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Síndrome Gilles Tourette: Revisión Teórica UNIVERSIDAD NACIONAL AUTÓNOMA DE MÉXICO FACULTAD DE PSICOLOGÍA DIVISIÓN DE ESTUDIOS PROFESIONALES SÍNDROME DE GILLES DE LA TOURETTE: UNA REVISIÓN TEÓRICA TESIS QUE PARA OBTENER EL TÍTULO DE LICENCIADO EN PSICOLOGÍA PRESENTA OMAR ORTEGA NORIEGA DIRECTOR: LIC. AIDA ARACELI MENDOZA IBARROLA REVISOR: LIC. ANA EUGENIA DÍAZ DE LEON D’ HERS. CIUDAD UNIVERSITARIA, D.F. MARZO 2013 UNAM – Dirección General de Bibliotecas Tesis Digitales Restricciones de uso DERECHOS RESERVADOS © PROHIBIDA SU REPRODUCCIÓN TOTAL O PARCIAL Todo el material contenido en esta tesis esta protegido por la Ley Federal del Derecho de Autor (LFDA) de los Estados Unidos Mexicanos (México). El uso de imágenes, fragmentos de videos, y demás material que sea objeto de protección de los derechos de autor, será exclusivamente para fines educativos e informativos y deberá citar la fuente donde la obtuvo mencionando el autor o autores. Cualquier uso distinto como el lucro, reproducción, edición o modificación, será perseguido y sancionado por el respectivo titular de los Derechos de Autor. Agradecimientos A Dios: Todo viene de ti y todo es para ti, gracias. A las maestras Ana Eugenia y Martha , son un regalo para la UNAM. A mi familia: Gracias por ser esos ángeles que me apoyan en todo. A Jani Esmeralda: Gracias por ser el amor de mi vida. A mis amigos: porque es un privilegio el poder estar a su lado. INDICE Resumen Introducción 1. Antecedentes históricos ............................................................................. 1 2. Descripción – Definición ............................................................................. 2 3. Síntomas ..................................................................................................... 4 3.1 Tics ...................................................................................................... 4 3.2 Comorbilidad ...................................................................................... 5 3.2.1 TOC ........................................................................................ 5 3.2.2 TDAH ...................................................................................... 8 3.3 Autolesiones ....................................................................................... 9 3.4 Agresividad ......................................................................................... 10 3.5 Cefalea ................................................................................................ 13 3.6 Coprolalia ............................................................................................ 14 3.7 Ecopraxia ............................................................................................ 16 3.8 Copropraxia ........................................................................................ 17 3.9 Problemas de aprendizaje .................................................................. 17 3.10 Alteraciones del sueño ...................................................................... 20 3.11 Dificultades sociales ........................................................................... 22 3.12 Otros problemas psicológicos ............................................................ 24 3.13 Evolución de los Tics .......................................................................... 26 3.14 Movimientos inconclusos .................................................................. 29 3.15 Movimientos estereotipados............................................................. 32 3.16 Ticquear: un impulso irrefrenable ..................................................... 33 3.17 Tics fusionados con obsesiones ......................................................... 35 4. Epidemiología ............................................................................................. 37 5. Factores y causas ........................................................................................ 40 5.1 Genéticos ............................................................................................ 40 5.2 Autoinmunidad ................................................................................... 42 5.3 Hormonas ........................................................................................... 44 5.4 Cerebro y Tourette ............................................................................. 45 5.4.1 El origen orgánico de los tics ..................................................... 46 5.4.2 Estructuras Cerebrales y ST ....................................................... 46 5.4.3 Inhibición deficiente .................................................................. 49 5.4.4 Integración de lo expuesto ........................................................ 52 5.5 Neurotransmisores .............................................................................. 53 5.5.1 Dopamina .................................................................................. 53 5.5.2 Serotonina ................................................................................. 54 6. Diagnóstico ................................................................................................ 56 6.1 Diagnóstico Diferencial ....................................................................... 58 6.2 Alternativas Diagnósticas ................................................................... 62 7. Neuropsicología del ST ............................................................................... 63 8. Tratamientos .............................................................................................. 71 8.1 Farmacológicos.................................................................................... 71 8.1.1 Antipsicóticos ...................................................................... 71 8.1.2 Benzodiacepinas y Anticonvulsivos ..................................... 72 8.1.3 Antidepresivos ..................................................................... 73 8.1.4 Tourette y mariguana .......................................................... 74 8.2 Terapia del comportamiento ............................................................... 75 9. Tourette e Inteligencia ............................................................................... 77 10. Conclusión .................................................................................................. 80 11. Referencias ................................................................................................. 83 12. Anexo 1: Estudios Neuropsicológicos. ........................................................ 101 13. Anexo 2: Imagenes ..................................................................................... 102 14. Imagen 1: Ganglios Basales ........................................................................ 102 15. Imagen 2: Córtex Prefrontal y núcleo subtalámico .................................... 103 16. Imagen 3: Zonas Fronto-Estritales .............................................................. 104 17. Imagen 4: Activación cortical en la coprolalia ............................................ 105 18. Imagen 5: Decremento en la sustancia blanca ........................................... 106 Resumen El presente trabajo constituye una revisión exhaustiva de la literatura científica sobre el síndrome de Gilles de la Tourette. Utilizando bibliografía que data del siglo XIX y complementándola con la literatura más actual sobre el tema, se pretende abarcar los principales aspectos de este síndrome, a fin de que obtener un conocimiento profundo sobre el mismo. Para ello se revisan desde los primeros casos expuestos por Gilles de la Tourette y Freud, hasta los tratamientos psicofarmacológicos actuales para los tics. Así mismo, se hace un énfasis en la neuropatogénesis del síndrome de Gilles de la Tourette y sus implicaciones en las funciones superiores de quien lo padece. Introducción En las últimas décadas, el estudio de las funciones cerebrales ha recibido mucha atención por parte de la comunidad científica, con la intención de desarrollar métodos de diagnóstico y tratamiento de afecciones del sistema nervioso. El síndrome de Gilles de la Tourette (ST) es uno de estos padecimientos, no obstante su baja incidencia, puede ser incapacitante para quien lo padece. Debido a su alta comorbilidad con otros trastornos como el trastorno obsesivo compulsivo y el trastorno por déficit de atención; el diagnóstico diferencial del ST representa un reto para el especialista por lo que éste requiere de un conocimiento profundo acerca del mismo. Este trabajo tiene como objetivos contribuir a una mejor comprensión de este síndrome para que sea más fácilmente reconocido en forma diferencial por quienes lo evalúan y para orientar al profesional de la salud sobre posibles formas de abordaje del mismo. Para lograr estos objetivos, se hace una revisión bibliográfica exhaustiva, iniciando desde los antecedentes históricos del estudio de este padecimiento, hasta los últimos tratamientos propuestos. 1. Antecedentes Históricos Areteo de Capadocia, un médico griego del siglo I D.C., describió varios casos de personas que emitían ladridos, maldiciones y blasfemias involuntarias, además de extraños movimientos (Sacks, 1997). ). Sin embargo, no sería sino hasta finales del siglo XIX que se describiría y aceptaría al ST como una entidad clínica separada de otros padecimientos. Gilles de la Tourette, compañero de Freud y alumno de Charcot, presentó en 1885 un artículo con una nueva tipología de diagnóstico, un síndrome denominado „Maladie des Tics de Gilles de la
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