ infantile spasms „Àâ ™—¥‡®π¢÷Èπ ‡π◊ËÕß®“°ºŸâªÉ«¬∫“ߧπ¡’Õ“°“√™—°§≈⓬§≈÷ß°—∫°“√™—°·∫∫ myoclonic ´÷Ëß∑”„Àâ¡’ªí≠À“„π°“√‡≈◊Õ°„™â ¬“°—π™—°·≈–欓°√≥å‚√§ ¢≥–π’Ȭ—߉¡à¡’¢âÕ √ÿª∑’Ë¡’§«“¡‡ÀÁπæâÕß°—π (consensus) ¥—ßπ—Èπ®÷ßÕ“»—¬°“√«‘π‘®©—¬μ“¡ ≈°— …≥–Õ“°“√¥ß— °≈“à «¢“â ßμπâ μ“¡·π«∑“ߢÕß International League Against Epilepsy (ILAE) 1989 √–∫“¥«‘∑¬“ Õÿ∫—μ‘°“√≥å¢Õß infantile spasms „πμà“ߪ√–‡∑»¡’ª√–¡“≥ 2.9-4.5/100,000 ¢Õß∑“√°‡°‘¥¡’™’æ „πª√–‡∑»‰∑¬¡’√“¬ß“π°“√»÷°…“„π referral center æ∫«à“¡’ºâŸªÉ«¬ infantile spasms √âÕ¬≈– 4.9 ¢ÕߺŸâªÉ«¬‚√§ ≈¡™—°∑’Ë√—∫‰«â√—°…“„π‚√ß欓∫“≈ Õ“°“√™—°æ∫‰¥âμ—Èß·μà«—¬∑“√°®π∂÷ßÕ“¬ÿ 2 ªï ºŸâªÉ«¬ à«π„À≠à®–‡√‘Ë¡¡’Õ“°“√™—° √–À«“à ßÕ“¬ÿ 3-7 ‡¥Õ◊ π ≈—°…≥–Õ“°“√·≈–Õ“°“√· ¥ß Õ“°“√™°— ·∫∫ infantile spasms Õ“®®–‡°¥‘ ‰¥â 3 √ªŸ ·∫∫ §Õ◊ ·∫∫ßÕμ«— (flexion) ·∫∫‡À¬¬’ ¥μ«— (extension) À√◊Õ·∫∫º ¡º “π (mixed flexion and extension) ºŸâªÉ«¬ à«π„À≠à®–æ∫·∫∫º ¡º “π Õ“°“√™—°∑’ˇ°‘¥®–‡ªìπ ™ÿ¥Ê Õ“®®–¡’°“√ à߇ ’¬ß√âÕߢ≥–™—° À√◊ÕÕ“®®–¡’Õ“°“√‡°√Á߇À¬’¬¥·≈⫇°‘¥Õ“°“√°√–μÿ°‡ªìπ™ÿ¥Ê μ“¡¡“ „π∫“ߧ√—ÈßÕ“®®–¡’Õ“°“√쓧â“߇°‘¥¢÷Èπæ√âÕ¡Ê °—∫¡’Õ“°“√°√–μÿ° ≈—°…≥–Õ“°“√™—°Õ“®®–‡°‘¥∑’ˇ©æ“– à«π ¢Õß√à“ß°“¬ À√◊ÕÕ“®®–¡’°“√°√–μÿ°„π≈—°…≥–‰¡à ¡¡“μ√ (asymmetry) ‰¥â ´÷ËßÕ“®®–∑”„Àâ —∫ π°—∫Õ“°“√™—° ™π‘¥Õ◊ËπÊ ·π«∑“ß°“√√—°…“ 55 ‚√§≈¡™°—

 “‡Àμÿ Õ“°“√™—°™π‘¥π’È®”·π°‡ªìπ°≈ÿà¡∑’Ë∑√“∫ “‡Àμÿ (symptomatic) ·≈–°≈ÿà¡∑’Ëμ√«®‰¡àæ∫ “‡Àμÿ (idiopathic/ cryptogenic) ºªŸâ «É ¬√Õâ ¬≈– 60-90 ®–¡§’ «“¡º¥‘ ª°μ¢‘ Õß√–∫∫ª√– “∑ ‰¥·â °à - Developmental anomaly/congenital malformation ‡™πà lissencephaly, cortical dysplasia, polymicrogyria, schizencephaly ‡ªπì μπâ ´ßË÷ æ∫‰¥√â Õâ ¬≈– 30 - §«“¡º¥‘ ª°μ∑‘ ¡’Ë º’ ≈μÕà √–∫∫ª√– “∑∑‡’Ë °¥‘ √–À«“à ß°“√μß—È §√√¿å √–À«“à ß°“√§≈Õ¥ À√Õ◊ ¿“¬À≈ß— °“√§≈Õ¥ ‡™àπ °“√μ‘¥‡™◊ÈÕ (sepsis, meningitis) ¿“«– ¡Õߢ“¥ÕÕ°´‘‡®π (hypoxic ischemic encephalopathy) ¿¬—πμ√“¬μàÕ √–∫∫ª√– “∑ ‡™àπ °“√∑’Ë¡’‡≈◊Õ¥ÕÕ°„π ¡Õß - ‚√§ tuberous sclerosis ´ßË÷ ‡ªπì ‚√§√–∫∫ª√– “∑√«à ¡°∫— ¡§’ «“¡º¥‘ ª°μ¢‘ Õߺ«‘ Àπß— (°≈¡àÿ Õ“°“√ neurocu- taneous) æ∫«à“¡’Õ“°“√™—°·∫∫ infantile spasms ‰¥â∂÷ß√âÕ¬≈– 50 - §«“¡∫°æ√Õà ߢÕß metabolism ‡™πà maple syrup urine disease, phenylketonuria - °≈ÿà¡‚√§∑’Ë¡’°“√‡ ◊ËÕ¡¢Õß√–∫∫ª√– “∑ (neurodegenerative disease) ‡ªì𠓇Àμÿ∑’Ëæ∫‰¥âπâÕ¬ °“√«‘π‘®©—¬ Õ“»—¬ª√–«—μ‘·≈–≈—°…≥–Õ“°“√™—°‡ªìπÀ≈—° ‚¥¬∑—Ë«‰ª«‘π‘®©—¬‰¥â‰¡à¬“°·μà„π∫“ß°√≥’∑’ËÕ“°“√º‘¥√ªŸ ·∫∫ (atypical presentation) §«√ ßà μ√«®§≈πË◊ ‰øø“Ñ  ¡Õß√«à ¡°∫— °“√∫π— ∑°÷ «¥’ ∑’ »— π®å –™«à ¬„π°“√«π‘ ®‘ ©¬— „À∂â °Ÿ μÕâ ß¡“°¢πÈ÷ °“√´—°ª√–«—μ‘·≈–°“√μ√«®√à“ß°“¬Õ¬à“ß≈–‡Õ’¬¥™à«¬∫Õ° “‡Àμÿ¢Õß°“√™—°‰¥â ‡™àπ ª√–«—μ‘°“√μ‘¥‡™◊ÈÕ ¢Õß√–∫∫ª√– “∑ ª√–«—μ‘°“√§≈Õ¥∑’Ë≈”∫“°´÷ËßÕ“®®–∫àß∫Õ°∂÷ß°“√‡°‘¥¿“«– ¡Õߢ“¥‡≈◊Õ¥ ‡ªìπμâπ °“√μ√«® √à“ß°“¬‚¥¬‡©æ“–º‘«Àπ—߇æ◊ËÕÀ“√Õ¬‚√§ ‡™àπ hypopigmented macule ´÷Ëßæ∫‰¥â„π‚√§ tuberous sclerosis °“√μ√«®æ∫√à“ß°“¬ Õß´’°∑’ˉ¡à‡∑à“°—π∫àß∫Õ°∂÷ß ¡Õß Õß´’°‡μ‘∫‚μ‰¡à‡∑à“°—π  ‘Ë߇À≈à“π’È®–™à«¬„π°“√®”·π° °≈ÿà¡∑’Ë¡’ “‡Àμÿ‡©æ“– (symptomatic) ÕÕ°®“°°≈ÿà¡∑’ˉ¡à¡’ “‡Àμÿ (idiopathic) À√◊Õμ√«®‰¡àæ∫ “‡Àμÿ·πàπÕπ (cryptogenic) ´÷Ëß„π°√≥’∑’Ëμ√«®‰¡àæ∫§«“¡º‘¥ª°μ‘„¥Ê °ÁÕ“®®”‡ªìπμâÕß¡’°“√μ√«®∑“ß√—ß ’«‘∑¬“‡æ‘Ë¡‡μ‘¡ °“√μ√«®∑“ß√—ß ’«‘∑¬“®–™à«¬„π°“√«‘π‘®©—¬§«“¡º‘¥ª°μ‘¢Õß√–∫∫ª√– “∑ ‡Õ°´‡√¬å°–‚À≈°»’√…– ‰¡à™à«¬„π°“√«‘π‘®©—¬ °“√μ√«® CT scan ¢Õß ¡Õߙ૬·¬°°≈ÿà¡ “‡Àμÿ ‡™àπ anomaly, infarction, vascular disease, brain tumor ∫“ß‚√§‰¥â·μଗ߉¡à≈–‡Õ’¬¥‡æ’¬ßæÕ∑’Ë®–„Àâ¢âÕ √ÿª«à“‰¡à¡’ “‡Àμÿ‰¥â Õ“®®”‡ªìπμâÕßμ√«®¥â«¬ MRI ´÷Ëß®–™à«¬‡æ‘Ë¡¢âÕ¡Ÿ≈¢Õߧ«“¡º‘¥ª°μ‘·≈–™à«¬„π°“√欓°√≥å‚√§‰¥â¥â«¬ ·μଗߧߡ’¢âÕ®”°—¥„π°“√μ√«®‡π◊ËÕß®“° √“§“·æß ·≈–‰¡à “¡“√∂∑”‰¥â„π∑ÿ°∑’Ë  ”À√—∫°“√μ√«®∑“ßÀâÕߪؑ∫—μ‘°“√„™â·π«∑“߇¥’¬«°—π°—∫°“√μ√«® „πºâŸªÉ«¬‡¥Á°∑’Ë¡’Õ“°“√™—° °“√«‘π‘®©¬— ·¬°‚√§ °“√™—°·∫∫ infantile spasms ®–¡’≈—°…≥–Õ“°“√∑’ˇ°‘¥™—¥‡®π Õ¬à“߉√°Áμ“¡§«√μâÕß·¬°®“°Õ“°“√ –¥ÿâß (startle) Õ“°“√ßÕμ—«√à«¡°—∫°“√√âÕßÕ“®®–æ∫‰¥â„π colic À√◊Õ gastro-esophageal reflux ´÷Ëß “¡“√∂Õ“»—¬ª√–«—μ‘ „π°“√«‘π‘®©—¬·¬°‚√§ πÕ°®“°π’ÈμâÕß®”·π°®“°°≈ÿà¡Õ“°“√™—°Õ◊ËπÊ ´÷ËßÕ“®¡’≈—°…≥–™—°·∫∫ myoclonic 56 ·π«∑“ß°“√√°— …“ ‚√§≈¡™°—

°“√√°— …“ „πª®í ®∫ÿ π— π¬È’ ß— ‰¡¡à ¢’ Õâ  √ªÿ „π°“√„™¬â “·μ≈à –™π¥‘ „π°“√√°— …“ infantile spasms ¬“À≈°— ∑„Ë’ ™„â π°“√√°— …“§Õ◊ ACTH ·≈–¬“ vigabatrin ∑—ÈߌÕ√å‚¡π·≈–¬“ “¡“√∂§«∫§ÿ¡Õ“°“√™—°‰¥âº≈„°≈⇧’¬ß°—π §◊Õª√–¡“≥√âÕ¬≈– 60 ·μà¡’º≈¢â“߇§’¬ß·μ°μà“ß°—π §◊Õ°≈ÿà¡ ACTH ®–°¥¿Ÿ¡‘μâ“π∑“π¢Õß√à“ß°“¬´÷Ëß®–‡æ‘Ë¡§«“¡‡ ’ˬßμàÕ°“√μ‘¥‡™◊ÈÕ ¢≥–∑’ˬ“ vigabatrin Õ“®®–¡’º≈μàÕ myelin ‡°‘¥¿“«– myelinolysis ‰¥â·≈–Õ“®∑”„À⇰‘¥§«“¡º‘¥ª°μ‘¢Õß≈“π  “¬μ“·∫∫∂“«√ (permanent visual field defect) ‡π◊ËÕß®“°‰¡à¡’ ACTH ®”Àπà“¬„πª√–‡∑»‰∑¬ ¥—ßπ—Èπ®÷ß·π–π” „Àâ„™â vigabatrin „π°“√√—°…“·μàμâÕßÕ∏‘∫“¬„À⺟⪰§√Õ߇¢â“„®·≈–¬Õ¡√—∫º≈¢â“߇§’¬ß∑’ËÕ“®‡°‘¥‚¥¬‡©æ“–§«“¡ º‘¥ª°μ‘¢Õß≈“𠓬쓰àÕπ‡√‘Ë¡°“√√—°…“ ¢π“¥∑’Ë„™â‡√‘Ë¡μâπª√–¡“≥ 30-50 ¡°./°°./«—π ·∫àß„Àâ«—π≈– 2 §√—Èß ·≈–‡æ‘Ë¡ 30- 50 ¡°./°°./«—π ∑ÿ° 2-3 «—π ®π§ÿ¡Õ“°“√‰¥â ¢π“¥ Ÿß ÿ¥‰¡à§«√‡°‘π 200 ¡°./°°./«—π °“√„™â prednisolone ‰¥âº≈πâÕ¬°«à“ ACTH ·≈–¡’º≈¢â“߇§’¬ß ‡™àπ °“√°¥¿¡Ÿ ‘μâ“π∑“π¢Õß√à“ß°“¬ ·≈–¿“«– adrenal insufficiency ¬“Õ◊ËπÊ ‡™àπ sodium valproate, benzodiazepines „Àâº≈°“√√—°…“‰¥â‰¡à¥’‡∑à“¬“ Õß™π‘¥·√° §◊ÕºŸâªÉ«¬®– μÕ∫ πÕߪ√–¡“≥√Õâ ¬≈– 30-40 ¡√’ “¬ß“π°“√𔬓°π— ™°— „À¡Õà πË◊ Ê ‡™πà topiramate, zonisamide ·≈– lamotrigine ¡“„™â„π°“√§«∫§ÿ¡Õ“°“√™—°™π‘¥π’È æ∫«à“‰¥âº≈„°≈⇧’¬ß°—π°—∫¬“ vigabatrin À√◊Õ ACTH ·μଗߡ’°“√»÷°…“„π ºŸâªÉ«¬®”π«ππâÕ¬ ®÷߬—߉¡à·π–π”„Àℙ⇪ì𬓙𑥷√°„π°“√√—°…“ πÕ°®“°π’È¡’√“¬ß“π°“√„™â pyridoxine ¢π“¥ ßŸ (150-300 ¡°./°°./«—π) ª√–°Õ∫°“√√—°…“ ·μàμâÕß√–«—ߪí≠À“ hypotonia, neuropathy  ”À√—∫°“√√—°…“ ¥â«¬°“√∑”„À⇰‘¥¿“«– ketosis ¥â«¬°“√„Àâ ketogenic diet π—Èπ “¡“√∂§«∫§ÿ¡Õ“°“√™—°‰¥â ·μଗߧߡ’ªí≠À“„π ∑“ߪØ∫‘ μ— „‘ π‡¥°Á ∑æË’ ≤— π“°“√‰¡≈à “à ™“â ¡“°π°— Õ“®‰¡‰à ¥√â ∫— §«“¡√«à ¡¡Õ◊ ‡πÕË◊ ß®“°‡¥°Á  “¡“√∂‡≈Õ◊ °Õ“À“√°π‘ ‡Õ߉¥â ∑”„Àâ°“√§ßÕ¬Ÿà¢Õß¿“«– ketosis ‰¡à∂“«√ „π°√≥’∑’ˉ¡à “¡“√∂„Àâ vigabatrin ‡π◊ËÕß®“°¡’º≈¢â“߇§’¬ß À√◊պ⟪ɫ¬‰¡àμÕ∫ πÕßμàÕ vigabatrin ‡¡◊ËÕ„™â ‡μ¡Á ¢π“¥·≈«â §«√殑 “√≥“„™¬â “Õπ◊Ë ‡™πà sodium valproate À√Õ◊ benzodiazepines ‡™πà nitrazepam À√Õ◊ clonazepam ·∑πÀ√Õ◊ „À√â «à ¡°√≥μ’ Õ∫ πÕßμÕà vigabatrin ‰¡‡à μ¡Á ∑Ë’ 欓°√≥å‚√§ Õ“°“√™—°·≈–°≈ÿà¡Õ“°“√™—°™π‘¥π’È¡—°®–§«∫§ÿ¡‰¥â¬“° ·≈–Õ“®¡’°“√·ª√‡ª≈’ˬπ√Ÿª·∫∫°“√™—°‡ªìπ·∫∫ Õ◊ËπÊ ‰¥â ºâŸªÉ«¬ª√–¡“≥√âÕ¬≈– 10  “¡“√∂§«∫§ÿ¡Õ“°“√™—°®πÀ“¬¢“¥ (remission) ·≈–¡’æ—≤π“°“√‡°◊Õ∫ª°μ‘ ∑—Èßπ’È à«πÀπ÷Ëߢ÷ÈπÕ¬àŸ°—∫ “‡Àμÿ∑’Ë∑”„À⇰‘¥Õ“°“√™—° ºŸâªÉ«¬√âÕ¬≈– 20 ‡ ’¬™’«‘μ¿“¬„π 2 ªï ·≈–√âÕ¬≈– 75 ¡’§«“¡ º‘¥ª°μ‘¢Õß√–∫∫ª√– “∑ „π∫“ß√“¬ß“πæ∫¡’§«“¡∫°æ√àÕߢÕß√–¥—∫ μ‘ªí≠≠“ (mental retardation) ‰¥â∂÷ß √âÕ¬≈– 70 ºâŸªÉ«¬√âÕ¬≈– 50-60 ¬—ß¡’Õ“°“√™—° ‚¥¬√âÕ¬≈– 40-60 ¢ÕߺŸâªÉ«¬°≈ÿà¡π’È¡’°“√·ª√‡ª≈’Ë¬π‰ª‡ªìπ°≈ÿà¡ Õ“°“√™°— ·∫∫ Lennox-Gastaut ‰¥â ·π«∑“ߪؑ∫—μ‘„π°“√√—°…“ ‡πÕ◊Ë ß®“°Õ“°“√™°— ·≈–°≈¡ÿà Õ“°“√™°— ™π¥‘ πμ’È Õâ ߉¥√â ∫— °“√«π‘ ®‘ ©¬— ∑∂Ë’ °Ÿ μÕâ ߇æÕË◊ „À‰â ¥√â ∫— °“√√°— …“ ∑’‡Ë À¡“– ¡Õ¬à“ß√«¥‡√Á« ¥—ßππÈ— ‡¡◊ËÕæ∫ºªâŸ «É ¬„π‚√ß欓∫“≈™¡ÿ ™π ‚√ß欓∫“≈®—ßÀ«—¥ À√Õ◊ ‚√ß欓∫“≈ »πŸ ¬å·π–π”„À â ßà μàÕ‰ªæ∫°¡ÿ “√·æ∑¬ å “¢“ª√– “∑«‘∑¬“ ·π«∑“ß°“√√—°…“ 57 ‚√§≈¡™°—

∫∑∑Ë’ 11 °“√º“à μ—¥√—°…“‚√§≈¡™°— ºŸâªÉ«¬∑’ˇÀ¡“– ¡∑’Ë®–‡¢â“√—∫°“√√—°…“‚¥¬°“√ºà“μ—¥ (·ºπ¿Ÿ¡‘∑’Ë 7) §◊Õ ºâŸªÉ«¬‚√§≈¡™—°∑’ˉ¡àμÕ∫ πÕßμàÕ °“√√—°…“¥â«¬¬“°—π™—° (medically refractory epilepsies) „πºâŸªÉ«¬°≈ÿà¡π’ÈÕ“°“√™—°¡’‚Õ°“ À“¬¢“¥À√◊Õ§«∫§ÿ¡‰¥â ®“°°“√ºà“μ—¥ ºŸâªÉ«¬‚√§≈¡™—°∑’Ë “¡“√∂√—°…“„ÀâÀ“¬‰¥â®“°°“√ºà“μ—¥ °“√欓°√≥å‚√§À≈—ߺà“μ—¥„πºâŸªÉ«¬°≈ÿà¡π’È ¥¡’ “°¡‚’ Õ°“ À“¬™°— ∂ß÷ √Õâ ¬≈– 80-90 ªí®®—¬∑’Ë ”§—≠∑’Ë¡’μàÕº≈°“√√—°…“‚√§≈¡™—°‚¥¬°“√ºà“μ—¥§◊Õ °“√‡≈◊Õ°ºâŸªÉ«¬∑’ˇÀ¡“– ¡ ´÷Ëß®”‡ªìπμâÕß Õ“»—¬°“√ª√–‡¡‘πºŸâªÉ«¬‡æ◊ËÕ‡¢â“√—∫°“√ºà“μ—¥ ·≈–¡’¢—ÈπμÕπ∑’ËÀ≈“°À≈“¬¢÷Èπ°—∫§«“¡™”π“≠¢Õߧ≥–·æ∑¬å∑’Ë ¥Ÿ·≈®“°À≈“¬ “¢“Õ“∑‘‡™àπ ª√– “∑·æ∑¬å ª√– “∑·æ∑¬åºâŸ‡™’ˬ«™“≠‚√§≈¡™—° °ÿ¡“√·æ∑¬å °ÿ¡“√·æ∑¬å ºŸâ‡™’ˬ«™“≠‚√§≈¡™—° ª√– “∑»—≈¬·æ∑¬å √—ß ’·æ∑¬å ®‘μ·æ∑¬å π—°®‘μ«‘∑¬“ π—°‡∑§π‘§°“√·æ∑¬åºâŸ‡™’ˬ«™“≠¥â“π §≈◊Ëπ‰øøÑ“ ¡Õß ·æ∑¬å‡«™»“ μ√å𑫇§≈’¬√å 欓∫“≈ π—° —ߧ¡ ß‡§√“–Àå ‡ªìπμâπ ·≈–¢÷Èπ°—∫§«“¡æ√âÕ¡¢Õß ‡§√◊ËÕß¡◊Õ∑’Ë„™â„π°“√ ◊∫À“®ÿ¥°”‡π‘¥§≈◊Ëπ‰øøÑ“ ¡Õß∑’Ë∑”„À⇰‘¥Õ“°“√™—° (epileptogenic foci) ·≈–°“√‡≈◊Õ°«‘∏’°“√ ºà“μ—¥∑’ˇÀ¡“– ¡°—∫ºâŸªÉ«¬ °“√§—¥‡≈◊Õ°ºªâŸ É«¬∑˧’ «√‰¥√â ∫— °“√ª√–‡¡π‘ ‡æËÕ◊ ‡¢â“√—∫°“√º“à μ¥— 1. ‚√§≈¡™—°∑’ˉ¡àμÕ∫ πÕßμàÕ°“√√—°…“¥â«¬¬“ (∫∑∑’Ë 6) 2. ºªâŸ «É ¬‚√§≈¡™°— ∑ Ë’ “¡“√∂√°— …“‰¥¥â «â ¬«∏‘ °’ “√º“à μ¥— (Surgically remediable syndromes) ºªâŸ «É ¬∑ˇ’ À¡“– ¡ ”À√—∫°“√º“à μ¥— 1. Partial seizure „π°≈¡àÿ Õ“°“√¥ß— μÕà ‰ªπÈ’ 1.1 Mesial temporal lobe epilepsy due to mesial temporal sclerosis 1.2 Lesion partial epilepsy either temporal or extra-temporal foci 1.3 Hemispheric epilepsy syndrome 2. ºŸâªÉ«¬‚√§≈¡™—° ∑’ËπÕ°‡Àπ◊Õ®“°ºŸâªÉ«¬°≈ÿà¡„π¢âÕ 1 2.1 Localization related epilepsy 2.1.1 Õ“°“√™—°‡°‘¥®“° ®ÿ¥°”‡π‘¥™—° ‡æ’¬ß®ÿ¥‡¥’¬« 2.1.2  ¡Õß„π «à π∑º’Ë “à μ¥— ÕÕ°‰¡‰à ¥∑â ”Àπ“â ∑∑’Ë  ’Ë ”§≠— ·≈–‰¡°à Õà „À‡â °¥‘ §«“¡ ≠Ÿ ‡ ¬’ Àπ“â ∑Õ’Ë ¬“à ß„¥ Õ¬à“ßÀπ÷Ëß ¿“¬À≈—ß 2.2 Generalized epilepsy ∑¡Ë’ ‚’ Õ°“ ‡°¥‘ Õπ— μ√“¬μÕà ºªâŸ «É ¬ ßŸ ‡™πà Õ“°“√™°— ™π¥‘ drop attacks 58 ·π«∑“ß°“√√—°…“ ‚√§≈¡™°—

¢âÕÀâ“¡ ”À√—∫°“√ºà“μ¥— 1. Progressive neurodegenerative diseases 2. Benign epileptic syndrome °“√º“à μ—¥√—°…“‚√§≈¡™°— (Epilepsy surgery) «μ— ∂ÿª√– ß§°å “√º“à μ—¥√—°…“‚√§≈¡™°— ‡æ◊ËÕ„À⺟âªÉ«¬À“¬®“°°“√™—°Õ¬à“ß∂“«√·≈– “¡“√∂°≈—∫¡“„™â™’«‘μ„π —ߧ¡‰¥â‡À¡◊Õπ§πª°μ‘ À“°ºâŸªÉ«¬ ∫“ß√“¬∑’˪√–‡¡‘π·≈â««à“‰¡à “¡“√∂√—°…“„ÀâÀ“¬¢“¥‰¥â °“√ºà“μ—¥®–°√–∑”‡æ◊ËÕ∫√√‡∑“Õ“°“√ ‚¥¬¡ÿàß≈¥§«“¡ √ÿπ·√ß·≈–§«“¡∂’Ë¢Õß°“√™—° ‡æ◊ËÕ≈¥§«“¡‡ ’ˬßμà“ßÊ ∑’ˇªìπº≈®“°°“√™—° ™π‘¥°“√ºà“μ—¥ °“√ºà“μ—¥√—°…“‚√§≈¡™—° “¡“√∂®”·π° μ“¡«—μ∂ÿª√– ß§å¢Õß°“√√—°…“‰¥â 2 ª√–‡¿∑ (μ“√“ß∑’Ë 12) μ“√“ß∑Ë’ 12 ™π¥‘ °“√º“à μ¥— √°— …“‚√§≈¡™°— 1. Resection /definite surgery a. Epileptic focus 1. Anterior temporal lobectomy (ATL) 2. Amygdalohippocampectomy 3. Neocortical resections b. Focal epilepsy secondary to foreign tissue lesions (e.g., AVM, tumor) c. Hemispheric lesion : Classical hemispherectomy 2. Non-resection/ palliative surgery a. Callosotomy 2.1 Disconnection b. Functional hemispherectomy c. Multiple subpial transection (MST) 2.2 Augmentation a. Cerebral stimulation b. Vagal nerve stimulation ·π«∑“ß°“√ºà“μ¥— √°— …“‚√§≈¡™°— °“√‡≈◊Õ°™π‘¥°“√ºà“μ—¥√—°…“‚√§≈¡™—°¢÷Èπ°—∫μ“¡μ”·Àπàß ·≈–≈—°…≥–¢Õß epileptogenic foci (μ“√“ß∑Ë’ 12) ·π«∑“ß°“√√—°…“ 59 ‚√§≈¡™°—

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°“√„À§â «“¡√Ÿâ ·°ºà ªâŸ «É ¬·≈–ºªŸâ °§√Õß °“√„À⧫“¡√⟷°àºŸªâ «É ¬·≈–∫¥‘ “¡“√¥“ ‡¡◊ÕË ∫ÿμ√‡ªπì ‚√§≈¡™°— 1. Õ∏‘∫“¬∂÷ߧ«“¡√⟇√◊ËÕß‚√§≈¡™—°‚¥¬ —߇¢ª„À⇢Ⓞ® ‚¥¬Õ“»—¬ª√–«—μ‘∑’ˉ¥âμà“ßÊ ‡À≈à“π’Ȫ√–°Õ∫‡ªìπ æ◊Èπ∞“π 1.1 ≈—°…≥–Õ“°“√™—°  ‘Ëß°√–μÿâπ∑’Ë∑”„À⇰‘¥Õ“°“√™—° 1.2 §«“¡∂’Ë¢ÕßÕ“°“√™—°·≈–§«“¡º‘¥ª°μ‘¢Õß√–∫∫ª√– “∑∑’ˇ°‘¥¢÷ÈπÀ≈—ß®“°°“√™—° 1.3 °“√√—°…“∑’˺à“π¡“‚¥¬‡πâπ™π‘¥¬“ ¢π“¥¬“ ·≈–°“√„™â¬“Õ¬à“ß ¡Ë”‡ ¡ÕÀ√◊Õ‰¡à 1.4 ª√–«—μ‘°“√μ—Èߧ√√¿å °“√§≈Õ¥ æ—≤π“°“√¢Õ߇¥Á° ª√–«—쑧√Õ∫§√—« ª√–«—μ‘°“√™—°‡°’ˬ«¢âÕß°—∫ «—§´’π·≈– “√æ‘… ·≈–§«“¡º‘¥ª°μ‘∑“ß√–∫∫ª√– “∑∑’Ë¡’¡“°àÕ𠇪ìπμâπ 2. Õ∏‘∫“¬∂÷ß “‡Àμÿ∑’Ëπà“®–‡ªìπ‰¥â®“°ª√–«—μ‘ ª√–°Õ∫°—∫°“√μ√«®√à“ß°“¬ 3. ·π–π”°“√μ√«®‡æ‘Ë¡‡μ‘¡‡∑à“∑’Ë®”‡ªìπ‡æ◊ËÕÀ“ “‡Àμÿ ´÷Ëߢ÷ÈπÕ¬Ÿà°—∫Õ“¬ÿ¢ÕߺŸâªÉ«¬ ª√–«—μ‘°“√™—° ·≈– §«“¡º‘¥ª°μ‘∑’Ëμ√«®æ∫ 4. „π°√≥∑’ ®Ë’ – ßà μ√«®‡æ¡Ë‘ ‡μ¡‘ §«√·®ßâ „À∑â √“∫∂ß÷ ‡Àμºÿ ≈∑®Ë’ –μ√«®·≈–‚Õ°“ ¢Õߺ≈°“√μ√«® ‡™πà EEG Õ“®‰¡æà ∫§«“¡º¥‘ ª°μ„‘ πºªŸâ «É ¬‚√§≈¡™°— ∑°ÿ §π ®ß÷ ‰¡™à «à ¬„π°“√μ¥—  π‘ „®„π°“√√°— …“‡ ¡Õ‰ª ‡ªπì μπâ  «à π CT scan À√◊Õ MRI ®–μ√«®„π§π‰¢â∑’Ë ß —¬«à“°“√™—°¡’ “‡Àμÿ¡“®“°æ¬“∏‘ ¿“æ„π ¡Õß 5. ∫Õ°∂÷ߧ«“¡®”‡ªìπ∑’ËμâÕß√—°…“·≈–·π–π”·π«∑“ß°“√√—°…“∑’Ë ”§—≠ ‰¥â·°à 5.1 °“√‡≈◊Õ°™π‘¥¢Õ߬“∑’Ë√—°…“ 5.2 ª√– ‘∑∏‘¿“æ¢Õß°“√√—°…“ 5.3 Õ“°“√∑’ˉ¡àæ÷ߪ√– ß§å¢Õ߬“∑’ËÕ“®‡°‘¥‰¥â √«¡∑—Èß«‘∏’°“√ªØ‘∫—μ‘∂â“æ∫¡’Õ“°“√ 5.4 ‚Õ°“ ∑’Ë®–‡°‘¥Õ“°“√™—°´È”„π√–¬–·√°Ê ¢Õß°“√√—°…“ ‡æ√“–√–¥—∫¬“„π‡≈◊Õ¥Õ“®¬—߉¡à∂÷ß√–¥—∫ ∑’Ë„™â„π°“√√—°…“ 5.5 °“√쥑 μ“¡°“√√°— …“Õ¬“à ßμÕà ‡πÕË◊ ß 6. ·π–π”„À⺟⪰§√ÕߥŸ·≈ºâŸªÉ«¬‡À¡◊Õπ‡¥Á°ª°μ‘ ·μà®–Õ∏‘∫“¬·≈–·π–π”„Àâ≈¥ªí®®—¬∑’Ë®– à߇ √‘¡„Àâ ‡°‘¥Õ“°“√™—° ‡™àπ °“√‡≈àπ®π‡Àπ◊ËÕ¬¡“° °“√Õ¥πÕπ °“√‡≈àπ«’¥’‚Õ‡°¡ å∫“ß™π‘¥ (‚¥¬‰¡à„À⇥Á°‡°‘¥§«“¡√⟠÷° ∂°Ÿ ∫—ߧ—∫ À√◊Õ∂Ÿ°§«∫§ÿ¡‡ªìπ摇»…) πÕ°®“°π—Èπ „Àâ欓¬“¡À≈’°‡≈’ˬßÕ—πμ√“¬∑’ËÕ“®®–‡°‘¥¢÷Èπ ¢≥–∑”°‘®°√√¡μà“ßÊ ‡™àπ ªïπμâπ‰¡â «à“¬πÈ” ¢—∫√∂ ‡ªìπμâπ ®π°«à“®–·πà„®«à“Õ“°“√™—°π—Èπ “¡“√∂§«∫§ÿ¡‰¥â¥’ 7. ·π–π”°“√™à«¬‡À≈◊Õª∞¡æ¬“∫“≈‡∫◊ÈÕßμâπ·°à∫‘¥“¡“√¥“ ∂Ⓡ°‘¥¡’Õ“°“√™—°∑—Èß∑’Ë¡’‰¢â·≈–‰¡à¡’‰¢â 8. Õ“®·π–π”„ÀâÀ≈’°‡≈’ˬ߰“√©’¥«—§´’π‰Õ°√π„πºâŸªÉ«¬∫“ß√“¬ 9. ∫հ欓°√≥å‚√§ ·π«∑“ß°“√√—°…“ 63 ‚√§≈¡™°—

°“√„À⧫“¡√⇟ √◊ÕË ßæπ— ∏ÿ°√√¡¢Õß‚√§≈¡™°— ‡¥Á°∑’Ë¡’∫‘¥“À√◊Õ¡“√¥“‡ªìπ‚√§≈¡™—°™π‘¥‰¡à∑√“∫ “‡Àμÿ (cryptogenic epilepsy) ®–¡’Õ—μ√“‡ ’ˬßπâÕ¬¡“° ∑’Ë®–‡ªìπ‚√§≈¡™—°¥â«¬ §◊Õª√–¡“≥√âÕ¬≈– 4 ·μà®– ßŸ ¢÷Èπ∂÷ß√âÕ¬≈– 20-30 ∂â“∑—Èß∫‘¥“·≈–¡“√¥“‡ªìπ‚√§≈¡™—° ∂ⓧŸà·Ω¥™π‘¥ identical twins §πÀπ÷Ë߇ªìπ‚√§≈¡™—°∑’ˉ¡à∑√“∫ “‡Àμÿ·Ω¥Õ’°§πÀπ÷Ëß®–¡’‚Õ°“ ‡ªìπ ‚√§≈¡™°— ¥«â ¬ ßŸ ∂ß÷ √Õâ ¬≈– 80 ·μ§à ·Ÿà Ω¥™π¥‘ non-identical twins ®–¡Õ’ μ— √“‡ ¬’ ßμ”Ë °«“à §Õ◊ √Õâ ¬≈– 10-20 Õ—μ√“°“√‡°‘¥‚√§¢Õß‚√§≈¡™—°„π°≈ÿà¡∑’Ëæ∫ “‡Àμÿ (symptomatic epilepsy) ®–‡æ‘Ë¡¢÷Èπ‡≈Á°πâÕ¬„π§√Õ∫§√—« ¢ÕߺâŸ∑’ˇªìπ‚√§π’È ·μà®–·μ°μà“ß°—∫°≈ÿà¡‚√§≈¡™—°∑’ˇ°‘¥μ“¡À≈—ßÕÿ∫—쑇Àμÿ∑“ß ¡Õß ´÷Ëß¡’·π«‚πâ¡∑’Ë®–‡°‘¥‚√§≈¡™—° Õ¬àŸ·≈â«°Á‰¥â „πª√–™“°√∑—Ë«‰ªæ∫Õ—μ√“‡ ’ˬߢÕß°“√‡°‘¥‚√§≈¡™—°ª√–¡“≥√âÕ¬≈– 1 ·≈–®– ßŸ ∂÷ß√âÕ¬≈– 2 ∂â“¡’§π„π §√Õ∫§√—«‡ªìπ‚√§≈¡™—° ∂“â ®”·π°‚√§≈¡™°— μ“¡ International classification æ∫«“à 1. °≈àÿ¡ generalized epilepsy - ∂“â ‡ªπì idiopathic with generalized onset ‡™πà childhood absence, juvenile absence, juvenile myoclonic epilepsy ®–¡’§«“¡‡ ’ˬ߄πæ’ËπâÕß√âÕ¬≈– 10 ·≈–„π∫ÿμ√√âÕ¬≈– 7 - ∂Ⓡªìπ cryptogenic ·≈– symptomatic epilepsy ‡™àπ West syndrome, Lennox-Gastaut syndrome §«“¡‡ ’ˬߪ√–¡“≥√âÕ¬≈– 3 - ∂“â ‡ªπì epilepsy with myoclonic-astatic seizure ®–¡§’ «“¡‡ ¬Ë’ ß„πæπË’ Õâ ß√Õâ ¬≈– 10 2. °≈¡ÿà focal À√Õ◊ localization related epilepsy - ∂“â ‡ªπì idiopathic with age-related onset ‡™πà benign chidhood epilepsy with centro-temporal spikes ®–¡§’ «“¡‡ ¬Ë’ ß„πæπË’ Õâ ß¡“°°«“à √Õâ ¬≈– 10 - ∂Ⓡªìπ symptomatic ·≈– cryptogenic epilepsy ‡™àπ complex partial seizure ®–¡’§«“¡‡ ’ˬ߄π æ’ËπâÕß·≈–∫ÿμ√ª√–¡“≥√âÕ¬≈– 4 - ∂Ⓡªìπ simple partial seizure §«“¡‡ ’ˬ߄π∫ÿμ√ª√–¡“≥√âÕ¬≈– 2-3 ¢÷ÈπÕ¬Ÿà°—∫ “‡Àμÿ 3. §«“¡‡ ¬’Ë ß„πæ’πË Õâ ß·≈–∫μÿ √∑ˇ’ ªπì febrile seizure æ∫ª√–¡“≥√âÕ¬≈– 10 À√◊Õ¡“°°«à“ 4. ‡¥Á°∑’ˇ°‘¥®“°¡“√¥“∑Ë’‡ªìπ‚√§≈¡™—° ®–¡’§«“¡‡ ’ˬߠŸß°«à“‡¥Á°∑’Ë¡’∫‘¥“‡ªìπ‚√§≈¡™—° ∂â“„π §√Õ∫§√—«‡¥’¬«°—π‡ªìπ‚√§≈¡™—°À≈“¬§π ‡¥Á°®–¡’‚Õ°“ ‡ªìπ‚√§≈¡™—° ßŸ ¢÷Èπ °“√ àßμÕà ºâŸªÉ«¬‡æÕË◊ °“√√—°…“ §«√ ßà μÕà ºªŸâ «É ¬‚√§≈¡™°— ‰ª¬ß— ‚√ß欓∫“≈∑¡’Ë ¢’ ¥’ §«“¡ “¡“√∂ ßŸ °«“à „π°√≥¥’ ß— μÕà ‰ªπÈ’ 1. ‰¡à·πà„®°“√«‘π‘®©—¬«à“‡ªìπ‚√§≈¡™—° 2. ºâŸªÉ«¬∑’Ë¡’§«“¡®”‡ªìπμâÕß àßμ√«®§âπÀ“ “‡Àμÿ‡æ‘Ë¡‡μ‘¡·μà‰¡à “¡“√∂∑”°“√μ√«®§âπ‡æ‘Ë¡‡μ‘¡‰¥â„π ‚√ß欓∫“≈¢Õß∑à“𠇙àπ  ß —¬‡π◊ÈÕßÕ°„π ¡Õß ‡ªìπμâπ (∫∑∑’Ë 3) 3. ºâŸªÉ«¬‚√§≈¡™—°∑’ˉ¡à “¡“√∂§«∫§ÿ¡Õ“°“√™—°‰¥â ‚¥¬‰¥â‡≈◊Õ°™π‘¥ ¢π“¥ ·≈–√–¬–‡«≈“¢Õß°“√‰¥â√—∫ ¬“∑’ˇÀ¡“– ¡·≈â« (∫∑∑’Ë 8) 4. ºâŸªÉ«¬æ∫¡’ “‡Àμÿ¢Õß°“√™—°·≈–®”‡ªìπμâÕß¡’°“√√—°…“®”‡æ“– ‡™àπ infantile spasms 64 ·π«∑“ß°“√√°— …“ ‚√§≈¡™°—

‚√§≈¡™—°„πºÀŸâ ≠ß‘ À≈—°∑—Ë«‰ª„π°“√¥Ÿ·≈ºŸâªÉ«¬À≠‘ß∑’ˇªìπ‚√§≈¡™—°π—Èπ§≈⓬§≈÷ß°—∫ºŸâªÉ«¬™“¬ ·μà®–¡’§«“¡®”‡æ“– ”À√—∫ ‡æ»À≠‘ß∑’˧«√„Àâ°“√¥Ÿ·≈‡ªìπ摇»…„π∫“߇√◊ËÕß ‰¥â·°à 1. ‡√◊ËÕߧ«“¡ «¬ß“¡ ¬“°—π™—°∫“ß™π‘¥¡’º≈¢â“߇§’¬ß∑’ˉ¡àæ÷ߪ√– ß§å ‡™àπ - Phenytoin Õ“®°Õà „À‡â °¥‘ ¿“«–¢π¥°À√Õ◊ ‡ÀßÕ◊ °∫«¡ - Sodium valproate Õ“®°Õà „À‡â °¥‘ º¡√«à ßÀ√Õ◊ ‡®√≠‘ Õ“À“√®ππ”È Àπ°— ‡°π‘ - Topiramate Õ“®°Õà „À‡â °¥‘ Õ“°“√‡∫ÕË◊ Õ“À“√®πº“à ¬ºÕ¡ ‡ªπì μπâ ®÷ߧ«√‡≈◊Õ°¬“°—π™—°„Àâ‡À¡“– ¡·≈–‡ΩÑ“√–«—ߺ≈¢â“߇§’¬ß 2. ¿“«–√–¥Ÿ·ª√ª√«π®“°‚√§≈¡™—°∑’ˬ—ߧ«∫§ÿ¡‰¡à‰¥âÀ√◊Õ®“°º≈¢â“߇§’¬ß¢Õ߬“°—π™—° ‡™àπ sodium valproate Õ“®°Õà „À‡â °¥‘ ¿“«–√–¥·Ÿ ª√ª√«π‰¥â 3. ¿“«–™°— ®“°°“√¡√’ –¥Ÿ (catamenial seizure) Õ“®ªÕÑ ß°π— ‰¥‚â ¥¬„À¬â “°π— ™°— ‡ √¡‘ ‡©æ“–™«à ߇«≈“¥ß— °≈“à « ‡™àπ clobazam À√◊Õ‡æ‘Ë¡¢π“¥¢Õ߬“°—π™—°∑’Ë√—∫ª√–∑“πª√–®”„À⧫∫§ÿ¡¿“«–™—°®“°°“√¡’√–¥Ÿ 4. °“√¡’‡æ» —¡æ—π∏å ‰¡à°√–μÿâπ„À⇰‘¥°“√™—° ∂Ⓣ¥âæ—°ºàÕπ‡æ’¬ßæÕ 5. °“√§¡ÿ °”‡π¥‘ ¬“°π— ™°— ∑¡Ë’ º’ ≈‡æ¡Ë‘ °“√∑”≈“¬¬“º“à π°“√°√–μπâÿ °“√∑”ß“π¢Õ߇Õπ‰´¡μå ∫— (cytochrome P-450 enzyme system) ‰¥â·°à phenobarbital, phenytoin ·≈– carbamazepine Õ“®≈¥ª√– ‘∑∏‘¿“æ¢ÕߌÕ√å‚¡π §ÿ¡°”‡π‘¥ ·π–π”„Àâ√—∫ª√–∑“𬓇¡Á¥§ÿ¡°”‡π‘¥∑’Ë¡’‡Õ ‚μ√‡®πª√–¡“≥ 50 ‰¡‚§√°√—¡μàÕ«—π ·≈–„™â∂ÿ߬“ß Õπ“¡—¬√à«¡¥â«¬ °“√§ÿ¡°”‡π‘¥¥â«¬ŒÕ√å‚¡π™π‘¥©’¥ ™π‘¥Ωíß„μ⺑«Àπ—ß À√◊Õ™π‘¥Àà«ß Õ¥„ à∑’Ë¡’ŒÕ√å‚¡π Õ“®‰¡à‰¥âº≈ 6. ¿“«–°“√¡’∫ÿμ√¬“°®“°‚√§≈¡™—°À√◊Õ®“°º≈¢â“߇§’¬ß¢Õ߬“°—π™—°∫“ß™π‘¥ ‡™àπ sodium valproate Õ“®∑”„À√â –¥·Ÿ ª√ª√«πÀ√Õ◊ ‡°¥‘ polycystic ovarian syndrome 7. °“√μ—Èߧ√√¿å Õ“®°√–μÿâπ„À⇰‘¥Õ“°“√™—°¡“°¢÷Èπ °“√μ—Èߧ√√¿åÕ“®∑”„Àâ metabolism ¢Õ߬“°—π™—°‡ª≈’ˬπ·ª≈߉ª ®÷ߧ«√μ‘¥μ“¡¥Ÿ·≈ºŸâªÉ«¬„°≈♑¥ À√◊Õ àßμàÕ„Àâ·æ∑¬åºŸâ‡™’ˬ«™“≠‚√§≈¡™—°¥·Ÿ ≈√à«¡°—∫ μŸ ‘·æ∑¬å ‰¡à§«√À¬ÿ¥¬“À√◊Õ‡ª≈’Ë¬π¬“°—π™—°√–À«à“ß∑’Ëμ—Èߧ√√¿å ‡π◊ËÕß®“°Õ“®‡°‘¥°“√™—°®π‡°‘¥Õ—πμ√“¬μàÕ∑“√°À√◊ÕºŸâªÉ«¬‰¥â ºŸâªÉ«¬´÷Ëß√—∫ª√–∑“𬓰—π™—°™π‘¥∑’Ë°√–μÿâπ‡Õπ‰´¡åμ—∫ §«√„À⺟âªÉ«¬√—∫ª√–∑“π«‘μ“¡‘π‡§„π™à«ß‡¥◊Õπ  ÿ¥∑⓬¢Õß°“√μ—Èߧ√√¿å ·≈–©’¥«‘μ“¡‘π‡§‡¢â“°≈â“¡‡π◊ÈÕ¢Õß∑“√°À≈—ߧ≈Õ¥∑ÿ°√“¬ ‡æ◊ËÕ≈¥°“√‡°‘¥¿“«–‡≈◊Õ¥ÕÕ° º‘¥ª°μ‘„π∑“√°·√°‡°‘¥ ºŸâªÉ«¬ “¡“√∂§≈Õ¥ª°μ‘‰¥â ‚¥¬Õ“®‰¥â√—∫°“√™à«¬§≈Õ¥μ“¡§«“¡‡À¡“– ¡ §«√∫—π∑÷°§”·π–π” ¢Õß·æ∑¬å·≈–°“√μ—¥ ‘π„®¢Õߺ⟪ɫ¬·≈–§√Õ∫§√—«‰«â‡ªìπÀ≈—°∞“π 8. ¿“«–∑“√°æ°‘ “√·μ°à ”‡π¥‘ ‚Õ°“ ∑®’Ë –‡°¥‘ §«“¡æ°‘ “√„π¡“√¥“∑‡’Ë ªπì ‚√§≈¡™°— Õ“®‡°¥‘ ®“°‚√§≈¡™°— ‡Õß æ—π∏ÿ°√√¡ À√◊Õ¬“°—π™—°  à«π„À≠à¡’§«“¡æ‘°“√‡≈Á°πâÕ¬ ‡™àπ ‡≈Á∫ —Èπ π‘È« —Èπ‡≈Á°πâÕ¬ §«“¡æ‘°“√∑’ˇªìπ¡“°¢÷Èπ ‰¥â·°à ª“°·À«àß ‡æ¥“π‚À«à ≈—°…≥–„∫Àπ⓺‘¥ª°μ‘ ·≈–‚¥¬‡©æ“–Õ¬à“߬‘Ëß neural tube defect ´÷Ëßæ∫ª√–¡“≥ √âÕ¬≈– 0.5-3 „πºªâŸ «É ¬∑‰’Ë ¥√â ∫— ¬“ sodium valproate À√Õ◊ carbamazepine ‡ªπì μπâ ¥—ßπ—Èπ °àÕπ∑’Ë®–μ—Èߧ√√¿å §«√ªØ‘∫—μ‘¥—ßμàÕ‰ªπ’È ·π«∑“ß°“√√—°…“ 65 ‚√§≈¡™°—

- °√≥’∑’˺⟪ɫ¬‰¡à¡’Õ“°“√™—°‡°‘π 2 ªï Õ“®æ‘®“√≥“À¬ÿ¥¬“°—π™—°°àÕπ - °√≥’∑’˺⟪ɫ¬‰¥â√—∫¬“°—π™—°À≈“¬™π‘¥ Õ“®æ‘®“√≥“≈¥¢π“¥·≈–™π‘¥¬“„Àâ‡À≈◊ÕπâÕ¬∑’Ë ÿ¥∑’ˬ—ß  “¡“√∂§«√§ÿ¡Õ“°“√™—°‰¥â - æ‘®“√≥“„Àâ«‘μ“¡‘π‚ø≈‘°‡ √‘¡ ¢π“¥ 5 ¡°. ∑ÿ°«—π„πÀ≠‘ß«—¬‡®√‘≠æ—π∏ÿå∑’Ë¡’‚Õ°“ μ—Èߧ√√¿å‚¥¬‰¡à‰¥â «“ß·ºπ ‡æ◊ËÕªÑÕß°—π°“√‡°‘¥ neural tube defect „π°√≥’∑’˺ŸâªÉ«¬μ—Èߧ√√¿å ¢≥–∑’Ë√—∫ª√–∑“𬓰—π™—°Õ¬àŸ ‰¡à§«√≈¥¢π“¥¬“°—π™—°À√◊ÕÀ¬ÿ¥¬“°—π™—° ‡π◊ËÕß®“°¡’§«“¡‡ ’ˬßμàÕ¡“√¥“·≈–∑“√°„π§√√¿å∑’ËÕ“®®–‰¥â√—∫Õ—πμ√“¬®“°°“√™—° ßŸ °«à“º≈‡ ’¬®“°¬“°—π™—° ºâŸªÉ«¬∑ÿ°√“¬∑’Ë¡’°“√μ—Èߧ√√¿å ‡¡◊ËÕÕ“¬ÿ§√√¿å‰¥â 12-16  —ª¥“Àå §«√‰¥â√—∫°“√μ√«®§—¥°√Õß¿“«–º‘¥√ªŸ ¢Õß∑“√°„π§√√¿å¥â«¬‡§√◊ËÕßÕ—≈μ√“´“«¥å 9. °“√‡≈¬’È ß¥∫Ÿ μÿ √ ¡“√¥“∑√’Ë ∫— ª√–∑“𬓰𗠙°—  “¡“√∂‡≈¬’È ß≈°Ÿ ¥«â ¬π¡·¡‰à ¥â  ”À√∫— ¬“ phenobarbital ·≈– °≈ÿà¡ benzodiazepine Õ“®∑”„Àâ∑“√°ßà«ß´÷¡‰¥â Õ“®®–μâÕß°√–μÿâπ∑“√°¢≥–„Àâπ¡ §«√ªÑÕß°—πÕ—πμ√“¬μàÕ∑“√° ¢≥–¡“√¥“‡°‘¥Õ“°“√™—° ‡™à𠇪≈’ˬπºâ“ÕâÕ¡∫πæ◊Èπ·∑π „Àâπ¡∫ÿμ√∫πæ◊È𠇙Á¥μ—«∑“√°·∑π°“√Õ“∫πÈ”„πÕà“ß À√◊Õ¡’ºâŸÕ◊Ëπ§Õ¬√–«—ß√–À«à“ßÕ“∫πÈ”„Àâ∑“√° ¡“√¥“§«√‰¥â√—∫°“√æ—°ºàÕπ‡æ’¬ßæÕ‡æ◊ËÕ≈¥‚Õ°“ ∑’Ë®–‡°‘¥°“√™—° ‚√§≈¡™°— „πºâŸ ŸßÕ“¬ÿ À≈—°°“√√—°…“‚√§≈¡™—°„πºŸâ ŸßÕ“¬ÿ‚¥¬∑—Ë«‰ª§≈⓬§≈÷ß°—∫„π«—¬Õ◊ËπÊ ‚¥¬∑’˧«√æ‘®“√≥“ª√–°“√μà“ßÊ ¥—ßμàÕ‰ªπ’ȇæ‘Ë¡‡ªìπ摇»… ‰¥â·°à 1. Õ“°“√¢Õß‚√§∑“ß°“¬Õ◊ËπÊ ∑’˧≈⓬Փ°“√™—° ®–æ∫‰¥â¡“°¢÷Èπ„πºâŸ ŸßÕ“¬ÿ ‡™àπ transient ischemic attack, syncope, metabolic derangement ‡ªìπμâπ „π√“¬∑’ˬ—ߧ«∫§ÿ¡Õ“°“√™—°‰¡à‰¥â Õ“®μâÕßæ‘®“√≥“·¬°¿“«– §≈⓬™—°∑’ËÕ“®‡°‘¥√à«¡¥â«¬ 2. ‡¿ —™®≈π»“ μ√å·≈–‡¿ —™æ≈»“ μ√å„πºŸâ ŸßÕ“¬ÿ·μ°μà“ß®“°«—¬Õ◊Ëπ √à«¡°—∫¡’‚√§ª√–®”μ—«μà“ßÊ ®÷ß¡’ º≈μÕà ª√– ∑‘ ∏¿‘ “æ·≈–º≈¢“â ߇§¬’ ߢÕ߬“ ¥ß— ππÈ— ®ß÷ §«√‡√¡Ë‘ ¬“„π¢π“¥μ”Ë ·≈–ª√∫— ‡æ¡Ë‘ ¢π“¥¬“∑≈’ –πÕâ ¬Õ¬“à ß™“â Ê ‡ΩÑ“√–«—ߺ≈¢â“߇§’¬ß¢Õ߬“ ·≈–º≈μàÕ‚√§ª√–®”μ—«Õ◊ËπÊ Õ¬à“ß„°≈♑¥ √–«—ß°“√æ≈—¥μ°À°≈â¡®“°¬“°—π™—° ∑’Ë∑”„À⇰‘¥Õ“°“√ßà«ß  ”À√—∫ºâŸªÉ«¬∑’Ë√—∫ª√–∑“𬓠phenytoin §«√„Àâ·§≈‡´’¬¡·≈–À√◊Õ«‘μ“¡‘π¥’√à«¡¥â«¬ ‡æ◊ËÕ ªÑÕß°—π°√–¥Ÿ°ºÿ 3. °“√√—∫ª√–∑“π¬“Õ“®‰¡à ¡Ë”‡ ¡Õ ‡π◊ËÕß®“°«‘∏’°“√∫√‘À“√¬“‰¡à –¥«° Õà“π©≈“°¬“º‘¥ ¡Õ߉¡à‡ÀÁπ ©≈“°¬“ §«“¡À≈ß≈◊¡À√◊Õ¿“«– ¡Õ߇ ◊ËÕ¡ ‡ªìπμâπ ®÷ߧ«√‰¥â√—∫°“√¥Ÿ·≈Õ¬à“ß∂Ÿ°μâÕ߇À¡“– ¡ §«√‡≈◊Õ°¬“ ∑’Ë∫√‘À“√ßà“¬ √—∫ª√–∑“π«—π≈–Àπ÷Ëß∂÷ß Õߧ√—Èß 66 ·π«∑“ß°“√√—°…“ ‚√§≈¡™°—

¬“∑Ë’Õ¬Ÿà„π∫≠— ™’¬“À≈°— ·Ààß™“μ‘ ®–®¥— ·∫ßà ‡ªπì ∫—≠™’¬àÕ¬ °. ¢. §. ß. ·≈– ®. ¥ß— πÈ’ ∫—≠™’ ° À¡“¬∂÷ß √“¬°“√¬“ ”À√—∫ ∂“π欓∫“≈∑ÿ°√–¥—∫ ‡ªìπ√“¬°“√¬“¡“μ√∞“π∑’Ë„™â„π°“√ ªÑÕß°—π·≈–·°â‰¢ªí≠À“ ÿ¢¿“æ∑’Ëæ∫∫àÕ¬ ¡’À≈—°∞“π™—¥‡®π∑’Ë π—∫ πÿπ°“√„™â ¡’ª√– ∫°“√≥å°“√„™â„πª√–‡∑» ‰∑¬Õ¬à“ßæÕ‡æ’¬ß ·≈–‡ªìπ¬“∑’˧«√‰¥â√—∫°“√‡≈◊Õ°„™â‡ªìπÕ—π¥—∫·√°μ“¡¢âÕ∫àß„™â¢Õ߬“π—Èπ ∫—≠™’ ¢ À¡“¬∂÷ß √“¬°“√¬“∑’Ë„™â ”À√—∫¢âÕ∫àß„™âÀ√◊Õ‚√§∫“ß™π‘¥∑’Ë„™â¬“„π∫—≠™’ °. ‰¡à‰¥âÀ√◊Õ‰¡à‰¥âº≈ À√◊Õ‡ªìπ¬“∑’Ë„™â·∑𬓄π∫—≠™’ °. ™—Ë«§√“«„π°√≥’∑’Ë®—¥À“¬“„π∫—≠™’ °. ‰¡à‰¥â ∫≠— ™’ § À¡“¬∂÷ß √“¬°“√¬“∑’ËμâÕß„™â„π‚√§‡©æ“–∑“ß ‚¥¬ºâŸ™”π“≠À√◊ÕºŸâ∑’ˉ¥â√—∫¡Õ∫À¡“¬®“° ºâŸÕ”𫬰“√¢Õß ∂“π欓∫“≈π—ÈπÊ ‚¥¬¡’¡“μ√°“√°”°—∫°“√„™â ´÷Ëß ∂“π欓∫“≈∑’Ë„™â®–μâÕß¡’§«“¡æ√âÕ¡ μ—Èß·μà°“√«‘π‘®©—¬®π∂÷ß°“√μ‘¥μ“¡º≈°“√√—°…“ ‡π◊ËÕß®“°¬“°≈ÿà¡π’ȇªìπ¬“∑’Ë∂â“„™â‰¡à∂Ÿ°μâÕß Õ“®‡°‘¥æ‘…À√◊Õ‡ªìπ Õ—πμ√“¬μàÕºŸâªÉ«¬À√◊Õ‡ªì𠓇Àμÿ„À⇰‘¥‡™◊ÈÕ¥◊ÈÕ¬“‰¥âßà“¬ À√◊Õ‡ªìπ¬“∑’Ë¡’·π«‚πâ¡„π°“√„™â‰¡àμ√ßμ“¡¢âÕ∫àß™’ÈÀ√◊Õ ‰¡à§ÿ⡧à“À√◊Õ¡’°“√𔉪„™â„π∑“ß∑’˺‘¥ À√◊Õ¡’À≈—°∞“π π—∫ πÿπ°“√„™â∑’Ë®”°—¥ À√◊Õ¡’ª√– ∫°“√≥å°“√„™â„π ª√–‡∑»‰∑¬Õ¬à“ß®”°—¥ À√◊Õ¡’√“§“·æß°«à“¬“Õ◊Ëπ„π°≈ÿࡇ¥’¬«°—π ∫—≠™’ ß À¡“¬∂÷ß √“¬°“√¬“∑’Ë¡’À≈“¬¢âÕ∫àß„™â ·μà¡’§«“¡‡À¡“– ¡∑’Ë®–„™â‡æ’¬ß∫“ߢâÕ∫àß„™âÀ√◊Õ¡’ ·π«‚πâ¡®–¡’°“√ —Ëß„™â¬“‰¡à∂Ÿ°μâÕß À√◊Õ‡ªìπ√“¬°“√¬“∑’Ë¡’√“§“·æß ®÷߇ªìπ°≈ÿ࡬“∑’Ë¡’§«“¡®”‡ªìπμâÕß¡’°“√√–∫ÿ ¢âÕ∫àß„™â·≈–‡ß◊ËÕπ‰¢°“√ —Ëß„™â¬“ °“√„™â∫—≠™’¬“À≈—°·Ààß™“쑉ªÕâ“ßÕ‘ß„π°“√‡∫‘°®à“¬§«√π”¢âÕ∫àß„™â·≈–‡ß◊ËÕπ‰¢ °“√ —Ëß„™â‰ªª√–°Õ∫„π°“√æ‘®“√≥“Õπÿ¡—μ‘°“√‡∫‘°®à“¬®÷ß®–°àÕª√–‚¬™πå Ÿß ÿ¥ ∑—Èßπ’Ȭ“„π∫—≠™’ ß ®”‡ªìπμâÕß„™â ”À√—∫ºâŸªÉ«¬∫“ß√“¬ ·μàÕ“®∑”„À⇰‘¥Õ—πμ√“¬μàÕºŸâªÉ«¬ À√◊Õ°àÕªí≠À“ ‡™◊ÈÕ¥◊ÈÕ¬“∑’Ë√⓬·√ß °“√ —Ëß„™â¬“´÷ËßμâÕß„Àâ ¡‡Àμÿº≈‡°‘¥§«“¡§ÿâ¡§à“ ¡ª√–‚¬™πå®–μâÕßÕ“»—¬°“√μ√«®«‘π‘®©—¬·≈– æ‘®“√≥“‚¥¬ºâŸ™”π“≠‡©æ“–‚√§∑’ˉ¥â√—∫°“√Ωñ°Õ∫√¡„π “¢“«‘™“∑’ˇ°’ˬ«¢âÕß®“° ∂“πΩñ°Õ∫√¡À√◊Õ‰¥â√—∫«ÿ≤‘∫—μ√ À√◊ÕÀπ—ß ◊ÕÕπÿ¡—μ‘®“°·æ∑¬ ¿“ À√◊Õ∑—πμ·æ∑¬ ¿“‡∑à“π—Èπ ·≈–‚√ß欓∫“≈®–μâÕß¡’√–∫∫°“√°”°—∫ª√–‡¡‘π ·≈–μ√«® Õ∫°“√„™â¬“ (Drug Utilization Evaluation, DUE) ‚¥¬μâÕß¡’°“√‡°Á∫¢âÕ¡Ÿ≈°“√„™â¬“‡À≈à“π—Èπ‡æ◊ËÕμ√«®  Õ∫„πÕπ“§μ‰¥â ∫≠— ™’ ® À¡“¬∂÷ß √“¬°“√¬“ ”À√—∫‚§√ß°“√摇»…¢Õß°√–∑√«ß ∑∫«ß °√¡ À√◊ÕÀπ૬ߓπÕ◊Ëπ¢Õß√—∞ ∑’Ë¡’°“√°”À𥫑∏’°“√„™â·≈–°“√μ‘¥μ“¡ª√–‡¡‘π°“√„™â¬“μ“¡‚§√ß°“√ ‚¥¬¡’Àπ૬ߓππ—Èπ√—∫º‘¥™Õ∫ À¡“¬‡Àμÿ : 1. ¬“·μà≈–™π‘¥ ®—¥Õ¬Ÿà„π∫—≠™’¬àÕ¬‰¥â¡“°°«à“ 1 ∫—≠™’ À“°«à“¢âÕ∫àß™’È°“√„™â¬“™π‘¥π—Èπ¡’À≈“¬Õ¬à“ß ·≈–§«√¡’°“√°”°—∫°“√„™â∑’Ë·μ°μà“ß°—π 2. ¡“μ√°“√°”°—∫°“√„™â æ‘®“√≥“®—¥∑”‰¥âμ—Èß·μà°“√°”Àπ¥·π«∑“ß°“√æ‘®“√≥“°“√„™â¬“ °“√μ‘¥μ“¡ ª√‘¡“≥°“√„™â¬“ ®π∂÷ß°“√μ‘¥μ“¡º≈°“√„™â¬“„πºâŸªÉ«¬‡©æ“–√“¬μ“¡§«“¡‡À¡“– ¡ ·π«∑“ß°“√√—°…“ 67 ‚√§≈¡™°—

√°003/896 13 ¡’π“§¡ æ.». 2549 ‡√◊ÕË ß ¢Õ§«“¡§¥‘ ‡ÀπÁ ‡°’¬Ë «°—∫§”»—æ∑å¿“…“‰∑¬¢ÕßÕ“°“√™°— ‡√¬’ π ‡≈¢“∏‘°“√ ¡“§¡‚√§≈¡™°— œ ¥â«¬ ∂“∫—πª√– “∑«‘∑¬“·≈– ¡“§¡‚√§≈¡™—°·Ààߪ√–‡∑»‰∑¬ ®–‰¥â¡’°“√ª√—∫ª√ÿß·π«∑“ß °“√√—°…“‚√§≈¡™°— (Guideline of Epilepsy) „π°“√πÈ’  ¡“§¡‚√§≈¡™°— ¢Õ¢Õâ §‘¥‡ÀπÁ „𧔻—æ∑μå Õà ‰ª ∑“ß√“™∫≥— ±‘μ ¿“‡ÀπÁ §«√„™§â ”»—æ∑¥å ß— πÈ’ Simple partial seizure Õ“°“√™—°‡©æ“–∑’Ë·∫∫¡’ μ‘ Partial complex seizure Õ“°“√™—°‡©æ“–∑’Ë·∫∫¢“¥ μ‘ Partial secondarily generalized tonic-clonic seizure ™—°‡©æ“–∑’Ëμ“¡¥â«¬™—°‡°√Áß°√–μÿ°∑—Èßμ—« Generalized seizure Õ“°“√™—°∑—Èßμ—« Absence ™—°‡À¡àÕ Tonic ™—°‡°√Áß Clonic ™—°°√–μÿ° Tonic-clonic seizure ™°— ‡°√ßÁ °√–μ°ÿ Atonic ™—°μ—«ÕàÕπ Myoclonic ™—° –¥ÿâß Infantile spasm ™—°º«“„π‡¥Á° ®÷߇√’¬π¡“‡æÕË◊ ¥”‡π‘π°“√ „À‡â ªìπª√–‚¬™π„å π°“√®¥— ∑” Guideline of Epilepsy μàÕ‰ª √“™∫—≥±μ‘  ¿“ 68 ·π«∑“ß°“√√°— …“ ‚√§≈¡™°—

§”¬àÕ∑Ë’„™„â π‡≈à¡ PB Phenobarbital PHT Phenytoin CBZ Carbamazepine VPA Valproic acid GBP Gabapentin LTG Lamotrigine LEV Levetiracetam OXC Oxcarbazepine TGB Tiagabine TPM Topiramate VGB Vigabatrin ZNS Zonisamide PGB Pregabalin FBM Felbamate ·π«∑“ß°“√√—°…“ 69 ‚√§≈¡™°—

Õ∏‘∫“¬»—æ∑å (glossary) Idiopathic epilepsy À¡“¬∂÷ß‚√§≈¡™—°∑’˺⟪ɫ¬‰¡à‰¥â¡’欓∏‘ ¿“æ„π ¡Õß·≈–πà“®–¡’ “‡Àμÿ¡“®“°ªí®®—¬ ∑“ßæ—π∏ÿ°√√¡ Cryptogenic epilepsy À¡“¬∂÷ß ‚√§≈¡™—°∑’˺ŸâªÉ«¬πà“®–¡’欓∏‘ ¿“æ„π ¡Õß·μà°“√μ√«®‡æ‘Ë¡‡μ‘¡∑“ß ÀâÕߪؑ∫—μ‘°“√¥â«¬«‘∑¬“°“√ªí®®ÿ∫—π ¬—ß‰¡à “¡“√∂μ√«®æ∫欓∏‘ ¿“扥â Symptomatic epilepsy À¡“¬∂÷ß ‚√§≈¡™—°∑’˺ŸâªÉ«¬¡’欓∏‘ ¿“æ„π ¡Õß´÷Ëß∑”„À⇰‘¥Õ“°“√™—°™—¥‡®π ‡™àπ ‡π◊ÈÕßÕ°„π ¡Õß Recent symptomatic seizure À¡“¬∂÷ß Õ“°“√™—°∑’ˇ°‘¥®“°¡’欓∏‘ ¿“æ™π‘¥‡©’¬∫æ≈—𠇙àπ ‚√§‰¢â ¡Õß Õ—°‡ ∫ ‡¬◊ËÕÀÿâ¡ ¡ÕßÕ—°‡ ∫ ‡ªìπμâπ Remote symptomatic seizure À¡“¬∂÷ß Õ“°“√™—°∑’ˇ°‘¥„πºâŸªÉ«¬∑’Ë¡’√Õ¬‚√§¢Õß ¡ÕßÕ¬Ÿà°àÕ𠇙àπ ºâŸ∑’Ë¡’ ª√–«—μ‘ ¡Õߢ“¥‡≈◊Õ¥¡“°àÕπ À√◊Õ‡ªìπ‚√§§«“¡®”‡ ◊ËÕ¡Õ¬Ÿà°àÕ𠇪ìπμâπ Precipitating factor/trigger À¡“¬∂ß÷ ª®í ®¬— °√–μπâÿ „À‡â °¥‘ Õ“°“√™°— „πºªâŸ «É ¬∑‡Ë’ ªπì ‚√§≈¡™°— À√Õ◊ º∑⟠¡Ë’ §’ «“¡ º‘¥ª°μ‘¢Õß ¡ÕßÕ¬Ÿà°àÕπ Provoked seizure/symptomatic seizure À¡“¬∂ß÷ Õ“°“√™°— ∑‡Ë’ °¥‘ ®“°¡ª’ ®í ®¬— ™°— π”„π§π∑‰Ë’ ¡¡à æ’ ¬“∏ ‘ ¿“æ ¢Õß ¡Õß ‡™à𠧫“¡º‘¥ª°μ‘∑“߇¡μ“‚∫≈‘° ¬“ À√◊Õ‰¢â Ÿß Unprovoked seizure À¡“¬∂ß÷ Õ“°“√™°— ∑‡Ë’ °¥‘ ¢πÈ÷ ‚¥¬‰¡¡à ª’ ®í ®¬— ™°— π”¡“‡°¬Ë’ «¢Õâ ß Convulsive status epilepticus À¡“¬∂÷ß Õ“°“√™—°μàÕ‡π◊ËÕß™π‘¥¡’Õ“°“√‡°√ÁßÀ√◊Õ°√–μÿ°¢Õß°≈â“¡‡π◊ÈÕ Non convulsive status epilepticus À¡“¬∂ß÷ Õ“°“√™°— μÕà ‡πÕË◊ ß™π¥‘ ‰¡¡à Õ’ “°“√‡°√ßÁ À√Õ◊ °√–μ°ÿ ¢Õß°≈“â ¡‡πÕÈ◊ ‡™àπ absence status epilepticus Monotherapy À¡“¬∂ß÷ °“√√°— …“‚√§≈¡™°— ¥«â ¬¬“°π— ™°— ™π¥‘ ‡¥¬’ « Polytherapy / polypharmacy À¡“¬∂ß÷ °“√√°— …“‚√§≈¡™°— ¥«â ¬¬“°π— ™°— À≈“¬™π¥‘ æ√Õâ ¡Ê °π— Controlled / sustain release drug À¡“¬∂ß÷ ¬“∑§Ë’ Õà ¬Ê ÕÕ°ƒ∑∏∑Ï‘ ≈’ –πÕâ ¬ Trough level (fasting, lowest level) À¡“¬∂÷ß °“√«—¥√–¥—∫¬“„π´’√—¡°àÕπ∑’Ë®–„À⬓¡◊ÈÕμàÕ‰ª 70 ·π«∑“ß°“√√°— …“ ‚√§≈¡™°—

∫√√≥“πÿ°√¡ 1. °—≈¬“≥å ∏’√–«‘∫Ÿ≈¬å, Õ‘ √’ μ√’°¡≈ : °“√ ”√«®ªí≠À“∑“ß°“√·æ∑¬å¥â“π‚√§√–∫∫ª√– “∑¢Õß‚§√ß°“√  √ªÿ ª√–‡¥πÁ ª≠í À“∑“ß°“√·æ∑¬∑å ‡’Ë ªπì ª≠í À“¢Õߪ√–‡∑»„π°“√ª√–™¡ÿ «™‘ “°“√°√¡°“√·æ∑¬å ª√–®”ªï 2549. °√ÿ߇∑æœ :  ”π—°æ—≤π“«™‘ “°“√·æ∑¬å °√¡°“√·æ∑¬å °√–∑√«ß “∏“√≥ ¢ÿ ; 2549. Àπ“â 66. 2. ®—π∑√å‡æÁ≠ ™Ÿª√–¿“«√√≥, ∫√√≥“∏‘°“√. §≥–°√√¡°“√Õ”π«¬°“√‚§√ß°“√ ”√«® : √“¬ß“π°“√ ”√«®  ∂“π– ¢ÿ ¿“æÕπ“¡¬— ¢Õߪ√–™“™π‰∑¬¥«â ¬°“√ Õ∫∂“¡·≈–μ√«®√“à ß°“¬∑«—Ë ª√–‡∑»§√ß—È ∑’Ë1æ.».2534-2535. °√ßÿ ‡∑æœ : ¥‰’ ´π;å 2539. 3.  ¡™“¬ ‚μ«≥–∫ÿμ√·≈–§≥–. The epilepsy quality of life survey in Thailand. „π 10 ªï  ¡“§¡‚√§≈¡™—° ·Àßà ª√–‡∑»‰∑¬. °√ßÿ ‡∑æœ : ∫¬’ Õπ¥‡å ÕπÁ ‡∑Õ√‰å æ√´;å 2549. Àπ“â 63-70. 4.  ¡“§¡‚√§≈¡™—°·Ààߪ√–‡∑»‰∑¬. Medical Facilities  ”À√—∫°“√«‘π‘®©—¬·≈–√—°…“ºâŸªÉ«¬‚√§≈¡™—°„π ‚√ß欓∫“≈¢Õß√—∞œ. „π : 10 ªï  ¡“§¡‚√§≈¡™—°·Ààߪ√–‡∑»‰∑¬. °√ÿ߇∑æœ : ∫’¬Õπ¥å‡ÕÁπ‡∑Õ√å‰æ√´å; 2549. Àπ“â 56-62. 5. Aicardi J. Epilepsy and other seizure disorders. In: Diseases of the nervous system in chidlhood. Oxford : Blackwell Scientific Publications, 1992:991-1000. 6. Annegers JF, Hauser WA, Beghi E, Nicolosi A, Kurland LT. The risk of unprovoked seizures after encephalitis and meningitis. Neurology. 1988; 38:1407-10. 7. Appleton RE, Sweeney A, Choonara I, Robson J, Molyneux E. Lorazepam versus diazepam in the acute treatment of epileptic seizures and status epilepticus. Dev Med Child Neurol 1995; 37:682-88. 8. Asawavichienjinda T, Sitthiamorn C, Tanyanont W. Prevalence of epilepsy in rural Thailand : A population based study. J Med ASSOC Thai 2002,85 : 1066-73. 9. Ben-Menachem E. Vagus-nerve stimulation for the treatment of epilepsy. Lancet Neurol. 2002; 1:477-82. 10. Bendadis SR. Epileptic seizures and syndrome. Neurol Clinic 2001; 19: 251-70. 11. Berg AT, Levy SR, Testa FM, Shinnar S. Treatment of newly diagnosed pediatric epilepsy: a community-based study. Arch Pediatr Adolesc Med. 1999 ;153:1267-71. 12. Bergin AN, Connolly M. New epileptic drug therapies. Neurol Clin 2002;20:1163-82 13. Bruni J.Episodic impairment of consciousness. In: Bradley WG, Daroff RB, Fenichel GM, Marsden CD, editors. Neurology in clinical practice, principles of diagnosis and management. 3rd ed. Boston:Butterworth-Heinemann, 2000. 14. Camfield P, Camfield C, Hirtz D. Treatment of febrile seizures. In: Engle J Jr, Pedley TA, eds. Epilepsy a comprehensive textbook. Philadelphia : Lippincott-Raven Publishers, 1998:1305-9. 15. Carpio A, Hauser WA. Prognosis for seizure recurrence in patients with newly diagnosed neurocysticercosis.Neurology. 2002 ; 59:1730-4. 16. Cascino GD. Use of routine and video electroencephalography Neurol Clinic 2001; 19: 271-87. ·π«∑“ß°“√√—°…“ 71 ‚√§≈¡™°—

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72. Verity CM, Greenwood R, Golding J. Long-term intellectual and behavioral outcomes of children with febrile convulsions. N Engl J Med 1998; 338:1723-8. 73. Wieser H-G, Engel J JR, Williamson PD, Babb TL, Gloor P. Surgically remediable temporal lobe syndromes. In: Engel J Jr. ed. Surgical treatment of the epilepsies. 2nd ed New York: Raven Press; 1993: 49-63. 74. Wibulpolprasent S. Mental health indicators. In: Thailand Health Profile. Bureau of Policy and Strategy, Ministry of Public Health; 1999-2000, p 187. 75. Wyler AR, Vossler DG. Surgical Strategies for Epilepsy. In: Grossman RG, Loftus CM. ed Principles of Neurosurgery, 2nd ed. Philadelphia: Lippincott-Raven; 1999, p 737-55. 76. Yucel O, Aka S, Yazicioglu L, Ceran O. Role of early EEG and neuroimaging in determination of prognosis in children with complex febrile seizure. Pediatr Int 2004; 46:463-7. ·π«∑“ß°“√√—°…“ 75 ‚√§≈¡™°—

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