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Manual De Neurología Y Conducción

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Manual De Neurología Y Conducción Manual de neurología y conducción Susana Arias Rivas Cristina Íñiguez Martínez José Miguel Láinez Andrés © 2021 Sociedad Española de Neurología © 2021 Ediciones SEN ISBN: 978-84-946708-6-2 Depósito legal: M-6014-2021 Fuerteventura, 4, oficina 4 28703 - San Sebastián de los Reyes (Madrid) e-mail: [email protected] http://www.edicionessen.es Ediciones SEN es la editorial de la Sociedad Española de Neurología. Se funda en el año 2012 con la intención de ofrecer obras de calidad, escritas por autores de prestigio mediante la publicación médica, científica y técnica, en el campo de las neurociencias. El compromiso que tenemos con nuestros lectores, es publicar las obras más actualizadas con alto contenido y soporte científico, en todos y cada uno de los avances de la especialidad de Neurología. Bajo Ediciones SEN, la Sociedad Española de Neurología ha editado varios volúmenes. El titular del copyright se opone expresamente a cualquier utilización del contenido de esta publicación sin su expresa autorización, lo que incluye la reproducción, modificación, registro, copia, explotación, distribución, comunicación pública, transformación, transmisión, envío, reutilización, publicación, tratamiento o cualquier otra utilización total o parcial en cualquier modo, medio o formato de esta publicación. La infracción de los derechos mencionados puede ser constitutiva de delito contra la propiedad intelectual (artículos 270 y siguientes del Código Penal). Reservados todos los derechos. Ninguna parte de esta publicación puede ser reproducida ni transmitida en ninguna forma o medio alguno, electrónico o mecánico, incluyendo las fotocopias o las grabaciones en cualquier sistema de recuperación de almacenamiento de información, sin el permiso escrito de los titulares del copyright. - 2 - MANUAL DE NEUROLOGÍA Y CONDUCCIÓN Autores EDITORES Susana Arias Rivas Vocal y responsable del Área de Relaciones Profesionales de la Sociedad Española de Neurología. Cristina Íñiguez Martínez Vicepresidenta y responsable del Área científica de la Sociedad Española de Neurología. José Miguel Láinez Andrés Presidente de la Sociedad Española de Neurología. AUTORES Sergio Calleja Puerta Miguel Ángel Llaneza González Servicio de Neurología, Hospital Universitario Sección de Neurología, Complejo Hospitalario Central de Asturias, Oviedo. Universitario de Ferrol, Ferrol, La Coruña. Javier Camiña Muñiz Nuria Muelas Gómez Servicio de Neurología, Hospital Universitari Servicio de Neurología, Unidad de Enfermedades Son Espases, Clínica Rotger Quirónsalud, Neuromusculares, Hospital Universitari i Politècnic Hospital Quirónsalud Palmaplanas, La Fe, Valencia. Palma, Illes Balears. Ayoze Nauzet González Hernández Míriam Eimil Ortiz Jefe de Servicio de Neurología y Neurofisiología Servicio de Neurología, Hospital Universitario clínica, Hospital Universitario San Roque, Las Palmas de Torrejón. de Gran Canaria. Profesor adjunto, Facultad de Ciencias de la Salud, Teresa Estellés Pals Universidad Fernando Pessoa, Canarias. Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona. Xiana Rodríguez Osorio Unidad de Epilepsia Refractaria, Servicio de Ana Fernández Arcos Neurología, Hospital Clínico Universitario, AdSalutem Instituto del Sueño. Santiago de Compostela. Grupo de estudio de trastornos de la vigilia y el sueño. Isabel Sala Matavera Servicio de Neurología, Hospital Carles Gaig de la Santa Creu i Sant Pau, Barcelona. Hospital Clínic de Barcelona. Grupo de estudio de trastornos de la vigilia Elena Valdés Rodríguez y el sueño. Jefa de Unidad de Programas de Aptitudes Psicofísicas. Subdirección General de Formación Juan Lahuerta Dal-Ré y Educación Vial. Dirección General de Tráfico. Neurólogo, Miembro del Comité Científico de la Sociedad Española de Neurología. - 3 - MANUAL DE NEUROLOGÍA Y CONDUCCIÓN Prólogo Los accidentes de tráfico, a pesar del esfuerzo realizado en los últimos años para reducirlos, siguen siendo la octava causa de muerte a nivel global y la primera en el grupo de edad entre 5 y 29 años. Además originan una importante morbilidad, un gran sufrimiento en las personas afectadas y un ele - vado coste económico para la sociedad. Se producen por la conjunción de una serie de factores hu - manos, técnicos y del entorno; pero sin duda el factor humano sigue siendo el más determinante. Hay múltiples patologías que aumentan el riesgo de que se produzca un siniestro y dentro de ellas las neurológicas ocupan un lugar destacado. Existen numerosas enfermedades del sistema nervioso que reducen las habilidades para la conducción al mermar la función cognitiva o las habilidades motoras o de coordinación. La Sociedad Española de Neurología, además de realizar las actividades científicas y de formación propias, intenta contribuir a mejorar las condiciones de vida y salud de la población desde la perspec - tiva de su especialidad. Por dicha razón pensamos que, a los 20 años del anterior, había que elaborar un nuevo Manual de Neurología y conducción para intentar aportar todo nuestro conocimiento en aras a seguir reduciendo las consecuencias de esta plaga social. La respuesta que recibimos por parte de la Dirección General de Tráfico fue muy positiva desde el inicio. El entusiasmo con el que aceptaron la colaboración en el proyecto todos los miembros de la Sociedad a los que se les pidió colaboración se ve plasmado en la magnífica calidad de los trabajos del manual con cuya lectura van a disfrutar. El resultado de todo este esfuerzo colectivo ha sido excelente y en la obra se abordan todos los aspec - tos relacionados con la conducción y el sistema nervioso. Al inicio se expone de forma muy ordenada y comprensible toda la normativa que regula la capacidad de los conductores y se dan respuesta a las preguntas más frecuentes que nos podemos plantear cuando emitimos un informe neurológico. En la segunda parte se abordan los aspectos más generales, con un magnífico análisis de las comple - jas bases neurológicas de un acto aparentemente simple como la conducción de vehículos. Se ana - lizan todos los aspectos importantes que debemos incluir al realizar una historia y una exploración neurológica cuando tenemos que emitir un informe de aptitud para la conducción de un paciente con patología neurológica. Se hace una revisión exhaustiva de todos los tratamientos farmacológicos que empleamos en las diferentes patologías y su influencia en la capacidad del manejo de vehículos y se abordan de forma detallada todas las limitaciones que producen el consumo de drogas y alcohol en la capacidad de los conductores. La última parte del manual describe de forma muy precisa todas las consideraciones que hay que tener cuando evaluamos las capacidades de un paciente que tiene o ha tenido una determinada pa - tología. Se dedica un apartado extenso a cada una de las patologías que sabemos pueden mermar las habilidades de los pacientes. Se abordan los aspectos de la conducción relacionados con la epilepsia, las enfermedades cerebrovasculares, la patología neuromuscular, los trastornos del movimiento, los procesos desmielinizantes, las alteraciones cognitivas, los problemas del sueño o los trastornos oftal- mológicos. Leer los capítulos es una delicia porque en todos ellos se describe la patología, se incide especialmente en aquellas condiciones que limitan la conducción y se abordan los aspectos legales; incluso se dan consejos para los pacientes. - 4 - Prólogo MANUAL DE NEUROLOGÍA Y CONDUCCIÓN Pensamos que estamos ante una manual que va a ser de una gran utilidad al neurólogo y a cualquier profesional que este interesado en conocer las consecuencias de las diferentes patologías neurológi- cas sobre la conducción de vehículos. Estamos seguros de que es un libro a tener cerca cuando ten - gamos que decidir sobre un paciente neurológico complicado que nos solicita un informe de capaci - tación para su permiso de conducción; es evidente que consultarlo nos va ayudar a tomar la decisión más apropiada. Como Sociedad creemos que con este manual podemos aportar un pequeño grano de arena a intentar reducir las dramáticas consecuencias de los accidentes de tráfico. Queremos terminar agradeciendo a la Dirección General de Tráfico su implicación en el proyecto y a todos los autores por el esfuerzo y el magnífico trabajo realizado. Susana Arias Rivas Cristina Íñiguez Martínez José Miguel Láinez Andrés - 5 - MANUAL DE NEUROLOGÍA Y CONDUCCIÓN Índice Capítulo 1 LA APTITUD PSICOFÍSICA DE LOS CONDUCTORES ....................................... 7 1.1 Magnitud del problema de las lesiones por accidente de tráfico .............................................. 8 1.2 El accidente de tráfico, un evento multicausal: el factor humano ........................................... 10 1.3 Las aptitudes psicofísicas requeridas para la obtención o prórroga ....................................... 12 del permiso de conducción. Aspectos normativos 1.4 Los centros de reconocimiento de conductores ......................................................................... 15 1.5 Conclusiones ..................................................................................................................................... 17 1.6 Preguntas del neurólogo ................................................................................................................. 17 Capítulo 2 NEUROLOGÍA Y CONDUCCIÓN ................................................................... 24 2.1 Neurología de la conducción ......................................................................................................... 25 2.2 El
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