Leg paralysis

Paralysis of the legs is a complete loss of functionality of the motor muscles of the lower limbs of a person. Usually, it occurs as a result of a disease of the nervous system and is not a separate disease. Paralysis of the legs can be temporary and permanent.

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Epidemiology

Approximately 5.6 million people, or 1.9% of the population, have difficulty moving one or both legs. Each year, approximately 1.2 million people suffer spinal cord injuries of varying severity.

The leading causes of leg paralysis are:

• Stroke - 29%.
• Spinal cord injury - 23%.
• Multiple sclerosis - 17%.
• Cerebral palsy - 7%.
• Poliomyelitis syndrome - 5%.
• Other - 19%.

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Causes leg paralysis

Paralysis of the legs usually develops when the motor nerve fibers or neurons are damaged. Nerve damage can take various forms - from mechanical damage to blood supply disruption. Paralysis mainly occurs due to trauma that has damaged the nerve fibers.

Also, paralysis of the legs can be caused by:

1. Congenital pathology.
2. Tumor.
3. Inflammatory processes.

Temporary paralysis of the legs can be a consequence of:

1. Transient ischemic attacks.
2. Stroke.
3. Guillain-Barre syndrome.

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Pathogenesis

A patient with paralysis of the legs must be carefully monitored for changes in his condition. If the disease was caused by organic reasons, then immediately there is a change in reflexes, a disorder of muscle tone appears, sometimes muscle atrophy can develop.

With central paralysis of the lower extremities, pathological reflexes occur in the muscles. Muscle tone is increased. Also, sometimes paralysis of the legs can be accompanied by a combination of the above symptoms with loss of speech.

If peripheral nerves are damaged, muscle atrophy and atony may be observed, reflexes disappear. If paralysis is functional and temporary, then no changes in muscle tone and tendon reflexes are observed.

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Symptoms leg paralysis

At first, paralysis of the lower limbs is characterized by the fact that the legs lose sensitivity. The motor activity of some muscles is impaired.

After this, a stage comes when the patient stops feeling pain in the paralyzed limbs.

Due to the disruption of blood circulation in the affected muscles, a disruption of the trophism of those areas of the body that were affected by the disease occurs.

When the corresponding nerve centers are damaged, the patient can no longer control defecation and urination.

Temporary paralysis of the legs is an alarming symptom that can manifest itself from weakness in the leg of varying intensity to complete loss of movement in the affected limb.

As a rule, paralysis of the right leg develops after a stroke. Moreover, if the stroke was in the left part of the brain, the patient loses the ability to move the right lower limb and vice versa.

Paralysis of the right or left arm and leg is also called hemiplegia. In addition to the arm and leg on one side of the body (right or left), hemiplegia also affects the same side of the face. As a rule, such paralysis is a consequence of a stroke.

Spastic paralysis of the legs

The main difference of spastic paralysis of the legs is the fact that the patient does not have atony or muscle atrophy, degeneration reaction, loss of basic reflexes. This disease manifests itself due to damage to the central motor neuron.

Among the main symptoms of spastic paralysis of the lower extremities are: increased tendon reflexes, muscle hypertonia, synkinesis and the presence of pathological reflexes.

The most common causes of nervous spastic paralysis of the legs include:

1. Central motor neuron lesion.
2. Strokes.
3. Traumatic brain injury.
4. Multiple sclerosis.
5. Encephalopathy.
6. Back injuries.
7. Meningitis.
8. Phenylketonuria.
9. Cerebral hypoxia.

Flaccid paralysis of the legs

Flaccid paralysis of the legs is a pathological condition in which the muscles involuntarily and too strongly relax. That is, they do not shorten or tense. It usually occurs when the spinal cord in the lumbar region (the "horse's tail") is damaged. It often complements the picture of spastic paralysis of the lower extremities.

The main difference between flaccid paralysis and spastic paralysis is a deeper lesion of the motor apparatus. The patient not only cannot move independently, but must also adhere to constant bed rest. The muscles in the paretic limbs lose their tone, become flaccid and flabby, and atrophy occurs.

Forms

There are the following types of leg paralysis:

1. Proximal paresis – the patient’s extension and flexion movements are greatly hampered. The disease usually affects the shin and thigh. Proximal paresis is characterized by weakness in the proximal muscles. This type of paralysis is usually peripheral, not spastic. Peripheral proximal paresis usually occurs due to a hip injury. Patients with diabetes mellitus often develop atrophic paralysis of the thigh muscles (one type of proximal paresis).
2. Distal paralysis of the lower extremities - the following subtypes are distinguished:

• Paralysis of one limb – the tibial muscle group is damaged, which prevents the foot from moving.
• Paralysis due to damage to the nerve of the peroneal region - the foot hangs down, the back of the foot loses sensitivity, steppage appears (gait changes).
• Paralysis due to damage to the nerve of the tibial region - usually occurs after an injury, plantar flexion of the foot is impaired, the toes also stop bending, the foot falls inward.
• Paralysis due to damage to the sciatic nerve trunk - often caused by a hip fracture. As a rule, after damage, the patient stops feeling the back of the thigh.
• Paresis of both limbs is usually peripheral in nature and leads to changes in gait.

1. Total paralysis of the legs - can also have the following subtypes:

• Monoparesis – is distributed to all parts of the lower extremities, sometimes it can become a manifestation of Brown-Sequard syndrome. The patient loses sensitivity in the paralyzed limb. Sometimes the cause of monoparesis is a cerebral infarction.
• Paraparesis of the lower character - can be central or peripheral. It is spread through muscles of all groups. Sometimes the cause is brain damage - ischemic or hemorrhagic stroke.

Complications and consequences

Paralysis of the lower extremities limits a person in functional terms. The ability to walk is lost for some time or forever, depending on what caused the pathology and how severe its form is. The main complication after this disease is the loss of the ability to move, which causes disability.

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Diagnostics leg paralysis

Diagnosis of leg paralysis includes the following points:

1. A thorough examination by a qualified neurologist.
2. Computed tomography of the skull.
3. Magnetic resonance imaging of the brain.
4. Checking reflexes of the lower limbs.
5. Neurosonography.
6. X-ray.

In case of leg paralysis, diagnosis is made using various medical examinations and study of clinical signs.

Instrumental diagnostics

Let's consider the main methods of instrumental diagnostics of paralysis of the lower limbs:

1. Computed tomography is based on rather complex processing and measurement of tissue density by a computer.
2. Magnetic resonance imaging – helps to examine the brain and spinal cord and see various changes in them. Usually this method is clarifying.
3. Neurosonography helps to obtain all the necessary data about the functionality of the brain and the structures located in the cranium.
4. Fluoroscopy is an X-ray examination that involves shining light through the patient to obtain an image on a special screen.

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Differential diagnosis

When diagnosing leg paralysis, it is very important to rule out the possibility of the following diseases, which have similar symptoms:

1. Bell's palsy.
2. Multiple sclerosis.
3. Cerebral palsy.

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Treatment leg paralysis

The most important thing is to eliminate the cause that led to the development of paralysis of the lower extremities. In any case, the important stages of treatment are:

1. Gymnastics.
2. Symptomatic drug treatment.
3. Special therapeutic massages.

The doctor selects an individual treatment system in each individual case.

The main method of treating leg paralysis is therapeutic exercise, in which the most important thing is to put the legs in the correct position. Thus, for central paralysis, they are positioned in such a way that there is no contracture. Gymnastics necessarily includes both passive and active movements.

Patients with peripheral paralysis also receive therapeutic massages before physical exercises. As soon as the patient begins to move, gymnastic exercises become more active. Physical education combined with a swimming pool is effective.

A neurologist selects a specific drug therapy for the patient. It is very important that the patient does not spend all his time in bed, as this can negatively affect his health.

The following methods are used to treat spastic paralysis of the legs:

1. Alleviating the patient's condition.
2. Reduction of muscle spasms and pain.
3. Daily hygiene of the patient, physical exercises to improve gait.

Physiotherapy procedures are performed to improve movement, coordination, strength and tone of damaged muscles. If normal muscle activity has been disrupted, special medications are prescribed. Botulinum toxin injections are also given, which helps transmit impulses in the nerves.

There are also surgical methods for treating spastic paralysis:

1. Intrathecal administration of baclofen.
2. Selective dorsal rhizotomy.

Medicines

Proserin. Injection solution, the active component of which is proserin. The dosage is prescribed individually, but usually adults are recommended to administer up to 1 mg of solution twice or three times a day. The duration of therapy depends on the severity of the disease.

It is not recommended to take proserin in case of hyperkinesis, epilepsy, bronchial asthma, vagotomy, bradycardia, peritonitis, intoxication, acute infectious diseases, thyrotoxicosis. The main side effects are: vomiting, diarrhea, flatulence, spasms, headaches, dizziness, visual impairment, tachycardia, shortness of breath, allergic reactions.

Dantrolene. A muscle relaxant whose active component is dantrolene (a hydantoin derivative). The drug is prescribed to treat spastic paralysis of the legs. The drug is released in powder form, with the help of which a solution for injections is made. The dosage is calculated individually, depending on the patient's weight.

In some cases, the drug causes irritation of the vascular wall and thrombophlebitis. Allergy is also a side effect.

Dibazol. An antispasmodic drug, the active component of which is dibazol (a benzimidazole derivative). The dosage is individual and prescribed by a specialist. Usually adults are prescribed 40 mg twice or three times a day.

The main side effects include: allergies, a feeling of increased temperature, dizziness, sweating, headaches and nausea. Should not be taken if you are intolerant to benzimidazole.

Melliktin. The drug has a relaxing effect, so it is prescribed for increased muscle tone. The active component is melliktin. At first, take 0.02 g of the drug once a day, but gradually increase to five times a day. The therapy lasts three weeks to two months.

When using the product, the following side effects may occur: respiratory depression, allergy. The drug should not be taken by patients with myasthenia, liver or kidney failure, heart failure.

Physiotherapy treatment

Physiotherapy is prescribed even to patients with deep paralysis of the lower extremities. It can be used to support the cardiovascular system, vestibular apparatus, muscles, joints, ligaments and bones. By selecting special exercises for the patient, blood pressure is normalized, pain is reduced, and nausea and dizziness are helped.

It is very important in physiotherapy treatment to involve both limbs in exercises, even if only one is affected. The movements should be performed in one direction and in full volume. As a rule, each exercise is done no more than five times, so as not to tire the patient.

Folk remedies

Today, you can find a huge number of different folk recipes that help improve the condition of a patient with leg paralysis.

1. If your limbs are immobilized, you can prepare this ointment: take 100 g of pork fat and 1 tablespoon of soda. Apply the ointment to the surface of your lower limbs and wrap them in nylon.
2. At the initial stage of paralysis, prepare a tincture from the roots of valerian, white mistletoe, oregano and yarrow. Take after meals.
3. Take 2 teaspoons of crowberry and pour a glass of boiling water over it. Let it brew for two hours. Strain and drink three times a day.

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Surgical treatment

As a rule, surgical treatment for paralysis of the lower extremities is recommended if the patient has a nerve rupture, compression or crushing of the nerve trunk, or when conservative treatment has not yielded results. The operation is performed on the affected nerve. The so-called secondary or primary nerve suture is applied to it. In some cases, neurolysis (freeing the nerve from cicatricial adhesions), plastic surgery or muscle transplantation, transosseous tenodesis, and tendon fixation are prescribed.

Massage for leg paralysis

Special massage can improve blood circulation in affected muscles, relax muscle spasms. Such procedures also help prevent tissue degeneration.

Even if only one lower limb is paralyzed, the massage is performed on both legs using two massage therapists. The massage starts with the feet and slowly moves to the hips. This helps reduce synkinesis and spasticity.

As a rule, patients or their relatives are also taught light massage, which helps to relax spastic muscles. It is important to understand that paralysis of the legs is treated not only with physical exercises and special massage, but also with medications.

Prevention

Usually, prevention of paralysis of the lower extremities is based on the prevention of those underlying diseases (stroke, injury) that can cause it.

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Forecast

The prognosis of this disease depends on the severity of the pathological process, the depth of paralysis, its prevalence, as well as the compensatory characteristics of the body.

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