Características clínicas y paraclínicas del diagnóstico de las crisis funcionales
DOI:
https://doi.org/10.22379/anc.2084Palabras clave:
Trastornos de conversión, Convulsiones, Epilepsia, Electroencefalografía, Enfermedades del sistema nerviosoResumen
Introducción: Las crisis funcionales hacen parte de las entidades a considerar dentro del diagnóstico diferencial en la evaluación de un paciente con crisis epilépticas. El propósito de esta revisión es dilucidar los elementos clínicos y paraclínicos para un correcto diagnóstico de las crisis funcionales.
Materiales y Métodos: Se realizó una revisión narrativa de la literatura, búsqueda en bases de datos Medline, Embase, Scielo y Scopus.
Resultados: La naturaleza paroxística de las crisis requiere un detallado análisis de las características clínicas dentro del relato del paciente o de los testigos de los eventos. El estándar de oro continúa siendo la visualización de los eventos en un video-electroencefalograma (VEEG) que permita evidenciar la ausencia de actividad epileptiforme durante la ocurrencia de las manifestaciones clínicas; el uso de neuroimágenes funcionales ha ayudado a dilucidar el entendimiento del sustento biológico este tipo de crisis. Otros estudios de laboratorio han demostrado una utilidad limitada por si solos, pero también se deben tener en cuenta en el arsenal diagnóstico.
Discusión: La presencia de factores de riesgo y especialmente la presencia de signos útiles, que se presentan con una mayor probabilidad de ocurrencia en crisis funcionales en comparación de las crisis epilépticas; asociado a la ausencia de actividad epiléptica en el registro electroencefalográfico. Un correcto y temprano diagnóstico permite evitar el uso innecesario de medicamentos anticrisis.
Conclusiones: Es crucial la identificación de las crisis funcionales con el fin de evitar la realización de estudios e intervenciones farmacológicas innecesarias, para finalmente encausar correctamente la estrategia terapéutica.
Biografía del autor/a
Andrés Felipe Morcillo Muñoz, Epileptología clínica, Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” (INNNMVS), Ciudad de México, México
Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
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