Spastic paralysis

Paralysis is divided into two large groups: spastic paralysis and sluggish. Spasticity occurs as a result of spinal cord lesions in the cervical or thoracic region, and it is characteristic of most cases of infantile cerebral palsy. Paralyzes are also classified according to the degree of defeat. Isolate partial paralysis, which is called paresis, and complete paralysis - plethysy.

[1], [2], [3], [4], [5], [6], [7], [8],

Epidemiology

Data on the area of spastic paralysis and the incidence of the disease are absent. As for infantile cerebral palsy, according to the World Health Organization, the average frequency is 2.5-4 cases per 1000 births.

[9], [10], [11], [12], [13], [14], [15]

Causes of the spastic paralysis

This is a consequence of the pathology of the motor neuron. Since the pyramidal beams are close together rather tightly, the paralysis most often covers the entire limb, either entirely to the left or right side of the body. Peripheral paralysis usually involves certain muscles or a group of muscles. But these rules have exceptions. For example, a tiny focus located in the cerebral cortex can cause paralysis of the palm, facial muscles, etc .; and, on the contrary, significant lesions of nerve fibers can lead to extensive peripheral paralysis.

In addition, the frequent cause of paralysis is brain trauma and multiple sclerosis. The main cause of spastic paralysis is a violation of the transmission of nerve signals, which lead to hypertonic muscle.

Spasticity can be a consequence of other disorders and diseases:

• Disruption of the brain due to hypoxia;
• Infectious diseases of the brain (encephalitis, meningitis);
• Amyotrophic lateral sclerosis;
• Hereditary factor. This refers to the family spastic paralysis of Strympel - a sluggish current disease that is inherited and progresses over time. The nervous system gradually degrades, as the pyramidal pathways in the cord of the spinal cord are affected. The name of this type of paralysis was due to A. Stryumpel, who revealed the family nature of the disease. In medical literature, it is also known as the family spastic paraplegia of Erba-Charcot-Strumpeel.

[16], [17], [18], [19], [20], [21], [22]

Risk factors

Separately identify risk factors that increase the likelihood of acquiring paralysis in the womb or during labor:

• Low birth weight and premature birth;
• Multiple pregnancy;
• Infections suffered during childbearing;
• Rhesus-incompatibility of blood groups;
• Intoxication (eg exposure to methyl mercury);
• Thyroid dysfunction in the mother;
• Complications of childbirth;
• Low scores on the Apgar scale;
• Jaundice;
• Convulsions.

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

Symptoms of the spastic paralysis

In addition to violations of the motor function, spastic paralysis is accompanied in almost all cases by other disorders, including disorders of consciousness, vision, hearing, speech, attention and behavior.

The first sign of paralysis and the main factor that prevents the renewal of motor functions is spasticity. Spasticity manifests itself as hypertonicity and involuntary contractions in the affected muscles. Abbreviations occur in those muscles that previously submitted to conscious control. In the first time after receiving an injury or after suffering a spinal cord is in a state of shock, and brain signals through this site are not transmitted. Reflexes in the tendons are not found. With the dispersion of the shock reaction, they resume, but the function is often distorted.

Muscles are in a tense state, dense, during passive movements, resistance is felt, which sometimes can be overcome with effort. Such spasticity arises from the high reflex tone and its distribution is uneven, which causes typical contractures. Such paralysis is easy to recognize. Usually one hand is pressed to the body and bent at the elbow, the wrist and fingers are also bent. The leg is unbent, only the foot bends and the sock looks inside.

Hyperreflexia is another sign of hyperactivity in the spinal cord. The reflex function of the tendons is very strong, manifested with the slightest slight irritation: the area of work of the reflex becomes more extensive: the reflex is caused both from the habitual zone and from the adjacent zones. Tendon and skin reflexes, on the contrary, weaken or disappear altogether.

Concomitant movements (they are also called synkinesis) can manifest themselves in the affected arms and legs involuntarily, for example, when the healthy muscles contract. This phenomenon is explained by the propensity to spread impulses in the spinal cord to neighboring segments, which are normally limited to the work of the cerebral cortex. With spastic paralysis, impulses spread with greater force, which leads to the appearance of "additional", involuntary contractions in the affected musculature.

Pathological reflexes are the key and permanent symptoms of spastic cerebral palsy. Particular mention should be made of reflexes of the foot in spastic paralysis of the legs: the symptoms of Babinsky, Rossolimo and Bekhterev often appear. Other pathological reflexes on the foot are less frequent. Such phenomena on the paralyzed hands are not so pronounced and therefore there is no data on them. If we talk about pathological reflexes on the facial muscles, they talk about bilateral lesions in the cortex, in the brain stem or in the subcortical department.

Diagnostics of the spastic paralysis

Differential diagnosis of spastic paralysis takes into account the symptoms and results of analyzes and studies.

At the consultation, the neurologist examines the patient: draws attention to the position of the body, motor functions, muscle tension, checks reflexes.

To exclude other conditions that have the same symptoms - a neoplasm in the brain or muscle dystrophy - studies are conducted using instrumental and laboratory diagnostics:

• Blood tests;
• X-ray of the skull;
• Computed tomography of the head and spine;
• Magnetic resonance imaging of the brain and spine;
• Neuron sonography.

[27], [28], [29]

Treatment of the spastic paralysis

Muscle relaxants eliminate hypertonic muscles. Depending on the mechanism of action, the relaxants of central and peripheral action are isolated. Practice shows that the use of muscle relaxants often leads to undesirable consequences and complications. To muscle relaxants, which affect the central nervous system and are often used to eliminate the symptoms of spastic paralysis, include baclofen, sirdalud, diazepam.

Baclofen - is analogous to gamma-aminobutyric acid, which is involved in presynaptic inhibition of signals. The drug suppresses synaptic reflexes and the function of gamma-efferents. The medicine easily overcomes the blood-brain barrier. The best effect is given with spinal forms of spasticity: the drug not only eliminates hypertonia and spasms of motor muscles, but also has a beneficial effect on the work of the pelvic organs. If the patient is affected by the brain, baclofen can affect the ability to concentrate and remember. Adults prescribe the drug at 10-15 mg per day, the dosage is divided into 2-3 admission. Then the dosage is gradually increased by 5-15 mg until the desired effect is achieved. Usually the dosage will vary from 30 to 60 mg per day. Possible side effects from taking baclofen - a decline in strength, low blood pressure, ataxia - disappear with a decrease in dosage. Dosage of the drug should be reduced gradually: a sharp cancellation can cause convulsions and hallucinations. Studies on the safety of baclofen for the treatment of childhood paralysis are not yet available, so children are appointed with extreme caution.

Sirdalud (tizanidine) selectively affects the polysynaptic pathways of the spinal cord. It reduces the production of amino acids, which have an exciting effect, due to which the frequency of the exciting signals to the neurons of the spinal cord decreases. On the effectiveness of reducing hypertension, sirdalud is similar to baclofen, but it has much better tolerability and it gives results, both in central spastic paralysis and in spinal paralysis. Adults are prescribed in a dosage of up to 2 mg per day (distributed for 2-3 doses) with a further increase in daily dosage to 12-14 mg (distributed for 3-4 doses). In the treatment of sirdalude, side effects can occur: a slight decrease in pressure, a decline in strength, a sleep disorder.

Diazepam (or valium) softens the effect of gamma-aminobutyric acid, which causes presynaptic inhibition of signals and suppression of spinal reflexes. The main reason why diazepam is not widely used is its marked sedative effect and a negative effect on cognitive function. Its reception begins with a dosage of 2 mg per day and gradually increases it to 60 mg per day, distributing for 3-4 doses.

To the muscle relaxants, which give results in spasticity of spinal genesis, refers to dantrolene. The drug acts on the actinomyosin complex, responsible for muscle contraction. Because of the action of dantrolene from the sarcoplasmic reticulum, calcium is released less, this reduces the contractility of muscle tissue. Dantrolen does not interfere in the spinal mechanisms that regulate muscle tension. It affects the fibers of the musculature more strongly, to a greater extent reducing manifestations of phasic reflexes and to a certain extent - tonic.

The best result is given in the treatment of spasticity of cerebral genesis (paralysis after a stroke, cerebral palsy) and slightly affects cognitive functions. Acceptance of the drug begins with a small dosage - 25-50 mg per day, after it is increased to 100-125 mg. The consequences and complications associated with taking dantrolene: a decline in strength, dizziness and nausea, a malfunction of the digestive system. In 1 out of 100 cases, patients have signs of liver damage, so dantrolene should not be taken with chronic liver diseases. The drug is also contraindicated in the violation of the heart.

The choice of the drug for the treatment of spastic paralysis is due to the origin of the disease, the degree of muscle hypertonia and the features of the mechanism of operation of each medication.

In addition to the described drugs, also shown the reception of medications fortifying action: B vitamins, metabolic drugs and drugs that activate blood circulation.

Physiotherapeutic treatment

Of the physiotherapeutic methods, local application of cold or, conversely, heat, as well as electrical stimulation of the peripheral nerves are popular.
Local cold application helps to reduce hypertrophied reflexes of tendons, increase the amplitude of joint mobility, and improve the work of antagonist muscles. Cold compress hypertension reduces for a short while, most likely, due to a temporary decrease in the receptivity of the skin receptors and delayed nerve conduction. A similar result is the use of local anesthetics. To achieve the best effect, ice applications are applied for 20 minutes or longer. The course of treatment is 15-20 procedures.

Local heat application is also aimed at reducing muscle hypertonicity. To do this, use applications of paraffin or ozocerite, which are superimposed in the form of wide strips, gloves, socks. At this time, the patient needs to take such a position that the affected muscle stretches as far as possible. The temperature of ozocerite or paraffin should be within the range of 48-50 degrees, the duration of applications is 15-20 minutes. The course of therapy is 15-20 applications. When performing warm applications in patients prone to increased arterial pressure, pressure should be observed.

Electrostimulation was first used to treat spasticity for a long time - about 150 years ago. Today, for the removal of hypertonic musculature use a superficial, subcutaneous, epidural overlapping electrodes, and even implantation. Electrostimulation of the peripheral nerves is usually resorted to in spastic paralysis of the legs in a standing position, with walking and physical exertion. Effective surface electrostimulation in the treatment of patients affected by paralysis as a result of a stroke.

The mechanism of electrical stimulation is due to neurotransmitter modulation at the level of certain sites. The tone decreases for a short time - literally, for several hours. Electrostimulation parameters are chosen taking into account the causes, the lesion site and the stage of paralysis. When spasticity is recommended electro-gimmick of antagonistic muscles: the impact on spastic muscles can lead to an even stronger tone. Usually electrostimulation is performed with high-frequency currents: low-frequency currents strongly irritate the skin and can be painful, which also increases hypertonicity.

Massage

Special massage with spastic paralysis is designed to relax muscles with hypertension as far as possible. Therefore, massage techniques are reduced to stroking, shaking, unintentional and unhurried warm-up. Sharp tricks that cause pain, on the contrary, lead to an increase in tone. In addition to classical massage, they turn to the methods of acupressure. The brake technique of this type of massage is performed with a step-by-step build-up of finger pressure on certain points. When the optimum pressure is reached, the finger is held for a while, and then the pressure gradually decreases until it stops completely. Work with each point lasts from 30 seconds to 90 seconds.

Physiotherapy

The exercise therapy for spastic paralysis consists of exercises that are designed to relax the muscles, to suppress pathological syncopeesis, and to develop the extensibility of the affected musculature. Moderate stretching of the muscle helps for a while to reduce hypertonicity and to increase the mobility of the joint. The mechanism of such influence of these exercises is not fully understood. Probably, exercises affect the mechanical characteristics of the musculoskeletal system and the modulation of the synaptic transmission. The tone is reduced for a short while, so the kinesitheater strives to make the most of this period for working on those movements that limited spasticity.

LFK with spastic paralysis has its own peculiarities:

• The session must be suspended if the muscle tone rises above the original level;
• so that syncopeesis does not occur, work on combined movements involving more than one joint is performed only when clear movements are achieved in a separate joint (first it is developed in one direction and the plane, in the next stage - in different joints);
• implementation of the rule of "partial" volumes - work on the muscle at the initial stage is carried out in a zone of small amplitudes, and only when the muscle is sufficiently strong, the amplitude is increased to physiological;
• the earliest possible transition from the "abstract" development of muscles to the development of skills necessary in everyday life;
• When exercising, breathing is monitored: it should be uniform, without difficulty, dyspnea.

If you teach a patient to exercise autogenic training and enter these elements into a session of physical therapy, the best result will be achieved.

Homeopathy

Homeopathic preparations should be used in the recovery period. They will help restore the conduction functions of nerve impulses and the work of pelvic organs. Preparations are selected by a homeopath taking into account the patient's condition, degree of injury and concomitant diseases.

Most often used such drugs:

• Lachezis activates the blood circulation in the brain. The drug is most effective at strokes with left-sided manifestations.
• Botrops also activates cerebral circulation, fights with blood clots, is effective in right-sided paralysis.
• Latirus sativus is shown with a spastic gait, when during a walk the knees beat against each other and it is impossible to take a pose with crossed or, on the contrary, elongated legs in the sitting position.
• Nux vomica improves the conduction of impulses of the brain, shows noticeable results in spastic paralysis of the legs. Beneficial effect on the operation of the pelvic organs.

Operative treatment

If other methods of treatment have proved ineffective, the possibility to expand the motor functions of the patient through surgery is being considered. When deciding on a surgical procedure, many factors are taken into account:

• How long the nervous system is affected. To surgical treatment resorted only if all methods of restoring motor functions were exhausted (not earlier than six months after the stroke and a year or two after a brain injury).
• The nature of spasticity can be of two types - dynamic or static. With dynamic spasticity, the tone increases during movements (for example, crossing legs during walking in cerebral palsy). The static nature of spastic paralysis appears due to a prolonged increase in muscle tone, causing contractions that are identically expressed both at rest and in motion. Sometimes, in order to determine the nature of spasticity, it is necessary to use blockades of nerve trunks with the help of anesthetics.
• The sensitivity of the limb, the degree of its deformation. An operation on the arm or leg may not produce results if the patient has obvious impairments in the ability to perform targeted movements.
• Damage to the musculoskeletal system (fractures, dislocations, arthritis). If these conditions are not taken into account, a favorable prognosis for surgical intervention may not be justified.

Alternative treatment

Alternative medicine has in the arsenal its funds for the treatment of spasticity:

• A teaspoon of the crushed roots of the peony deviant is brewed with a glass of boiling water. After an hour, the broth is ready. It is filtered and drunk 1 tablespoon to 5 times a day.
• Bay oil. To make it, 30 g of laurel leaves are poured 200 grams of sunflower oil and allowed to brew in the heat for 55-60 days. Then the oil is filtered and heated to a boil. With such oil, affected areas are treated every day.
• Green tea, if properly brewed, helps to recover from paralysis due to a stroke.
• Broth of rose hips roots are prepared for taking baths. The full course of baths is 20-30 procedures.

Paralyzed muscles are treated with volatile ointment. It is prepared very simply: alcohol and sunflower oil are mixed in a 1: 2 ratio. To prepare the ointment, you can use the ether, but you should not forget that it easily lights up.

[30], [31], [32], [33], [34], [35]

Herbal Treatment

• Herbal infusion is prepared from chamomile flowers (2 parts), lemon balm (1 part), hop cones (1 part), wormwood root (1 part). Infusion drink 100 ml three times a day for half an hour before meals.
• Infusion of flowers of mountain arnica. To do this, 1 teaspoon of flowers pour a glass of boiling water, and, after brewing for a while, filter. Infusion drink 1 tablespoon 3 times a day. Arnika lowers excitability, helps relieve pain and cramps.
• The flowers of the white acacia are used to make tincture for alcohol. It rubs the affected muscles. To prepare tincture, you need 4 table flowers and 200 ml of vodka. After a week, tincture is filtered and 1 teaspoonful is drunk 3 times a day.

Include in the treatment complex alternative means can only with the consent of the attending physician. It is not worth taking independent decisions in such matters: spastic paralysis is a serious disease requiring an integrated approach to treatment for the resumption of motor functions. If doctors, relatives and the patient make every effort, in many cases, complete healing or partial restoration of lost functions is quite possible.

Prevention

The main measure of prophylaxis of spastic paralysis is the prevention of diseases, which causes such consequences and complications. First of all, it concerns diseases of the cardiovascular system: paralysis as a consequence of stroke is the most frequent case.

[36], [37]