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EPILEPSIA Y AUTISMO ¿Qué sabemos?
Como muchos ya sabréis, la relación entre la epilepsia y el autismo, es innegable a día de hoy. En este nuevo artículo me gustaría hablar sobre ésta latente relación y como no, de las últimas investigaciones y principales hallazgos al respecto. Si bien es cierto que hay mucha información publicada; creo que es necesario recoger y resumir la misma frecuentemente, con el objetivo de tener una perspectiva actualizada y evitar caer en mitos y prejuicios. Esto resulta indispensable en nuestro deber como profesionales a la hora de guiar y orientar a las familias hacia el conocimiento y sobre todo, hacia el reto colectivo de conocer el autismo cada día, un poco más de cerca con sus infinitas implicaciones.
El autismo y la epilepsia son dos condiciones neurológicas diferentes que, aunque comparten mecanismos fisiopatológicos comunes, pueden aparecer o no de forma conjunta. Multitud de estudios científicos generales han arrojado como resultado que entre el 5 y el 40 por ciento de los niños con diagnóstico de espectro autista (TEA/CEA) padecen epilepsia con crisis y convulsiones. A su vez, la epilepsia sin episodios de convulsión aumenta hasta entre el 20 y el 65 por ciento de niños con el diagnóstico frente a tan sólo un 2% de la población general
Antes de continuar me gustaría remarcar que, se hace especial alusión a la infancia debido a que es cuando se inician las crisis epilépticas en la mayoría de los casos hasta llegar a encontrar (en la medida de lo posible) un tratamiento farmacológico que ayude a controlar, reducir e incluso extinguir los episodios conforme el niño va creciendo. Sin embargo, esto no siempre es posible y se calcula que entre el 20 y el 30 por ciento de los casos, son diagnosticados como epilepsia refractaria y por ello, resistentes al tratamiento farmacológico. En definitiva se trata de una incidencia elevada que parece seguir una evolución diferente a lo largo del ciclo vital con especial énfasis en las primeras etapas de desarrollo y el paso de la adolescencia a la pubertad.
¿Qué es la epilepsia?
Una crisis epiléptica se define por la presencia de descargas eléctricas que son anormales y excesivas en las neuronas. Estas suelen ser de corta duración aunque es un dato indeterminado que varía también de una persona a otra: puede durar desde segundos a minutos. Durante las crisis el niño puede perder el control de su cuerpo e incluso el conocimiento y pueden aparecer convulsiones.
Las convulsiones pueden estar causadas por diferentes motivos, algunos de ellos son la aparición de fiebre alta frecuentemente, bajadas de azúcar, traumatismos o lesiones en la cabeza entre otros. La falta de sueño y el estrés, también se han identificado como preceptores de la epilepsia que cursa con convulsiones.
Antes de seguir avanzando, me gustaría dejar claro una vez más que la epilepsia no se contagia ni es una enfermedad psiquiátrica. Comúnmente surge este prejuicio cuando hablamos de “problemas o alteraciones en la cabeza” y nada más lejos de la realidad.
¿Cuál es la relación entre la epilepsia y el autismo?
En ocasiones, los Trastornos del Espectro del Autismo (TEA) aparecen asociados a otro tipo de trastornos, lo que da lugar a un diagnóstico doble. Entre ellos, el autismo presenta una alta frecuencia de asociación con la epilepsia, siendo la tasa de epilepsia en los TEA mayor que en otros trastornos del desarrollo.
Numerosos estudios documentan la alta prevalencia de casos de epilepsia entre personas con TEA, estimándose entre un 2 y un 46 por ciento, dependiendo de la edad y los criterios diagnósticos. La alta frecuencia de comorbilidad de la epilepsia con los TEA sugiere que existe una base neurobiológica y genética común de ambos trastornos.
En los trastornos del espectro autista se han detectado alteraciones epileptiformes en el electroencefalograma entre un 10.3 – 72.4 por ciento de los pacientes y alteraciones subclínicas en el 6.1 – 31 por ciento. La focalidad de la actividad epileptiforme se localizaba en las áreas temporales (30%), en el área central (28%), en el área frontal (23%) y en la región occipital (8%). Además de la actividad epileptiforme, aparecía actividad de ondas lentas con más frecuencia y mayor grado de severidad.
Las consecuencias clínicas de las descargas epileptiformes varían dependiendo de si son generalizadas o focales, de tal manera que en las descargas generalizadas se observa un mayor compromiso de las funciones cognitivas y en las descargas focales se observa una mayor especificidad, dependiendo de la zona cerebral en la cual se localiza el foco.
Se estima que entre el 10 – 50 por ciento de los niños autistas sufren una regresión de la conducta adquirida después de un periodo inicial de desarrollo madurativo normal. Esta regresión abarca las habilidades lingüísticas, la sociabilización y el juego. Generalmente la causa es desconocida, sin embargo en estos casos debe considerarse el papel directo de la epilepsia en la sintomatología y manifestación clínica de los TEA.
La ausencia de crisis clínicas en el momento de la regresión no descarta el origen epileptogénico del proceso regresivo. En muchos niños autistas las crisis sutiles y crisis subclínicas pueden pasar desapercibidas, sin embargo se ha observado que una proporción significativa de niños con autismo presentan actividad epileptiforme subclínica, siendo estas alteraciones del electroencefalograma muy variables. Por tanto cada vez se admite más que la regresión mantiene una asociación significativa con los hallazgos epileptiformes en el electroencefalograma en los niños autistas que han sufrido un proceso regresivo. Esta actividad epileptiforme se localiza predominantemente en las áreas centrotemporales. En próximos artículos hablaremos más específicamente sobre el diagnóstico de autismo de origen recesivo y las últimas investigaciones que se han publicado dado el aumento de casos a nivel mundial.
¿Qué puedo hacer si creo que mi hijo sufre epilepsia?
El primer paso en estas ocasiones es sin duda, acudir a profesionales especializados en éste área como el neurólogo o el neuropediatra en función de la edad. Si hablamos de las primeras etapas de desarrollo, puedes pedir derivación a través de tu pediatra o médico de referencia para que lleven a cabo las pruebas pertinentes como son el electroencefalograma (ECG) o el estudio del sueño y la vigilia entre otros. Estas pruebas ayudan a detectar y analizar la actividad eléctrica y el funcionamiento neurológico de forma relativamente sencilla a la hora de identificar anomalías. Cuando acudas al médico, trata de haber reflexionado previamente la información y para ello algunas preguntas que te puedes hacer son ¿Duerme bien durante la noche? ¿Ha habido cambios extremos en su comportamiento o necesidades? ¿Se ha producido algún episodio de ausencia por breve que sea? ¿Se queja de dolores de cabeza recurrentes o visión borrosa? ¿Notamos que el niño está más nervioso o alterado de lo normal sin causa aparente? La respuesta a algunas de estas preguntas, puede arrojar información muy útil a los especialistas. Mientras tanto, recuerda que está bien informarte, pero no te obsesiones ni saques conclusiones previas al diagnóstico médico. Esto a veces hace caer a multitud de familias en pseudocreencias y pseudo tratamientos que pueden llegar a ocasionar un gran perjuicio para el niño.
Tratamiento farmacológico para la epilepsia infantil
Constituye el tratamiento básico de todos los pacientes con epilepsia y engloba los llamados fármacos antiepilépticos (FAE). Estos fármacos persiguen eliminar la aparición de crisis con los mínimos efectos secundarios posibles. Están diseñados para restaurar el equilibrio químico de las neuronas y tomados con regularidad pueden reducir, controlar o incluso eliminar las crisis epilépticas. Los fármacos logran control de crisis en aproximadamente entre el 70 y el 80% de las personas.
Normalmente el tratamiento se inicia con medicamentos para detener las crisis epilépticas. Los medicamentos para las crisis son los antiepilépticos, son el tratamiento más común para las crisis. Han sido una forma eficaz de tratamiento durante muchos años. Por todo lo anteriormente expuesto, cabe recomendar a todas las familias de niños con TEA o necesidades similares, la evaluación exhaustiva con un neurólogo que permita conocer en mayor profundidad la posibilidad de que se produzcan episodios de epilepsia con o sin manifestación clínica aparente. De este modo podremos obtener información fundamental y relevante en el desarrollo del niño y sobre todo, afianzar o descartar otras comorbilidades al diagnóstico de TEA. Cabe destacar para concluir que, hoy en día una persona con el diagnóstico de epilepsia y autismo, puede llevar a cabo una vida totalmente funcional y autónoma si las crisis son controladas y hay un seguimiento médico recurrente en los casos que sea necesario.
Algunas referencias de interés
1. Kanner L. Autistic disturbances of affective contact. Nervous Child 1943; 10: 217-50
2. Deykin E, MacMahon B. The incidence of seizures among children with autistic symptoms. American Journal of Psychiatry 1979; 136: 1310-2
3. Canitano R, Luchetti A, Zapella M. Epilepsy, electroencephalographic abnormalities, and regression in children with autism. J Child Neurol 2005; 20:27-31
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