2017, Número 6
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Rev Mex Neuroci 2017; 18 (6)
Recomendaciones sobre el diagnóstico y tratamiento de la polineuropatía desmielinizante inflamatoria crónica
Vargas-Cañas, Edwin Steven; Chiquete, Erwin; Ruano-Calderón, Luis A; León-Manríquez, Elizabeth; Salmerón-Mercado, Mónica Edith; Plascencia-Álvarez NI, Madrigal-Salas G, Zúñiga-García DG, Juárez-Jiménez H, Carrera-Pineda R
Idioma: Español
Referencias bibliográficas: 55
Paginas: 2-19
Archivo PDF: 414.94 Kb.
RESUMEN
Introducción. La polineuropatía (o también polirradiculoneuropatía)
desmielinizante inflamatoria crónica (PDIC) es una entidad
infrecuente, de comportamiento clínico muy heterogéneo, pero
susceptible de tratamiento. Existen varias propuestas sobre los
criterios de diagnóstico electrofisiológico, así como numerosos
estudios sobre la respuesta a tratamientos inmunomoduladores. El
consenso general sobre su diagnóstico y manejo, sin embargo, no
se ha alcanzado en México a través de sus principales instituciones
sanitarias.
Objetivo. Elaborar una guía sobre definición, diagnóstico y
tratamiento de la PDIC utilizando la mejor evidencia científica
existente y cuando no esté disponible, el consenso de expertos.
Métodos. Un grupo de neurólogos de instituciones mexicanas y
pertenecientes al grupo de estudio de Enfermedades Neuromusculares
de la Academia Mexicana de Neurología realizó una búsqueda
en MEDLINE y revisiones sistemáticas Cochrane, seleccionando
la mejor evidencia disponible clasificando la recomendación
de acuerdo al sistema GRADE (Grading of Recommendations
Assessment, Development and Evaluation por sus siglas en inglés).
Las recomendaciones se organizan en enunciados breves que son
sustentados por una breve disertación sobre la evidencia científica
de la que derivaron.
Recomendaciones. Este panel recomienda utilizar las pruebas
y criterios diagnósticos propuestos por la EFNS/PNS (European
Federation of Neurological Societies/ Peripheral Nerve Society por
sus siglas en inglés), mismos que son expuestos en este documento.
El panel recomienda la inmunoglobulina humana o esteroides como
primera línea de tratamiento para las formas sensitivo-motoras
clásicas de la PIDC, exclusivamente inmunoglobulina para la PDIC
motora pura y en caso de falla a inmunoglobulina o esteroide debe ser
considerado el recambio plasmático. Si la respuesta es inapropiada o
se requieren dosis altas o largos periodos con los medicamentos de
primera línea, debe ser considerada la terapia coadyuvante sola o
combinada con inmunomoduladores.
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