Diagnóstico y tratamiento médico de la epilepsia
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OBJETIVO: Proponer unas guías prácticas basadas en la mejor evidencia científica y clínica disponible para el manejo diagnóstico y el tratamiento médico del paciente con epilepsia.
DESARROLLO: En una primera parte se hace un análisis de las definiciones de crisis epiléptica y de epilepsia formuladas por la Liga Internacional Contra la Epilepsia (ILAE). Varios elementos de la definición de epilepsia más reciente resultan polémicos y otros constituyen un paso de avance con respecto a las concepciones originales. Se revisan los criterios con respecto a: 1) La epilepsia considerada como enfermedad, 2) La distinción de las crisis epilépticas “no provocadas” y reflejas, 3) La valoración del riesgo de recurrencia de las crisis epilépticas, y 4) Las implicaciones prácticas del término epilepsia “resuelta”. En la segunda parte se aborda el manejo médico especializado de los pacientes con epilepsia, específicamente la organización de la consulta especializada, las ocho medidas de calidad o estándares para el manejo señaladas por la Academia Americana de Neurología, y las recomendaciones sobre el régimen de vida e integración social y los principios de la terapéutica con los fármacos antiepilépticos orales. En este último acápite se incluyen las recomendaciones para la selección del fármaco antiepiléptico oral según el tipo de crisis epiléptica y las características del paciente. Al final se valoran determinadas características farmacológicas de los fármacos antiepilépticos disponibles y otros que han sido incorporados en los últimos años.
CONCLUSIONES: El diagnóstico y tratamiento médico de la epilepsia en la práctica clínica debe de considerar las recientes publicaciones sobre el tema y las diferentes perspectivas aportadas por los expertos. Al final, el manejo óptimo de esta enfermedad debe de lograrse a través de la discusión formal de las opciones disponibles entre el médico de asistencia y el paciente o sus cuidadores.
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