Peripheral paralysis

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

[1], [2], [3], [4], [5], [6],

Causes of the peripheral paralysis

Poliovirus and other viruses

Peripheral paralysis is the most common sign of acute poliomyelitis. He also accompanies illnesses caused by enteroviruses, echoviruses, the West Nile virus and adenoviruses.

[7], [8]

Botulism

Botulinum Clostridium bacteria cause botulism and cause flaccid paralysis due to blocking the release of acetylcholine thereby stopping the postsynaptic transmission of the impulse through the neuromuscular junction. Other symptoms associated with an infection from a neurotoxin include double vision, blurred vision, eyelid drooping, 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. The 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 lubricate the tips of their arrows to hunt the beasts. This poison is also used by South Americans to treat dropsy, insanity, swelling, fever, kidney stones, and bruises. Curare blocks neuromuscular transmission, causing peripheral paralysis. This poison binds to acetylcholine receptors in the muscles, blocking them from interaction with acetylcholine.

[16], [17], [18], [19], [20], [21]

Other reasons

Transverse myelitis, Guillain-Barre syndrome, enteroviral encephalopathy, traumatic neuritis, Reye syndrome, etc.

Pathogenesis

Atony and loss of reflexes are due to a violation of the integrity of the reflex arc, which leads to a loss of muscle tone. Muscular atrophy develops due to the dissociation of muscle fibers with neurons in the spinal cord.

There may be fibrillar twitching in the muscles.

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Symptoms of the peripheral paralysis

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

1. Complete absence or a strong decrease in the basic reflexes (areflexia, hyporeflexia).
2. Reduced or completely absent muscle tone (hypotension, atony).
3. The muscle tissue atrophies.
4. Sluggish form of numbness.
5. Paralysis can cover only certain parts of the body (this depends on the damaged horn of the spinal cord and their location).

Peripheral Palsy Syndrome

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

A good example of this syndrome is the defeat of the limbs, which arises from poliomyelitis. In addition, the patient may experience paralysis of the respiratory muscles, which leads to the violation of respiratory movements, up to the stopping of breathing.

Paralysis of peripheral nerves

Almost always, when the peripheral nerve is damaged, there is a loss of its sensitivity. Paralysis is manifested by the violation of the motor properties of the nerve. At the same time there is a sluggishness of those muscle groups that move along the trunk below the damaged nerve. Due to this important diagnostic feature, the doctor will be able to determine in which place the damage occurred.

Paralysis of the peripheral nerves is a frequent manifestation in such diseases:

1. Stroke.
2. Polio.
3. Trauma, which caused damage to the nerve.
4. Botulism.
5. Amyotrophic lateral sclerosis.
6. Guillain-Barre syndrome.
7. Multiple sclerosis.
8. Some poisoning.
9. Paralysis due to tick.

Peripheral paralysis of 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, this can lead to peripheral paralysis in the lower limbs. If the lesion affects the lumbar or cervical compaction on both sides, then paralysis of both legs and hands, or any one area, may occur.

Most often, peripheral paralysis affects only one leg. In this case, the movement of the feet is impossible, since the lesion of the tibial muscular group occurs.

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

Before the appearance of peripheral paralysis of the lower limbs, 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 dependence should pay special attention to paresthesia. In this case, the muscles on the hands become paretic. The disease can develop for several days.

Complications and consequences

• Contracture is the hardening of muscles that can not be prevented.
• Ankylosis of the joints (the joint becomes immovable).
• A persistent defect that is distinguished by a decrease in muscle strength (or lack thereof) in the muscular group (legs, arms, or neck).

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Diagnostics of the peripheral paralysis

1. An analysis of the patient's medical history and complaints:
   • How long does the muscle group lack strength.
   • What was the reason for the complaint.
   • Were there such complaints from other family members?
   • Whether the place of residence or the profession of the patient is associated with harmful toxic substances.
2. The neurologist examines: the muscular strength of the patient is estimated on a five-point scale, and the doctor also looks for other symptoms of pathology (there are no reflexes, the face acquires asymmetry, the muscles become thinner, the swallowing is disturbed, and strabismus appears).
3. Analyzes are carried out, as well as instrumental diagnostics.
4. In some cases, a consultation of a neurosurgeon is necessary.

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Analyzes

The most common tests that a patient must pass are:

1. General blood test: thanks to this, inflammatory markers (accelerated ESR, C-reactive protein) or an increase in creatine kinase can be detected.
2. Toxicological analysis of blood helps to identify certain toxic substances in the blood.

In some cases, a proselyte test is carried out. It helps to detect myasthenia gravis. This is the pathological fatigue of muscle groups. After the administration of this drug, the muscle strength returns very quickly.

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Instrumental diagnostics

1. Electroneuromyography (ENMG) - thanks to this method, you can evaluate the electrical activity of muscles, as well as see how fast the nerve impulse is passed through the fibers.
2. Electroencephalography (EEG) - the method allows you to check the electrical activity of various areas of the brain, which can change in peripheral paralysis.
3. Computer tomography (CT) and magnetic resonance imaging (MRI) are methods by which you can check the activity of the spinal cord and brain and see what their tissues were damaged.
4. Magnetic resonance angiography (MRA) - due to this method, the patency of arteries in the cranial cavity is assessed. It also allows you to see the development of tumors.

Differential diagnosis

During the diagnosis it is very important not to confuse the peripheral paralysis with the central paralysis of the body. The latter develops if the pyramidal path is damaged. In the symptomatology there is no atrophy of muscle groups. First, the patient is noticeable hypotension of the muscles, from which hypertension and hypertrophy develop.

It is also important to distinguish peripheral paralysis from limited movement due to various injuries, damage to the tendon or contracture of the joints.

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Treatment of the 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 noting that peripheral paralysis is not only a symptom of a disease, but it can also be a separate disease.

Medical measures, which are used in this case, represent a whole complex. It is designed to eliminate the signs and consequences of the disease. But some doctors believe that it is also necessary to use symptomatic treatment. But in this complex the main role is played by physiotherapy exercises and various massages.

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

During the therapeutic walk, for example, the patient must learn to step on the paralyzed limb again, therefore, it is she who is primarily involved.

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

Medications

Proserin. This is a synthetic agent that is used to treat various diseases of the nervous system. Active active substance - proserin. It leads to the accumulation of acetylcholine in the synaptic space. They are produced in two main forms: injection and tablets.

Tablets Proserin is consumed three times a day (one capsule) half an hour before a meal. Subcutaneously, this drug is used twice a day. Dosage should not exceed 2 mg. As a rule, injections are recommended to be done during the day, as it is at this time that the person is most tired.

The drug is contraindicated in patients with: bradycardia, epilepsy, angina pectoris, stomach ulcer, atherosclerosis, ischemic heart disease, intoxications, bronchial asthma, peritonitis. Side effects from the use of Proserin: nausea with vomiting, flatulence, tremor, convulsions, loss of consciousness, cephalgia, drowsiness, shortness of breath, increased frequency of urination, fatigue.

Dibasol. Active active substance of the drug is bendazole. It is available in the form of injectable solutions, tablets and suspensions (pediatric form).

Dosage for adult patients is 5 mg five to ten times a day (in some cases, you can enter every other day). After four weeks, the course is repeated again. Further, the break between the courses is one to two months.

The drug is contraindicated for intolerance to its components, as well as for use by elderly patients. Among the main side effects are: allergies, severe sweating, headaches, nausea, a sensation of fever.

Melliktin. The active ingredient in the formulation is the hydroiodide of the alkaloid. Produced in the form of powder and tablets.

With different paralysis, one to five times a day, 0.02 grams are used. The duration of therapy is up to eight weeks. The course can be repeated in three to four months.

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

Side effects from the use of the remedy: weakness in the limbs, heaviness, apnea, hypotension.

A solution of thiamine chloride. The active ingredient is thiamine. It is a vitamin-like remedy. It is produced in the form of a solution, which is used for injections.

The introduction is recommended slowly and deeply enough. Treatment is conducted every day. One dose is 50 mg. The course lasts ten to thirty days.

Contraindicated with intolerance of the drug components. Among the main side effects can be identified: tachycardia, sweating, allergic reactions.

Physiotherapeutic treatment

Physiotherapeutic treatment of peripheral paralysis is a long, but rather effective method, the result of which depends on the severity of the disease and the area where it is taking place. In addition, physiotherapy does not need a lot of money.

Please note that physiotherapeutic procedures will help restore motor functions only partially, therefore, it is recommended to be carried out in complex with other methods of treatment.

Alternative treatment

1. Take one teaspoon of peony evasive (dry roots) and pour three cups of hot boiled water. Insist one hour, then strain. It is necessary to take one tablespoon three times a day for a quarter of an hour before a meal.
2. Take one teaspoon of fresh leaves of sumato dye and a sum of tan. Pour one cup of hot boiled water. Insist one hour and strain. It takes half an hour before meals for one tablespoon three times a day.
3. Infusion of rose hips can be used to make special baths, which are quite effective for paralysis of the lower limbs.

Physical rehabilitation with peripheral paralysis

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

1. Laying in the correct position of the paralyzed limb (limbs).
2. Carrying out a massage.
3. Active and passive movements.

With peripheral paralysis it is very important to give the body such a position that will help in the future to prevent the development of contractures. Massage should be selective. Paretic muscles can be massaged with the help of all methods, but antagonistic ones - only stroking. Passive movements are also carried out with the massage. When a patient develops independent movements, active exercises are gradually added to them. A great efficiency is the gymnastics, which is held in the pool or bath.

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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 (more often go outdoors, take walks, do physical exercises).
4. Eat right.
5. If you have any health problems, contact your doctor right away.
6. Monitor blood pressure.

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Forecast

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

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