Distonía muscular. Síntomas y tratamiento.

Distonía muscular. Síntomas y tratamiento. Blog Idealia centro de día para mayores Charmartín (Madrid)

Puede estar asociada con temblor, a veces parecido al observado en ciertos ancianos, pues actúa frecuentemente acompañada de una rigidez media y torpeza parecidas a la de los enfermos de Parkinson; también se produce un temblor con irregulares y fuertes contracciones.

Aunque es muy variable, la distonía puede afectar a cualquier área corporal, y de acuerdo a esta circunstancia, se clasifican en:

  • Distonías Generalizadas: Que suelen ser hereditarias y aparecen durante la infancia,
  • Distonías Focales y Segmentarias: Que son las formas más frecuentes, especialmente durante la edad adulta.

Síntomas

De acuerdo con el Instituto Nacional de Enfermedades Neurológicas y Apoplejía de Estados Unidos, los síntomas iniciales pueden incluir un deterioro de la escritura después de escribir varias líneas (“calambre del escritor”), calambres en el pie y una tendencia a levantar o arrastrar un pie después de correr o de caminar una cierta distancia. El cuello puede girar o moverse involuntariamente, sobre todo cuando se está cansado.

Otros síntomas posibles son los temblores y dificultades en la voz o en el habla. Es posible que los síntomas iniciales sean muy leves y se perciban solamente después de un esfuerzo prolongado, tensión o fatiga. Con el tiempo, los síntomas pueden llegar a ser más notorios y extensos e incluso continuos. Sin embargo, hay casos en los que existe poca o ninguna progresión.

Distonía muscular. Síntomas y tratamiento. Blog Idealia centro de día para mayores Charmartín (Madrid)

 

Distonías Secundarias y focales

Por su mayor frecuencia vamos a detenernos especialmente en las distonías secundarias y en las focales. Las primeras deben su nombre a que precisamente son “secundarias” a daños en pequeñas áreas del cerebro. Según la Asociación de Lucha contra la Distonía en España (ALDE), pueden estar causadas por falta de oxígeno, antes, durante o inmediatamente después del nacimiento (parálisis cerebral), por lesiones en el cerebro, particularmente en la infancia, o por pequeños golpes. Puede también ser secundaria a pequeñas áreas dañadas relacionadas con afecciones como la esclerosis múltiple, encefalitis, o secundarias a un gran número de enfermedades que afectan al sistema nervioso, incluyendo la enfermedad de Wilson.

Las distonías focales son las más frecuentes y se manifiestan en forma de blefaroespasmo, “calambre del escritor”, tortícolis espasmódica, distonía orofacial-bucal y distonía laríngea. En el caso del “calambre del escritor”, se produce una contracción de los músculos de la mano y brazo únicamente durante el acto de la escritura. La mano puede contraerse tan fuertemente que no puede moverse, pero en cuanto se deja de escribir se relaja. Bajo esta denominación se incluyen las distonías sufridas por músicos que tocan determinados instrumentos (piano, por ejemplo).

Con el Blefarospasmo los ojos se cierran fuertemente durante minutos o incluso horas. Puede ocurrir por exposición a la luz solar o por un estado de ansiedad. En la Tortícolis espasmódica (Distonía cervical) los músculos del cuello se contraen, haciendo girar la cabeza hacia un lado o inclinarla hacia abajo o hacia atrás.

En cuanto a la distonía orofacial-bucal, llamada síndrome de Meige, a veces los músculos de la mandíbula actúan sobre la boca abriéndola o cerrándola. La distonía laríngea o disfonía es, por su parte, una distonía focal que afecta a los músculos laríngeos o caja de la voz; actúa sobre las cuerdas tensándolas y manteniéndolas unidas, particularmente al intentar hablar. La voz resulta forzada, ronca y entrecortada. A veces existe dificultad en la respiración. Cuando las cuerdas vocales están forzadamente separadas, la voz tiene un sonido de aliento, y a veces no es posible la fonación.

Tratamiento

La predicción del progreso de la distonía es incierta. Se puede decir que si afecta a otros miembros de la familia y si comienza en la infancia, tenderá a empeorar al cabo de los años. Sin embargo, se conocen casos de no empeoramiento e incluso de recuperaciones parciales y hasta de completa recuperación.

Por fortuna, existen tratamientos médicos efectivos para la mayoría de las distonías, aunque todavía no se ha encontrado un tratamiento universal eficaz. En su lugar, los médicos utilizan una variedad de terapias individualizadas orientadas a reducir o eliminar los espasmos y dolores musculares. Así, se han descubierto medicamentos que pueden ayudar a corregir desequilibrios en los neurotransmisores, si bien con el paso del tiempo la respuesta a los fármacos varía entre los diversos pacientes e incluso en la misma persona.

En la distonía focal, el tratamiento de elección es la infiltración local de toxina botulínica, habitualmente con excelentes resultados según los especialistas. Utilizada inicialmente para tratar los blefaroespasmos, se constató posteriormente que la toxina inyectada en el músculo o músculos distónicos es capaz de detener los espasmos musculares. El efecto dura varios meses antes de que sea necesario repetir las inyecciones.

Por desgracia en ocasiones, aunque pocas, la terapia puede resultar ineficaz o, aunque la primera aplicación se haya hecho con éxito, puede ir perdiendo efectividad en los sucesivos tratamientos. En cualquier caso, la toxina botulínica alivia los síntomas de la distonía, reduce el dolor y mejora el movimiento de forma significativa.

Respecto al tratamiento de la distonía generalizada, el tratamiento es fundamentalmente de tipo farmacológico (anticolinérgicos, benzodiacepinas, neurolépticos) y tiene igualmente una gran eficacia.

Por último, existe la opción del tratamiento quirúrgico, a través del cual se realiza una estimulación cerebral profunda. La cirugía se recomienda a algunos pacientes cuando los medicamentos no son eficaces o sus efectos secundarios son demasiado severos. Se encuentra en fase experimental, pero los resultados preliminares publicados son muy esperanzadores.

ACTITUD POSITIVA Y AYUDA

El doctor David Mariden, experto en distonías, ofrece los siguientes consejos:

» Tu actitud ante esta enfermedad será uno de los más importantes factores que deciden cómo te afecta. La distonía no te matará, pero si permites que te derrumbe, puede estropear tu vida. Es completamente natural, cuando comprendes la naturaleza de tu enfermedad, que pases por estados de ansiedad, desesperación y depresión, y después de aceptación. Esta evolución lleva tiempo, pero tú debes trabajar positivamente para llegar al estado final de aceptación, Habla con tu familia y con tu médico acerca de estos problemas.

Bibliografía

  • org
  • El periódico de la farmacia.es
  • com, artículos sobre distonía muscular.
  • Aldan-distonia.org
  • org
  • blogspot.com.es

 

Ana Sandoval Herrera – DUE Idealia Centro de día para mayores

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