Flaccid paralysis is a dangerous complication after infectious diseases. Pathology is characterized by progressive death of neurons in the peripheral nervous system. This leads to a significant deterioration or complete impossibility of movement in the affected area. Most often, the muscles of the arms, legs and neck are paralyzed. How does this type of paralysis develop? And is it possible to restore motor function? These questions can be answered in the article.
Description of pathology
Motor neurons are located in the peripheral nerves. These cells are equipped with long processes (axons) that transmit signals 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 gradually destroyed. Stops the flow of signals from the nervous system to the muscles. As a result, a person cannot move the affected part of the body. SoOver time, muscle atrophy occurs, tendon reflexes are lost, and muscle tone worsens. Weakness of 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 belong to flaccid paralysis and paresis:
- movement disorders after injuries and injuries (including birth injuries);
- paresis and paralysis of the mimic muscles of the face.
It is also very 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 movement disorder develops after polio.
In the past, this dangerous viral disease was widespread. It often led to 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 also get a dangerous virus while traveling to regions that are unfavorable for polio.
The polio virus is transmitted in several ways:airborne, contact, and also through the 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. In the future, a scar is formed in its place. The more motor neurons that die in polio, the faster acute flaccid paralysis develops.
Polio is the most common, but not the only cause of this pathology. Flaccid paralysis can also develop due to other diseases:
- Inflammatory process in the spinal cord (myelitis). In half of the cases, this disease is provoked by an infection. Its causative agents can be enteroviruses, mycoplasmas, cytomegaloviruses, as well as the causative agent of herpes. Sometimes inflammation occurs after an injury. But even in this case, the cause of the pathology is microorganisms that have entered the spinal cord through the wound. With myelitis, the supply of impulses 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 simultaneously affected. 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 hemophilicwand. The infectious process leads to malfunctions of the immune system. Protective antibodies begin to attack peripheral nerve cells, which leads to flaccid paralysis.
- Infection with the Coxsackie virus. 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 inflammation of skeletal muscles. The consequence of this pathology can be acute flaccid paralysis in children. Adults are much less likely to become infected.
Currently, a new type of enterovirus (type 70 strain) has appeared. Most often, it causes a severe form of conjunctivitis. But there are also atypical forms of the disease, which are similar in symptoms to polio. This pathology can also cause damage to peripheral nerves.
Different from Central Genetic Paralysis
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:
- 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.
- There is no damage to motor neurons in spastic paralysis.
- With the peripheral form of paralysis, there are no flexion and extensor reflexes, muscle weakness is noted. With pathology of central genesis, the muscles are tense, involuntary muscle contractions are noted,reflex movements.
- Central paralysis can lead to impaired movement throughout the body. In the peripheral form, there is a deterioration in motor function in a certain area.
Only a neurologist can differentiate these two forms of paralysis based on a comprehensive examination.
Symptomatics
Disorders of motor function most often appear suddenly and rapidly increase. The following symptoms of flaccid paralysis can be distinguished:
- impossibility or difficulty of movement;
- severe weakness of the muscles in the affected area;
- lack of reaction of paralyzed muscles to mechanical impact;
- asymmetric lesion;
- muscle atrophy (a paralyzed leg or arm becomes thinner than a he althy one).
If paralysis develops against the background of poliomyelitis, then the patient's general signs of infectious pathology disappear. Usually, shortly before the onset of movement disorders, the temperature decreases, muscle pain and spasms subside.
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 move his foot, it becomes very difficult for him to walk. The onset of paralysis is preceded by severe back pain. In severe cases, the lesion moves to the cervical region, and the patient paralyzes the right or left arm.
Features of pathology in a child
Flaccid paralysis is more common in children than in adults. The 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 the peripheral nerves.
The manifestations of flaccid paralysis in children are the same as in adults. However, the child often has damage to the neurons responsible for the work of the respiratory and swallowing muscles. Affected children breathe rapidly and shallowly, leading to hypoxia. As a result, there are frequent headaches, lethargy, difficulty falling asleep. It becomes difficult for the child to swallow, he often chokes on food. Children often lose weight due to lack of nutrition.
Complications
If untreated, flaccid paralysis causes severe complications. This pathology can lead to the following dangerous consequences:
- Ankylosis. Lack of movement in a paralyzed limb leads to fusion of the bones in the articular joints.
- Muscle contractures. Over time, the muscles in the affected area shorten and harden.
- Persistent muscle weakness. Peripheral paralysis is accompanied by a sharp decrease in the tone of the muscles of the neck and limbs. Without treatment, muscle atrophy becomes irreversible.
If a patient has already developed such complications, then it is no longer possible to restore motor function by conservative methods. In most cases, it is necessary to resort to surgical methods of treatment.
Diagnosis
A neurologist deals with 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 motor dysfunction. In order to clarify the diagnosis, the following types of examinations are carried out:
- Neurological examination. The doctor examines the patient's muscle strength, tendon reflexes, and 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 study of feces. This test is done when polio is suspected.
- Toxicological blood test. Helps distinguish flaccid paralysis from motor dysfunction caused by chemical poisoning.
- Electromyography. This study helps evaluate muscle electrical conductivity.
- Prozerin test. The test distinguishes paralysis from myasthenia gravis.
Drug therapy
The treatment of flaccid paralysis requires an integrated approach. The main task of therapy is to restore the normal functioning of motor neurons. Patients are prescribed high dose nootropic and antioxidant drugs:
- "Piracetam".
- "Actovegin".
- "Mexidol".
- "Trental".
- "Cerebrolysin".
These drugs help normalize the metabolism of damaged nerves and protect neurons from harmful effects.
The course of injections of the drug "Prozerin" is shown. This remedy improves signal transmission from neurons to muscles and helps to 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 B1 and B12 are used, which have a positive effect on the state of the nervous tissue.
Physiotherapy and rehabilitation
Restoration of movements is impossible without physiotherapy. This is the main part of the treatment of peripheral paralysis. It is impossible to get rid of violations of motor function only by 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 constant electric current of low voltage is applied. This helps to improve metabolism in tissues and restore damaged neurons, as well as increase muscle tone. Baths with mineral waters are also shown. This allows you to influence the peripheral nerves through the skin receptors.
Such procedures are allowed to be carried out only after the relief of acute symptoms of an infectious disease. Galvanization and water treatments are quite effective, but the process of restoring movement takes a long period of time.
Massage for flaccid paralysis helps restore muscle tone and prevent muscle atrophy. The impact on the affected areas should be quite intense, kneading and rubbing the damaged muscles is used. But it is very important to avoid injury to muscle tissue. Therefore, this procedure should be trusted only by a qualified specialist. It is useful to combine classic and acupressure.
Exercise therapy for flaccid paralysis is an indispensable part of treatment. However, it must be taken into account that patients have weakened muscles and joints. Therefore, at the initial stage, passive movements using a support are shown. For example, the patient leans the affected foot on a special box and tries to bend the leg. Crawling on all fours is also useful. First, the patient moves the diseased limb due to the muscles of the body, leaning on his hands. As the movements develop, the exercises are performed while kneeling.
Very useful gymnastics in the water. Limb exercises can be combined with healing baths.
In case of violation of the movements of the patient's hands, it is necessary to teach simple everyday skills. For this, tables with special stands are used in physiotherapy rooms. The patient learns to fasten buttons on his own, press the switch button, turn the key in the lock. Plasticine modeling helps restore fine motor skills of the hands.
Braces are recommended during rehabilitation. This will help support the injured limb.in the optimal position.
Surgical methods
In severe cases and in the presence of complications, surgical treatment is indicated. The most commonly used types of operations are:
- transplanting he althy muscles to an atrophied area;
- elimination of joint deformity in ankylosis (osteotomy);
- plastic surgery to thicken the lower leg (for severe muscle atrophy).
Movement recovers much faster after operations than with conservative treatment.
Forecast
Prognosis of the disease depends on the degree of damage to neurons. If diagnosis and treatment were carried out in a timely manner, then it is quite possible to restore movement. However, this will require long-term complex therapy and rehabilitation. It usually takes about 2 years to recover motor function. After surgery, movement returns to normal after about 1 year.
In advanced cases, it is already impossible to restore movement even by surgery. If more than 70% of neurons have died in a patient, then such changes are considered irreversible.
Prevention
How to prevent the death of motor neurons and the occurrence of paralysis? Most often, enterovirus diseases lead to such complications. To avoid infection, follow these guidelines:
- get your polio shot on time;
- avoid contact with patients with enterovirus infections;
- strengthen the immune system;
- to cure infectious diseases in time and to the end;
- after the transferpolio within 6-12 months to regularly visit a neurologist.
These measures will help to avoid dangerous complications of infectious pathologies and preserve motor function.
