Acute flaccid paralysis in children and adults

Acute flaccid paralysis occurs due to damage to the peripheral neuron in any part of it: on the spine or peripheral nerve, in the plexus or anterior horn. With the development of this pathology, muscles lose reflex, as well as arbitrary innervation.

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Epidemiology

Today, the risk of acute flaccid paralysis in children remains serious enough. This is due to the high prevalence of various enteroviruses that are non-poliomyelitis.

[2], [3], [4],

Causes of the acute flaccid paralysis

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

[5], [6], [7]

Pathogenesis

Falling out of reflexes, as well as hypotension, are due to the interruption of the reflex monosynaptic arch to tension, as well as the disruption of the work of stretching the mechanism of fast and slow reflexes. Muscle atrophy appears, as the anterior horn stops to have a trophic effect on the muscle fibers - this problem appears after a few weeks after the denervation of the nerve endings in the muscles and can be so strong that after a few months or years only the connective tissue will remain in the affected muscles.

[8], [9], [10], [11], [12]

Symptoms of the acute flaccid paralysis

Acute flaccid paralysis is characterized by such manifestations:

• the muscle does not resist the movements of a passive character;
• atrophy is very pronounced;
• there is a decrease or a complete absence of deep reflexes;
• Muscular and nervous electroexcitability varies.

Sluggish leg paralysis

If there is a disruption in the functioning of the anterior horns located in the spinal cord in the place of the lumbar thickening, development of flaccid paralysis of the legs is possible. When such a lesion extends to the cervical or lumbar region of compaction on both sides, it is possible to develop simultaneous paralysis of all limbs or some particular area.

Flaccid paralysis usually affects only one leg. Stop while it becomes impossible, because the disease affects the tibial group of muscles.

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

[13], [14]

Acute flaccid paralysis in children

Children also show symptoms of this disease - they are expressed in the form of weakness or trembling in the limbs, and besides this in the malfunctioning of the swallowing and respiratory muscles, because the lower motor neurons are destroyed.

[15], [16]

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, polyneuric and segmental.

[17], [18], [19],

Complications and consequences

Among the complications of this disease:

• The development of contracture - the muscles harden, and it is impossible to prevent this;
• Joints become completely immobile - ankylosis;
• A stable defect whose main difference is the decrease (or total absence) of force in muscles of the muscles of the arm, leg or neck.

[20], [21], [22]

Diagnostics of the acute flaccid paralysis

When diagnosing, an anamnesis of the disease is analyzed, as well as patient complaints. It is necessary to answer the following questions: how long ago the force in the muscle group disappeared; for what reason it happened; whether such symptoms were observed in other family members; Do not have to contact at home or work with harmful toxic elements.

It is necessary to pass a survey with a neurologist - the evaluation of the strength of the patient's muscles is carried out on a 5-point scale, and in addition to that, other signs of the disease are searched for (absence of reflexes, facial asymmetry, problems with swallowing function, muscle thinning, strabismus appearance).

In some cases, you need to consult a neurosurgeon.

[23], [24], [25], [26]

Analyzes

The main analyzes that are required to pass to the patient are the following:

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

[27], [28], [29], [30], [31], [32],

Instrumental diagnostics

The main instrumental diagnostic method for determining the level, as well as the degree of destruction of nerve receptors, is electromyography (modern variations of this procedure are needle or stimulatory).

Differential diagnosis

During the diagnosis it is very important to differentiate the flaccid (peripheral) paralysis with the central one. In addition, it should be distinguished from injuries to the tendons, limited movement due to various injuries, as well as from the contracture of the joints.

Sluggish and spastic paralysis

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

Treatment of the acute flaccid paralysis

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

Medications

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 r./d., or 20% solution in a dosage of 5-10 ml IM or IV);
• Cerebrolysin (in a dosage of 3-5 ml IM or IV);
• Actovegin (in a dosage of 5-10 ml IM or I / O through a dropper of 1-2 r./day, 1 ml of the drug contains 40 mg of the active ingredient);
• trental (dragee in a dosage of 0.1 g 3 r./day or IV in a dropper of 1 r./d. In a dose of 5 ml, 1 ml of the drug contains 0.02 g of the active ingredient).

Vitamins

There is also a reception of vitamins:

• vitamin B1 (solution 2.5% (thiamine chloride) or 5% (thiamine bromide), 3% or 6% in a dose of 1 ml IM in each day of 1 r./d.);
• vitamin B12 (dose 400 μg 1 r./2 days in / m, it is allowed to combine with vitamin B1, but you can not mix them in one syringe).

Physiotherapeutic treatment

Acute flaccid paralysis is effectively treated with electrotherapy, as well as other methods of physiotherapy. Basically, with such a disease, balneotherapy is prescribed, as well as galvanization.

Massage with flaccid paralysis

In the case of flaccid paralysis, massage is performed to stimulate the muscular system, which is why when performing it, deep kneading is used, and with it, rubbing with high intensity, and in addition the masseur actively influences the so-called segmental zones. But you can not massage the paretic muscles with excessive force - the procedure should be short and moderate. It is necessary to spend it for many months (it is necessary to make small breaks between medical courses). If you perform rough, painful, receptions, the muscle on the contrary can begin to weaken.

In addition, a point massage is performed using a toning technique. In this case it is necessary to press the tip of the finger on the necessary points to cause rapid short vibrating stimuli, which will stimulate the necessary movement.

Alternative treatment and herbal treatment

There are several recipes for alternative treatment:

The roots of the peon dodging. It is necessary to take 1 tsp. Dry ingredients and pour boiling water (3 stacks), then wrap the container and insist for 1 hour, then strain. You need to drink tincture three times a day. 1 tbsp each before meals (15 minutes). Tincture on alcohol should be taken in a dosage of 30-40 drops. 3 rubles / day. Before eating.

Dye or tannic sumac (fresh leaves are used). Take 1 tsp. Ingredient and pour boiling water (1 stack.), wrap the container and insist for 1 hour, then strain. Drink 3-4 r. / Day. 1 tbsp each

Fruits and roots of dog rose. Decoction of the roots is used externally - with paralysis in the bath with him you need to bathe your feet.

[33], [34], [35], [36]

Operative treatment

In the case of destruction of anatomical integrity in the peripheral nerve system, a neurosurgical operation may be prescribed to the patient.

Prevention

For the prevention of disease should follow these rules:

• It is necessary to treat infectious pathologies in time;
• Refuse all bad habits and lead a healthy lifestyle - walk in the fresh air, exercise, keep the right diet, etc .;
• In case of deterioration of health, without delay, consult a doctor;
• Control the blood pressure level.

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Forecast

Acute flaccid paralysis in some cases is able to have a favorable prognosis. Everything depends on the volume and distribution of pathology in the structure of the organs of the motor system, and besides on what the compensatory possibilities of the organism are. Lost movements can be restored by regenerating nerve endings or compensating replacement innervation. Carrying out of active treatment can allow to completely restore movement after 1-2 years.

In the treatment of a damaged nerve by surgery, relief of atrophic processes, as well as restoration of the motor system, occurs at least six months to a year later. The period of re-adaptation may include the use of prostheses, as well as orthopedic operations on the tendons, joints, and muscles.

[38], [39], [40], [41]