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Neurología Mancha-Centro

Servicio de Neurología del Area Mancha Centro - Hosp. General Mancha Centro y Hosp. General de Tomelloso

Blog de Neurologia Post New Entry

DUDAS COTIDIANAS DE PACIENTES EPILEPTICOS

Posted by Laura Turpín Fenoll on May 28, 2015 at 6:15 PM


La epilepsia es una patologia neurológica que se desencadena por la actividad anormal de un grupo de neuronas que descargan de un modo excesivo. Para considerar a un paciente epiléptico debe tener al menos dos crisis.

Existen multiples manifestaciones:

De modo genérico podemos diferenciarlas en crisis generalizadas y parciales.

  • Generalizadas: En las que se produce una desconexión del medio. Las mas conocidas son las llamadas crisis generalizadas tónico clonicas en las que el paciente cae al suelo, sufre movimientos convulsivos, puede morderse la lengua y perder el control esfinteriano. Pero no son las únicas. En niños son frecuentes las llamadas crisis de ausencia (antiguamente conocidas como "petit mal"), en ellas el paciente permanece con la mirada fija, sin interacción con el medio, pueden durar escasos segundos y continuar con su actividad normal. Dado que pueden suceder varias veces al dia es importante diagnosticarlas sobre todo en niños por su posible interferencia en el rendimiento escolar.
  • Parciales: Son muy variables pueden ser visuales, sensitivas, motoras, vegetativas... En general se trata de fenómenos que aparecen y desaparecen de modo súbito, repetido y estandarizado (son tipicas la sensación de miedo no explicado con piloerección, malestar epigástrico, movimiento de una extremidad....). En estos casos es importante descartar la presencia de lesión subyacente.

 

Mitos y realidades sobre la epilepsia.

No se trata de pacientes violentos, de hecho aunque en la literatura se encuentra el término "psicosis epileptógena" esto es excepcional.

A pesar de la creencia generalizada, no necesariamente se asocia a personalidades especiales ó a deficit cognitivos. Si bien pueden existir trastornos asociados, ésto dependerá del caso concreto. La epilepsia puede aparecer en el contexto de un síndrome polimalformativo, ser secundaria a una lesión cerebral y tendran las manifestaciones típicas de éstos, pero también puede ser idiopatica, es decir, de causa no conocida y en estos casos las repercusiones dependerán del control de las crisis.

Por tanto el diagnóstico de epilepsia no implica necesariamente la existencia de una alteracion cognitiva. Si bien es cierto que en el contexto de ciertos síndromes de la infancia que presentan retraso mental, éste se acompaña de crisis epileticas: encefalopatías mitocondriales, encefalopatías hipóxicas connatales...entre otras muchas. Por otro lado solo reseñar que la presencia de crisis repetidas y mal controladas de localización en lóbulo temporal si podría llegar a causar limitaciones en un futuro; de igual modo el uso crónico de ciertos fármacos se asocia con déficit de atención o afectación cognitiva prinicipalmente en tareas ejecutivas.

En el siguiente enlace podemos ver como a lo largo de la historia personajes importantes en el campo de la música, deporte, ciencia...han sufrido ésta enfermedad: http://www.todosobreepilepsia.com/index.php?option=com_content&view=category&id=20&Itemid=443

Deporte: No existen contraindicaciones salvo para deportes de riesgo (se recomienda no realizar alpinismo, nadar siempre acompañado...), de hecho el deporte aeróbico podría ser beneficioso. 

Salidas nocturnas: Es importante mantener un ritmo de sueño vigilia adecuado. En caso de no cumplirse intentar descansar al día siguiente y sobre todo no conducir ni realizar  otra actividad peligrosa. No deben añadir otros factores de riesgo de crisis como consumo de alcohol y mucho menos olvidar la medicación. 

Viajes: Tan solo precisa informe medico para justificar el uso de farmacos

En edad escolar es muy importante que el niño, los profesores y los compañeros conozcan el diagnóstico (por supuesto adaptado a las capacidades de cada uno), para saber cómo actuar y para evitar rechazo. En casos en los que asocie una discapacidad la educación estará adaptada a esta.

Profesiones: No existe impedimento para casi ninguna actividad, con excepciones: piloto y aquellas profesiones que requieran el empleo de armas de fuego

Conducción: su limitación esta directamente relacionada con el control ya que exige un periodo mínimo libre de crisis de un año con tratamiento estable o de 6 meses en caso de solo presentar mioclonias. Se puede ampliar información en el siguiente enlace:

http://www.todosobreepilepsia.com/index.php?option=com_content&view=article&id=360&Itemid=380

 

Dra. Laura Turpín Fenoll
Servicio de Neurología HGMC

Categories: Epilepsia

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