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Epilépticos farmacorresistentes se podrían beneficiar de la cirugía
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Epilépticos farmacorresistentes se podrían beneficiar de la cirugía

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Epilépticos farmacorresistentes se podrían beneficiar de la cirugía

El 10% de los enfermos epilépticos que no responde a la medicación son candidatos a la cirugía de la epilepsia; de este 10%, entre el 60 y el 80% consigue controlar las crisis e incluso eliminarlas , según los expertos participantes en el V Simposium Internacional de Epilepsia y Cirugía de la Epilepsia, que se celebra en Sevilla. En España hay cerca de 500 000 epilépticos.

El simposio, organizado por el equipo de Neurocirugía de Hospital Quirón Sagrado Corazón-IENSA, liderado por el doctor Trujillo Madroñal, versa en esta edición sobre las "Controversias en epilepsia y cirugía de la epilepsia". La dirección del mismo corre a cargo de los doctores Juan Rodríguez Uranga y José Manuel Montero Elena, neurólogo y neurocirujano, respectivamente, de la Unidad Integral de Epilepsia de Quirón Sagrado Corazón-IENSA.

"Aunque existe el error de pensar que es hereditaria, las causas de la epilepsia son diversas", ha destacado Uranga, que señala que las más comunes son "las malformaciones del desarrollo, traumatismos craneoencefálicos, tumores cerebrales, sufrimiento fetal o enfermedades infecciosas como la meningitis, entre otras".

El Hospital Quirón Sagrado Corazón-IENSA ha sido pionero en la intervención quirúrgica de la epilepsia dentro del sector privado. Para ello, cuenta con un equipo formado por neurólogos, neuropsicólogos, neurofisiólogos, psiquiatras, anestesistas y neurocirujanos especializados en epilepsia, que realizan una valoración integral del paciente.

La unidad ha incorporado tecnologías de última generación, como son la monitorización video-EEG con electrodos invasivos, siendo en la actualidad el único hospital privado de Andalucía que cuenta con una unidad específica de dicha técnica, y la Resonancia Magnética Intraoperatoria, una herramienta de gran utilidad para el cirujano, con el propósito de garantizar la correcta resección de las lesiones, además de aportar mayor seguridad y mejor pronóstico para el paciente.

La epilepsia sigue siendo una enfermedad altamente estigmatizante. Aún se produce una infravaloración social y laboral de los afectados, por lo que muchos enfermos siguen escondiendo su enfermedad.

Muchos pacientes sufren una enorme limitación en el desarrollo de su vida cotidiana, pues deben tomar medicación de por vida, no exenta de efectos adversos, y en los casos más severos (el 35% de los pacientes epilépticos son farmacorresistentes), son personas dependientes de su familia, presentan limitaciones para determinadas actividades de riesgo, no pueden conducir hasta llevar un año sin crisis, deben evitar situaciones de riesgo y tienen riesgo aumentado de afectación de funciones cognitivas y de mayor riesgo de trastornos conductuales y psiquiátricos.

Las crisis continuadas durante muchos años pueden generar un deterioro cognitivo progresivo a algunos pacientes, cuya esperanza de vida puede ser inferior al resto de la población. De hecho, si se analiza la mortalidad general en pacientes con epilepsia refractaria al tratamiento médico, se considera varias veces mayor a la población general.

Aunque los fármacos han mejorado mucho en cuanto a resultados en el control de las crisis, todavía no han conseguido controlarlas en su totalidad y hay un 10% de los pacientes fármaco-resistentes que son candidatos posibles a la cirugía de la epilepsia.

En estos casos, la cirugía puede conseguir no sólo controlar las crisis o hacerlas desaparecer, sino también mejorar la calidad de vida del paciente que, en muchas ocasiones, puede llegar a ser independiente. La cirugía en los síndromes candidatos a cirugía consigue controlar entre el 60 y el 80% de los pacientes y ayuda a mejorar a entre un 10 y un 20% más.

En términos de incidencia, se estima que algo más del 3% de todos los epilépticos de nuevo diagnóstico se pueden considerar candidatos a cirugía de la epilepsia, por lo que unos 30 pacientes al año se podrían beneficiar de este tipo de cirugía en un área como Sevilla.

116 pacientes intervenidos con éxito

Hasta el momento, en la Unidad Integral de Epilepsia de Quirón Sagrado Corazón-IENSA se han intervenido con éxito 116 casos de epilepsia, estando el 79% libre de crisis tras la cirugía, la mejoría significativa se consiguió en el 91% de los pacientes. No se presentaron complicaciones mayores irreversibles en ningún caso, la mortalidad fue cero en esta serie.

febrero 8/2013 (JANO), Infomed.cu

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