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2002, Número 5

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Rev Med Inst Mex Seguro Soc 2002; 40 (5)


Estrategias neuroprotectoras después de una lesión traumática de la médula espinal

Díaz RA, Guízar SG, Ríos CC

Idioma: Español
Referencias bibliográficas: 110
Paginas: 437-455
Archivo PDF: 177.45 Kb.


RESUMEN

La lesión traumática de la médula espinal es un problema de salud pública que afecta principalmente a la población económicamente activa, con una incidencia anual de aproximadamente 20 nuevos casos por cada millón de habitantes. Actualmente no se cuenta con ninguna estrategia terapéutica efectiva para restablecer la función neurológica normal, debido a la complejidad para regular los mecanismos de daño secundario, así como a la baja capacidad de regeneración espontánea que se observa en el sistema nervioso central maduro. Existe una gran cantidad de estudios experimentales que describen los mecanismos fisiopatológicos desencadenados después de una lesión, y con base en estos antecedentes se ha abordado el problema proponiendo el uso de diversos fármacos neuropro-tectores como la metilprednisolona, actualmente el fármaco de elección en pacientes con trauma-tismo medular. Así mismo, existen estudios en animales donde la estrategia es el uso de an-tagonistas de los receptores n-metil-D-aspartato para contrarrestar el efecto excitotóxico que favorece la muerte celular, de fármacos secuestradores de radicales libres para modular el estrés oxidante (el mexilatin y el OPC-14117), y de in-munosupresores (ciclosporina-A y el tacrolimus), entre otros. Por otra parte, los trasplantes de células indiferenciadas y de células gliales en el sitio de la lesión parecen ser otra buena alternativa para favorecer los procesos de regeneración axonal. Finalmente, se ha propuesto que el incremento en la síntesis y en la secreción de diversos factores tróficos es importante para una recuperación funcional.


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