La película ‘Joker’, protagonizada por Joaquin Phoenix, evidencia la falta de preocupación de la sociedad por la salud mental. Arthur Fleck, quien termina convirtiéndose en el ‘Guasón’, vive un infierno a causa de un trastorno que le provoca risas agudas que no puede controlar.
Para sobrellevar sus síntomas, el personaje toma siete tipos de medicación, escribe un diario, y visita regularmente a una asistente social. Ante esto, ¿existe realmente una enfermedad que pueda generar esta reacción? ¿O simplemente se trata de un elemento más de esta historia de ficción?.
¿EXISTE REALMENTE?
En conversación con BBC Mundo, el doctor Francisco Javier López, coordinador del Grupo de Estudio de Epilepsia de la Sociedad Española de Neurología, explica que la risa descontrolada e involuntaria es síntoma de una serie de condiciones médicas y, en el caso del personaje interpretado por Phoenix, puede tratarse de una “crisis de epilepsia gelástica”, la cual es más común en pacientes adultos, de más de 20 años, que en niños.
“Es un tipo de crisis epiléptica muy infrecuente. Se calcula que representa el 0,2% del total de todos los tipos de crisis epilépticas (…) La característica es que es una risa que aparece de forma inapropiada, y al paciente no le supone alegría sino que es inmotivada”, precisa.
De acuerdo al médico especialista, la causa más frecuente de este tipo de epilepsia “es una pequeña tumoración en el hipotálamo que llamamos hamartoma hipotalámico, pero también puede deberse a otras causas como crecimientos tumorales en los lóbulos frontales o temporales”.
Asimismo, López señala que, por lo general, si tienen este clase de crisis, suelen tener otras más generalizadas que afectan a los pacientes con epilepsia.
“Las crisis gelásticas suponen un estrés añadido, porque si uno tiene una crisis (de las otras) y pierde la conciencia, no pasa nada, pero si estás consciente y te ríes en situaciones inoportunas, eso provoca un sufrimiento importante”, indica.
¿CÓMO SE CONTROLA?
Según el doctor Francisco Javier López, quien recuerda por lo menos haber visto a tres pacientes con esta patología, este tipo de condición se suele controlar con fármacos antiepilépticos y, en algunos casos en los que resulta posible, con cirugía.
Si no se controla, un paciente puede tener crisis a diario, pero si se hace se pueden reducir a una o dos al mes o pueden desaparecer, dependiendo de cada caso.
OTROS CASOS
Sin embargo, el neurólogo aclara que la epilepsia gelástica no es la única condición que puede dar lugar a risas involuntarias y descontroladas.
Están también las patologías pseudobulbares, conocidas también como incontinencia afectiva, que pueden provocar episodios de risa o llanto, “pero son más típicas en pacientes ancianos con enfermedades neurodegenerativas”, resalta.
“Son pacientes mayores en los estados finales de sus enfermedades, que no sería el caso del Joker”, asevera.
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