Actualidades en la neuropsicología y el tratamiento del síndrome del “miembro fantasma” JOS+ ANTONIO PORTELLANO P+REz @=>. "=>= ?@= / D=?? / ">. F@?/ / ">. '=>// C@?> / M/=/ EL MIEMBRO FANTASMA: UNA DOLOROSA RESURRECCI3N TRAS LA MUERTE @=? @ ? ?=/ @// ? / <@ @ = @?/ @/= @>= >>>, =? /=>>, > =>>, />@> / = >@=/ @?. A/>, /> >>> @/ =>>?= /@=? => I> />@> / => =/@/ / =. E >/= / = ?> (MF) > @ @= ? ? , , @ @>> > >> > @=> // >= /> >@ ??//. C>>? @> / =>>? / @ =? / @= ?=> >@ @?, <@ > / 90% / > @?/> == >>> = >??. G=? > ?=? / >>> @ /=>> : ?, ??, =, =, = =>, @<@ =/ > / ? />=/ /=>. C@/ >> / = @>? > /=>, > / /=
D
?>, >?/> <@ =? > ?== =? / <@> >@=/ @ @?. "= ?= =?, 10% =>? >>> /=>> ?>> /?? />@> / @?, >@ / => / ?= / @I; /> >>> @/ =?=> > > /? > ==/@ @ > / @I. F?, > >>> /=>> > >@ =>?/ / / =? />?@ = @?/, > <@ // / @I, > / ==>? / = @>? ==. L> >>> <@ = ? @/ >= / @ =/: >??, =/=, = (K?? L, 1999). L> >>> ?>> > > =/@ ?=> @? / @ ?=//, > ? ?=> ?= / ?=> => ?> : >, ?>, >, /?> /@ (, 2003). "= ?= =?, > / > ?=//> ? = => >=>, <@ >
I> <@ / > => => @/ =?= >>> >=> > / > ?> <@ >@=/ @ @?. ' =// / = ?> > E?=// @@ =@==N (E). E>? ?=>?= > / = => / >>> =/?> / @ ?=// >@=@==, @> / ?=> >?> / ? /=?. #@> =>? >? ?=>?= >@=/ @?, = />= >>> /=>> =?? /> @ = >?? (= =). L E > =/@ >@ / >> = =>@=>, @<@ ? > />=? >=>> ? . L> ?> ?/> =>? @ =? ?// / = ?= >@?=. E> /=, @<@ ==>? >>= / @ = > ? / @ =?, > ?? <@ @ =? ? >? / >? /// / = ?> (MG ? , 2002).
EL hOM4NCULO DE PENFIELD: DONDE hABITAN LAS SENSACIONES PROCEDENTES DE LA PIEL L> >>> >?> =/?> / >@= == ?=> / /@ > ?= == >? > > ?=>> / ?; >>> >? = =@@ >??= =? >?>>= ==. E >?
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
==>? =? / @= @> / => ??> =/?> / = @?/ (M6, 1989). ' >= > =/@ />, <@ >?= @= = @ />> ?= ><@ == == = =? >??/= / />?. E>? />> ?= @= >@ = = <@ H@ / "/ > == = =?= @ /@/ ==>? >? / @ ==. C > >I/, > I> <@ = > ?=//> @/ ?= >>> >=> > / > @?/>. E>? = <@ >>? => ? @ ==>? == =, //?? / @ > == / @=, <@ > >: >= / <@ @ = / / > => > =>, >@ == =? ? > =, <@ > @ // = / />== =?.
POSIBLES ExPLICACIONES NEUROBIOL3gICAS DEL 0MIEMBREO FANTASMA1 E / <@ > >>> /=>> / = ?> >? @ /I = = ?, =/@ />=?, = >? =@>? >? @/ ?> // / == / =? ==. C > >I/, />/ > >?? <@ > =/@ @?,
===> =? >=/, =/@/ = = @ / @=. =, =// / @ = = >@ > <@ >@ ==>? >?>>= =? ? />=, > <@ >? =. E>? /> >> > = @>?= =>>? / > >>> >>?>> ?>> />@> / = >@=/ @? / @ =: ?= / =? ?= / >?.
a) Te#&-a de c&eci!ie"(# a*#"a C@/ > @? @ =, > == @??? =? >?>>= ==, / ? = <@ > @=> /> =>/= >?@> =/?> / > /?> @ / "/. E>? > / > <@ =? = > <@ = => / = @?/, @/ =/@=> >@ / =? / @> =?> > <@ > /= =? =/ / =>. C >@, > @=> <@ ?==? = => =/?> / = @?/ ? ?= = =>/= >?@> =/?> / ?=> =>, => = <@ = @> =@?> == / > @?/>. L / / =? / @> > => >?-
>>=> @/ > >? /=/> / ?=/> >>=>, > // />?== > /@?>.
b) Te#&-a de '#a$a!ie"(# L> /=?> >?@/> ? @ ==>? >?? H@ / "/, > /=, / = / >@= / /=> ? @ => =? >>?> ==. =, / @ / > /=?> ? @ ?==?= / /?, > <@ >? @ >? > > ?> ?= /> /=?> /?>. L =// / @ = ?=> >@ @? /= >=> = / <@ @ /=? /? > / => == <@ =?= >@= =/ = >>= / = ?>. E >? ?= /> /=?> /?> = =? =>>? / >>> =/?> / = ?=/, @<@ ?=> @?=> >>? <@ @/ > =/@ @ @? <@ >@/ =// > <@ > => =/?> / == /? <@ @ ==>? / = @?/ /<@= = @=, >@/ > >>> <@ =/ / <@. "= >? =, > > <@ @ ? <@ >@=/ @? / @ =, = >>> / = @/ > >?@ . "=? ?> / => =/@-
/ @? / ?=// >@==, >? ==@?> >>=> =/?> / / =, = >?> <@/ >=/> =? =? ==, = = @= <@ ? > =@?> >>?>=> =/?> / =.
TRATAMIENTO DEL MIEMBROS FANTASMA >? >? ? ?=?? /? ? <@ =? ? @?/ >?=> =? =/ / >@> >>> /=>>. H>? > =?> ?=?? / = ?> = @ , =?? /?, <@ > / 1% / > /> ?> >?= @ = / > @ I / /@=. =, > ?> I> > / =?/ ?=@? ?=?? / MF. A?@? > @? @ == / ?> @=<@==>, / ==?=, => >> = >@ ?=??. T,c"ica' "e%i&/&ica' L ?= @=<@== / /=>> => / >>? => > @? ? =? > = ?= />@= > >>> /=>>. L??, /= ?> ?/ >= =/? = / > >> <@ > <@ > =/@/ @=<@==. ' / > ?> /> > =/? ?=?=, >>?-
? / > => / >>// = /= >??> /@ >. A@<@ >? ? == ?, @/ >@/ / =@== ?=/ / /= ?>, @> @/ > = =/?> ?=> ?> => ?=>. A = >? ? / ?=??> >@ >/ ? / ?==>> > @/ ?> /=>> ?=> > =? / > @> /=>> /@=>. !?= ? = ?=?= MF >>? <@== / =? >?>>? ==, <@ = =/@= / /= ?>, @<@ > @ >>? />/ =/ = ?? />>.
Bi#&&e(&acci." L> ?> <@ >? /= ?>, >? > <@ ? >>> / = =>, @/ == >@> >?> /? ? / ==?= ?==. E>? ? =? > ?/> =/= @?==@= ?=?@= / >@ =, />@/ > > >>> /=>>. E ? / ? >>? >?=@= @?/ / ?> <@ =? @?= ?> >?=? = =>/@. E == @= > = >?? ?= ?=?@= / = =>/@ ?>// / /= ?>. E @ >@/ >, > >?=@ =? / ?> 35
@>@= ?=?@= @ ?=? >=/ > ?> / = / J>. M/? => / = > ?> @/ =@= />@= > >>> ?> =/?> / = @?/.
T&a(a!ie"(# fa&!ac#.ic# C =@ <@ =@=== @> / => <@ =? <@= /@ => = /= ?>. L / = @I > => /=>> / > => ==> =/@ >?> ?=>?= @/ = =// / @ =/. !?=> ?> => / =@= / ? >@ > =? > ?> ?=>>> ? > @? = ?= > >>> /=>> MF. T&a(a!ie"(#' $'ic#.ic#' L / ?> >> @?/> = ?=?? / /= ?> > @ =/: >>, = / / /@? >/ =@?? /> = = /= >?> ?>. L> ?> ?/@?@> @? @? / =, = @ > ?=> = >@ =/ @?//. E> =?? =>I= <@ > ?> / ?=?? > / MF > >= > >> =>>??>, @? > =? > @? ? @?/, <@ >= @ = =/ / >?// ?=> =@, 36
<@ ? => / =// @= ?. ' / > ==> ?> <@ > / =/= > @ ? = / @I, > =// >@= >?/ = @?/. E ? / =?= > >@> / @I =/ ?> => /= ?,
>@= = = @> >=> >== ?/ / @ =//=. E>?> => > / == @?/ >@?? = = > (K??6, F=/= L, 1999). "= ?, @? / =?>> > ? @ = @ >??, > <@ />@ >// / =@== / /= ?>.
BIBLIOgRAF2A G!LDEBE$G, G. (2003). Di$!#de#$ !f b!d* "e#ce"%i! ad #e"#e$e%a%i!. E: T. Feimbe#g * M. Fa#ah, M. (E/>). @== @= / @=>. *=6. M G= H, : 285-294. K !KE, F..; F$EDE$iC, J.; LEHMA, J. (1999). Medicia F+$ica * Rehabili%aci. M/=/: K=@> (4 /), : 1097 - 1100. LO"E+, J.A.; HE$$E$!, J.F. (1998) S!me$%e$ia: meca!ce"ci, %e#m!##ece"ci * !cice"ci. E: J.M. Delgad!; A. Fe##$; F. M!#a * F. R&bia (E/>). M@ / @=. M/=/: ?>>, : 454-480.
MCG!iGLE , D.J.; HAiE , $.; ALEi', .; HA$i. $.; F$ACK!iAC; $J.; F$iCH CD. (2002). Wh!$e a#m$ i% a*(a*. A ca$e $%&d* !f $&"e#&me#a#* "ha%!m limb. B=, 125: 125-1 MEL+ACK , $. (1989) Pha%!m limb$, %he $elf ad %he b#ai. D. !. H M= L?@=. C/ ">, 30: 1-14. MEL+ACK , $. (1990). Pha%!m limb$ ad %he c!ce"% !f a e!ma%#i). i: 13: 88-92. AH!LD , B.. (1991) Pa#a"legia ad "ai. E Deaffe#e%ia%i! Pai S*d#!me$: Pa%h!"h*$i!l!g* ad %#ea%me%. B.. >/ & !?-L?? (E/>.) *=6: $ "=>>, :301-319. "!$ELLA!, J.A. (2005) I%#!d&cci a la Ne!"$ic!l!g+a. M/=/: M G= H. $ AMACHAD$A , ..; BLAKELEE (1998) Pha%!m$ i %he b#ai. *=6: M== & C. $ AMACHAD$A , ..; $ AMACHAD$A D.$ (2000) "?> / @= >??. A#chi'e$ !f Ne!l!g*, 57: 317-321.. EME+A, C. (2003) A$$e$$ig di$!#de#$ !f a(a#ee$$ ad #e"#e$e%a%i! !f %he b!d* $chema. E: " H, . K>6, .; JC M=> (E/>). H/6 @=>. *=6: !=/ '=>? "=>>, : 195-213. HE$MA, $; HE$MA , C. (1983). El "#ed!mii! * ca#ac%e#+$%ica$ de d!l!# del miemb#! fa%a$ma c#ic! e%#e 'e%e#a!$ ame#ica!,
: 227-238.