Central paralysis

Paralysis cannot be linked to a single cause: the factors that cause it are very diverse.

Motor functions can be affected by a wide variety of injuries to the nervous tissue.

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Causes central palsy

The development of paralysis is known to be due to organic factors: as a result of physical injuries, severe poisoning, metabolic or nutritional disorders, vascular pathology, cancerous neoplasms, infections, hereditary or congenital pathologies.

Central paralysis syndrome occurs after infections that develop in the brain or spinal cord - syphilis, tuberculosis, viral encephalitis, meningitis, poliomyelitis.

Paralysis due to intoxication includes poisoning with heavy metal derivatives, alcoholic neuritis, vitamin B1 deficiency, and nicotinic acid deficiency.

Multiple sclerosis, the nature of which is not identified, causes dysfunction of movements of varying degrees. Wounds and fractures are fraught with similar consequences if the motor centers or conduction pathways are damaged.

Paralysis can even occur under the influence of psychogenic factors.

Central paralysis most often affects older people, but now there is a clear tendency for it to become "rejuvenated". According to statistics, more than half of cases of paralysis are the result of a stroke. A thrombus, like a hemorrhage, can cause a disruption in blood supply by blocking the vessels in the area of the brain responsible for movement or the conduction pathways. Infantile paralysis usually occurs as a result of birth injuries or as a result of inherited spastic paraplegia.

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Pathogenesis

The most common pathological conditions of the nervous system are destruction, degenerative, inflammatory processes, sclerotic changes, demyelination. Paralysis occurs due to pathological conditions of the brain or as a result of damage to the peripheral nerves.

There are two types of central paralysis: cerebral (brain) and spinal. The nature of spinal paralysis is pathological changes in neurons responsible for movement. Cerebral palsy implies capsular, bulbar, cortical or subcortical nature.

There are two types of neurons responsible for movement. They differ in their functional load and structure. Therefore, if pathological changes occur in them, two different types of signs are distinguished: affected nerve cells responsible for movement cause spastic paralysis, while peripheral nerve cells cause flaccid paralysis.

There are no internal causes for psychogenic paralysis, so it can be disguised as any of the types, showing general signs of central and peripheral paralysis or any combination of them.

Central paralysis may combine the signs of peripheral paralysis, or may exhibit exclusively pure symptoms; it is often accompanied by disturbances in vascular tone, sensitivity, and digestion. A frequent manifestation of peripheral paralysis is sensory disturbances.

In the body, during paralysis, motor function often suffers as a whole and does not affect muscles selectively. Paralyzed muscle tissues are in permanent tension and do not atrophy (this is possible only due to complete inactivity). In immobilized limbs, deep tendon reflexes are maintained or intensified, and clonuses (rapid convulsive contractions) are often detected. On the side affected by paralysis, abdominal reflexes weaken or disappear completely.

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Symptoms central palsy

Let's list the first signs of central paralysis:

• hypertonicity of muscles;
• expansion of the scope of reflexive reactions;
• strengthening of reflexive reactions;
• rapid, jerky contractions of the muscles of the knees or feet (clonus).

With hypertonicity, the muscles are too dense. High muscle resistance is noted. A high degree of muscle tension is fraught with the appearance of contractures. Therefore, movements are limited partially or completely. Contracture is characterized by an unnatural frozen position of the limb.

The most noticeable visible signs of paralysis are provoked by the expansion of the area of action of reflex reactions. Spasmodic rhythmic contractions of the muscles of the knees or feet appear due to stretching of the tendons. Usually such contractions appear due to the intensification of tendon reflex reactions. Contraction of the feet is the result of accelerated dorsiflexion. Reflexive twitching of the leg is a response to such an effect. Clonus of the patella is noticeable during rapid abduction of the limb. Pathological reflexes in the feet or hands are a visible symptom of pathology of the pyramidal tract. The most typical are the reflex reactions of Oppenheim, Rossolimo, Zhukovsky, Babinsky, Gordon and Schaeffer.

Protective reflexes, manifested by trembling of the affected limb, reacting to mechanical irritation, are also a manifestation of central paralysis syndrome.

Sykinesia is another symptom of paralysis. Sykinesia is a reflexive simultaneous movement in the affected limb with conscious active movements. For example, waving the arms while walking, flexion and extension of the limbs simultaneously with directed movements on the half of the body that is not subject to paralysis. There are many types of sykinesia that indicate the development of paralysis.

Muscle spasms due to hypertonia are often distributed unequally. Most often, the left or right side of the body suffers as a whole, the arm is usually pressed, the hand and fingers are crooked, the leg is straightened, and the foot is bent and turned inward.

In central paralysis, reflex reactions in the tendons are more pronounced, while abdominal, muscular and plantar ones disappear completely or are noticeably weakened.

The most obvious symptoms of central paralysis are:

• Unnatural body position;
• Decreased or increased mobility;
• Weakening of facial muscles;
• Articulation and speech disorders;
• Muscle twitching and tremors;
• Unnatural gait;
• Accidental opening of the mouth;
• Closing eyes;
• Non-directional shoulder movements;
• Accidental flexion and extension of the joints of the arms or legs;
• Hypertonicity of muscles.

The symptoms that accompany central paralysis help to accurately distinguish it from other types of motor dysfunction and even determine the area of the pyramidal tract that is subject to pathological processes.

Central facial nerve paralysis occurs as a result of cortical processes or pathology of the nerve pathways leading to the facial nerve. Facial paralysis appears opposite the affected area and is usually located in the lower region.

Facial muscles contract randomly due to nerve connectivity with the extrapyramidal system. This appears as a tic or spasm. This type of paralysis may be accompanied by epileptic seizures.

The development of central paralysis of the limbs occurs due to pathological changes in the descending system of nerve fibers. A noticeable manifestation of pathology is reflex reactions in the tendons, hypertonicity of muscles, manifestations of pathological reflex reactions. Such symptoms can appear together with other signs of organic paralysis.

In cases of paralysis of functional etiology, the reflex reactions of the tendons do not undergo changes and normal muscle tone is maintained.

Central spastic paralysis indicates that the area of the brain in the hemisphere opposite to the affected limb is damaged.

Combined pathologies of the limbs are characteristic of disorders in the brainstem.

Cross paralysis refers to disturbances in the area where the medulla oblongata and spinal cord meet.

When the limbs are paralyzed only on the left or right, and the cranial nerves have not been injured, this indicates a failure of the descending system of the nerve tissues of the cervical region.

Central paralysis of the legs means pathologies either along the lateral funiculus of the spinal cord, in the convolutions of the brain, or in the radiant crown.

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Infantile central paralysis

Infantile central paralysis unites a whole group of diseases characterized by damage to the central nervous system, motor dysfunction, and slow mental development. Infantile central paralysis does not develop. This may indicate perinatal paralysis of the central nervous system or brain damage during childbirth, when lack of oxygen, birth trauma, or stroke causes the development of encephalopathy. Paralysis is often associated with impaired oxygen supply to brain cells. Complications of hypoxia include insufficient development of areas of the brain responsible for balance, coordination, and ensuring the functioning of reflexes. This is why asymmetric muscle tone develops and pathological motor reactions appear.

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Diagnostics central palsy

Instrumental diagnostics of central paralysis includes: neuroimaging (CT and MRI), radiography of the bones of the spine and skull, electromyography, puncture of spinal cord fluid, histology and histochemistry of a biopsy of the affected muscles.

Differential diagnosis

Differential diagnostics includes assessment of volumes and severity of paralysis. The map of affected muscles can indicate the area of pathological processes of the central nervous system.

In case of limb paralysis, its extent must be assessed: immobility of four limbs means damage to the spinal cord in the neck area; paralysis of the limbs on one side is characteristic of pathology of the internal capsule; paralysis of the legs - for disorders of the spinal cord in the chest or lumbar region; the cause of paralysis of one limb lies in disorders of the peripheral nerve.

Other muscles may be paralyzed. For example, dysfunction of the eye muscles is a pathology of the cranial nerves; immobility of the facial muscles is a pathology of the facial nerve or the central motor neuron of the opposite hemisphere; flaccidity of the sternocleidomastoid and trapezius muscles means disorders in the accessory nerve; flaccidity of the tongue muscles - the hypoglossal nerve is affected.

For diagnosis, it is necessary to clarify the circumstances of the onset of paralysis: how it began, whether it was accompanied by injuries, impaired consciousness, fainting, high temperature, signs of an infectious disease. It is important to analyze whether other neurological symptoms have appeared: sensory disorders, ataxia, vision problems, impaired emptying of the bladder, bowel cleansing.

Electromyography is effective for differential diagnostics of central and peripheral paralysis, which notes pathologies inherent in damaged neurons of the anterior horn of the spinal cord, emerging neuropathies. These disorders are not characteristic of central paralysis. With central paralysis, the H-reflex changes. It manifests itself in all affected muscles, when normally it is determined exclusively in the shin.

Treatment central palsy

Patients undergo therapy for the main disease with treatment of the paralysis itself at the same time. If the vessels are affected, the immobilized limb is given a position that does not interfere with normal blood supply.

In parallel with the prevention of contractures, they are treated with medications. The therapy intensifies the exchange in the nerves, circulation in small vessels, improving nerve and synaptic conductivity.

Conservative treatment brings results when the morphological substrate that allows muscle function to regenerate has survived. If there is still a possibility of muscle function resuming, the goal of conservative treatment is to avoid contractures and deformation and accelerate muscle function resumption.

Physiotherapy, balneotherapy, exercise therapy, and reflexology are widely used.

Physiotherapy for central paralysis is prescribed after some time. The time of introduction of physiotherapy depends on the factors that caused the paralysis: inflammation, injury or stroke.

Electrophoresis of medications helps restore blood circulation in the affected area of the brain. UHF and microwave treatment is used for inflammation. Electrical stimulation in the area of the immobilized limb is carried out along the motor points of the antagonist muscles. This helps relieve hypertonicity and reduce the reflex response of the paralyzed muscles. Electrical stimulation is combined with muscle-relaxing medications and acupuncture. To reduce the risk of contractures, warm ozokerite or paraffin therapy is used. Positive dynamics are possible when using cold, especially in spastic infantile central paralysis.

Physical rehabilitation for central paralysis begins with massage, and after a week or a week and a half, therapeutic exercise is introduced.

The first exercises involve working on maintaining the limb's position. When working on developing conscious movements, special equipment is used: frames with blocks and various ropes attached to the bed, balls, and expanders.

When the patient can already sit independently, the next stage of therapeutic gymnastics is learning to walk. At first, the methodologist helps, and then the patient tries to move independently, using crutches and sticks. Then they begin to master more subtle movements: buttoning clothes, lacing shoes, controlling equipment using a remote control, keyboard.

Drug treatment of paralysis

The main drugs are benzodiazepines, baclofen, dantrolene. How these drugs work has not been reliably established. Medicines are prescribed if disturbances in normal muscle activity occur every day. Drug therapy will give excellent results if two or more drugs are used and combined with other methods of therapy.

• Baclofen has an inhibitory effect, affecting the gamma-aminobutyric acid receptors that are not sensitive to bicuculline. The dose is prescribed individually in each case to identify the minimum effective dosage that is not associated with side effects. The result is usually obtained with a dosage in the range of 30 to 75 mg daily.

The first 3 days are prescribed half a tablet 3 times a day (if the tablet dosage is 10 mg); 4-6 days - a whole tablet; 7-9 days - 1.5 tablets 3 times a day; 10-12 days - 2 tablets. A gradual increase in dosage ensures good tolerability of the drug. Abrupt cessation of baclofen intake is fraught with hallucinations and exacerbation of paralysis symptoms.

• Benzodiazepines enhance the postsynaptic effects of gamma-aminobutyric acid, promoting presynaptic inhibition. The drugs also affect processes in the brainstem. Diazepam is a very common drug. The dosage is 2–8 mg 2 times a day. A course of diazepam requires complete restriction of alcohol. Side effects include liver dysfunction and blood composition disorders. Extreme caution should be exercised when administering diazepam and when discontinuing it for patients taking blood-thinning medications.

Diazepam can cause drowsiness, dizziness, slow reaction, provoke allergies, nausea, vomiting.

• Dantrolene stops the release of calcium in the muscles, dividing the electromechanical coordination. That is, it reduces tone, increasing muscle weakness. With hypertonia, the drug gives noticeable results, but it is usually prescribed to patients with plegia. For admission, it is prescribed in a dosage of 4-8 mg per day in 3 or 4 doses. Dantrolene is excreted due to metabolism in the liver, so it is limited for use by patients with an unhealthy liver. Also, special care is needed when prescribing dantrolene to people with problems in the lungs or heart.
• Sirdalud affects the polysynaptic pathways of the spinal cord, reducing the production of excitatory signals to alpha motor neurons. The drug is similar to baclofen in its effectiveness in influencing muscle hypertonicity, but sirdalud is better tolerated. Sirdalud is prescribed to adults, starting with a dosage of 1 to 2 mg per day (in 2-3 doses) with a gradual increase in dosage to 12-14 mg, divided into 3 or 4 doses. It can cause a reaction in the form of weakness, a feeling of dry mouth, sleep disorders.

Anticholinesterase agents are also used to treat central paralysis. Anticholinesterase agents quickly enter the CNS, intensify the transmission of signals from nerves to muscles and weaken the signs of CNS dysfunction.

Surgical treatment of paralysis

Before the operation, the functional capabilities of the muscles are identified, measures are taken to strengthen them, and measures are taken to eliminate the contractures that have arisen. After the operation, measures are developed to promote the growth and enhancement of the function of the implanted muscles, and then - training of movements that are difficult in terms of coordination. Surgical intervention is more often performed in cases of flaccid paralysis or cerebral palsy, when conservative therapy has not improved the situation.

Surgical operation is advisable in case of neurogenic deformation, when the limb muscles are partially affected, changes in the mechanical axis, shape, size are noticeable, for example, in case of complete paralysis of the muscular part of the limb. Then surgical treatment is a preparatory stage before subsequent prosthetics.

Surgical operation for cerebral palsy aims to remove limb deformation that distorts statics. Such intervention is advisable when conservative treatment methods have not yielded results. It is also effective if areas with fixed deformation are detected that are caused by disorders of the tendon-muscle system and ligaments of the system. Sometimes operations aim to eliminate reflex contractures.

Operations are divided into three different types:

• operations on tendons and muscles;
• ligament operations;
• operations on bones and joints.

It happens that operations combine elements of all types.

The success of the operation and recovery time depend on a set of conservative therapy measures.

Folk recipes

Traditional medicine advises patients to drink fresh celery, nettle or plantain juice.

If the cause of paralysis lies in pathologies of cerebral blood circulation, feijoa will help. Noticeable improvement is provided by taking both juice and the fruits themselves.

In case of paralysis, drink a tincture of wolfberry. For 5 grams of bark or roots, take 0.5 liters of vodka or alcohol. Take a two-week course of 1-2 drops three times a day. Rub the ointment with the tincture externally. To prepare, pour 20 ml of the tincture into 50 grams of heated lanolin, and, without stopping stirring, gradually pour in 50 grams of petroleum jelly. Apply the ointment along the entire path of the nerve, and wrap the treated area in woolen fabric.

Baths can also help with paralysis. To prepare a bath with a decoction of rose hips, take 4-6 teaspoons of crushed roots, add a liter of boiling water, boil for 20-30 minutes. Then pour the decoction into the bath. For the bath, the water temperature should be moderate - 38 degrees is enough. You can also prepare a juniper decoction for the bath: 4-6 teaspoons of juniper branches or fruits are poured with a liter of water, boiled for 20-30 minutes. For baths, one plant is used up to 10 times, and then it is necessarily replaced with some other one.

Baths and herbal infusions are recommended to be combined with mumiyo treatment. Twice a day, a piece the size of a pinhead is mixed with 20-30 ml of water and drunk before meals.

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Herbal Treatment for Paralysis

• An infusion based on peony roots. It is also known as Maryin root.

1 teaspoon of roots is brewed with a liter of boiling water, after an hour it is filtered through a sieve or gauze. Take an infusion of peony roots 1 tablespoon 3 times before meals. Roots infused with alcohol are drunk in a dosage of 30-40 drops 3 times a day.

• A decoction of sumac leaves.

1 tablespoon of sumac dyeing or sumac tanning is brewed in 0.5 l of boiling water and left for an hour. Take the decoction 1 tablespoon 3-4 times a day.

• Pine cone tincture

For the tincture, 10-15 ripe pine cones are prepared. The cones are poured with vodka (0.5-0.6 liters) and infused for a month. The tincture is drunk 1 teaspoon 3 times a day.

Homeopathy

It is optimal to combine homeopathic preparations with classical medicine medications. Homeopathy does not replace the main treatment, but can complement the set of measures that stimulate the body to recovery.

• The homeopathic drug Conium relieves convulsions. Its basis is an extract from hemlock, an extremely poisonous plant. Conium is indicated for paralysis accompanied by paresthesia, and the patient feels weak, suffers from insomnia, and often feels cold. Dissolve 8 granules 5 times a day. Conium is taken in a course of up to 2 months.
• Fibiaron is a complex drug. It acts as a preventive measure against paralysis, and is also indicated for treatment. Belladonna, mistletoe, and amber in Fibiaron harmonize the excitation-inhibition mechanism and protect the central nervous system. Dosage: 5-7 granules 3 to 5 times a day. Fibiaron is taken for 6 to 8 months.
• Barium aceticum is available in granules and drops. It is prescribed for paralysis rising from the extremity to the center. The drug is prescribed for absent-mindedness, hesitation before making decisions, a feeling of "goosebumps", a feeling of a web on the face, tingling and pain spreading along the left leg. Barium aceticum acts almost like Barita acetica.
• Botrops is made from the venom of the lancehead snake, produced in the form of granules or drops. Botrops is prescribed for paralysis with signs of speech impairment, signs of paralysis of the right side of the body.
• CAUSTICUM (Caustic) is effective in paralysis caused by lead intoxication.

Rehabilitation after central paralysis may take months or possibly years, the most important thing is to follow recommendations, regularly do independent exercises, try to expand motor functions, gradually move on to sports activities: swimming, jogging, jumping.