Flaccid paralysis is a dangerous complication after infectious diseases. Pathology is characterized by the progressive death of neurons in the peripheral nervous system. This leads to a significant deterioration or complete impossibility of movement in the affected area. The most commonly paralyzed muscles in the arms, legs and neck. How does this type of paralysis develop? And is it possible to restore motor function? You can find answers to these questions in the article.
Pathology Description
In the peripheral nerves are motor neurons. These cells are equipped with long processes (axons) that transmit a signal from the nervous system to the muscles. Thanks to these structures, a person has the ability to make movements.
In acute flaccid paralysis, motor neurons and axons are affected and gradually destroyed. The signal from the nervous system to the muscles stops. As a result, a person cannot make movements with the affected part of the body. Over time, muscle atrophy occurs, tendon reflexes are lost, muscle tone deteriorates. The weakness of the limbs grows and progresses.
If the motor function of the affected area is completely lost, then doctors call this pathology paralysis. If the movements are weakened and difficult, then experts talk about muscle paresis.
The following pathological conditions do not apply to flaccid paralysis and paresis:
- movement disorders after injuries and injuries (including birth injuries);
- paresis and paralysis of the facial muscles of the face.
It is also important to differentiate this pathology from paralysis resulting from damage to the central nervous system.
Etiology
Peripheral flaccid paralysis is not an independent disease. Most often, it occurs as a complication of infectious pathologies caused by enteroviruses. In most cases, this type of motor impairment develops after polio.
In the past, this dangerous viral disease was widespread. It often led to the death and disability of the patient. Today, thanks to mass vaccination, only isolated cases of pathology are noted. However, the risk of infection cannot be completely ruled out. An unvaccinated person has a high risk of infection. Cases of imported infections are periodically recorded. You can get a dangerous virus while traveling to regions that are not polio-safe.
The polio virus is transmitted in several ways: by airborne droplets, contact, as well as through dishes. In addition, the microorganism can live in the environment for several days. Children under the age of 15 are especially susceptible to infection.
The virus enters the motor neurons and causes dystrophic changes in them. The nerve cell dies and is replaced by glial tissue. Subsequently, a scar forms in its place. The more motor neurons die off during polio, the faster acute flaccid paralysis develops.
Poliomyelitis is the most common, but not the only cause of this pathology. Flaccid paralysis can also develop due to other diseases:
- The inflammatory process in the spinal cord (myelitis). In half the cases, this disease is provoked by an infection. Enteroviruses, mycoplasmas, cytomegaloviruses, and also the causative agent of herpes can become its causative agents. Sometimes inflammation occurs after an injury. But even in this case, the pathology is caused by microorganisms that penetrate the spinal cord through the wound. With myelitis, the supply of pulses from the central nervous system to the peripheral nerves is disrupted, which causes paralysis.
- Poly and mononeuropathies. These diseases are also caused by various viruses. With polyneuropathy, a large number of peripheral nerves are affected simultaneously. Mononeuropathy is characterized by pathological changes in neurons in a separate area, most often in one of the upper limbs.
- Guillain-Barré Syndrome. The disease occurs as an autoimmune complication after viral pathologies: mononucleosis, mycoplasmosis, cytomegaly, infection with a hemophilic bacillus. The infectious process leads to malfunctions of the immune system. Protective antibodies begin to attack peripheral nerve cells, which leads to flaccid paralysis.
- Coxsackie virus infections. In most cases, this microorganism causes a disease that occurs with fever, rash and inflammation of the oropharynx. However, there is another strain of the virus that causes skeletal muscle inflammation. The consequence of this pathology can be acute flaccid paralysis in children. Adults become infected much less frequently.
Currently, a new type of enterovirus (strain of the 70th type) has appeared. Most often, it causes severe conjunctivitis. But there are also atypical forms of the disease that are symptomatically similar to polio. Such a pathology can also cause damage to peripheral nerves.
Unlike paralysis of central genesis
It is necessary to distinguish between flaccid and spastic paralysis. These two pathological conditions are accompanied by impaired motor function. However, they differ in etiology, pathogenesis and symptoms:
- A spastic form of pathology occurs due to damage to the central nervous system. Acute flaccid paralysis is characterized by damage to the peripheral nerves or roots of the spinal cord.
- With spastic paralysis, there is no damage to motor neurons.
- With the peripheral form of paralysis, there are no flexion and extensor reflexes, muscle weakness is noted. With a pathology of central genesis, the muscles are tense, involuntary muscle contractions are noted, reflex movements are preserved.
- Central paralysis can lead to impaired movement throughout the body. With the peripheral form, a deterioration in motor function in a certain area is noted.
Differentiate these two forms of paralysis can only a neurologist on the basis of a comprehensive examination.
Symptomatology
Violations of motor function most often appear suddenly and are rapidly increasing. The following symptoms of flaccid paralysis can be distinguished:
- impossibility or difficulty of movement;
- severe muscle weakness in the affected area;
- lack of response of paralyzed muscles to mechanical stress;
- asymmetry of the lesion;
- muscle atrophy (a paralyzed leg or arm becomes thinner than a healthy one).
If paralysis develops against the background of poliomyelitis, then the general symptoms of an infectious pathology disappear in the patient. Usually, shortly before the appearance of motor disorders, the temperature decreases, muscle pains and cramps subside.
A fairly common form of pathology is lower flaccid paralysis. It is characterized by damage to the roots of the spinal cord. As a result, the patient has paralysis of one of the lower extremities. Most often, the innervation of the muscles of the feet is disturbed. A person cannot make foot movements; it becomes very difficult for him to walk. The onset of paralysis is preceded by severe back pain. In severe cases, the lesion passes to the cervical spine, and the patient paralyzes the right or left arm.
Features of pathology in a child
Flaccid paralysis in children is more common than in adults. A child is much more susceptible to infection with enteroviruses. Poliomyelitis is quite rare these days. The main danger to the child is other types of enteroviruses that affect peripheral nerves.
Manifestations of flaccid paralysis in children are the same as in adults. However, the child is more often affected by neurons responsible for the work of the respiratory and swallowing muscles. Sick children breathe often and shallowly, which leads to hypoxia. As a result of this, frequent headaches, lethargy, difficulty falling asleep occur. It becomes difficult for a child to swallow; he often chokes on food. Due to lack of nutrition, children often lose weight.
Complications
In the absence of therapy, flaccid paralysis causes severe complications. This pathology can lead to the following dangerous consequences:
- Ankylosis. The lack of movement in the paralyzed limb leads to fusion of bones in the articular joints.
- Musculature contractures. Over time, the muscles in the affected area shorten and harden.
- Persistent muscle weakness. Peripheral paralysis is accompanied by a sharp decrease in muscle tone of the neck and limbs. Without treatment, atrophy of muscle tissue becomes irreversible.
If the patient has already developed such complications, then it is no longer possible to restore motor function by conservative methods. In most cases, you have to resort to surgical methods of treatment.
Diagnostics
A neurologist is involved in the treatment and diagnosis of this pathology. Since paralysis is usually triggered by viral pathologies, consultation with an infectious disease specialist may be required.
Peripheral paralysis must be differentiated from other types of impaired motor function. In order to clarify the diagnosis, the following types of examinations are carried out:
- Neurological examination. The doctor examines muscle strength, tendon reflexes and the patient's swallowing function.
- Clinical and biochemical blood tests. The presence of pathology is indicated by an increase in ESR and an increased concentration of creatine kinase.
- Virological examination of feces. This test is for suspected polio.
- Toxicological blood test. Helps distinguish peripheral paralysis from impaired motor function provoked by chemical poisoning.
- Electromyography. This study helps evaluate the electrical conductivity of muscles.
- Sample with proserin. The test distinguishes paralysis from myasthenia gravis.
Drug therapy
Treating flaccid paralysis requires an integrated approach. The main objective of therapy is to restore the normal functioning of motor neurons. Patients are prescribed nootropic and antioxidant drugs in high doses:
- "Piracetam".
- "Actovegin".
- Mexidol.
- Trental.
- "Cerebrolysin".
These drugs help normalize the metabolism in damaged nerves and protect neurons from the harmful effects.
The course of injection of the drug "Proserin" is shown. This tool improves signal transmission from neurons to muscles and helps increase muscle tone.
Be sure to prescribe a course of vitamin therapy. It is necessary to take high doses of drugs, most often drugs are administered intramuscularly. For treatment, vitamins B 1 and B 12 are used , which positively affect the state of the nervous tissue.
Physiotherapy and rehabilitation
Restoration of movements is impossible without physiotherapy. This is an essential part of treating peripheral paralysis. It is impossible to get rid of impaired motor function only with medical methods. It is necessary to develop damaged muscle groups in order to avoid their complete atrophy.
Patients are prescribed galvanization sessions. Electrodes are applied to the affected areas and a direct current of low voltage is applied. This helps to improve metabolism in tissues and restore damaged neurons, as well as increase muscle tone. Mineral water baths are also shown. This allows you to act on the peripheral nerves through skin receptors.
Such procedures are allowed to be carried out only after the relief of acute symptoms of an infectious disease. Galvanization and water procedures are quite effective, but the recovery process takes a long period of time.
Massage with flaccid paralysis helps restore muscle tone and prevent their atrophy. The impact on the affected areas should be quite intense, using kneading and rubbing the damaged muscles. But it is very important to prevent injury to muscle tissue. Therefore, such a procedure should be trusted only by a qualified specialist. It is useful to combine classic and acupressure.
Exercise therapy for flaccid paralysis is an essential part of treatment. However, it must be borne in mind that patients have weakened muscles and joints. Therefore, at the initial stage, passive movements using a support are shown. For example, a patient rests his affected foot on a special box and tries to bend his leg. Crawling on all fours is also helpful. First, the patient moves the affected limb due to the muscles of the body, resting on his hands. As the movements develop, the exercises are performed on your knees.
Very useful gymnastics in the water. Exercise for the extremities can be combined with treated baths.
In case of violation of the movements of the patient's hands, it is necessary to teach simple household skills. For this, in physiotherapy rooms tables with special stands are used. The patient learns to button buttons on his own, to press the switch button, to turn the key in the lock. Restoring fine motor skills of brushes is helped by modeling clay from clay.
During rehabilitation, wearing orthoses is recommended. This will help maintain a damaged limb in an optimal position.
Surgical methods
In severe cases and in the presence of complications, surgical treatment is indicated. The following operations are most commonly used:
- transplantation of healthy muscles to an atrophied area;
- elimination of joint deformation in ankylosis (osteotomy);
- plastic surgery to thicken the lower leg (with severe muscle atrophy).
After operations, movements recover much faster than with conservative treatment.
Forecast
The prognosis of the disease depends on the degree of damage to neurons. If the diagnosis and treatment were carried out in a timely manner, then it is quite possible to restore the movement. However, this will require long-term comprehensive therapy and rehabilitation. It usually takes about 2 years to restore motor function. After surgical treatment, the movements normalize after about 1 year.
In advanced cases, it is already impossible to restore movements even surgically. If the patient lost more than 70% of the neurons, then such changes are considered irreversible.
Prevention
How to prevent the death of motor neurons and the occurrence of paralysis? Most often, enteroviral diseases lead to such complications. To avoid infection, the following recommendations must be observed:
- be vaccinated against polio on time;
- avoid contact with patients with enterovirus infections;
- strengthen the immune system;
- timely and completely cure infectious diseases;
- after polio for 6-12 months regularly visit a neurologist.
These measures will help to avoid dangerous complications of infectious pathologies and maintain motor function.