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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


Posted by Enrique Botia Paniagua - Jefe de Neurología HGMC on April 10, 2016 at 3:10 PM

El 11 de abril es el Día Mundial del Parkinson


La enfermedad de Parkinson (EP) es la segunda enfermedad neurodegenerativa más frecuente (la primera es la enfermedad de Alzheimer). Su causa principal es la degeneración progresiva de células dopaminérgicas en la sustancia negra.  Aunque la mayoría de las veces la enfermedad es esporádica, hay un porcentaje de formas genéticas.

Los síntomas motores cardinales de la enfermedad son temblor, rigidez y bradicinesia (lentitud de movimientos). Otros datos clínicos característicos son el comienzo asimétrico y la buena respuesta al tratamiento con levodopa. Además de los síntomas motores, hay síntomas no motores como trastornos del ánimo, déficit olfatorio, estreñimiento, alteraciones del sueño REM, dolor de hombro.... presentes incluso antes del diagnóstico de la enfermedad (enfermedad "premotora"). Tanto la clínica motora como la no motora, indicen de manera variable en la calidad de vida de los pacientes.

La escala que utilizamos para valorar el estadío del paciente es la clasificación de Hoenh-Yahr.

El diagnóstico es clínico y se puede apoyar en diferentes pruebas diagnósticas, ninguna definitiva, ya que diagnóstico definitivo es la necropsia.Utilizamos la resonancia magnética cerebral para diferenciar entre EP y otros parkinsonismos (vascular, atrofia multisistémica o hidrocefalia entre otros.) La sonografia, (medición de hiperecogenidad de la sustancia negra) para diferenciar EP de temblor esencial y otros parkinsonismos. Las pruebas de medicina nuclear como el SPECT -DATSCAN- ayudan a diferenciar los síndromes parkinsonianos del temblor esencial o parkinsonismos farmacológicos. El SPECT con IBZM, se solicita para diferenciar la EP de otros parkinsonismos. No obstante, como ya hemos mencionado, el diagnóstico es clínico y debe reemplantearse de manera periódica en busca de datos atípicos.

El tratamiento, sintomático que no curativo, suele ser eficaz en los primeros 10-15 años. Posteriormente y en relación con el tratamiento prolongado, pueden aparecer complicaciones que llamamos fluctuaciones motoras (discinesias, acortamiento del beneficio de dosis, bloqueos) y no motoras (sialorrea, disfagia, síntomas urinarios, somnolencia diurna excesiva, apatía, alucinaciones, déficit cognitivos y trastornos del control de impulsos donde encontramos entre otros la hipersexualidad). En esta etapa se pueden plantear otras alternativas terapeúticas como pueden ser la infusión de duodopa, apormorfina o técnicas quirúrgicas como la estimulación cerebral profunda.

Los pacientes con EP se benefician de una vida activa con ejercicio físico diario (mejora el estado físico, metal y entre otros, los dolores articulares debidos a la rigidez).

En conclusión, la EP es una enfermedad degenerativa con manifestaciones clínicas motoras y no motoras que indicen en la calidad de vida de los pacientes.

No disponemos actualmente de ninguna prueba diagnóstica definitiva durante la vida del paciente siendo el diagnóstico clínico. Tiene un tratamiento aceptable en los primeros años de la enfermedad que se debe complementar con ejercicio físico diario.


11 de abril de 2016. DRA MARTA RECIO BERMEJO. 
Coordinadora de la Unidad de Parkinson y Trastornos del Movimiento.
Servicio de Neurología del Hospital General La Mancha Centro. Alcázar de San Juan.



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Video-1 Videochat sobre la enfermedad de Parkinson. Clínica Universidad de Navarra.

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Video 2 - Ejercicios para la enfermedad de Parkinson




Categories: Parkinson y Trast. del Movimiento

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