Foto 1. Molécula de dopamina..
En la entrada anterior del blog criticamos negativamente la recomendación del uso de la Risperidona en la Guía de buena práctica para el tratamiento de los trastornos del espectro autista, elaborada por J. Fuentes-Biggi a, M.J. Ferrari-Arroyo b, L. Boada-Muñoz b, E. Touriño-Aguilera b, J. Artigas-Pallarés c, M. Belinchón-Carmona d, J.A. Muñoz-Yunta e,f, A. Hervás-Zúñiga g,h, R. Canal-Bedia i, J.M. Hernández j, A. Díez-Cuervo k, M.A. Idiazábal-Aletxa l, F. Mulas m, S. Palacios n, J. Tamarit ñ, J. Martos-Pérez o, M. Posada-De la Paz p (Grupo de Estudio de los Trastornos del Espectro Autista del Instituto de Salud Carlos III. Ministerio de Sanidad y Consumo, España) publicada además en las prestigiosas revistas RevNeurol y PubMed. En ella se recomienda expresamente el uso de un antipsicótico atípico llamado Risperidona. El artículo completo pueden verlo en http://www.revneurol.com/ . Puede suscribirse gratis a esta estupenda revista.
En la entrada anterior dimos a conocer a nuestros lectores la existencia de una alerta médica sobre su uso en personas mayores.
Ahora damos a conocer diversos casos médicos que también alertan sobre la aparición de enfermedades sumamente graves, potencialmente mortales, en niños y jóvenes.
Lamentamos que no aparezca claramente ninguna referencia a este asunto en la citada Guía.
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En el DSM-IV se describen diversos trastornos motores inducidos por medicamentos, fundamentalmente neurolépticos:
G21.0 Síndrome neuroléptico maligno (333.92)
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Rigidez muscular grave, temperatura elevada y otros síntomas ( sudoración, disfagia, incontinencia, alteraciones del nivel de conciencia que van de la confusión al coma, mutismo, elevación o labilidad en la tensión arterial, elevación de la creatinfosfocinasa (CPK)) que aparecen con el consumo de neurolépticos.
Rigidez muscular grave, temperatura elevada y otros síntomas ( sudoración, disfagia, incontinencia, alteraciones del nivel de conciencia que van de la confusión al coma, mutismo, elevación o labilidad en la tensión arterial, elevación de la creatinfosfocinasa (CPK)) que aparecen con el consumo de neurolépticos.
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El Síndrome Neuroléptico Maligno es una complicación neurológica poco frecuente, pero sumamente grave grave, con una elevada mortalidad en los casos no tratados de manera inmediata.
El Síndrome Neuroléptico Maligno es una complicación neurológica poco frecuente, pero sumamente grave grave, con una elevada mortalidad en los casos no tratados de manera inmediata.
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Al objeto de informar a nuestros lectores hemos tomado al azar 8 artículos que aparecen en PubMed. Si Vd. pincha, una vez esté en PubMed, Risperidona y Síndrome Neuroléptico Maligno aparecen muchos más.
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La información no sesgada de los efectos de los medicamentos neurolépticos a las familias es la base para que consientan o no esa medicación.
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Un documento como la Guía debería haber hecho explícitos TODOS los efectos negativos de la droga que RECOMIENDAN.
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1: J Child Adolesc Psychopharmacol. 2000 Winter;10(4):327-30.
Links
Case study. Risperidone-Induced neuroleptic malignant syndrome in an adolescent.
· Robb AS,
· Chang W,
· Lee HK,
· Cook MS.
Department of Psychiatry and Behavioral Science, The Children's National Medical Center, Washington, DC 20010, USA. arobb@cnmc.org
Neuroleptic malignant syndrome (NMS) is a potentially fatal complication of neuroleptic therapy, characterized by fever, rigidity, mental status changes, and autonomic instability. Although NMS was previously associated with the use of high-potency neuroleptics, cases have begun to emerge with atypical neuroleptics. This article presents a risperidone-induced case in the youngest patient to date, raising issues concerning our perceptions, the safety of newer neuroleptics, and treatment of NMS.
PMID: 11191694 [PubMed - indexed for MEDLINE]
Links
Case study. Risperidone-Induced neuroleptic malignant syndrome in an adolescent.
· Robb AS,
· Chang W,
· Lee HK,
· Cook MS.
Department of Psychiatry and Behavioral Science, The Children's National Medical Center, Washington, DC 20010, USA. arobb@cnmc.org
Neuroleptic malignant syndrome (NMS) is a potentially fatal complication of neuroleptic therapy, characterized by fever, rigidity, mental status changes, and autonomic instability. Although NMS was previously associated with the use of high-potency neuroleptics, cases have begun to emerge with atypical neuroleptics. This article presents a risperidone-induced case in the youngest patient to date, raising issues concerning our perceptions, the safety of newer neuroleptics, and treatment of NMS.
PMID: 11191694 [PubMed - indexed for MEDLINE]
Traduzca con
http://babelfish.altavista.com/tr
2: J Psychopharmacol. 2005 Jul;19(4):422-5.
Links
Neuroleptic malignant syndrome due to three atypical antipsychotics in a child.
· Chungh DS,
· Kim BN,
· Cho SC.
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Bundang Hospital, Seoul, Korea.
Neuroleptic Malignant Syndrome (NMS) is a rare, potentially fatal and idiosyncratic drug reaction. It is characterized by a sudden loss of body temperature control, renal and respiratory failure, muscle rigidity, loss of consciousness and impairment of autonomic nervous system. Although NMS was previously associated with the use of classical high-potency neuroleptics, cases have started to emerge with atypical neuroleptics. This article discusses the first case of NMS in a child, induced by the use of risperidone, olanzapine and quetiapine.
PMID: 15982999 [PubMed - indexed for MEDLINE]
2: J Psychopharmacol. 2005 Jul;19(4):422-5.
Links
Neuroleptic malignant syndrome due to three atypical antipsychotics in a child.
· Chungh DS,
· Kim BN,
· Cho SC.
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Bundang Hospital, Seoul, Korea.
Neuroleptic Malignant Syndrome (NMS) is a rare, potentially fatal and idiosyncratic drug reaction. It is characterized by a sudden loss of body temperature control, renal and respiratory failure, muscle rigidity, loss of consciousness and impairment of autonomic nervous system. Although NMS was previously associated with the use of classical high-potency neuroleptics, cases have started to emerge with atypical neuroleptics. This article discusses the first case of NMS in a child, induced by the use of risperidone, olanzapine and quetiapine.
PMID: 15982999 [PubMed - indexed for MEDLINE]
Traduzca con
http://babelfish.altavista.com/tr
3: J Toxicol Clin Toxicol. 2004;42(6):921-5.
Links
Neuroleptic malignant syndrome in a child treated with an atypical antipsychotic.
· Abu-Kishk I,
· Toledano M,
· Reis A,
· Daniel D,
· Berkovitch M.
Pediatric Intensive Care Unit, Assaf Harofeh Medical Center, Israel.
Neuroleptic malignant syndrome (NMS) is an uncommon potentially fatal side effect of neuroleptic drugs, characterized by movement disorder, altered mental status and autonomic instability. A single dose of clotiapine was administered to an 11-year old male with acute psychosis. The previously healthy child had signs consistent with NMS including hyperthermia, hypertension, motor and mental changes. Repeat examination performed two weeks later, demonstrated that while his hyperthermia subsided, his mental status deteriorated. Olanzapine was administered, after which the child had hyperthermia, dystonia and more pronounced restlessness, once again consistent with NMS. He developed respiratory failure and was intubated and mechanically ventilated. Lorazepam, dantrolene and bromocriptine were administered as treatment of possible NMS. His mental condition, movement disorder and autonomic dysfunction improved significantly. Two weeks later, the patient was discharged in good general condition without the need for any ongoing medical treatment. There are only few case reports of NMS in children treated with olanzapine, an atypical antipsychotic. In children, caution must be exercised when prescribing antipsychotics, particularly atypical antipsychotics as these drugs may cause NMS. Because of the low incidence of NMS, a high index of suspicion is needed to identify cases so prompt treatment can be undertaken.
PMID: 15533033 [PubMed - indexed for MEDLINE]
3: J Toxicol Clin Toxicol. 2004;42(6):921-5.
Links
Neuroleptic malignant syndrome in a child treated with an atypical antipsychotic.
· Abu-Kishk I,
· Toledano M,
· Reis A,
· Daniel D,
· Berkovitch M.
Pediatric Intensive Care Unit, Assaf Harofeh Medical Center, Israel.
Neuroleptic malignant syndrome (NMS) is an uncommon potentially fatal side effect of neuroleptic drugs, characterized by movement disorder, altered mental status and autonomic instability. A single dose of clotiapine was administered to an 11-year old male with acute psychosis. The previously healthy child had signs consistent with NMS including hyperthermia, hypertension, motor and mental changes. Repeat examination performed two weeks later, demonstrated that while his hyperthermia subsided, his mental status deteriorated. Olanzapine was administered, after which the child had hyperthermia, dystonia and more pronounced restlessness, once again consistent with NMS. He developed respiratory failure and was intubated and mechanically ventilated. Lorazepam, dantrolene and bromocriptine were administered as treatment of possible NMS. His mental condition, movement disorder and autonomic dysfunction improved significantly. Two weeks later, the patient was discharged in good general condition without the need for any ongoing medical treatment. There are only few case reports of NMS in children treated with olanzapine, an atypical antipsychotic. In children, caution must be exercised when prescribing antipsychotics, particularly atypical antipsychotics as these drugs may cause NMS. Because of the low incidence of NMS, a high index of suspicion is needed to identify cases so prompt treatment can be undertaken.
PMID: 15533033 [PubMed - indexed for MEDLINE]
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· Ananth J,
· Parameswaran S,
· Gunatilake S,
· Burgoyne K,
· Sidhom T.
University of California, Los Angeles, CA, USA.
OBJECTIVE: The incidence of neuroleptic malignant syndrome (NMS) is not known, but the frequency of its occurrence with conventional antipsychotic agents has been reported to vary from 0.02% to 2.44%. DATA SOURCES: MEDLINE search conducted in January 2003 and review of references within the retrieved articles. DATA SYNTHESIS: Our MEDLINE research yielded 68 cases (21 females and 47 males) of NMS associated with atypical antipsychotic drugs (clozapine, N = 21; risperidone, N = 23; olanzapine, N = 19; and quetiapine, N = 5). The fact that 21 cases of NMS with clozapine were found indicates that low occurrence of extrapyramidal symptoms (EPS) and low EPS-inducing potential do not prevent the occurrence of NMS and D(2) dopamine receptor blocking potential does not have direct correlation with the occurrence of NMS. One of the cardinal features of NMS is an increasing manifestation of EPS, and the conventional antipsychotic drugs are known to produce EPS in 95% or more of NMS cases. With atypical antipsychotic drugs, the incidence of EPS during NMS is of a similar magnitude. CONCLUSIONS: For NMS associated with atypical antipsychotic drugs, the mortality rate was lower than that with conventional antipsychotic drugs. However, the mortality rate may simply be a reflection of physicians' awareness and ensuing early treatment.
PMID: 15119907 [PubMed - indexed for MEDLINE]
· Ananth J,
· Parameswaran S,
· Gunatilake S,
· Burgoyne K,
· Sidhom T.
University of California, Los Angeles, CA, USA.
OBJECTIVE: The incidence of neuroleptic malignant syndrome (NMS) is not known, but the frequency of its occurrence with conventional antipsychotic agents has been reported to vary from 0.02% to 2.44%. DATA SOURCES: MEDLINE search conducted in January 2003 and review of references within the retrieved articles. DATA SYNTHESIS: Our MEDLINE research yielded 68 cases (21 females and 47 males) of NMS associated with atypical antipsychotic drugs (clozapine, N = 21; risperidone, N = 23; olanzapine, N = 19; and quetiapine, N = 5). The fact that 21 cases of NMS with clozapine were found indicates that low occurrence of extrapyramidal symptoms (EPS) and low EPS-inducing potential do not prevent the occurrence of NMS and D(2) dopamine receptor blocking potential does not have direct correlation with the occurrence of NMS. One of the cardinal features of NMS is an increasing manifestation of EPS, and the conventional antipsychotic drugs are known to produce EPS in 95% or more of NMS cases. With atypical antipsychotic drugs, the incidence of EPS during NMS is of a similar magnitude. CONCLUSIONS: For NMS associated with atypical antipsychotic drugs, the mortality rate was lower than that with conventional antipsychotic drugs. However, the mortality rate may simply be a reflection of physicians' awareness and ensuing early treatment.
PMID: 15119907 [PubMed - indexed for MEDLINE]
Traduzca con
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5: Can J Psychiatry. 1996 Feb;41(1):52-4.
Links
Risperidone-induced neuroleptic malignant syndrome: a case report and review.
· Meterissian GB.
Department of Psychiatry, McGill University, St. Mary's Hospital Center, Montreal, Quebec.
OBJECTIVES: 1. To report the case of a 53-year-old patient who developed neuroleptic malignant syndrome (NMS) - a rare but potentially life-threatening complication of neuroleptic therapy - 4 days after treatment with risperidone was initiated. 2. To review previously reported cases of NMS associated with risperidone. METHODS: A computerized search of several databases, including MEDLINE, was conducted to find all previously reported cases of NMS with risperidone. RESULTS: Five reported cases of risperidone-induced NMS were found in the literature. All cases including the one reported here displayed typical clinical features of NMS and all 6 patients had a prior history of extrapyramidal side effects and/or NMS. Age and duration of exposure to risperidone did not seem to be of significance. CONCLUSIONS: These cases illustrate that clinicians should be on the lookout for risperidone-induced NMS.
PMID: 8919425 [PubMed - indexed for MEDLINE]
5: Can J Psychiatry. 1996 Feb;41(1):52-4.
Links
Risperidone-induced neuroleptic malignant syndrome: a case report and review.
· Meterissian GB.
Department of Psychiatry, McGill University, St. Mary's Hospital Center, Montreal, Quebec.
OBJECTIVES: 1. To report the case of a 53-year-old patient who developed neuroleptic malignant syndrome (NMS) - a rare but potentially life-threatening complication of neuroleptic therapy - 4 days after treatment with risperidone was initiated. 2. To review previously reported cases of NMS associated with risperidone. METHODS: A computerized search of several databases, including MEDLINE, was conducted to find all previously reported cases of NMS with risperidone. RESULTS: Five reported cases of risperidone-induced NMS were found in the literature. All cases including the one reported here displayed typical clinical features of NMS and all 6 patients had a prior history of extrapyramidal side effects and/or NMS. Age and duration of exposure to risperidone did not seem to be of significance. CONCLUSIONS: These cases illustrate that clinicians should be on the lookout for risperidone-induced NMS.
PMID: 8919425 [PubMed - indexed for MEDLINE]
Traduzca con
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6: Ann Pharmacother. 2001 Jun;35(6):698-701.
Links
Neuroleptic malignant syndrome during a change from haloperidol to risperidone.
· Reeves RR,
· Mack JE,
· Torres RA.
GV (Sonny) Montgomery Veterans Administration Medical Center, USA. roy.reeves2@med.va.gov
OBJECTIVE: To report a case of neuroleptic malignant syndrome (NMS) in a patient whose therapy was being switched from haloperidol to risperidone. CASE REPORT: A 57-year-old African-American man, treated for schizophrenia with haloperidol for several years, developed NMS within 48 hours of the addition of low doses of risperidone and mirtazapine to his regimen. Symptoms, which included fever, generalized rigidity, and altered mental status, resolved after discontinuation of psychotropics, supportive management, and several weeks of treatment with bromocriptine and dantrolene. He was subsequently treated with olanzapine without adverse effects. DISCUSSION: Several cases of NMS have been reported with risperidone, but none under these circumstances. NMS most likely occurred in this patient as a result of the additive dopamine 2 receptor blocking of haloperidol and risperidone. Sympathetic hyperactivity secondary to mirtazapine may also have been a contributing factor. If NMS may be induced by the simultaneous use of older, high-potency antipsychotics and newer, atypical antipsychotics such as risperidone, switching patients from older to newer antipsychotics may at times be difficult, since completely stopping one antipsychotic before starting the second may place patients at risk for psychotic relapse. CONCLUSIONS: Clinicians should closely monitor patients receiving both haloperidol and risperidone or combinations of similar medications.
PMID: 11408988 [PubMed - indexed for MEDLINE]
6: Ann Pharmacother. 2001 Jun;35(6):698-701.
Links
Neuroleptic malignant syndrome during a change from haloperidol to risperidone.
· Reeves RR,
· Mack JE,
· Torres RA.
GV (Sonny) Montgomery Veterans Administration Medical Center, USA. roy.reeves2@med.va.gov
OBJECTIVE: To report a case of neuroleptic malignant syndrome (NMS) in a patient whose therapy was being switched from haloperidol to risperidone. CASE REPORT: A 57-year-old African-American man, treated for schizophrenia with haloperidol for several years, developed NMS within 48 hours of the addition of low doses of risperidone and mirtazapine to his regimen. Symptoms, which included fever, generalized rigidity, and altered mental status, resolved after discontinuation of psychotropics, supportive management, and several weeks of treatment with bromocriptine and dantrolene. He was subsequently treated with olanzapine without adverse effects. DISCUSSION: Several cases of NMS have been reported with risperidone, but none under these circumstances. NMS most likely occurred in this patient as a result of the additive dopamine 2 receptor blocking of haloperidol and risperidone. Sympathetic hyperactivity secondary to mirtazapine may also have been a contributing factor. If NMS may be induced by the simultaneous use of older, high-potency antipsychotics and newer, atypical antipsychotics such as risperidone, switching patients from older to newer antipsychotics may at times be difficult, since completely stopping one antipsychotic before starting the second may place patients at risk for psychotic relapse. CONCLUSIONS: Clinicians should closely monitor patients receiving both haloperidol and risperidone or combinations of similar medications.
PMID: 11408988 [PubMed - indexed for MEDLINE]
Traduzca con
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7: Ann Pharmacother. 1996 Jul-Aug;30(7-8):775-8.
Links
Risperidone-induced neuroleptic malignant syndrome.
· Sharma R,
· Trappler B,
· Ng YK,
· Leeman CP.
Arnold and Marie Schwartz College of Pharmacy, Long Island University, NY, USA.
OBJECTIVE: To describe a patient with neuroleptic malignant syndrome (NMS) induced by risperidone, an atypical antipsychotic, and to review the available literature related to risperidone-associated NMS. DATA SOURCE: Case report information was obtained from the resident physician and medical records. MEDLINE and Index Medicus were searched to obtain literature published between 1960 and 1995. DATA SYNTHESIS: We report an adolescent boy who developed NMS after treatment with risperidone. Risperidone therapy was started after unsuccessful treatment and development of extrapyramidal adverse effects with haloperidol. The patient demonstrated the classic tetrad of fever, generalized skeletal muscle rigidity, altered mental status, and autonomic dysfunction. Risperidone was discontinued and the patient recovered after a prolonged hospital course with supportive management. CONCLUSIONS: Clinicians are cautioned about the possibility of NMS with risperidone.
PMID: 8826559 [PubMed - indexed for MEDLINE]
7: Ann Pharmacother. 1996 Jul-Aug;30(7-8):775-8.
Links
Risperidone-induced neuroleptic malignant syndrome.
· Sharma R,
· Trappler B,
· Ng YK,
· Leeman CP.
Arnold and Marie Schwartz College of Pharmacy, Long Island University, NY, USA.
OBJECTIVE: To describe a patient with neuroleptic malignant syndrome (NMS) induced by risperidone, an atypical antipsychotic, and to review the available literature related to risperidone-associated NMS. DATA SOURCE: Case report information was obtained from the resident physician and medical records. MEDLINE and Index Medicus were searched to obtain literature published between 1960 and 1995. DATA SYNTHESIS: We report an adolescent boy who developed NMS after treatment with risperidone. Risperidone therapy was started after unsuccessful treatment and development of extrapyramidal adverse effects with haloperidol. The patient demonstrated the classic tetrad of fever, generalized skeletal muscle rigidity, altered mental status, and autonomic dysfunction. Risperidone was discontinued and the patient recovered after a prolonged hospital course with supportive management. CONCLUSIONS: Clinicians are cautioned about the possibility of NMS with risperidone.
PMID: 8826559 [PubMed - indexed for MEDLINE]
Traduzca con
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8: Int J Adolesc Med Health. 2004 Apr-Jun;16(2):179-82.
Links
Atypical neuroleptic malignant syndrome associated with risperidone treatment in two adolescents.
· Zalsman G,
· Lewis R,
· Konas S,
· Loebstein O,
· Goldberg P,
· Burguillo F,
· Nahshoni E,
· Munitz H.
Adolescence Inpatient Unit, Geha Psychiatric Hospital, Petach Tiqva, Israel. zalsman@post.tau.ac.il
Neuroleptic Malignant Syndrome (NMS) is a known, life threatening, side effect of classical antipsychotic drugs. We report two cases of 16 and 17 year old males, who suffered life-threatening "NMS-Like" syndromes in association with Risperidone treatment. Further controlled studies are needed.
PMID: 15266995 [PubMed - indexed for MEDLINE]
Finalmente se recuerda la importancia de notificar todas las sospechas de reacciones adversas al Centro Autonómico de Farmacovigilancia correspondiente (puede consultarse el directorio en http://www.agemed.es/directorio/pdf/dir_sefv_100204.pdf ).Más información : División de Farmacoepidemiología y Farmacovigilancia de la Agencia Española de Medicamentos y Productos Sanitarios Teléfonos: 915967711 e-mail: fvigilancia@agemed.es
8: Int J Adolesc Med Health. 2004 Apr-Jun;16(2):179-82.
Links
Atypical neuroleptic malignant syndrome associated with risperidone treatment in two adolescents.
· Zalsman G,
· Lewis R,
· Konas S,
· Loebstein O,
· Goldberg P,
· Burguillo F,
· Nahshoni E,
· Munitz H.
Adolescence Inpatient Unit, Geha Psychiatric Hospital, Petach Tiqva, Israel. zalsman@post.tau.ac.il
Neuroleptic Malignant Syndrome (NMS) is a known, life threatening, side effect of classical antipsychotic drugs. We report two cases of 16 and 17 year old males, who suffered life-threatening "NMS-Like" syndromes in association with Risperidone treatment. Further controlled studies are needed.
PMID: 15266995 [PubMed - indexed for MEDLINE]
Finalmente se recuerda la importancia de notificar todas las sospechas de reacciones adversas al Centro Autonómico de Farmacovigilancia correspondiente (puede consultarse el directorio en http://www.agemed.es/directorio/pdf/dir_sefv_100204.pdf ).Más información : División de Farmacoepidemiología y Farmacovigilancia de la Agencia Española de Medicamentos y Productos Sanitarios Teléfonos: 915967711 e-mail: fvigilancia@agemed.es
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Aquí les dejo una serie de direcciones con animaciones que le puede ayudar a entender mejor el funcionamiento del cerebro y en qué consisten las sinapsis y los neurotransmisores...
La primera dirección es para que se familiarice con distintas formas de interacción entre drogas y sinapsis.
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http://meneame.net/story/efectos-drogas-nuestro-cerebro-animado
http://www.ucsd.tv/greymatters-spanish/lesson-addiction-study.asp
http://www.ucsd.tv/greymatters-spanish/lesson-addiction-links.asp
http://es.brainexplorer.org/neurological_control/Neurological_Neurotransmission.shtml
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http://www.ucsd.tv/greymatters-spanish/lesson-addiction-study.asp
http://www.ucsd.tv/greymatters-spanish/lesson-addiction-links.asp
http://es.brainexplorer.org/neurological_control/Neurological_Neurotransmission.shtml
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ETIOPATOGENIA (1)
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Hay dos hipótesis:
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a) La primera está en relación con el aumento de la termogénesis provocada por la depleción/bloqueo de dopamina en las vías dopaminérgicas. La serotonina interviene en la termogénesis por su estimulación en el hipotálamo, la dopamina inhibe este proceso. Los neurolépticos producen un bloqueo dopaminérgico, desinhibiendo la liberación de serotonina, que tiene como resultado un aumento de la termogénesis. Pero como la termorregulación a nivel central está mediada también por vías noradrenérgicas, serotoninérgicas y colinérgicas (las propiedades anticolinérgicas de los neurolépticos favorecen al aumento de temperatura al inhibir la sudoración e impidiendo disipar el calor corporal), en la génesis del SNM probablemente intervengan más factores que aún están por aclarar. Por otro lado la dopamina puede inhibir la contracción del músculo esquelético, por lo que el bloqueo dopaminérgico daría como resultado un aumento en la contracción del músculo esquelético. Este aumento del tono muscular implica también un aumento de temperatura. En esta dirección apuntan los casos de SNM descritos tras la supresión de fármacos dopaminérgicos, amantadina y L-dopa, y el uso empírico del agente dopaminérgico bromocriptina en el tratamiento del SNM.
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b) La segunda teoría está en relación con las similitudes entre el SNM y la hipertermia maligna. Se estima que los neurolépticos y otros fármacos pueden producir en el músculo esquelético un estado tóxico/hipermetabólico asociado a un incremento de la liberación de calcio desde el retículo sarcoplasmático, produciendo hipertermia, rigidez y aumento de la Creatín Fosfoquinasa (CPK). Esta teoría apoyaría el uso de dantroleno en el tratamiento del SNM.
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3 comentarios:
Muchas gracias Eduardo por tuyo informe acerca de la Risperidona y del Sindrome Neuroléptico Maligno
Thanks Eduardo for your opinion and advice about Risperidona and Neuroleptic Malignant Syndrom (NMS)
Both have been useful
Best wishes
Pedro Leitao (nefro)
Horta Hospital, Fayal Island, Azores
pleitao@sapo.pt
Estimado amigo:
Me da Vd. una alegría al hacerme saber que le ha sido de utilidad la información publicada sobre la Risperidona y el Síndrome Neuroléptico Maligno.
Los comentarios sobre la Risperidona surgieron porque en la Guía de buena práctica para el tratamiento de los trastornos del espectro autista, publicada por el Grupo de Estudios del Instituto de Salud Carlos III (España), no se hacía mención ni a la alerta médica sobre su uso en personas mayores, ni a su relación con el Síndrome Neuroléptico Maligno en niños y adolescentes.
No es adecuado "recomendar" el uso de Risperidona para niños; digo adecuado porque el término "recomendar" tiene en la citada Guía del Instituto de Estudios Carlos III, un valor cualitativo, de excelencia, del mayor nivel de evidencia en la eficacia del tratamiento. Esa excelencia no se desprende de la aplicación rigurosa de los propios criterios que la Guía propone para calificar la bondad de diversos tratamientos posibles.
Es una anomalía metodológica la que eleva la Risperidona a "tratamiento recomendado".
Es sorprendente, además, que en la "búsqueda guiada" sobre la Risperidona, el Grupo de Estudios del Instituto de Salud Carlos III, no haya tropezado con ninguno de los artículos de PubMed que previenen de los riesgos en niños y adolescentes, ni con las alertas médicas sobre su uso en personas mayores. Claro que la Guía citada no define cual es la diferencia entre "búsqueda de información médica" y "búsqueda GUIADA de información médica".
Según consta textualmente, leemos:
"Además, en el caso de determinadas terapias farmacológicas
(sobre las que no se había encontrado información en estas
fuentes), se realizaron búsquedas guiadas en PubMed que quedaron
limitadas a los ensayos clínicos aleatorios controlados del
tratamiento que se estaba intentando evaluar." párrafo 2º, pág.426 REV NEUROL 2006; 43 (7): 425-438. Guía de buenas prácticas para el tratamiento de los trastornos del espectro autista. Autores: J. Fuentes-Biggi et al.
No puede entenderse que el estudio de ciertas terapias farmacológicas, excluyan el estudio y difusión de los graves efectos adversos en niños, adolescentes y ancianos a que hacen referencia muchos artículos en PubMed.
Salvo que la palabra "guiada" signifique precisamente eso.
Por la enorme tirada, 12.000 suscriptores, y prestigio de la revista RevNeurol, creíamos oportuno informar explícitamente de los riesgos de la Risperidona.
La "recomendación" de la Risperidona como tratamiento en una Guía dirigida al "tratamiento de los trastornos del espectro autista", abre extraordinariamente la potencialidad de su uso. Pues según palabras del Sr. Biggi, dependiendo de los criterios de inclusión, la población infantil incluída bajo el rótulo de "trastorno del espectro autista" , puede ser en España de 7.000, 15.000 o 30.000 niños.
El término TEA ( Trastorno del Espectro Autista)facilita la comprensión de la realidad social de estos trastornos e impulsa el establecimiento de apoyos para las personas afectadas y sus familiares. No obstante, para la investigación es imprescindible la utilización de clasificaciones internacionales, el establecimiento de los subgrupos específicos y la descripción sus características.
Esta es una razón más para hacer una crítica al tratamiento "recomendado" de la Risperidona en una Guía que puede servir de referencia a muchas personas y a poblaciones infantiles extraordinariamente numerosas.
El tándem Risperidona-Trastorno del Espectro Autista, en una Guía de difusión internacional, borra a través de la vacuidad y generalidad de los términos las muy necesarias restricciones de su uso y borra conceptualmente las diferencias entre los distintos pacientes, convirtiéndolos en una masa homogénea.
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Aquí trascribimos la siguiente clasificación para "TRATAMIENTO DE LOS TEA":
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"Tabla II. Valoración de tratamientos.
Sin evidencia y no recomendados
Doman-Delacato
Lentes de Irlen
Comunicación facilitada
Terapia psicodinámica
Secretina
Terapia antimicótica
Tratamiento con quelantes
Inmunoterapia
Terapia sacrocraneal
Terapias asistidas con animales
Evidencia débil y sólo recomendados en estudios experimentales
Integración auditiva
Integración sensorial
Psicoterapias expresivas
Vitaminas y suplementos dietéticos
Dietas sin gluten/caseína
Evidencia débil, aunque recomendados
Promoción de competencias sociales
Sistemas alternativos/aumentativos de comunicación
Sistema TEACCH
Terapia cognitivoconductual
ISRS en adultos con TEA
Estimulantes en TEA + TDA/H
Evidencia de eficacia y recomendados
Intervenciones conductuales
Risperidona "
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ISRS: inhibidores selectivos de la recaptación de serotonina;
TDA/H: trastorno de déficit de atención/hiperactividad;
TEA: trastorno del espectro autista;
TEACCH: tratamiento y educación de alumnado discapacitado por autismo y problemas
de comunicación.
434 REV NEUROL 2006; 43 (7): 425-438. Guía citada.
(Obsérvese que mientras algunos tratamientos como ISRS, aparecen con restricciones, en este caso sólo para adultos, no es así en el caso de la Risperidona, que se recomienda sin restricción alguna )
Sin otro particular, quedamos muy agradecidos al Sr. Pedro Leitao, del Hospital Horta, de Fayal Island, Azores, por hacernos llegar su comentario.
Don Eduardo, le suelo leer con asiduidad y he de decirle que este tema es uno de los que más me han impresionado.
Como médico general que soy, decirle que si tenia conocimiento del sindrome neuroléptico maligno derivado del uso de antipsicóticos pero desconocia por completo el empleo ( recomendación ) de Risperidona en crios con trastornos del espectro de autismo.
Gracias por la gran exquisitez plasmada en todos y cada uno de los temas en su blog planteados.
Sin otro particular...reciba un cordial saludo de un habitual lector.
Doctor Garcia.
Alhaurin de la Torre
Málaga
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