ÿࡪ√–§ —∫ª√–§Õß„πº ŸâªÉ«¬≈¡™ —° · Vol.5 No.2 North-Eastern...

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45 North-Eastern Thai Journal of Neuroscience Vol.5 No.2 Topic Review ‡πμ√™π° ·°â«®—π∑“ 1 , Õ—≠∏‘¥“  √–·°â« 1 ,  ÿ®‘μμ“ ƒ∑∏‘Ï¡πμ√’ 1 , ¢«—≠ ÿ¥“ ∫ÿ≠‡∑» 1 , ªè≠≠“ ∑Õß∑—∫ 1 , °ƒμ¬“ · «ß‡®√‘≠ 2 1 π—°»÷°…“ª√‘≠≠“‚∑  “¢“°“√欓∫“≈ ÿ¢¿“殑μ·≈–®‘쇫™ 2 √Õß»“ μ√“®“√¬å §≥–欓∫“≈»“ μ√å ¡À“«‘∑¬“≈—¬¢Õπ·°àπ °“√∑”°≈ÿࡪ√–§—∫ª√–§Õß„πºŸâªÉ«¬≈¡™—° ∫∑§—¥¬àÕ ºŸâªÉ«¬‚√§≈¡™—°¡—°¡’ªí≠À“°“√‡®Á∫ªÉ«¬∑’Ë ‡√◊ÈÕ√—ß®“°≈—°…≥–¢Õß‚√§ ·≈–§«“¡‡™◊ËÕ¢Õßμπ ®÷ß¡’º≈μàÕ®‘μ„®‚¥¬μ√ß∑”„À⇰‘¥§«“¡√Ÿâ ÷°‰¡à ·πàπÕπ„π°“√√—°…“·≈–¥Ÿ·≈μπ‡Õß °“√‡¢â“ —ߧ¡ ·≈– —¡æ—π∏¿“æ°—∫ºŸâÕ◊Ëπ °“√®—¥°≈ÿࡪ√–§—∫ ª√–§Õß„πºŸâªÉ«¬‚√§≈¡™—°„π·ºπ°ºŸâªÉ«¬πÕ° ‡æ◊ËÕ·°âªí≠À“®‘μ —ß§¡‚¥¬ºŸâªÉ«¬ “¡“√∂‡¢â“√à«¡ °≈ÿà¡‚¥¬ ¡—§√„® º≈®“°°“√‡¢â“°≈ÿࡺŸâªÉ«¬‰¥â ·≈°‡ª≈’ˬπª√–‡¥Áπªí≠À“ ·≈–‡√’¬π√Ÿâ«‘∏’°“√ ‡º™‘≠ªí≠À“√à«¡°—π ‰¥â·°à §«“¡μâÕß°“√¥â“π ¢âÕ¡Ÿ≈‡°’ˬ«°—∫¿“«– ÿ¢¿“æ °“√‡®Á∫ªÉ«¬°“√√—°…“ °“√ªØ‘ ∫— μ‘ μ— «À√◊ Õ°“√¥Ÿ·≈μπ‡Õ߇¡◊Ë Õ‡ªì π‚√§≈¡™— ° °“√«‘ π‘ ®©— ¬ °“√√— °…“ ·≈–‡¢â “∂÷ ß∫√‘ °“√ ÿ¢¿“æ ¿“æ ≈—°…≥å·≈–§«“¡´÷¡‡»√â“ §«“¡√Ÿâ ÷°∑âÕ·∑â  ‘ÈπÀ«—ß §ÿ≥¿“æ™’«‘μ §«“¡°—ß«≈„® ·≈–§«“¡§—∫¢âÕß„® §«“¡‡§√’¬¥ ·≈–°“√ªØ‘‡ ∏°“√‡®Á∫ªÉ«¬ ‡¡◊ËÕ‡¢â“ °≈ÿà¡·≈â«¡’°“√‡ª≈’ˬπ·ª≈ߧ«“¡§‘¥·≈– æƒμ‘°√√¡‡°‘¥‡π◊ËÕß®“°°“√∑’Ë¡’§«“¡À«—ß √Ÿâ ÷°«à“ ¡’§π∑’Ë¡’ªí≠À“§≈⓬§≈÷ß°—𠧫“¡√Ÿâ ÷°‡ªìπÀπ÷Ëß ‡¥’¬«°—𠧫“¡√Ÿâ ÷°¡’§ÿ≥§à“ °“√‰¥â√–∫“¬ °“√ ‡√’¬π√Ÿâ∑—°…–∑“ß —ߧ¡ æ—≤π“∑—°…–°“√‡¢â“°≈ÿà¡ ‰¥â ¢â Õ¡Ÿ≈¢à “« “√ ·≈–‡√’ ¬π√Ÿâ §«“¡®√‘ ߢÕß™’ «‘ μ °≈ÿà ¡  “¡“√∂‡ªìπ·À≈àß π—∫ πÿπ„À⇰‘¥§«“¡¡—Ëπ§ß ∑“ßÕ“√¡≥å™à«¬„À⇰‘¥°“√ª√—∫μ—«μàÕªí≠À“ ‡√’¬π √Ÿâ«‘∏’°“√‡º™‘≠ªí≠À“‰¥â¥’¢÷Èπ  ”§—≠: °≈ÿࡪ√–§—∫ª√–§Õß ‚√§≈¡™—° ªí≠À“®‘μ  —ߧ¡ ∫∑π” ‚√§≈¡™—° (epilepsy) ¡“®“°§”°√’°«à“ epilambanein À¡“¬∂÷ß 'to seize' À√◊Õ†'to at- tack' ¡’°“√∫—π∑÷°§√—Èß·√°„π‚≈°μ–«—πμ°„π μ”√“¢Õß∫“∫‘‚≈‡π’¬π∑’˧âπæ∫„π∑“ß„μâ¢Õßμÿ√°’ μàÕ¡“æ∫«à“‚√§≈¡™—°¡’°“√‡¢’¬π„πμ”√“°“√ ·æ∑¬å ¢Õß®’ π‡¡◊Ë Õ 221 ∂÷ ß 770†ªï °à Õπ§√‘  μ°“≈ ‡¡◊Ë Õ √“« 400 ªï°àÕπ§√‘ μå»—°√“™ Œ‘ª‚ª‡§√μ‘ ‰¥â ∫√√¬“¬∂÷ß‚√§≈¡™—°«à“‡ªìπ '‚√§»—°¥‘Ï ‘∑∏‘Ï' ·μà  —ߧ¡ à«π„À≠à‡¢â“„®„π∑“ß«à“‡ªìπ‚√§¢Õߪﻓ® ‡π◊ËÕß®“°Õ“°“√·≈–Õ“°“√· ¥ß¢Õß‚√§ ®π °√–∑Ë ß„πªï §». 1875 ∑Ë ª√– “∑·æ∑¬å ™“«Õß°ƒ…

Transcript of ÿࡪ√–§ —∫ª√–§Õß„πº ŸâªÉ«¬≈¡™ —° · Vol.5 No.2 North-Eastern...

45North-Eastern Thai Journalof Neuroscience

Vol.5 No.2Topic Review

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Vol.5 No.2

North-Eastern Thai Journalof Neuroscience46

John Hughlings Jackson ‰¥âæ∫«à“Õ“°“√™—°

‡ªì𧫓¡º‘¥ª°μ‘®“° ¡Õß ‚√§≈¡™—°‡ªì𧫓¡

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47North-Eastern Thai Journalof Neuroscience

Vol.5 No.2

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6. ªí≠À“‡√◊ËÕߧÿ≥¿“æ™’«‘μ ¡’ ¡“™‘°„π

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‰¡à “¡“√∂∑”„π ‘Ëß∑’Ëμπ‡Õ߇§¬∑”‰¥â μâÕ߇ªìπ

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∑”„®·≈–ª≈àÕ¬«“ß √Ÿâ®—°§‘¥„π·ß॒‡æ◊ËÕ„Àâ°”≈—ß

μπ‡Õß √«¡∂÷ß¡’°“√ª√–§—∫ª√–§Õß∑“ßÕ“√¡≥å ‡™àπ

°“√√—∫øíߧ«“¡‰¡à ∫“¬„® ‡ªî¥‚Õ°“ „À≥â查∂÷ß

53North-Eastern Thai Journalof Neuroscience

Vol.5 No.2

§«“¡√Ÿâ ÷°μà“ßÊ °“√„Àâ°”≈—ß„® °“√· ¥ß∂÷ߧ«“¡

‡¢â“Õ°‡¢â“„®´÷Ëß°—π·≈–°—π ‡À≈à“π’ȇªìπ ‘Ëß∑’˙૬„Àâ

 “¡“√∂‡º™‘≠°“√‡®Á∫ªÉ«¬‰¥â¥’¢÷Èπ

7. ªí≠À“‡√◊ËÕߧ«“¡°—ß«≈„®·≈–§«“¡§—∫

¢âÕß„® ‡°’ˬ«°—∫Õ“°“√‡®Á∫ªÉ«¬ ‰¡à∑√“∫«à“μπ‡Õß

®–√—°…“À“¬À√◊Õ‰¡à ‰¡à∑√“∫«à“ “‡Àμÿ¢Õß‚√§‡°‘¥

®“°Õ–‰√ °“√√—°…“ºà“μ—¥À√◊Õ°‘𬓫‘∏’‰Àπ¥’∑’Ë ÿ¥

 ”À√—∫μπ‡Õß ¡’ ¡“™‘°∫“ߧπ∑’ˇæ‘Ë߇√‘Ë¡‡ªìπ·≈–

°”≈—ß√Ÿâ ÷°°—ß«≈„®°—∫°“√∑”∫∑∫“∑Õ¬à“ß¡“° ¡’

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‡ªìπ¿“√–§√Õ∫§√—«∑—È ß∑’Ë·μà ‡¥‘¡‡ªìπÀ—«Àπâ“

§√Õ∫§√—« §Õ¬À“√“¬‰¥â‡¢â“∫â“π æÕ‡ªìπÕ¬à“ßπ’È

‡¥‘π°Á‰¡à§≈àÕß ®–∑”ß“πÕ–‰√°Á≈”∫“° ß“π∑’ˇ§¬

∑”‰¥â°ÁμâÕßÀ¬ÿ¥ ∑”„À⢓¥√“¬‰¥â ≈Ÿ°‡¡’¬≈”∫“°

·≈–„π°≈ÿà¡°Á‰¥â¡’°“√·≈°‡ª≈’ˬπª√– ∫°“√≥å∑’Ë

μπ‡Õߺà“π¡“ ∑—Èß°“√¥Ÿ·≈μπ‡Õß·∫∫μà“ßÊ ·≈–

°“√ª√—∫‡ª≈’Ë¬π§«“¡§‘¥‡æ◊ËÕ„Àâ ¡“™‘°√Ÿâ ÷°°—∫

μπ‡Õߥ’¢÷Èπ ¡’ ¡“™‘°∫“ߧπ∑’Ë∫Õ°‡≈à“ª√– ∫

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∑”„Àâ ÿ¢¿“æ·¬à≈ß ·≈–‰¥â≈Õߪ√—∫§«“¡§‘¥„À¡à

À“«‘∏’∑’Ë®–Õ¬Ÿà°—∫ ¿“æªí®®ÿ∫—π¢Õßμπ‡ÕßÕ¬à“ß¡’

§«“¡ ÿ¢ ´÷Ëß¡—π∑”„À⇰‘¥°”≈—ß„®∑’Ë®– ŸâμàÕ‰ª ®“°

‡¥‘¡∑’ˇ¥‘π‰¡à‰¥â°Á “¡“√∂‡¥‘π‰¥â‡À¡◊Õπª°μ‘ ·≈–

‰¥â„Àâ°”≈—ß„® ¡“™‘°„π°≈ÿà¡ „Àâ¡’§«“¡ ÿ¢„À⥟·≈

μπ‡Õß „Àâ√—°…“μπμàÕ‰ª Õ¬à“¢“¥°“√√—°…“ ‰¥â

‡√’¬π√Ÿâ°“√„™â™’«‘μÕ¬à“ß ß∫‡¡◊ËÕ‡º™‘≠°—∫‚√§·≈–

™’«‘μ∑’ˇª≈’ˬπ·ª≈ß ∫“ߧπ°Á¡’§«“¡√Ÿâ ÷°§—∫¢âÕß„®

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8. ªí≠À“‡√◊ËÕߧ«“¡‡§√’¬¥ ¡’ ¡“™‘° à«π

„À≠à∑’ˉ¥â·≈°‡ª≈’ˬπª√– ∫°“√≥å„π°≈ÿà¡ ‰¥â

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Vol.5 No.2

North-Eastern Thai Journalof Neuroscience54

9. ªí≠À“°“√‰¡à¬Õ¡√—∫°“√‡®Á∫ªÉ«¬ ºŸâªÉ«¬

∑’Ë¡’Õ“°“√≈¡™—°„π™à«ßªï·√°¬—߬ա√—∫‰¡à‰¥â ‡ÀÁπ

‰¥â®“°∫“ߧπ√Ÿâ«à“‚√§π’ÈμâÕßÀ¬ÿ¥¥◊Ë¡ ÿ√“ ·μà°Á

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¥◊Ë¡°Á‰¡à‡ÀÁπ™—° ∂â“®–™—°°Á™—°‡©¬Êé ªØ‘‡ ∏∑—ÈßÊ√Ÿâ

«à“™—°∂’Ë¢÷Èπ  —ß§¡√—∫√Ÿâ‰¡àÕ¬“°„Àâ§πÕ◊Ëπ查∂÷ß

 ¡“™‘°∫“ߧπ‰¡àÕ¬“°‡¢â “°≈ÿà¡μâÕß√’∫°≈—∫

‡π◊ËÕß®“°¡“æ∫·æ∑¬å‡æ◊ËÕ√—∫¬“μàÕ‡π◊ËÕß·μà‡¡◊ËÕøíß

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„À≠à«‘Ëßæ≈à“π ÀπŸμ◊Ëπ¡“°Áª°μ‘·μફ¥À—«π‘¥

ÀπàÕ¬·¡àÀπŸ°—ß«≈¡“°°«à“ÀπŸî À≈—ß®“°‰¥â√—∫°“√

·≈°‡ª≈’ˬπª√– ∫°“√≥å°—∫ºŸâÕ◊Ëπ ºŸâªÉ«¬ ß∫øíß

·≈–‡¢â“¡“√à«¡·≈°‡ª≈’ˬπ ¬Õ¡√—∫«à“μπ√Ÿâ ÷°

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‡√’¬π‰¡à∑—π‡æ◊ËÕπμâÕß°“√°“√™à«¬‡À≈◊Õ®“°‡æ◊ËÕπ

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∫”∫—¥∑’ˇ°‘¥¢÷Èπ∫àÕ¬·≈–‡°◊Õ∫∑ÿ°§√—Èß„π°“√∑”

°≈ÿà¡·μà≈–§√—Èß ‰¥â·°à

1. °“√ √â“ߧ«“¡À«—ß (inspiration) ‚¥¬¡’

 ¡“™‘°À≈“¬§π∫Õ°«à“ √Ÿâ ÷°¥’∑’ˉ¥â¡“‡¢â“°≈ÿࡇÀÁπ

 ¡“™‘°À≈“¬∑à“πÕ“°“√¥’¢÷Èπ ¡’ ¡“™‘°∫“ß∑à“π∑’Ë

À“¬°Á∑”„À⇰‘¥§«“¡À«—ß«à“μπ‡ÕßμâÕßÀ“¬À√◊Õ¡’

Õ“°“√¥’¢÷È𠧑¥«à“‡√“μâÕß Ÿâ·≈–√—°…“μπ‡ÕßμàÕ‰ª

∫“ߧπ°Á∫Õ°«à“

ç°“√‡¢â“°≈ÿࡧ√—Èßπ’È∑”„Àâμπ‡Õß¡’°”≈—ß„®∑’Ë

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´÷Ëß®“°°“√»÷°…“º≈°“√∑”°≈ÿà¡®‘μª√–§—∫

ª√–§√Õß·°à¡“√¥“∑’Ë¥Ÿ·≈∫ÿμ√μ“¡≈”æ—ßæ∫«à“

¡“√¥“√Ÿâ ÷°¡’§«“¡À«—ß¡’°”≈—ß„®∑’Ë®–¥Ÿ·≈∫ÿμ√μàÕ

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∑’Ë ‡°‘¥¢÷Èπ®“°°“√∑”°≈ÿà¡®‘μ∫”∫—¥°—∫ºŸâªÉ «¬

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√—°…“‚√§μàÕ‰ª17

2. §«“¡√Ÿâ ÷°§≈⓬§≈÷ß°—π (universaliza-

tion) ¡’ ¡“™‘°„π°≈ÿà¡À≈“¬§π‡°‘¥§«“¡√Ÿâ ÷°¥’∑’Ë

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‚√§‡À¡◊Õπ‡√“ ¥—ß∑’Ë ¡“™‘°„π°≈ÿà¡∫Õ°‰«â„π™à«ß

∑⓬¢Õß°“√∑”°≈ÿà¡«à“

ç√Ÿâ ÷°¥’∑’˧πÕ◊Ëπ°Á‡ªìπ‡À¡◊Õπ‡√“ ‰¡à„™à‡√“

§π‡¥’¬«∑’˪ɫ¬‡ªìπ‚√§π’Èé

çÀ“¬§—∫¢âÕß„®∑’˧πÕ◊Ëπ°Á‡ªìπ‡À¡◊Õπ‡√“é

ç°“√‰¥â¡“‡¢â“°≈ÿà¡∑”„Àâ‡√“ ∫“¬„® ‡æ√“–

∑”„Àâ‡√“‰¥â√Ÿâ«à“¡’§πÕ◊ËπÕ’°À≈“¬§π∑’ˇ®Á∫ªÉ«¬

‡À¡◊Õπ‡√“ ·μà°àÕπ‡√“Õ¬Ÿà∑’Ë∫â“π°Á¡’·μà‡√“∑’˪ɫ¬

‡ªìπ‚√§π’È ∫“ß∑’°Á∑”„Àâ‡√“√Ÿâ ÷°πâÕ¬„® ·≈–∑âÕ·∑âé

55North-Eastern Thai Journalof Neuroscience

Vol.5 No.2

π’ˇªìπ‡æ’¬ßμ—«Õ¬à“ß∫“ß à«π¢Õߧ”查∑’Ë

 ¡“™‘°„π°≈ÿࡉ¥â∫Õ°‡≈à“„À⺟âπ”°≈ÿࡉ¥â√—∫√Ÿâ«à“ ‘Ëß

∑’ˇ¢“‰¥â¡“‡¢â“°≈ÿࡧ√—Èßπ’ȇ¢“√Ÿâ ÷°Õ¬à“߉√ ·≈–‡ªìπ

ª√–‚¬™πå°—∫æ«°‡¢“Õ¬à“߉√ ´÷Ë߉¥â¡’°“√»÷°…“

°“√∑”°≈ÿà¡®‘μª√–§—∫ª√–§√Õß„πºŸâªÉ«¬À≠‘ß∑’Ë

μ‘¥‡™◊ÈÕ‡Õ¥ å ∑’Ë¡’Õ“¬ÿ√–À«à“ß 30-35 ªï æ∫«à“À≈—ß

∑”°≈ÿà¡ ºŸâ‡¢â“√—∫°“√∫”∫—¥‰¥âμ√–Àπ—°«à“ ¡“™‘°

§πÕ◊Ëπ°Á¡’ªí≠À“∑’˧≈⓬§≈÷ß°—π¡’ªí≠À“‡À¡◊Õπ°—π

´÷Ëߧ«“¡√Ÿâ ÷°∑’Ë«à“μπ‡Õ߇ªìπ∑ÿ°¢åÕ¬Ÿà§π‡¥’¬«°Á≈¥

≈ß18 ∑”„À⇰‘¥§«“¡√Ÿâ ÷°„À¡à«à“‡¢“‰¡à‰¥âÕ¬Ÿà§π

‡¥’¬«„π‚≈° ¬—ß¡’‡æ◊ËÕπÊÕ’°À≈“¬§π∑’Ë¡’ªí≠À“

·≈–¡’§«“¡∑ÿ°¢å‡À¡◊Õπ‡¢“

3. §«“¡√Ÿâ ÷°¡’§ÿ≥§à“„πμπ‡Õß (altruism)

‡™àπ ¡’ ¡“™‘°À≈“¬§π∫Õ°«à“

ç√Ÿâ ÷°¥’∑’ˉ¥â¡“·∫àߪíπª√– ∫°“√≥å¥’Ê °—∫

‡æ◊ËÕπÊ∑’Ë¡’°“√‡®Á∫ªÉ«¬¥â«¬‚√§‡¥’¬«°—πé

纡√Ÿâ ÷°¥’¡“° ∑’ˉ¥â¡“∫Õ°‡≈à“ª√– ∫°“√≥å

¢Õßμπ‡Õß„Àâ‡æ◊ËÕπ„π°≈ÿࡉ¥â√—∫√Ÿâ‡æ√“–°«à“º¡®–

ºà“π®ÿ¥π—Èπ¡“‰¥â º¡°Á·¬à‡À¡◊Õπ°—πé

纡«à“‡ªìπ°“√¥’¡“°∑’ˉ¥â¡“查§ÿ¬·≈°

‡ª≈’ˬπª√– ∫°“√≥å∑’ˇªìπª√–‚¬™πå º¡Õ¬“°„Àâ

 ‘Ëß∑’Ëæ«°‡√“‰¥â查§ÿ¬°—π«—ππ’È ‰¥â¡’°“√𔉪‡º¬

·æ√à„À⇪ìπª√–‚¬™πå ”À√—∫ºŸâ∑’ˉ¥âÕà“π ‚¥¬‡©æ“–

ºŸâ∑’ˇ®Á∫ªÉ«¬¥â«¬‚√§≈¡™—°‡À¡◊Õπ‡√“ º¡«à“¡—π®–

‡ªìπª√–‚¬™πå¡“°‡≈¬∑’ˇ¥’¬«é

´÷Ëß°“√‡¢â“°≈ÿà¡∑”„Àâ ¡“™‘°‰¥â¡’°“√·°âªí≠À“

√à«¡°—π ·≈°‡ª≈’ˬπ¢âÕ¡Ÿ≈ ‘Ëß∑’ˇªìπª√–‚¬™πå´÷Ëß

°—π·≈–°—π ™à«¬‡À≈◊Õ‡æ◊ËÕπ∑’Ë¡’§«“¡∑ÿ°¢å¡“°°«à“

®÷ß∑”„Àâ ¡“™‘°„π°≈ÿࡇÀÁπ§ÿ≥§à“„πμπ‡Õߥ—ß∑’Ë

°≈à“«¡“ ´÷Ëß®“°»÷°…“°“√∑”°≈ÿà¡®‘μª√–§—∫ª√–

§√Õß·∫∫®‘μæ≈«—μ√„πºŸâªÉ«¬®‘μ‡¿∑ ·≈–°“√∑”

°≈ÿà¡®‘μª√–§—∫ª√–§√Õß„π¡“√¥“∑’ˇ≈’Ȭß∫ÿμ√μ“¡

≈”æ—ß æ∫«à“ ¡“™‘°∑’ˇ¢â“°≈ÿࡇ°‘¥§«“¡√Ÿâ ÷°¿“§

¿Ÿ¡‘„®„πμπ‡Õß √Ÿâ ÷°¥’°—∫μπ‡Õß∑’ˉ¥â√à«¡°—π·°â

ªí≠À“·≈–„Àâ¢âÕ¡Ÿ≈∑’ˇªìπª√–‚¬™πå°—∫‡æ◊ËÕπÊ

 ¡“™‘°„π°≈ÿà¡7,16

4. °“√‰¥â√–∫“¬ (catharsis) §«“¡√Ÿâ ÷°

§«“¡§—∫¢âÕß„® ªí≠À“μà“ßÊ∑’ˇ°‘¥¢÷Èπ °“√‡¢â“°≈ÿà¡

∑”„Àâ ¡“™‘°‰¥â√–∫“¬ÕÕ°∑—Èß ‘Ëß∑’Ë¥’·≈–‰¡à¥’ §«“¡

§—∫¢âÕß„® §«“¡«‘μ°°—ß«≈„Àâ°—∫ ¡“™‘°°≈ÿࡉ¥â

√—∫øíß °“√‰¥â√–∫“¬ÕÕ°®–∑”„Àâ ¡“™‘°√Ÿâ ÷°

 ∫“¬„® ∑”„À⇢Ⓞ®μπ‡Õß·≈–™’«‘μ¡“°¢÷È𠇙àπ

牥⇢⓰≈ÿࡧ√—Èßπ’ȇªìπ§√—Èß∑’Ë Õß °Á√Ÿâ ÷°¥’∑’Ë

‰¥â¡“查§ÿ¬°—∫‡æ◊ËÕπ‰¥â¡“查§ÿ¬√–∫“¬ªí≠À“

∑”„Àâ‡√“ ∫“¬„®¢÷Èπé

ç√Ÿâ ÷° ∫“¬„®¢÷Èπ§à– ‰¥â查§ÿ¬‰¥â√–∫“¬ ‰¥â

¡’‡æ◊ËÕπ查§ÿ¬é

ç°“√‰¥â¡“‡¢â“°≈ÿà¡°Á¥’§à– ‡æ√“–∑”„Àâ‡√“‰¥â

查‰¥â√–∫“¬ ‘Ëß∑’ˇ√“§—∫¢âÕß„® ∫“ß∑’‡√“‰¥â查

ÕÕ°‰ª∂÷ß·¡â®–·°â‰¢ªí≠À“‰¡à‰¥â ·μà°Á∑”„Àâ‡√“

√Ÿâ ÷°‚≈àßé

π’ȇªìπ§”查 à«πÀπ÷Ëß∑’Ë ¡“™‘°∑’ˇ¢â“°≈ÿࡉ¥â

∫Õ°‡≈à“À≈—ß®“°‰¥â‡¢â“√à«¡°≈ÿà¡∫”∫—¥ ´÷Ëß®“°°“√

»÷°…“°“√∑”°≈ÿà¡®‘μª√–§—∫ª√–§√Õß„πºŸâªÉ«¬

‡Õ¥ å‡æ»À≠‘ß º≈°“√∑”°≈ÿà¡æ∫«à“ ¡“™‘°°≈ÿà¡

∫Õ°«à“√Ÿâ ÷° ∫“¬„® ‡¢â“„®μπ‡Õß¡“°¢÷Èπ®“°°“√∑’Ë

‰¥â查‰¥â√–∫“¬ªí≠À“ ·≈–§«“¡§—∫¢âÕß„®18

Vol.5 No.2

North-Eastern Thai Journalof Neuroscience56

5. §«“¡‡ªìπÕ—πÀπ÷ËßÕ—π‡¥’¬«°—π (cohesion)

‡™àπ ¡’ ¡“™‘°„π°≈ÿà¡∫Õ°«à“

ç‡√“μâÕß Ÿâ ‡√“μâÕß„Àâ°”≈—ß„®´÷Ëß°—π·≈–°—π

Õ¬“°„Àâ°”≈—ß„®æ«°‡√“∑ÿ°§π„Àâ ŸâμàÕ‰ªé À√◊Õ

çÕ¬“°„Àâ°”≈—ß„®‡æ◊ËÕπÊ∑ÿ°§ππ“π·§à‰Àπ‡√“°Á

μâÕß√—°…“μàÕ‰ª ¢Õ„Àâ¡“æ∫·æ∑¬åμ“¡π—¥·≈–

°‘π¬“Õ¬à“ßμàÕ‡π◊ËÕßé

‡™à𠇥’¬«°—∫°“√»÷°…“°“√∑”°≈ÿà¡®‘μª√–

§—∫ª√–§√Õß„πºŸâªÉ«¬‡Õ¥ åÀ≠‘ß∑’˺≈°“√∑”°≈ÿà¡

∑”„Àâ ¡“™‘°‡°‘¥§«“¡√Ÿâ ÷°‡¢â“„®‡ÀÁπ„®¡’°“√™à«¬

‡À≈◊Õ‡ªìπÕ—πÀπ÷ËßÕ—π‡¥’¬«°—π18

6. °“√‡√’¬π√Ÿâ∑—°…–∑“ß —ߧ¡ (interper-

sonal learning)  ¡“™‘°À≈“¬∑à“π∑’ˇ¢â“°≈ÿà¡

°Á‰¥â‡√’¬π√Ÿâ°“√√—∫øíߪí≠À“¢ÕߧπÕ◊ËπÕ¬à“ßμ—Èß„®

‡ß’¬∫‡æ◊ËÕ‡ªî¥‚Õ°“ „À⺟âÕ◊Ëπ‰¥â√–∫“¬§«“¡‰¡à

 ∫“¬„® ‡√’¬π√Ÿâ∑’Ë®–查„Àâ°”≈—ß„®ºŸâÕ◊Ë𠇙àπ

ç‡√“∑ÿ°§π‡¢â“„®§ÿ≥π–‡æ√“–Õ“°“√∑’˧ÿ≥

‡≈à“¡“¡—π§ß∑”„Àâ§ÿ≥‡®Á∫¡“° ‡æ√“–æ«°‡√“·§à

™—°‡©¬Ê·μà§ÿ≥¡’Õ“°“√ª«¥∑’Ë„∫Àπⓥ⫬ ·μà

æ«°‡√“∑ÿ°§π°ÁÕ¬“°„Àâ°”≈—ß„®§ÿ≥π–„Àâ√—°…“„Àâ

À“¬é

çÕ¬“°„Àâ°”≈—ß„®∑ÿ°§π ŸâÊ μàÕ‰ªé

π’ȧ◊Õμ—«Õ¬à“ߧ”查∑’ˬ°¡“‡æ◊ËÕ· ¥ß„Àâ

‡ÀÁπ«à“°“√∑”°≈ÿà¡®‘μª√–§—∫ª√–§Õß∑”„À⺟âªÉ«¬

‚√§≈¡™—°·≈–≠“μ‘√Ÿâ®—°°“√查„Àâ°”≈—ß´÷Ëß°—π·≈–°—π

√Ÿâ®—°æ¬“¬“¡‡¢â“„®§«“¡√Ÿâ ÷°¢ÕߺŸâÕ◊Ë𠉥â‡√’¬π√Ÿâ

∑—°…–∑“ß —ߧ¡16

7. °“√æ—≤π“∑—°…–°“√‡¢â“°≈ÿà¡ (develop-

ment of socializing techniques) ¡’°“√‡√’¬π√Ÿâ

∑’Ë®–√—∫øíß °≈â“· ¥ß§«“¡§‘¥‡ÀÁπ·≈°‡ª≈’ˬπ

ª√– ∫°“√≥å ‡™àπ

ç°“√¡“∑”°≈ÿà¡Õ¬à“ßπ’È°Á¥’ ∂◊Õ‡ªìπ°“√¡“查

§ÿ¬·≈°‡ª≈’Ë¬π§«“¡√Ÿâ´÷Ëß°—π·≈–°—π ∫“ߧπ‰¡à查

·μà°Á‡ÀÁππ—ËßøíߧπÕ◊Ëπ查π–§à–é

牥â„Àâ°”≈—ß„®´÷Ëß°—π·≈–°—π ‡ÀÁπ„®‡¢â“„®

‡æ◊ËÕπ∑’ˇ¢“¡’§«“¡∑ÿ°¢å¡“°°«à“‡√“é

8. °“√‰¥â√—∫¢âÕ¡Ÿ≈¢à“« “√ (imparting of

information) ¡’ ¡“™‘°À≈“¬§π‰¥â∫Õ°‡≈à“

§«“¡√Ÿâ ÷° ‡™àπ

纡¡“‡¢â“°≈ÿà¡π’È º¡√Ÿâ ÷°¥’ ‰¥âª√–‚¬™πå ‰¥â

¡“查§ÿ¬·≈°‡ª≈’ˬπª√– ∫°“√≥å´÷Ëß°—π·≈–°—π

·≈–‰¥â¢âÕ¡Ÿ≈„π°“√¥Ÿ·≈μπ‡Õßé

ç©—π‰¥â∑√“∫«‘∏’°“√ªØ‘∫—μ‘μ—«‡æ◊ËÕÀ≈’°‡≈’ˬß

ªí®®—¬°√–μÿâπ∑’Ë®–∑”„À⇰‘¥Õ“°“√™—°é

ç©—π√Ÿâ ÷°¥’π– ‡æ√“–«à“¡“‡¢â“°≈ÿà¡∑”„À≥â

‡√’¬π√Ÿâ«‘∏’°“√§≈“¬§«“¡‡§√’¬¥ ‡æ◊ËÕ«à“μπ‡Õß®–

‰¥â𔉪ªØ‘∫—μ‘·≈– “¡“√∂∫Õ°§πÕ◊Ëπ∑’Ë ‡¢“¡’

ªí≠À“‡√◊ËÕ߇§√’¬¥‰¥â¥â«¬é

纡«à“°“√‰¥â¡“查§ÿ¬°—π°Á¥’π– ‰¥â‡√’¬π√Ÿâ

«‘∏’°“√ªØ‘∫—μ‘μ—«‡¡◊ËÕ‡°‘¥Õ“°“√™—°«à“§«√∑”Õ¬à“߉√

‡√“®–‰¥â∫Õ°„À⇢“¥Ÿ·≈‡√“«à“§«√∑”Õ¬à“߉√‡¡◊ËÕ

‡√“™—°é ‡ªìπμâπ

9. °“√‰¥â√Ÿâ§«“¡®√‘ߢÕß™’«‘μ (existential

factors) °“√√Ÿâ®—°ª≈àÕ¬«à“ß °“√∑”„® °“√ª≈ß ‡™àπ

¡’ ¡“™‘°°≈ÿà¡∫“ߧπ∫Õ°«à“

ç‡√“μâÕß√Ÿâ®—°ª≈àÕ¬«“ß √Ÿâ®—°ª≈ß Õ–‰√®–

‡°‘¥¡—π°ÁμâÕ߇°‘¥é

ç∑ÿ°§π¡’ªí≠À“¥â«¬°—π∑—Èßπ—Èπ Õ¬à“‰ª§‘¥¡“°

57North-Eastern Thai Journalof Neuroscience

Vol.5 No.2

‡√“μâÕß√Ÿâ®—°ª≈ß·≈–ª≈àÕ¬«“ßé

Õÿª √√§·≈–«‘∏’°“√·°â‰¢ë ºŸâªÉ«¬¡’ªí≠À“‚√§≈¡™—°¢≥–¡’ªí≠À“

∑“ß°“¬¿“æ ‡Àπ◊ËÕ¬ ÕàÕπ‡æ≈’¬ ¡“æ∫·æ∑¬å®–

‰¡àÕ¬“°‡¢â“°≈ÿà¡

ë ºŸâªÉ«¬‰¡à¡—Ëπ„®°≈—«°“√™—°„π°≈ÿà¡ ·π–π”

„À⺟âªÉ«¬ —߇°μÕ“°“√π”°√–μÿâπ·≈–∫հ欓∫“≈

‡æ◊ËÕ„Àâ°“√™à«¬‡À≈◊Õ∑—π∑à«ß∑’

ë °“√‡§¬™‘πμàÕ°“√μàÕ§‘«‡æ◊ËÕ√Õμ√«®°—∫

·æ∑¬å °≈—«∂Ÿ°√—¥§‘«·≈â«∑”„À≥â√—∫°“√μ√«®™â“

®÷߉¡àÕ¬“°‡¢â“°≈ÿà¡μâÕß„Àâ≠“μ‘§Õ¬¥Ÿ§‘«·≈–øíß

‡√’¬°™◊ËÕ®÷ß ∫“¬„®

ë ºŸâ ªÉ «¬·≈–≠“μ‘¡’ «‘ ∂’ ™’ «‘ μ∑’Ë √’ ∫√â Õπ

‡π◊Ë Õß®“°ºŸâªÉ «¬¡’Õ“™’æÀ√◊Õ≠“μ‘μâÕß√’∫‰ª

ª√–°Õ∫Õ“™’æ∑”„À≡àÕ¬“°‡¢â“°≈ÿà¡°≈—«‡ ’¬‡«≈“

·μà‡¡◊ËÕ¢Õ„À⇢Ⓡæ◊ËÕ∑¥≈ÕߺŸâªÉ«¬≈Õ߇¢â“·≈â«°Á

√Ÿâ ÷°¡’ª√–‚¬™πå

ë ‡¢â“°≈ÿà¡∫àÕ¬·≈⫉¡àÕ¬“°‡¢â“Õ’° ‰¡à™Õ∫

查 ‰¡àÕ¬“°§ÿ¬ ‡∫◊ËÕ ¡—°æ∫„πºŸâªÉ«¬∑’Ë´÷¡‡»√â“ ·μà

‡¡◊ËÕ∂Ÿ°°√–μÿâπ„À⇢⓺ŸâªÉ«¬¬‘È¡·≈â«¡’§«“¡À«—ß

¢âÕ‡ πÕ·π–„π°“√¥”‡π‘π°≈ÿà¡ë ‡æ◊ËÕ„Àâ°“√¥”‡π‘π°≈ÿࡇ¢â“ Ÿàª√–‡¥Áπ∑’Ë

‡°‘¥ª√–‚¬™π剥â√«¥‡√Á«¢÷Èπ§«√°√–μÿâπºŸâªÉ«¬∑’Ë

√Ÿâ ÷°¥’∑’ˇ§¬¡“‡¢â“°≈ÿà¡·≈â« ‡¢â“√à«¡‡ªìπμ—«Õ¬à“ß

„π°≈ÿà¡ ‡æ◊ËÕ‡ªìπ·√ß®Ÿß„®·≈–∂à“¬∑Õ¥„À⺟âÕ◊Ëπ‰¥â

√—∫√Ÿâª√–‚¬™πå¢Õß°“√‡¢â“°≈ÿà¡

ë §«√®—¥„À⇪ìπ°‘®°√√¡‡¢â“ Ÿàß“πª√–®”

‚¥¬¡’欓∫“≈ºŸâ¥”‡π‘π°≈ÿà¡∑’Ë¡’∑—°…–·≈–®—¥°“√

∫√‘À“√‡«≈“„π°“√¥”‡π‘π°“√

ë °“√∫√‘À“√®—¥°“√∑’Ë¥’„π°“√®—¥§‘« °“√

μ√«®  —¡¿“…≥姫“¡μâÕß°“√ªí≠À“μà“ßÊ ‡™àπ

ªí≠À“∑“ß°“¬ Õ“®§«√¡’‡ πÕ„Àâπ—Ëßøí߇©¬ÊÀ√◊Õ

„Àâæ—°‰¥â

ë °“√·®âß«—μ∂ÿª√– ß§å °“√μ‘¥ª√–°“»

‡™‘≠™«π ·≈–· ¥ßº≈ß“π°≈ÿà¡∑’ËÀπⓧ≈‘π‘°®–

™à«¬„π°“√μ—¥ ‘π„®‡¢â“„™â∫√‘°“√°≈ÿࡉ¥âßà“¬¢÷Èπ

®“°°“√∑”°≈ÿà¡®‘μª√–§—∫ª√–§√Õß„π

ºŸâªÉ«¬‚√§≈¡™—°∑’Ë·ºπ°ºŸâªÉ«¬πÕ°§√—Èßπ’È æ∫«à“

‡°‘¥ª√“°Ø°“√≥åª√–‡¥Áπªí≠À“∑“ß®‘μ —ß§¡∑’Ë

‡°‘¥¢÷ÈπÀ≈“°À≈“¬ §◊Õ ªí≠À“‡√◊ËÕߧ«“¡μâÕß°“√

¥â“π¢âÕ¡Ÿ≈‡°’ˬ«°—∫¿“«– ÿ¢¿“æ °“√‡®Á∫ªÉ«¬ °“√

√—°…“ ªí≠À“°“√¥Ÿ·≈μπ‡Õ߇¡◊ËÕ‡ªìπ‚√§≈¡™—°

ªí≠À“‡√◊ËÕß°“√«‘π‘®©—¬ °“√√—°…“·≈–°“√‡¢â“∂÷ß

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‡√◊ËÕߧ«“¡√Ÿâ ÷°∑âÕ·∑â  ‘ÈπÀ«—ß ªí≠À“‡√◊ËÕߧÿ≥¿“æ

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ªí≠À“‡√◊ËÕߧ«“¡‡§√’¬¥ ªí≠À“‡√◊ËÕß°“√‰¡à

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∫àÕ¬·≈–‡°◊Õ∫∑ÿ°§√—Èß∑’Ë∑”°≈ÿà¡ ‰¥â·°à °“√¡’§«“¡

À«—ß §«“¡√Ÿâ ÷°§≈⓬§≈÷ß°—𠧫“¡‡ªìπÕ—πÀπ÷ËßÕ—π

‡¥’¬«°—π °“√‰¥â√–∫“¬ °“√‰¥â‡√’¬π√Ÿâ∑—°…–°“√‡¢â“

°≈ÿà¡ °“√‰¥â·≈°‡ª≈’ˬπª√– ∫°“√≥å °“√‡¢â“„®

§«“¡®√‘ߢÕß™’«‘μ ¥—ßπ—Èπ®–‡ÀÁπ«à“°“√∑”°≈ÿà¡®‘μ

ª√–§—∫ª√–§Õß„πºŸâªÉ«¬‚√§≈¡™—°·≈–≠“μ‘™à«¬

∑”„À⺟âªÉ«¬·≈–≠“쑉¥â¡’°“√·≈°‡ª≈’ˬπ‡√’¬π√Ÿâ

Vol.5 No.2

North-Eastern Thai Journalof Neuroscience58

√à«¡°—π ¡’°“√ª√—∫μ—«μàÕªí≠À“ °“√‡º™‘≠ªí≠À“

∑’ˇÀ¡“– ¡ ¡’·À≈àß π—∫ πÿπ ‡°‘¥§«“¡¡—Ëπ§ß∑“ß

Õ“√¡≥å ¡’°“√‡√’¬π√Ÿâ·∫∫Õ¬à“ß∑’Ë¥’„π°“√¥Ÿ·≈

μπ‡ÕßμàÕ‰ª

‡Õ° “√Õâ“ßÕ‘ß1. «‘√‘¬“ ‡™◊ÈÕ≈’ ·≈–§≥–. §ÿ≥¿“æ™’«‘μ¢ÕߺŸâ

ªÉ«¬‚√§≈¡™—°„π‚√ß欓∫“≈»√’π§√‘π∑√å.

«“√ “√ ¡“§¡®‘μ·æ∑¬å·Ààߪ√–‡∑»‰∑¬

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 ”√«®ªí≠À“∑“ß°“√·æ∑¬å¥â“π‚√§√–∫∫

ª√– “∑¢Õß‚§√ß°“√ √ÿªª√–‡¥Áπªí≠À“

∑“ß°“√·æ∑¬å∑’ˇªìπªí≠À“¢Õߪ√–‡∑»„π

°“√ª√–™ÿ¡«‘™“°“√°√¡°“√·æ∑¬å ª√–®”ªï

2549 : 66

3. ≈¡™—°. §âπ®“° http://www.thaiepilepsy.com/

index.php?option=com_content&

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¡“√¥“‡¥Á° ¡Õßæ‘°“√. √“¬ß“π°“√»÷°…“

Õ‘ √–ª√‘≠≠“欓∫“≈»“ μ√¡À“∫—≥±‘μ

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ª√–§—∫ª√–§Õß·∫∫®‘μæ≈«—μ ”À√—∫ºŸâªÉ«¬

®‘ μ ‡ ¿ ∑∑’Ë √— ∫ ‰ «â √— ° … “ „ π ‚ √ ßæ¬ “ ∫ “ ≈

æ√–»√’¡À“‚æ∏‘Ï.«“√ “√ ¡“§¡æ¬“∫“≈œ

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·≈–ªí®®—¬∑’Ë¡’§«“¡ —¡æ—π∏å°—∫§«“¡μâÕß°“√.

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ºŸâªÉ«¬πÕ° ‚√ß欓∫“≈ «πª√ÿß.«“√ “√

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North-Eastern Thai Journalof Neuroscience60

Topic Review

¿≠. ÿ¿‘≠≠“ μ—π쓪°ÿ≈ “¢“«‘™“‡¿ —™°√√¡ªØ‘∫—μ‘ §≥–‡¿ —™»“ μ√å ¡À“«‘∑¬“≈—¬¢Õπ·°àπ

°“√„™â¬“ªÑÕß°—π‚√§ª«¥»’√…–‰¡‡°√π

‚√§ª«¥»’√…–‰¡‡°√π‡ªìπ‚√§∑’Ë¡’§«“¡

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∑ÿææ≈¿“æ∑—Ë«‚≈° ®“°√“¬ß“π¢Õß World Health

Organization (WHO) „πªï æ.».2544 æ∫«à“

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™’«‘μ§√Õ∫§√—«·≈– —ߧ¡ ‚¥¬ºŸâªÉ«¬ªÆ‘‡ ∏°“√∑”

°‘®°√√¡√à«¡°—∫§√Õ∫§√—«√âÕ¬≈– 1 ·≈–ªÆ‘‡ ∏

°“√‡¢â“√à«¡ —ߧ¡√âÕ¬≈– 304

¥—ßπ—Èπ°“√√—°…“®÷ß·∫àßÕÕ°‡ªìπ 2 ·π«∑“ß

¥â«¬°—π §◊Õ °“√√—°…“„π√–¬–‡©’¬∫æ≈—π·≈–°“√

ªÑÕß°—π ‚¥¬°“√√—°…“„π√–¬–‡©’¬∫æ≈—π¡’‡ªÑ“

À¡“¬„π°“√≈¥Õ“°“√ª«¥¢≥–¡’Õ“°“√‚¥¬¬“∑’Ë

„™â‡ªì𬓷°âμàÕ‰ªπ’Ȫ«¥5,6 ¥—ßμ“√“ß∑’Ë 1

61North-Eastern Thai Journalof Neuroscience

Vol.5 No.2

μ“√“ß∑’Ë 1 ¬“∑’Ë„™â„π°“√√—°…“‚√§ª«¥»’√…–‰¡‡°√π√–¬–‡©’¬∫æ≈—πμ“¡·π«∑“ߢÕß The European

Federation of Neurological Societies (EFNS) 2009

Drug Daily dose(mg) Level of evidence

Analgesics

Acetylsalicylic acid (ASA) 1000 (oral, intravenous) A

ASA plus Paracetamol plus Caffeine 250 plus 200-250 plus 50 A

Ibuprofen 200-800 A

Naproxen 500-100 A

Diclofenac 50-100 A

Paracetamol 1000 (oral, suppository) A

Metamizol 1000 (oral, intravenous) B

Tolfenamic acid 200 B

Ergot alkaloids

Ergotamine plus Caffeine 0.5-2 plus 50-200 B

Triptans (5-HT 1B/D

-agonists)

Sumatriptan 25-100(oral), 25(suppository), A

10-20(Nasal spray), 6(subcutaneous)

Zolmitriptan 2.5-5 (oral, nasal spray) A

Naratriptan 2.5 A

Rizatriptan 10 A

Almotriptan 12.5 A

Triptans (5-HT 1B/D

-agonists)

Eletriptan 20-40 A

Frovatriptan 2.5 A

Antiemeitcs

Metroclopramide 10-20(oral), 20(suppository), B

10(intramuscular, intravenous,

subcutaneous)

Domperidone 20-30 B

Vol.5 No.2

North-Eastern Thai Journalof Neuroscience62

°“√„™â¬“√—°…“„π√–¬–‡©’¬∫æ≈—π¬—ßæ∫

ªí≠À“§◊Õ ‡°‘¥Õ“°“√°≈—∫¡“„À¡à (recurrence)

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(ergotamine 2 mg plus caffeine 200 mg) ¡’

Õ“°“√°≈—∫¡“„À¡à√âÕ¬≈– 30 ¬“ sumatriptan

(100 mg) √âÕ¬≈– 41 À≈—ß®“°„™â¬“‰ª·≈â« 24

™—Ë«‚¡ß ºŸâªÉ«¬¡’°“√„™â¬“‡°‘π¢π“¥ ¡’ªí≠À“

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∑ÿ°∑√¡“π®“°Õ“°“√ª«¥ ¥—ßπ—Èπ®÷ß¡’°“√√—°…“

·∫∫ªÑÕß°—π‡æ◊ËÕ≈¥§«“¡∂’Ë„π°“√‡°‘¥Õ“°“√ª«¥

‡æ‘Ë¡§ÿ≥¿“æ™’«‘μ„À⺟âªÉ«¬ ≈¥ªí≠À“®“°°“√„™â¬“

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»’√…–‰¡‡°√πμ“¡·π«∑“ߢÕß The European

Federation of Neurological Societies (EFNS)

2009 ¡’¥—ßμàÕ‰ªπ’È

1. ¡’Õ“°“√ª«¥»’√…–μ—Èß·μà 2 §√—ÈßμàÕ‡¥◊Õπ

2. Õ“°“√ª«¥»’√…–¡’ªí≠À“μàÕ§ÿ≥¿“æ

™’«‘μÕ¬à“ß√ÿπ·√ߧ◊Õ ºŸâªÉ«¬μâÕߢ“¥ß“π ¢“¥

‚√߇√’¬π‡¡◊ËÕ¡’Õ“°“√ª«¥»’√…– ‡ªìπμâπ

3. ‰¡àμÕ∫ πÕßμàÕ°“√√—°…“„π°“√„™â¬“

√—°…“„π√–¬–‡©’¬∫æ≈—∫

4. ¡’Õ“°“√π”∫àÕ¬À√◊ÕÕ“°“√𔇪ìπ√–¬–

‡«≈“π“π

μ“√“ß∑’Ë 2 ¬“∑’Ë„™â„π°“√ªÑÕß°—π‚√§ª«¥»’√…–‰¡‡°√πμ“¡·π«∑“ߢÕß The European Federation of

Neurological Societies (EFNS) 2009

Drug Daily dose(mg) Level of evidence

Betablockers

Metoprolol 50-200 A

Propanolol 40-240 A

Bisopolol 5-10 B

Calcium channel blockers

Flunarizine 5-10 A

Antiepileptic drugs

Valproic acid 500-1800 A

Topiramate 25-100 A

Gabapentin 1200-1600 C

Non-steroidal anti inflammatory drugs

(NSAID)

Acetylsalicylic acid (ASA) 300 C

Naproxen 250-500 twice daily B

63North-Eastern Thai Journalof Neuroscience

Vol.5 No.2

Drug Daily dose(mg) Level of evidence

Antidepressant

Amitriptyline 50-150 B

Venlafaxine 75-150 B

Miscellaneous drugs

Lisinopril 20 C

Candesartan 16 C

Coenzyme Q10 300 C

Riboflavin 400 C

Magnesium 24 mmol C

Methysergide 4-12 C

Tanacetum parthenium 6.25 mg twice daily C

®“°·π«∑“ß°“√√—°…“¢Õß The European

Federation of Neurological Societies (EFNS)

2009 ¬“∑’Ë„™â„π°“√√—°…“‡ªìπμ—«‡≈◊Õ°·√° (First-

line) §◊Õ propanolol, metoprolol, flunarizine,

valproic acid ·≈–topiramate ´÷Ëß¡’¢âÕ¡Ÿ≈

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congestive heart failure (unstable), hypoten-

sion, diabetes mellitus, peripheral vascular

disease, Raynaudûs disease ‡ªìπμâπ12 ¢π“¥

Vol.5 No.2

North-Eastern Thai Journalof Neuroscience64

∑’Ë„™â„π°“√ªÑÕß°—π§◊Õ ¬“ propanolol 40-240 mg/

d metoprolol 50-200 mg/d ·μà°“√‡√‘Ë¡μâπ

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®”Àπà“¬„π∑âÕßμ≈“¥ª√–‡∑» À√—∞Õ‡¡√‘°“·μà®–

æ∫°“√„™âÕ¬à“ß·æ√àÀ≈“¬„πª√–‡∑»∑“߬ÿ‚√ª ≈–

μ‘πÕ‡¡√‘°“ ·≈–‡Õ‡™’¬14 °≈‰°„π°“√ÕÕ°ƒ∑∏‘Ï

¢Õ߬“§◊Õ¬—∫¬—Èß calcium channel ´÷ËßÕ“®¡’º≈

„π°“√¬—∫¬—Èß°“√‡°‘¥ CSD15 ¬“§«√æ‘®“√≥“‡≈◊Õ°

„™â„πºŸâªÉ«¬∑—Ë«‰ªÀ√◊Õ¡’‚√§√à«¡ ‡™àπ dizziness,

vertigo ·≈–§«√À≈’°‡≈’ˬ߄πºŸâªÉ«¬‚√§

Parkinsonûs disease, depression ‡ªìπμâπ ∑’Ë

‚¥¬¢π“¥¬“∑’Ë„™â„π°“√ªÑÕß°—π‚√§ª«¥»’√…–

‰¡‡°√π §◊Õ 5-10 mg/d §«√‡√‘Ë¡®“°¢π“¥μË”

°àÕπ·≈⫧àլʇæ‘Ë¡¢π“¥¬“¢÷Èπ®π∂÷ß¢π“¥‡ªÑ“

À¡“¬√à«¡°—∫ —߇°μº≈¢â“߇§’¬ß®“°¬“  à«π¬“

Calcium channel blockers Õ◊ËπÊ∑’Ë¡’°“√„™â

ªÑÕß°—π„π‚√§ª«¥»’√…–‰¡‡°√π §◊Õ verapamil

¢π“¥ 240-480 mg/d, nimodipine 120 mg/d,

ditiazem 120-160 mg/d ·≈–¡’°“√»÷°…“°“√„™â

¬“°≈ÿà¡ calcium channel blockers μ—«„À¡à¡“

„™â„π°“√ªÑÕß°—𠇙àπ isradipine10,13

º≈¢â“߇§’¬ß¢Õß flunarizine §◊Õ depres-

sion, weight gain, parkinsonism º≈¢â“߇§’¬ß

¢Õ߬“ verapamil, nimodipine, ditiazem §◊Õ

constipation (‚¥¬‡©æ“– verapamil), dizzi-

ness, hypotension, peripheral edema,

weight gain

¬“°≈ÿà¡ Antiepileptic

Valproic acid ‡ªìπ¬“∑’Ë¡’¢âÕ¡Ÿ≈™—¥‡®π„π

°“√„™â¬“ªÑÕß°—π‚√§ª«¥»’√…–‰¡‡°√π ‚¥¬

valproic acid ¡’º≈„π°“√¬—∫¬—Èß°“√‡°‘¥ cortical

spreading depression (CSD) ‡æ‘Ë¡ gamma-

aminobutyric acid (GABA) ¬—∫¬—Èß glutamate,

calcium channel „π ¡Õß ·≈–Õ“®¬—∫¬—Èß sero-

tonergic „π∫√‘‡«≥ dorsal raphe nuclei9,11,15

¬“§«√æ‘®“√≥“‡≈◊Õ°„™â„πºŸâªÉ«¬∑—Ë«‰ªÀ√◊Õ¡’‚√§√à«¡

‡™àπ epilepsy, mania, anxiety ·≈–§«√À≈’°

‡≈’ˬ߄πºŸâªÉ«¬‚√§ liver disease, bleeding dis-

orders ‡ªìπμâπ ¢π“¥¬“∑’Ë„™â„π°“√ªÑÕß°—π‚√§

ª«¥»’√…–‰¡‡°√π §◊Õ 500-1800 mg/d §«√‡√‘Ë¡

®“°¢π“¥μË”°àÕπ·≈⫧àլʇæ‘Ë¡¢π“¥¬“¢÷Èπ®π∂÷ß

¢π“¥‡ªÑ“À¡“¬√à«¡°—∫ —߇°μº≈¢â“߇§’¬ß®“°¬“

Topiramate ‡ªì𬓠antiepileptic °≈ÿà¡

„À¡à∑’Ë„™â„π°“√ªÑÕß°—π‚√§ª«¥»’√…–‰¡‡°√π

¬“ÕÕ°ƒ∑∏‘Ϭ—∫¬—Èß glutamate, sodium channel,

L-type calcium channel ‡æ‘Ë¡ GABA ¬—∫¬—Èß

65North-Eastern Thai Journalof Neuroscience

Vol.5 No.2

°“√‡°‘¥ CSD„π ¡Õß 1,9,11,15 ¬“§«√æ‘®“√≥“

‡≈◊Õ°„™â„πºŸâªÉ«¬∑—Ë«‰ªÀ√◊Õ¡’‚√§√à«¡ ‡™àπ epilepsy,

mania, anxiety, essential tremor, overweigh

·≈–§«√À≈’°‡≈’ˬ߄πºŸâªÉ«¬‚√§ kidney stone

¢π“¥¬“∑’Ë„™â„π°“√ªÑÕß°—π‚√§ª«¥»’√…–‰¡‡°√π

§◊Õ 50-100 mg/d §«√‡√‘Ë¡®“°¢π“¥μË”°àÕπ·≈â«

§àÕ¬Ê ‡æ‘Ë¡¢π“¥¬“¢÷Èπ®π∂÷ß¢π“¥‡ªÑ“À¡“¬√à«¡

°—∫ —߇°μº≈¢â“߇§’¬ß®“°¬“

º≈¢â“߇§’¬ß¢Õß valproic acid §◊Õ weight

gain, tremor  à«π topiramate §◊Õ weight loss,

parethesia, cognitive effect, kidney stone

μ“√“ß∑’Ë 3 ¬“∑’Ë„™â„π°“√ªÑÕß°—π‚√§ª«¥»’√…–‰¡‡°√π‡ªìπμ—«‡≈◊Õ°·√°μ“¡ EFNS 2009

Flunarizine 5 mg Oral hs ‡æ‘Ë¡ 5 mg /2 weeks Parkinson, depression, Depression, weight

(target & max dose other extrapyramidal gain

10 mg)

Propranolol 40 mg Oral OD ‡æ‘Ë¡ 40 mg/week Asthma, COPD, Depression, fatigue,

(target dose 120 mg, depression, congestive bradycardia

max 240 mg) heart failure (unstable),

hypotension, diabetes

mellitus, peripheral

vascular disease,

Raynaudûs disease

Metoprolol 50 mg Oral OD ‡æ‘Ë¡ 50 mg/week Asthma, COPD, Depression, fatigue,

(target dose 100 mg, depression,congestive bradycardia

max 200 mg) heart failure (unstable)

hypotension, diabetes

mellitus, peripheral

vascular disease,

Raynaudûs disease

Topiramate 50 mg Oral OD ‡æ‘Ë¡ 50 mg/week Kidney stone Weight loss, parethesia,

(target & max dose cognitive effect,

100 mg) kidney stone

Valproic acid 500 mg Oral OD ‡æ‘Ë¡ 500 mg/week Liver disease,bleeding Weight gain, tremor

(target dose 1000 mg, disorders

max 1800mg)

¬“ ¢π“¥¬“‡√‘Ë¡μâπ °“√ª√—∫¢π“¥¬“ ¢âÕ§«√À≈’°‡≈’ˬß

„π°“√„™â¬“º≈¢â“߇§’¬ß¢Õ߬“

Vol.5 No.2

North-Eastern Thai Journalof Neuroscience66

 √ÿª°“√„™â¬“√—°…“‚√§ª«¥‰¡‡°√π§«√‡≈◊Õ°„Àâ

‡À¡“– ¡°—∫Õ“°“√¢ÕߺŸâªÉ«¬ À“°ºŸâªÉ«¬∑’Ë¡’

Õ“°“√∫àÕ¬·≈– àߺ≈μàÕ™’«‘μª√–®”«—π °“√∑”ß“π

§«√æ‘®“√≥“„À⬓ªÑÕß°—π‚√§ª«¥»’√…–‰¡‡°√π

‡æ◊ËÕ‡æ‘Ë¡§ÿ≥¿“æ™’«‘μ·≈–≈¥ªí≠À“®“°°“√„™â¬“

„π√–¬–‡©’¬∫æ≈—π ‚¥¬§«√§”π÷ß∂÷ßÕ“°“√·≈–

‚√§√à«¡Õ◊ËπÊ¢ÕߺŸâªÉ«¬ π—∫ πÿπ°“√‡≈◊Õ°„™â¬“

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