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Parkinson

¿Qué es y cómo se trata?

El mal de Parkinson es una enfermedad neurológica progresiva crónica, afecta a las células nerviosas (neuronas) en una zona del cerebro cerca del cuello conocida como «sustancia negra». Estas células normalmente producen dopamina, un químico (neurotransmisor) que transmite señales entre las zonas del cerebro.

Cuando estas señales trabajan normalmente coordinan el movimiento muscular suave y equilibrado. Pero el mal de Parkinson produce una falta de dopamina en el cerebro y hace que los pacientes pierdan la capacidad de controlar sus movimientos corporales.

¿Cuáles son las causas?

Existen cada vez más pruebas que demuestran que el mal de Parkinson puede ser hereditario. Los hombres mayores de 60 años (edad promedio para la aparición de los síntomas) tienen más probabilidades de desarrollar esta enfermedad que las mujeres. El 10 % de los pacientes reciben un diagnóstico de mal de Parkinson antes de los 40 años.

¿Cuáles son los síntomas?

Los más comunes son: el temblor, un movimiento que comienza en una parte del cuerpo, por ejemplo, la mano o el pie. Este se puede propagar a medida que la enfermedad avanza y se agrava con el estrés. Raramente el temblor incapacita a un paciente y, a menudo, desaparece durante el sueño y cuando se mueve el brazo o la pierna.

Entre los principales síntomas se encuentran el endurecimiento muscular (rigidez), temblores, bradicinesia (lentitud de los movimientos y pérdida gradual de actividad espontánea), cambios en el patrón de desplazamiento y postura, cambios en el habla y en la escritura y pérdida de equilibrio que genera una mayor cantidad de caídas. A esto pueden sumarse menores expresiones faciales, cambios en el habla y en la escritura, problemas urinarios, estreñimiento, problemas en la piel y trastornos del sueño.

Los síntomas del mal de Parkinson pueden variar significativamente entre los pacientes, y, en realidad, el 25 % de los casos recibe un diagnóstico erróneo.

¿Cómo se realiza el diagnóstico?

A veces es complicado diagnosticarlo, ya que las primeras características pueden ser difíciles de evaluar y asemejarse a otros trastornos. Por ejemplo, el temblor puede no evidenciarse si una persona está sentada descansando, o los cambios posturales pueden considerarse resultado de la osteoporosis o simplemente como un signo de envejecimiento.

En la actualidad, no existen análisis de laboratorio o sangre sofisticados que permitan diagnosticar la enfermedad. Por eso, el médico quizá deba observar al paciente durante un tiempo para reconocer los síntomas de temblor y rigidez, y compararlos con otros síntomas característicos. También recopilará todos los antecedentes de los síntomas del paciente, sus actividades, medicamentos, otros problemas médicos y exposición a sustancias químicas tóxicas. Luego realizará un examen físico de las funciones del cerebro y del sistema nervioso, evaluando reflejos, coordinación, fuerza muscular y función mental del paciente.

¿En que consiste el tratamiento? 

Hay distintas opciones:

  • Medicamentos: existen fármacos que imitan el rol de la dopamina, y funcionan estimulando ciertas partes del cerebro y el sistema nervioso. Pero, para tratar los síntomas de la enfermedad de Parkinson, se utilizan otras clases de fármacos, que bloquean una enzima que destruye la levodopa y la dopamina.
  • Quirúrgicas: las cirugías más antiguas requerían la destrucción intencional de partes del cerebro, y presentaban un mayor riesgo de sufrir complicaciones. Hoy, este tipo de cirugías son poco frecuentes.

En general, la cirugía se considera únicamente cuando los medicamentos no pueden brindar un control adecuado. Dentro de las nuevas opciones, la estimulación cerebral profunda ofrece varias ventajas significativas. Esta técnica implica colocar permanentemente un electrodo en un sitio profundo del cerebro. El electrodo, luego, se conecta a un tipo de marcapasos implantado debajo de la piel en el pecho. Una vez activado, el dispositivo envía pulsos eléctricos continuos a los sitios objetivo, bloqueando los impulsos que causan temblor.

Esta opción no requiere la destrucción intencional de una parte del cerebro y, por lo tanto, presenta pocas complicaciones. Además, es ajustable, y puede cambiarse a medida que cambie la enfermedad o la respuesta del paciente hacia los medicamentos. Y si la estimulación cerebral profunda genera una cantidad excesiva de efectos colaterales, es posible apagar el estimulador y revertir los efectos.

Prevención 

No hay manera de prevenir esta enfermedad, pero si varias maneras de atenderla. Por eso se recomienda acudir inmediatamente a un médico especialista en trastornos de movimiento en caso de percibir alguno de los síntomas característicos.