Paralysis of the legs

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

[1], [2], [3], [4],

Epidemiology

Approximately 5.6 million people, or 1.9% of the population, have difficulty in moving one or two legs. Annually about 1.2 million people get injuries of the spinal cord of varying severity.

The leading causes of paralysis of the legs are:

• Stroke - 29%.
• Trauma of the spinal cord - 23%.
• Multiple sclerosis is 17%.
• Children's cerebral palsy - 7%.
• Poliomyelitis syndrome - 5%.
• Other - 19%.

[5], [6], [7],

Causes of the paralysis of the legs

Paralysis of the legs develops, as a rule, when motor nerve fibers or neurons are affected. The defeat of nerves can have a different form, from mechanical damage to impaired blood flow. In most cases, paralysis occurs due to an injury that has resulted in nerve fiber damage.

Also paralysis of the legs can be provoked:

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

Temporary paralysis of the legs may be a consequence:

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

[8], [9]

Pathogenesis

The patient has to carefully monitor changes in his condition for paralysis of the legs. If the disease was caused by organic causes, then immediately there is a change in the reflexes, there is a breakdown in muscle tone, sometimes muscle atrophy can develop.

With central paralysis of the lower limbs, pathological reflexes in the muscles appear. Muscular tone is increased. Also, sometimes paralysis of the legs can be accompanied by a combination of the above signs with loss of speech.

If peripheral nerves are damaged, atrophy and atony of muscles can occur, reflexes fall out. If paralysis is functional, temporary, then changes in muscle tone and tendon reflexes are not observed.

[10], [11], [12]

Symptoms of the paralysis of the legs

First paralysis of the lower extremities is characterized by the fact that the legs lose sensitivity. Violated motor activity of some muscles.

After this, the stage begins when the patient ceases to feel pain in the paralyzed limbs.

Because of a circulatory disturbance in the affected muscles, a trophic disorder occurs in those areas of the body that were affected by the disease.

With the defeat of the corresponding nerve centers, the patient can no longer control defecation and urination.

Temporary paralysis of the legs is an alarming symptom, it can manifest 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. At what, if the stroke was the area of the brain to the left, then the patient loses the ability to move just the right lower limb and vice versa.

Paralysis of the right or left arm and leg is also called hemiplegia. In addition to the arms and legs on one side of the trunk (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 between spastic paralysis of the legs is the fact that the patient does not have atony or muscle atrophy, the reaction of degeneration, the loss of basic reflexes. This disease is manifested due to the defeat of the central motor neuron.

Among the main symptoms of spastic paralysis of the lower extremities can be identified: increased tendon reflexes, hypertension of muscles, syncopeesis and the presence of pathological reflexes.

The most common reasons for the occurrence of spastic paralysis of the legs can be called:

1. The defeat of the central motor neuron.
2. Strokes.
3. Craniocerebral injury.
4. Multiple sclerosis.
5. Encephalopathy.
6. Injuries to the back.
7. Meningitis.
8. Phenylketonuria.
9. Hypoxia of the brain.

Sluggish leg paralysis

Sluggish paralysis of the legs is called a pathological condition, when the muscles involuntarily and relax too much. That is, there is no shortening or tension. It usually occurs when the spinal cord is damaged in the lumbar region ("ponytail"). 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 can not move independently, but must also observe a constant bed rest. Muscles in the paretic limbs lose their tone, become flabby and flabby, their atrophy occurs.

Forms

There are the following types of paralysis of the legs:

1. Proximal paresis - the extensor and flexion movements of the patient are greatly hampered. Usually the disease affects the areas of the lower leg and thigh. Proximal paresis is characterized by weakness in the proximal muscles. Usually this type of paralysis is peripheral, not spastic. Usually, peripheral proximal paresis occurs due to a hip injury. Patients with diabetes often experience atrophic paralysis of the hip muscles (one of the types of proximal paresis).
2. Distal paralysis of the lower extremities - the following subspecies are distinguished:

• Paralysis of one limb - the tibial group of muscles is damaged, which does not allow the foot to move.
• Paralysis due to the defeat of the nerve of the peroneal region - the foot hangs, the back side of it loses its receptivity, stepping occurs (the gait changes).
• Paralysis due to damage to the nerve of the tibial region - usually occurs after an injury, the plantar flexion of the foot is broken, the toes also stop bending, the foot falls inside.
• Paralysis due to damage to the trunk of the sciatic nerve - the cause is often a fracture of the hip. As a rule, after a lesion, the patient ceases to feel the hind surface.
• Paresis of both extremities - usually of a peripheral nature, leads to a change in gait.

1. Total paralysis of the legs - may also have the following subspecies:

• Monoparesis - distributed to all parts of the lower limbs, sometimes it can become a manifestation of the Brown-Sekar syndrome. The patient loses sensitivity in the paralyzed limb. Sometimes the cause of monoparesis is a cerebral infarction.
• Paraparesis of a lower character - may have a central or peripheral character. Distributed in the muscles of all groups. Sometimes the cause is brain damage - ischemic or hemorrhagic stroke.

Complications and consequences

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

[13], [14], [15], [16], [17]

Diagnostics of the paralysis of the legs

Diagnosis of leg paralysis includes such items:

1. Carefully screening by a qualified neurologist.
2. Computerized tomography of the skull.
3. Magnetic resonance imaging of the brain.
4. Checking the reflexes of the lower limbs.
5. Neurosonography.
6. Fluoroscopy.

With paralysis of the legs, the diagnosis is performed using various medical studies and studying clinical signs.

Instrumental diagnostics

Let's consider the basic methods of instrumental diagnostics of paralysis of the lower extremities:

1. Computer tomography - is based on a rather complex processing and measurement of tissue density by computer.
2. Magnetic resonance imaging - helps to examine the brain and spinal cord and see the various changes in them. Usually this method is more specific.
3. Neurosonography - helps to get all the necessary data on the functionality of the brain and those structures that are located in the cranium.
4. X-ray examination is an x-ray study that is based on the transmission of a patient to get an image on a special screen.

[18], [19], [20]

Differential diagnosis

When diagnosing paralysis of the legs, it is very important to exclude the possibility of the following diseases that have similar symptoms:

1. Bell's paralysis.
2. Multiple sclerosis.
3. Children's cerebral palsy.

[21], [22], [23], [24]

Treatment of the paralysis of the legs

The most important is to eliminate the cause, which 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 system of treatment in each individual case.

The main method of therapy of paralysis of the legs is therapeutic exercise, in which the most important thing is to put your feet in the right position. So, for central paralysis, they are placed in such a way that there is no contracture. Gymnastics necessarily includes both passive and active movements.

Patients with peripheral paralysis before the physical exercises also make therapeutic massages. As soon as the patient shows movements, gymnastic exercises become more active. Effective is the physical culture in combination with the pool.

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

For the treatment of spastic paralysis of the legs, the following methods are used:

1. Relief of the patient.
2. Reduction of muscle spasm and pain in them.
3. Daily hygiene of the patient, physical exercises to improve gait.

Physiotherapy procedures are carried out in order to improve the movement, coordination, strength and tone of the damaged muscles. If normal muscular activity has been disrupted, special medication is prescribed. Also injected are botulinum toxin, which helps to transmit impulses in the nerves.

There are also surgical methods for treating spastic paralysis:

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

Medications

Proserin. Solution for injection, the active ingredient of which is proserin. Dosage is prescribed individually, but usually adults are advised to inject up to 1 mg of solution twice or thrice a day. The duration of therapy depends on the severity of the disease.

It is not recommended to take prozerin for hyperkinesia, 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, dyspnea, allergic reactions.

Dantrolene. Miorelaxant, the active ingredient of which is dantrolene (hydantoin derivative). Assign a drug to treat spastic paralysis of the legs. The agent is produced in the form of a powder, by means of which an injection for injection is made. Dosage is calculated individually, depending on the weight of the patient.

In some cases, the drug leads to irritation of the vascular wall and thrombophlebitis. Among the side effects also allergic.

Dibasol. Spasmolytic drug, the active component of which is dibazol (benzimidazole derivative). Dosage is individual and is prescribed by a specialist. Usually adults are prescribed 40 mg twice or thrice a day.

Among the main side effects are: allergies, feelings of fever, dizziness, sweating, headaches and nausea. Do not take with intolerance benzimidazole.

Melliktin. The drug has a relaxing effect, so it is prescribed with increased muscle tone. The active ingredient is mellitin. First take 0.02 g of the drug once a day, but gradually bring up to five times a day. The therapy lasts three weeks or two months.

When using the product, such side effects can occur: respiratory depression, allergy. The drug should not be taken to patients with myasthenia gravis, liver or kidney failure, heart failure.

Physiotherapeutic treatment

Physiotherapy is prescribed even for patients with deep paralysis of the lower limbs. With its help, you can maintain the cardiovascular system, the vestibular apparatus, muscles, joints, ligaments and bones. By choosing special exercises the patient normalizes blood pressure, reduces pain, helps to cope with nausea and dizziness.

It is very important for physiotherapy to use both limbs in exercises, even if only one is affected. Movement should be carried out in one direction and full. As a rule, each exercise is done no more than five times, so as not to tire the patient.

Alternative treatment

To date, you can find a huge variety of alternative recipes that help improve the condition of the patient with leg paralysis.

1. With immobilized limbs, you can prepare such ointment - take 100 g of pork fat and 1 tablespoon of soda. Spread the surface of the lower extremities with a substance and wrap them with nylon.
2. At the initial stage of paralysis, tincture from the roots of valerian, white mistletoe, oregano and yarrow is prepared. Take after meals.
3. Take 2 teaspoons of crows and fill it with a glass of steep boiling water. Insist for two hours. Strain and drink three times a day.

[25], [26], [27]

Operative treatment

Typically, surgical treatment for paresis of the lower limbs is recommended if the patient has a nerve break, squeezing or crushing the nerve trunk or, when conservative treatment has not produced a result. The operation is performed on the affected nerve. It is applied to the so-called secondary or primary neural suture. In some cases, neurolisis is prescribed (release of the nerve from scarring), plastic or muscle grafting, transosal tenodesis, fixation of the tendon.

Massage with paralysis of legs

Thanks to a special massage, it is possible to improve the blood circulation in the affected muscles, to relax the spasms in the musculature. Also, such procedures help prevent tissue degeneration.

Even with paralysis of only one lower limb, massage is performed on both legs with the use of two masseurs. Massage begins with feet and slowly moves to the hips. This helps reduce syncopeesis and spasticity.

As a rule, patients or their relatives are also trained in an easy massage that helps to relax the spastic musculature. It is important to understand that paralysis of the legs is treated not only by physical exercises and special massage, but also by medication.

Prevention

Usually the prevention of paralysis of the lower limbs is based on the prevention of those major diseases (stroke, trauma) that can cause it.

[28], [29]

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 organism.

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