paresis of the lower body

Myorelaxants: tizanidine (Sirdalud), baclofen, tolperisone (Mydocalm).

Hereditary spastic paraplegia

Hereditary spastic paraplegia Hereditary spastic paraplegia (Struempel's familial spastic palsy) refers to an inherited degenerative disease of the nervous system, which represents a large group of diseases caused by changes in genetic information. Hereditary spastic paraplegia can be inherited in either an autosomal dominant or autosomal recessive manner. Familial cases are common.

In hereditary spastic paraplegia, the degenerative process, manifested by axonal degeneration, primarily affects the pyramidal tracts and anterior cords of the spinal cord, most commonly in the thoracic and lumbar regions, and occasionally also in the brainstem. Muscle hypertonia outweighs the severity of the paralysis, which allows patients to move even at later stages of the pathological process. There is a typical form and a temporary form.

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classification

Classification of hereditary spastic paraplegia (HARDING AE, 1993 with changes)

1. Autosomal dominant type 1, onset before age 35

2. Autosomal dominant type 2, onset after age 35.

II. Complicated spastic paraplegia (c):

2. Hand amiotrophy - autosomal recessive type (Troyer's syndrome).

3. Hand amiotrophy - autosomal dominant type (Silver syndrome).

4. Ichthyosis, mental retardation, retinopathy (Sjogren-Larson syndrome).

5. Pigmentary macular degeneration, mental retardation.

Types of muscle paralysis of the limbs

Muscle fiber palsy can be caused by a variety of diseases. Muscle weakness can therefore be localized or widespread. Individual areas (e.g., thigh, shin, foot, forearm, hand, shoulder) or an entire limb may be affected. Only one arm, one leg or both limbs can be affected.

Depending on the location of the lesion, the following types of paresis are distinguished

• Central motor - when the disorder occurs in the cerebral cortex, cerebellum, or corticospinal pathways (e.g., as a result of hemorrhage or ischemia);
• Peripheral motor activity - may be impaired if disease develops in the spinal horns, radial nerves, or dural sheaths;
• Motor activity is reduced when the neuromuscular junction, individual main nerves and their branches are damaged;
• Local pathology occurs when conduction directly to the myocytes is impaired.

Depending on the severity of the lesions, the paresis is divided into mild, moderate and severe. The severity of the latter often borders on complete paralysis and indicates severe damage to the motor nerve impulse transmission pathways. As the underlying disease progresses, lower or upper limb paresis may progress from mild to severe and gradually progress to paralysis.

The neurological classification of these lesions includes the following types:

1. Peripheral muscle paralysis refers to a flaccid type of lesion against a background of motor neuron pathology, which is accompanied by decreased reflexes and tone and can lead to dystrophy and myocytic atrophy;
2. Spastic paresis is a central lesion of the cerebral cortex or dura mater of the spinal cord, in which muscle tone is increased, reflexes are more pronounced, and synkinesia may be induced;
3. with lesions of the corticospinal tract, mixed forms of this symptom occur;
4. Psychogenic changes are also common, but they are not associated with damage to the autonomic nervous system.

Causes of muscle paralysis

There are various causes of muscle paralysis in the upper and lower limbs. The most common causes include:

• myasthenia gravis and myasthenic syndromes caused by ion channel disorders;
• infectious lesions of the brain and spinal cord structures (meningitis, encephalitis, poliomyelitis, tuberculosis, syphilis, botulism);
• muscular dystrophies and myopathies, including metallic dystrophies (e.g. in diabetes);
• tendon and muscle sheath changes and subsequent degeneration of the scars;
• arthritis, arthrosis, tendonitis, vaginitis, etc;
• Vascular diseases (atherosclerosis, varicose veins, obliterative arteritis, vasculitis, diabetic angiopathy, Raynaud's syndrome, etc.).
• Effects of certain medications taken without a doctor's prescription, poisoning from heavy metal salts;
• prolonged immobilization, e.g. B. after a hip or spine fracture;
• ischemic or hemorrhagic stroke and transient cerebral hemorrhage;
• head, spinal cord and brain injuries;
• Spinal stenosis, dura mater compression, myelopathy, ischemia, myelitis;
• Consequences of advanced osteochondrosis in the form of intervertebral hernias and their sequestration into the lumen of the spinal canal;
• Dislocations of vertebral bodies and curvatures of the spine (e.g. scoliosis).

It is important to know that only an experienced neurologist can make an accurate diagnosis. Don't self-diagnose. This can be dangerous. You will lose the time it takes to complete the treatment. Paralysis of the limbs is common in the development of various types of cancer. And it is better to start their treatment as early as possible. Therefore no time should be wasted. If muscle weakness occurs, you should see a neurologist or spinal surgeon immediately.

Classification and species.

• According to the degree of CNS damage;
• according to the severity;
• according to localization within a limb;
• according to the number of affected limbs.

In addition to the paresis of the musculoskeletal system, there are paresis of the intestine, bladder and other internal muscular organs.

The severity of the paralysis is determined using two special scales. One scale shows the degree of reduction in muscle strength, the other the severity of the paralysis:

• Score - no voluntary movement, complete paralysis;
• 1 Score - no joint movement, but slight noticeable muscle movement;
• 2 Result - in dysarthrosis, movement is present, but the amplitude is very small;
• 3 Result – there is severe limitation of joint movement, but muscles are able to overcome gravity. The patient can lift the limb off the floor;
• 4 pt - full range of motion is maintained but muscle strength is slightly reduced; score – full range of motion is maintained, but muscle strength is slightly reduced;
• 5 pt - full range of motion and satisfactory muscle strength.

All facial expressions

Facial nerve palsy causes serious discomfort that affects a person's self-esteem. A facial nerve palsy that does not resolve over a longer period of time is the result of a tumor, an unsuccessful operation or a stroke.

• When the patient tries to raise the eyebrow arches, the skin folds on the forehead do not appear;
• the eye does not close;
• smoothing of the nasolabial folds is observed;
• the corners of the mouth do not move;
• Face grimaces when you try to smile.

Since other nerve branches are also involved in the facial nerve, there may be impaired taste, dry eyes, increased salivary gland secretion, and paracentesis, in which the patient hears the speech of others more easily in noisy surroundings than in complete silence.

In most cases, the mild facial paralysis resolves after a few days. However, sometimes it can lead to complications:

1. Irreversible damage that Lifelong signs of paralysis.
2. Abnormal recovery of the nerve fibers leading to. synkinesia (involuntary muscle contraction). If the patient smiles, the eye may open or something similar may happen.
3. The side of the constantly open eye may experience the following symptoms Total or partial blindnessThis is caused by dehydration of the cornea.

clinical picture

Paresis of the lower limbs is characterized by rapid development. Pathological changes cause clear symptoms that should be clarified by a doctor:

1. Sensitivity in the legs is reduced. The skin reacts poorly to external stimuli (cold, heat, pain).
2. The sufferer has difficulty bending the leg at the hip joint.
3. Weakening of the calf muscles.
4. The patient finds it difficult to support himself on the heel and 'balloons' occur.
5. The mobility of the ankle is restricted.
6. The gait becomes unbalanced.

If the condition spreads to the pelvis, the organs in it can no longer function properly. Common signs of hemiparesis include the following symptoms

• lack of sleep, indifference to the outside world,
• increased irritability,
• decreased appetite,
• weakening of the body's defenses,
• disorder of the digestive system,
• mood swings.

It is important to detect the disease early and, after a series of tests, undergo the treatment recommended by a neurologist. Lower spastic paraparesis in a child is more difficult to detect. It can be caused by trauma or congenital changes.

Parents should see a doctor if their child begins to tiptoe. This symptom can indicate not only the development of lower paraparesis. It can also be caused by hypertonicity of the leg muscles. The doctor will recommend therapeutic exercises, special exercises to strengthen the legs and massage treatments.

diagnostic procedures

When the first symptoms of paresis of the lower limbs appear, doctors recommend going to the hospital. The patient must undergo an examination and tests there. These are used to make an accurate diagnosis, determine the degree of damage, and use the results to choose the most effective treatment. The cause of the disease must also be determined.

Patients are prescribed the following diagnostic measures:

• x-rays of the spine,
• magnetic resonance imaging (MRI),
• myelography,
• electroencephalogram, to analyze brain activity,
• computed tomography (CT),
• analysis of the liquor,
• Magnetic resonance angiography to look for brain tumors,
• electroneuromyography to determine muscle status,
• and general and biochemical blood tests.

The spastic paraparesis is treated by a neurologist. It is necessary to consult a neurologist who will prescribe medication and rehabilitation measures, taking into account the development of pathological processes, as well as the individual characteristics of the body.

paresis

Paresis is a partial impairment of motor function in which the ability to move a limb is partially, but not fully, retained. Patients can move by pulling on the leg or with the help of special devices. Paresis also differs from paralysis in that it has a greater chance of regression, since this pathology tends to regress spontaneously. However, this does not mean that paresis does not require professional treatment.

As with paralysis, there can be total paresis, hemiparesis (affecting half the body), upper and lower paraparesis (affecting the upper and lower limbs) and tetraparesis (affecting all the limbs). In most cases, the feeling remains.

If a person begins to feel weakness in a limb, being unable to move it, having no tactile or other sensations, this may indicate nervous system damage or a stroke - a specialist should be seen.

Do not self-medicate or self-diagnose! See your doctor for an accurate diagnosis of your condition. Only a doctor can make the correct diagnosis and prescribe the right treatment.

Impaired mobility

Impaired mobility significantly reduces the patient's quality of life. The patient is forced to endure limitations, which often happens. In addition to the classic symptoms of paralysis and paresis, there are other diseases in which certain subcortical centers or specific areas responsible for motor function are damaged.

spinal shock – A relatively common condition in which, due to a lack of downstream stimuli from the brain, strong stimuli from the spinal cord begin to dominate, leading to increased excitability and muscle tension.

This occurs when the spinal cord is damaged, when it becomes isolated from the brain and almost all connections are broken. The spinal cord then regulates its tension, and until it has adjusted, there are movement disorders, reduced reflex function, breathing problems and general innervation disorders.

This is most often caused by trauma, a blunt blow, or swelling of the brain. This condition is also known as pathological extensibility and is characterized by a significantly increased tone of the extensor muscles. In order to flex the limb, a significant amount of force must be exerted.

The damage leads to a distortion of the movement. In patients with a cerebellar injury (usually a concussion - such pathologies are observed in boxers during a knockout match), this means drunken gait, increased extensor muscle tension, the inability to hold oneself up for a long time, miscommunication and movement disorders - ataxia .

Local manifestations are involuntary muscle contractions, usually of a single muscle bundle or muscle group. This is due to imbalances in water and salt balance, mediator systems, and signaling.

Central seizures usually occur during an epileptic seizure. There are different types of seizures: tonic (sustained muscle tension, spasms) and clonic (paroxysmal spasms at short intervals).

Paralysis or paresis - what's the difference?

Although paresis and paralysis are two distinct neurological disorders, there is some overlap in the way patients' motor functions are affected. We will therefore look at the two disorders by their definition and their characteristics so that it can be understood how different the two serious disorders are and how similar they are. Of course, the disease can be treated, but the prognosis for full motor recovery depends on the cause and the concomitant pathology.

The upper motor neurons are connected to the motor cortex, which is involved in controlling muscle tone and performing active movements. When the upper motor neurons are damaged, it leads to a partial muscle weakness called paresis. Paresis is also possible with a stroke. This condition is usually temporary and can be resolved with appropriate treatment. The lower motor neurons connect to intermediate centers in the spinal cord that are responsible for muscle contraction. When the lower motor neurons are damaged, it leads to absolute muscle paralysis. Degeneration of the lower motor neurons occurs. This causes the muscle to become sluggish and there is a loss of contraction and a significant reduction in muscle tone.

What is paresis?

• Paraparesis means there is weakness and impairment of voluntary movements in both limbs (more commonly in the arms);
• Hemiparesis means that only one side of the body (arm and leg) is paralyzed;
• Tetraparesis - Loss of mobility in both arms and legs.
• The paresis is not limited to the limbs; it can also affect the vocal cords, stomach, eyes, and other parts of the body.

Causes of paresis

What can cause paresis? Here are some examples:
Spinal cord injury (injury to the spine). Not all spinal cord injuries result in paralysis. With a partial injury, a person can move very little. Certain nerves can remain intact and cause weakness but not complete paralysis.
Stroke. Sometimes a stroke can damage the brain enough to cause paralysis, but sometimes the damage is milder and causes only paralysis.

Pinched nerve or sciatica. This is an example of a pinched nerve leading to paralysis. If the sciatica is severe enough, the patient may have difficulty feeling or moving a leg or foot. This can cause weakness in one leg, which can make walking difficult.
Peripheral nerve damage. Sometimes nerve damage is not in the brain or spine, but in the limb itself. The damage can affect the function of the affected limb or other part of the body.
A complication of the operation. After surgery, muscles at the surgical site may not respond as fully or as quickly as they did before surgery.

Some patients can regain a significant level of motor function with the help of physical therapy, while in others the paralysis becomes permanent. In these cases, physical therapy or vocational rehabilitation can help preserve the muscle function that the tissue still has. Doctors can teach people to carry out everyday tasks independently despite the paralysis.

prognosis and complications

If the spasticity is caused by a head injury or a stroke, treatment must be started immediately to restore function to the damaged nerve tissue and motor function in the arms and legs.

If left untreated, elderly people can develop spinal deformities and their overall health will deteriorate significantly.

In this case, therapy must always be carried out within the first 1.5 to 2 months after the cerebral hemorrhage.

Missing the right time to start treatment makes it much more difficult to return to normal. Therapy and rehabilitation will take much longer. In addition, there is a risk that the patient will simply be disabled.

In the case of congenital tetraparesis, it is almost impossible to cure a child with a severe diagnosis of cerebral palsy if he has severe symptoms of intellectual disability.

In the absence of symptoms of mental impairment, significant positive results can be achieved with appropriate and timely treatment.

consequences and prognosis

Struempel's disease is not life-threatening, but it does affect the quality of life and ability to work. Hereditary spasticity

Hereditary paraplegia is progressive and varies in severity. The prognosis varies from case to case.

The disease is most severe when it occurs at a young age. In patients with uncomplicated symptoms, the situation may stabilize in adolescence.

In most cases, patients are able to walk independently, but there may be a loss of mobility.

Patients often have a normal life expectancy.

antimuscular agents

Muscle weakness is often caused by an acute bacterial infection, including meningitis. A series of laboratory tests are carried out in advance to determine the type of pathogen and its sensitivity to certain groups of antibiotics. Based on the test results, the doctor prescribes drug treatment for the patient for one to three weeks.

The following antibiotics are the focus of therapy

• Semi-synthetic proprietary penicillins – Amoxiclav, Augmentin, Panclav, Flemoclav;
• macrolides - azithromycin, erythromycin, clarithromycin;
• Cephalosporins - cefazolin, ceftriaxone, cefotaxime.

In addition to antibiotics, antibacterial agents such as Trichopol, Metronidazole, Co-Trimoxazole and Biseptol are also used to treat paralysis and paresis.

Antibiotics in the form of tablets, syrup, suspensions, solutions for intramuscular and intravenous injection are used to treat muscle weakness.

After antibiotic therapy, patients are prescribed eubiotics to restore the intestinal microflora, useful representatives of which have perished along with pathogens. Enterol, Lactobacillus, Hilac forte, Bifidumbacterin, Acipol, Linex are used. Their effectiveness is higher when combined with lactulose (Normase, Lactusan).

Effectiveness of conservative treatment

Reduced muscle strength requires a comprehensive solution to address the root cause of the motor dysfunction and restore motor skills. A conservative strategy consists in the use of pharmacological drugs that immediately eliminate all symptoms of paralysis or paresis, as well as the factors provoking the development of pathology.

A balanced intake of vitamin and mineral supplements, immunostimulants, or immunosuppressants can help increase resistance to these drugs. Transdermal agents – patches with NSAIDs (Voltaren), topical irritants (turpentine, red pepper), warming ointments, gels, lotions (Capsicam, Finalgon, Nayatox) are actively used for treatment.

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