Subtipos neuropsicológicos del síndrome disatencional con hiperactividad
Correspondencia: Dr. Máximo Carlos Etchepareborda. Laboratorio para el estudio de las Funciones Cerebrales Superiores. Estados Unidos 3402, 1228. Buenos Aires, Argentina.
E-mail: metchepareborda@janssen.com.ar
Introduction. One of the commonest neurological development disorders is the syndrome of inattention with hyperactivity, ADHD. The complex neurobiological network which intervenes in paying attention permits us to maintain a basal state of alertness, to focalize and maintain attention for long periods, select the stimulus-signal required and analyze its components, and also to simultaneously carry out processes of input-output and performance (tutorial, controlling). Development. Damage to the various systems participating in ‘paying attention’ leads to a syndrome of inattention, with or without hyperactivity. The distinction into clinical sub-types (combined, mainly lacking attention or mainly hyperactive and impulsive) gives a primary differentiation of the syndrome. However, from the neuropsychological point of view, some degree of heterogeneity within the groups which defines academic behaviour and conduct may also be recognized. This type of study permits a more specific neurocognitive and pharmacological approach. Some clinical characteristics of the syndrome of inattention improve with different drugs, such as the state of alertness (methylphenidate), impulsivity (pipamperone) and selective attention (tiapride). However, this treatment is symptomatic and in most cases is useful to accompany the ultimate biological development of the neocortical control mechanisms. Conclusions. A neurocognitive approach which permits acquisition of habits of control, functional strategies, sequential planning of activities and per- and post-functional surveillance is fundamental. The EFE programme for training executive functions is directed towards working with the damaged processing mechanisms in each neuropsychological subtype [REV NEUROL 1999; 28 (Supl 2): S 165-73].
Desarrollo El compromiso de los diversos sistemas atencionales genera un trastorno disatencional, con o sin hiperactividad particular. La distinción en subtipos clínicos (combinado, de predominio desatento y de predominio hiperactivo-impulsivo) ofrece una diferenciación primaria del síndrome. Sin embargo, desde el punto de vista neuropsicológico podemos reconocer aún un grado de heterogeneidad intragrupal que define patrones conductales y académicos. Este tipo de estudio nos permitirá un abordaje neurocognitivo y farmacológico más específico. Algunas características clínicas del síndrome disatencional se benefician con diversos fármacos, por ejemplo el estado de alerta (metilfenidato), la impulsividad (pipamperona) y la atención selectiva (tiapride). Sin embargo, la medicación es sintomática, y se emplea en la mayoría de los casos para acompañar el desarrollo final biológico de los mecanismos de control neocorticales.
Conclusiones Es fundamental un abordaje neurocognitivo que permita adquirir hábitos de control, estrategias funcionales, planificación secuencial de actividades y monitorización per y posfuncional. El programa EFE, de entrenamiento de las funciones ejecutivas, tiene como objetivo trabajar aquellos mecanismos de procesamiento comprometidos en cada subtipo neuropsicológico
