Acute flaccid paralysis in children and adults

Acute flaccid paralysis occurs as a result of damage to a peripheral neuron in any part of it: on the root or peripheral nerve, in the plexus or anterior horn. With the development of this pathology, muscles lose reflex and voluntary innervation.

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Epidemiology

Nowadays, the risk of acute flaccid paralysis in children remains quite serious. This is due to the widespread prevalence of various non-polio enteroviruses.

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Causes acute flaccid paralysis

The main cause of this disease is considered to be various enteroviruses. For example, enterovirus 71 is currently the most dangerous neurotropic virus, it very often leads to the development of flaccid paralysis epidemics in children.

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Pathogenesis

Loss of reflexes and hypotension occur due to interruption of the reflex monosynaptic arc to stretching, as well as disruption of the mechanism of fast and slow reflexes to stretching. Muscle atrophy occurs because the anterior horn ceases to exert a trophic effect on muscle fibers - this problem appears after several weeks after the denervation of nerve endings in the muscles has occurred and can be so pronounced that after several months or years only connective tissue remains in the affected muscles.

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Symptoms acute flaccid paralysis

Acute flaccid paralysis is characterized by the following manifestations:

• the muscle does not provide resistance to passive movements;
• atrophy is very pronounced;
• a decrease or complete absence of deep reflexes is noted;
• Muscular and nervous electrical excitability changes.

Flaccid paralysis of the legs

If there is a disruption in the functioning of the anterior horns located in the spinal cord at the site of the lumbar thickening, flaccid paralysis of the legs may develop. When such a lesion spreads to the cervical or lumbar region of the thickening on both sides, simultaneous paralysis of all limbs or some separate area may develop.

Flaccid paralysis usually affects only one leg. It is impossible to move the foot because the disease affects the tibial muscle group.

Before the onset of flaccid paralysis of the legs, the patient feels sharp pain in the lumbar region.

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Acute flaccid paralysis in children

Children also show symptoms of this disease - they are expressed in the form of weakness or tremors in the limbs, and in addition to this, in the improper functioning of the swallowing and respiratory muscles, because the lower motor neurons are destroyed.

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Forms

There are 4 types of flaccid paralysis, which differ depending on the level of destruction of the peripheral neuron responsible for movement. These are: neural, as well as radicular, polyneuritic and segmental.

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Complications and consequences

Among the complications of this disease:

• Development of contracture – muscles harden and it is impossible to prevent this;
• The joints become completely immobile – ankylosis;
• A persistent defect, the main characteristic of which is a decrease (or complete absence) of strength in the muscles of the arm, leg or neck.

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Diagnostics acute flaccid paralysis

During diagnosis, the anamnesis of the disease and the patient's complaints are analyzed. The following questions need to be answered: how long ago did the muscle group lose strength; what caused this; were other family members observed such symptoms; do you have to come into contact with harmful toxic elements at home or at work.

It is necessary to undergo an examination by a neurologist - the patient's muscle strength is assessed on a 5-point scale, and in addition, other signs of the disease are looked for (lack of reflexes, facial asymmetry, problems with swallowing function, thinning of muscles, the appearance of strabismus).

In some cases, it is necessary to consult a neurosurgeon.

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Tests

The main tests that the patient needs to take are the following:

• Blood for a general analysis to determine markers of inflammation (increased ESR, as well as C-reactive protein) or an increase in creatine kinase;
• Blood for toxicological analysis to determine the presence of individual toxic elements;
• Sometimes a prozerin test is performed to detect myasthenia (pathological fatigue of muscle groups). The introduction of this drug allows the body to quickly regain muscle strength.

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Instrumental diagnostics

The main instrumental diagnostic method for determining the level and degree of destruction of nerve receptors is considered to be electromyography (modern variations of this procedure are needle or stimulation).

Differential diagnosis

In the process of diagnosis, it is very important to differentiate flaccid (peripheral) paralysis from central. In addition, it should be distinguished from tendon injuries, limited movement due to various injuries, as well as from joint contractures.

Flaccid and spastic paralysis

The main difference between flaccid paralysis and spastic (central) paralysis is the preservation or destruction of the lower motor neuron. If it is preserved, as well as its axon, the disease will be spastic, and if it is destroyed, it will acquire a peripheral form.

Treatment acute flaccid paralysis

In the development of flaccid paralysis, treatment procedures are aimed at restoring (if possible) the work of the peripheral neuron, and in addition to this, preventing the process of muscle tissue atrophy and the possible appearance of contracture.

Medicines

To improve the functioning of the nervous tissue, treatment with vasoactive and neurotropic drugs is necessary:

• nootropil or piracetam (tablets/capsules in a dosage of 0.4-0.8 g 3 times a day or a 20% solution in a dosage of 5-10 ml intramuscularly or intravenously);
• Cerebrolysin (at a dosage of 3-5 ml intramuscularly or intravenously);
• actovegin (at a dosage of 5-10 ml intramuscularly or intravenously through a dropper 1-2 times a day; 1 ml of the drug contains 40 mg of the active ingredient);
• Trental (pills in a dosage of 0.1 g 3 times a day or intravenously through a dropper 1 time per day in a dosage of 5 ml; 1 ml of the medicine contains 0.02 g of the active ingredient).

Vitamins

Vitamins are also taken:

• vitamin B1 (solution 2.5% (thiamine chloride) or 5% (thiamine bromide), 3% or 6% at a dosage of 1 ml intramuscularly every day 1 time per day);
• vitamin B12 (dose 400 mcg 1 time/2 days intramuscularly, can be combined with vitamin B1, but they cannot be mixed in one syringe).

Physiotherapy treatment

Acute flaccid paralysis is effectively treated with electrotherapy and other physiotherapy methods. Balneotherapy and galvanization are mainly prescribed for this disease.

Massage for flaccid paralysis

In case of flaccid paralysis, massage is performed to stimulate the muscular system, which is why deep kneading is used, along with high-intensity rubbing, and in addition, the massage therapist actively affects the so-called segmental zones. But at the same time, paretic muscles cannot be massaged with excessive force - the procedure should be short and moderate. It must be carried out over many months (short breaks should be taken between treatment courses). If rough, painful techniques are performed, the muscle, on the contrary, may begin to weaken.

In addition, acupressure is performed using a tonic technique. In this case, it is necessary to press the necessary points with the tip of the finger to cause quick short vibrating irritations that will stimulate the necessary movement.

Traditional and herbal medicine

There are several folk remedies:

Peony roots. Take 1 teaspoon of dry ingredients and pour boiling water (3 cups), then wrap the container and leave for 1 hour, then strain. Drink the tincture three times a day, 1 tablespoon before meals (15 minutes). Alcohol tincture should be taken in a dosage of 30-40 drops 3 times a day before meals.

Dyeing or tanning sumac (fresh leaves are used). Take 1 teaspoon of the ingredient and pour boiling water (1 glass), wrap the container and leave for 1 hour, then strain. Drink 3-4 times a day, 1 tablespoon.

Rose hips and roots. A decoction of the roots is used externally - in case of paralysis, you need to bathe your feet in a bath with it.

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Surgical treatment

In case of destruction of anatomical integrity in the peripheral nerve system, the patient may be prescribed neurosurgery.

Prevention

To prevent the disease, you should follow these rules:

• It is necessary to treat infectious pathologies in a timely manner;
• Give up all bad habits and lead a healthy lifestyle - walk in the fresh air, do physical exercises, follow a healthy diet, etc.;
• In case of deterioration of health, consult a doctor without delay;
• Monitor blood pressure levels.

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Forecast

Acute flaccid paralysis in some cases can have a favorable prognosis. Everything depends on the volume and spread of pathology in the structure of the motor system organs, and in addition, on what the compensatory capabilities of the body are. Lost movements can be restored due to the regeneration of nerve endings or compensatory substitution innervation. Active treatment can allow for full restoration of movements after 1-2 years.

When treating a damaged nerve with surgery, the atrophic processes are stopped and the motor system is restored at least after six months to a year. The readaptation period may include the use of prostheses, as well as orthopedic surgeries on tendons, joints, and muscles.

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