Peripheral paralysis

Peripheral paralysis (flæksɪd pəræləsɪs) is a symptom characterized by muscle weakness and decreased muscle tone and complete or partial immobilization due to various causes (e.g., injuries, infectious diseases). The basis for development is damage to the peripheral neurons of the motor system (the so-called horn cells of the anterior part of the spinal cord), as well as fibers or nuclei of the cranial or somatic nerves that innervate the skeletal muscles.

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Causes peripheral paralysis

Poliovirus and other viruses

Peripheral paralysis is the most common symptom of acute poliomyelitis. It also accompanies diseases caused by enteroviruses, echoviruses, West Nile virus, and adenoviruses.

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Botulism

Clostridium botulinum bacteria are the cause of botulism and cause flaccid paralysis by blocking the release of acetylcholine, thereby stopping postsynaptic transmission of impulses across the neuromuscular junction. Other symptoms associated with infection from the neurotoxin include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness.

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Curare

Curare is a plant poison. The plant grows in the tropical forests of South America. Wild tribes of South America grind and boil the roots and stems of curare, and then mix it with poison from other plants and animals. Then they smear the tips of their arrows for hunting animals. This poison is also used by South Americans to treat dropsy, madness, edema, fever, kidney stones, and bruises. Curare blocks neuromuscular transmission, causing peripheral paralysis. This poison binds to acetylcholine receptors in the muscles, blocking them from interacting with acetylcholine.

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Other reasons

Transverse myelitis, Guillain-Barré syndrome, enteroviral encephalopathy, traumatic neuritis, Reye's syndrome, etc.

Pathogenesis

Atony and loss of reflexes occur due to disruption of the reflex arc, which leads to loss of muscle tone. Muscle atrophy develops due to the disconnection of muscle fibers from neurons in the spinal cord.

Fibrillary twitching of the muscles may occur.

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Symptoms peripheral paralysis

The main symptoms and first signs that distinguish peripheral paralysis from central paralysis are:

1. Complete absence or severe reduction of basic reflexes (areflexia, hyporeflexia).
2. Reduced or completely absent muscle tone (hypotonia, atony).
3. Muscle tissue atrophies.
4. A flaccid form of torpor.
5. Paralysis may affect only certain parts of the body (this depends on the damaged horns of the spinal cord and their location).

Peripheral paralysis syndrome

Disturbances in any peripheral nerve lead to the development of a syndrome of peripheral paralysis of those muscle groups that are innervated by it. In such cases, vegetative disorders and changes in sensitivity may occur. This is explained by the fact that the peripheral nerve is considered mixed - it contains both sensory and motor fibers.

A good example of this syndrome is the limb damage that occurs as a result of poliomyelitis. In addition, the patient may experience paralysis of the respiratory muscles, which leads to impaired breathing movements, up to respiratory arrest.

Peripheral nerve paralysis

Almost always, when a peripheral nerve is damaged, its sensitivity is lost. Paralysis occurs due to a violation of the motor properties of the nerve. In this case, there is a flaccidity of those muscle groups that extend along the trunk below the damaged nerve. Thanks to this important diagnostic sign, the doctor will be able to determine exactly where the damage occurred.

Peripheral nerve paralysis is a common manifestation in the following diseases:

1. Stroke.
2. Polio.
3. An injury that results in damage to a nerve.
4. Botulism.
5. Amyotrophic lateral sclerosis.
6. Guillain-Barre syndrome.
7. Multiple sclerosis.
8. Some poisonings.
9. Paralysis due to a tick.

Peripheral paralysis of the lower extremities

When there is a disruption in the functioning of the anterior horns of the spinal cord in the area of the lumbar thickening, it can lead to peripheral paralysis in the lower extremities. If the lesion affects the lumbar or cervical region of the thickening on both sides, then paralysis of both legs and arms, or of one area, can occur.

Most often, peripheral paralysis affects only one leg. In this case, foot movement is impossible, since the tibial muscle group is affected.

Distal peripheral paralysis of both lower extremities often develops in those who have experienced an ischemic stroke.

Before the onset of peripheral paralysis of the lower extremities, the patient feels acute pain in the lumbar region.

In some cases, paralysis of both legs can develop due to alcohol intoxication. Therefore, patients with alcohol addiction should pay special attention to paresthesia. In this case, the muscles in the arms become paretic. The disease can develop over several days.

Complications and consequences

• Contracture is a hardening of muscles that cannot be prevented.
• Ankylosis of joints (the joint becomes immobile).
• A persistent defect characterized by decreased muscle strength (or lack thereof) in a muscle group (legs, arms, or neck).

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Diagnostics peripheral paralysis

1. Analysis of the patient's medical history and complaints:
   • How long is there no strength in a muscle group?
   • What caused the complaint?
   • Have other family members had similar complaints?
   • Is the patient's place of residence or profession associated with harmful toxic substances?
2. The neurologist conducts an examination: the patient's muscle strength is assessed on a five-point scale, and the doctor also looks for other symptoms of pathology (no reflexes, the face becomes asymmetrical, the muscles become thinner, swallowing is impaired, strabismus appears).
3. Tests and instrumental diagnostics are carried out.
4. In some cases, a consultation with a neurosurgeon is necessary.

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Tests

The most common tests that a patient must undergo are:

1. Complete blood count: This can detect markers of inflammation (increased ESR, C-reactive protein) or increased creatine kinase.
2. A blood toxicology test helps identify certain toxic substances in the blood.

In some cases, a proselin test is performed. It helps to identify myasthenia. This is a pathological fatigue of muscle groups. After the introduction of this drug, muscle strength returns very quickly.

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Instrumental diagnostics

1. Electroneuromyography (ENMG) – this method allows you to evaluate the electrical activity of muscles, as well as see how quickly a nerve impulse is transmitted along the fibers.
2. Electroencephalography (EEG) is a method that allows you to check the electrical activity of various areas of the brain, which can change with peripheral paralysis.
3. Computed tomography (CT) and magnetic resonance imaging (MRI) are methods that can check the activity of the spinal cord and brain and see which tissues have been damaged.
4. Magnetic resonance angiography (MRA) – this method evaluates the patency of the arteries in the cranial cavity. It also allows you to see the development of tumors.

Differential diagnosis

During diagnostics, it is very important not to confuse peripheral paralysis with central paralysis of the body. The latter develops if the pyramidal tract is damaged. The symptoms do not include atrophy of muscle groups. At first, the patient shows muscle hypotonia, from which hypertension and hypertrophy develop.

It is also important to distinguish peripheral paralysis from limited movement due to various injuries, tendon damage, or joint contractures.

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Treatment peripheral paralysis

When treating peripheral paralysis, it is very important to first get rid of the cause that caused it. In difficult cases, surgical intervention is necessary. The operation is performed on the part of the spinal cord where the muscles were damaged.

But it is also worth understanding that peripheral paralysis is not only a symptom of some disease, but can also be a separate disease.

The treatment measures used in such cases are a whole complex. It is developed in such a way as to eliminate the signs and consequences of the disease. But some doctors believe that symptomatic treatment should also be used. But in this complex, the main role is played by therapeutic physical training and various massages.

It is very important during the treatment of peripheral paralysis to restore the patient's motor activity. This will help maintain proper coordination of movements and prevent the possible development of other deformation processes.

During therapeutic walking, for example, the patient must learn to step on the paralyzed limb again, so it is the one that is used first.

Drug treatment is based primarily on the recommendations of a neurologist. It is also very important that the patient is constantly under his supervision.

Medicines

Prozerin. This is a synthetic drug used to treat various diseases of the nervous system. The active ingredient is prozerin. It leads to the accumulation of acetylcholine in the synaptic space. It is produced in two main forms: injection solution and tablets.

Prozerin tablets are taken three times a day (one capsule) half an hour before meals. Subcutaneously, this drug is used twice a day. The dosage should not exceed 2 mg. As a rule, injections are recommended to be done during the day, since this is when a person gets the most tired.

The drug is contraindicated for patients with: bradycardia, epilepsy, angina, gastric ulcer, atherosclerosis, coronary heart disease, intoxication, bronchial asthma, peritonitis. Side effects from the use of Prozerin: nausea with vomiting, flatulence, tremor, convulsions, loss of consciousness, cephalgia, drowsiness, shortness of breath, increased urination, fatigue.

Dibazol. The active ingredient of the drug is bendazole. It is available in the form of solutions for injection, tablets and suspensions (children's form).

The dosage for adult patients is 5 mg five to ten times a day (in some cases, it can be administered every other day). After four weeks, the course is repeated again. Then the break between courses is one to two months.

The drug is contraindicated in case of intolerance to its components, as well as for use by elderly patients. The main side effects include: allergies, heavy sweating, headaches, nausea, a feeling of increased temperature.

Melliktin. The active ingredient in the drug is alkaloid hydroiodide. It is available in powder and tablet form.

For various paralysis, apply one to five times a day at 0.02 g. Duration of therapy is up to eight weeks. The course can be repeated after three to four months.

The drug is contraindicated in heart failure, renal or hepatic failure, myasthenia.

Side effects from using the drug: weakness in the limbs, heaviness, apnea, hypotension.

Thiamine chloride solution. The active ingredient is thiamine. It is a vitamin-like agent. It is produced in the form of a solution that is used for injection.

It is recommended to inject slowly and deeply enough. Treatment should be carried out every day. One dose is 50 mg. The course lasts ten to thirty days.

Contraindicated in case of intolerance to the components of the drug. The main side effects include: tachycardia, sweating, allergic reactions.

Physiotherapy treatment

Physiotherapy treatment of peripheral paralysis is a long-term but quite effective method, the result of which depends on the severity of the disease and the area where it occurs. In addition, physiotherapy does not require large financial costs.

Please note that physiotherapy procedures will help restore motor functions only partially, so it is recommended to carry it out in combination with other treatment methods.

Folk remedies

1. Take one teaspoon of peony (dry roots) and pour three glasses of hot boiled water. Infuse for one hour, then strain. It is necessary to take one tablespoon three times a day a quarter of an hour before meals.
2. Take one teaspoon of fresh sumac and sumac tanning leaves. Pour one glass of hot boiled water. Infuse for one hour and strain. Take one tablespoon three times a day half an hour before meals.
3. Rosehip infusion can be used to prepare special baths, which are quite effective for paralysis of the lower extremities.

Physical rehabilitation for peripheral paralysis

The main role in physical rehabilitation for peripheral paralysis is played by therapeutic exercise. It helps to partially restore movement. A set of physical exercises for the treatment of peripheral paralysis consists of:

1. Placing the paralyzed limb(s) in the correct position.
2. Carrying out massage.
3. Carrying out active and passive movements.

In peripheral paralysis, it is very important to give the body a position that will help prevent the development of contractures in the future. Massage should be selective. Paretic muscles can be massaged using all techniques, but antagonistic muscles can only be stroked. Passive movements are also performed along with massage. When the patient begins to move independently, active exercises are gradually added to them. Gymnastics performed in a pool or bath is very effective.

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Prevention

1. It is necessary to treat infectious diseases in a timely manner.
2. Give up all your bad habits.
3. Lead a healthy lifestyle (spend more time outdoors, take walks, exercise).
4. Eat right.
5. If you have any health problems, consult a doctor immediately.
6. Monitor your blood pressure.

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Forecast

With the right treatment and timely diagnosis, peripheral paralysis can be almost completely or completely cured.

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