Spastic paralysis

Paralysis is divided into two large groups: spastic paralysis and flaccid. Spasticity occurs as a result of damage to the spinal cord in the cervical or thoracic region, and is also characteristic of most cases of cerebral palsy. Paralysis is also classified by the degree of damage. Partial paralysis, called paresis, and complete paralysis, called plegia, are distinguished.

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Epidemiology

There are no data on the area of distribution of spastic paralysis and the frequency of the disease. As for cerebral palsy, according to the World Health Organization, the average frequency is 2.5-4 cases per 1000 births.

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Causes spastic paralysis

This is a consequence of motor neuron pathology. Since the pyramidal bundles are quite tightly adjacent to each other, paralysis often affects the entire limb or the entire left or right side of the body. Peripheral paralysis usually affects certain muscles or a group of muscles. But these rules have exceptions. For example, a tiny lesion located in the cerebral cortex can cause paralysis of the palm, facial muscles, etc.; and, conversely, significant damage to nerve fibers can cause extensive peripheral paralysis.

In addition, a common cause of paralysis is brain injury and multiple sclerosis. The main cause of spastic paralysis is a disruption in the transmission of nerve signals, which leads to muscle hypertonicity.

Spasticity can also be a consequence of other disorders and diseases:

• Brain dysfunction due to hypoxia;
• Infectious diseases of the brain (encephalitis, meningitis);
• Amyotrophic lateral sclerosis;
• Hereditary factor. This refers to Strumpell's familial spastic paralysis, a sluggish disease that is inherited and progresses over time. The nervous system gradually degrades, as the pyramidal tracts in the cords of the spinal cord are affected. This type of paralysis received its name thanks to A. Strumpell, who identified the familial nature of the disease. In medical literature, it is also known as "Erb-Charcot-Strumpell familial spastic paraplegia."

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Risk factors

Risk factors that increase the likelihood of acquiring paralysis in the womb or during childbirth are separately identified:

• Low birth weight and preterm birth;
• Multiple pregnancy;
• Infections suffered during pregnancy;
• Rhesus incompatibility of blood groups;
• Intoxication (eg, exposure to methyl mercury);
• Maternal thyroid dysfunction;
• Complications during childbirth;
• Low Apgar scores;
• Jaundice;
• Cramps.

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Symptoms spastic paralysis

In addition to motor function disorders, spastic paralysis in almost all cases is accompanied 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 restoration of motor functions is spasticity. Spasticity manifests itself as hypertonicity and involuntary contractions in the affected muscles. Contractions occur in those muscles that were previously subject to conscious control. In the first period after receiving an injury or after an illness, the spinal cord is in a state of shock, and signals from the brain are not transmitted through this area. Reflexes in the tendons are not detected. As the shock reaction dissipates, they resume, but the function is often distorted.

The muscles are tense, dense, during passive movements resistance is felt, which is sometimes overcome with effort. Such spasticity occurs due to high reflex tone and its distribution is uneven, due to which typical contractures appear. Such paralysis is easy to recognize. Usually one arm is pressed to the body and bent at the elbow, the hand and fingers are also bent. The leg is straightened, only the foot bends and the toe points inward.

Hyperreflexia is another sign of spinal cord hyperactivity. The reflex function of the tendons is greatly enhanced, manifested by the slightest minor irritation: the area of the reflex becomes wider: the reflex is caused both from the usual zone and from adjacent zones. Tendon and skin reflexes, on the contrary, weaken or disappear altogether.

Associated movements (also called synkinesis) may occur involuntarily in the affected arms and legs, for example, when healthy muscles contract. This phenomenon is explained by the tendency of impulses in the spinal cord to spread to neighboring segments, which are normally limited by the work of the cerebral cortex. In spastic paralysis, impulses spread with greater force, which leads to the occurrence of "additional", involuntary contractions in the affected muscles.

Pathological reflexes are the key and permanent symptoms of spastic cerebral palsy. Of particular note are the reflexes of the foot in spastic paralysis of the legs: Babinski, Rossolimo and Bekhterev symptoms are often present. Other pathological reflexes on the foot are less common. Such phenomena are not expressed so clearly on paralyzed arms and therefore there is no data on them. If we talk about pathological reflexes on the facial muscles, they indicate a bilateral lesion in the cortex, in the brain stem or in the subcortical region.

Diagnostics spastic paralysis

In differential diagnosis of spastic paralysis, symptoms and results of tests and studies are taken into account.

During the consultation, the neurologist examines the patient: pays attention to the position of the body, motor functions, muscle tension, and checks reflexes.

To exclude other conditions that have the same symptoms – a brain tumor or muscle dystrophy – studies are carried out 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;
• Neurosonography.

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Treatment spastic paralysis

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

Baclofen is similar to gamma-aminobutyric acid, which is involved in presynaptic inhibition of signals. The drug suppresses synaptic reflexes and the function of gamma efferents. The drug easily overcomes the blood-brain barrier. It has the best effect in spinal forms of spasticity: the drug not only eliminates hypertonicity and spasms of motor muscles, but also has a beneficial effect on the functioning of the pelvic organs. If the patient has a brain disorder, baclofen can affect the ability to concentrate and remember. Adults are prescribed 10-15 mg of the drug per day, the dosage is divided into 2-3 doses. Then the dosage is gradually increased by 5-15 mg until the desired effect is achieved. Usually the dosage varies from 30 to 60 mg per day. Possible side effects from taking baclofen - loss of strength, low blood pressure, ataxia - disappear when the dosage is reduced. The dosage of the drug should be reduced gradually: sudden withdrawal can cause seizures and hallucinations. There are no studies on the safety of using baclofen to treat infantile paralysis, so it is prescribed to children with extreme caution.

Sirdalud (tizanidine) selectively affects the polysynaptic pathways of the spinal cord. It reduces the production of amino acids that have an excitatory effect, thereby reducing the frequency of excitatory signals to the neurons of the spinal cord. In terms of the effectiveness of reducing hypertonia, sirdalud is similar to baclofen, but it is much better tolerated and gives results in both central spastic paralysis and spinal paralysis. Adults are prescribed a dosage of up to 2 mg per day (divided into 2-3 doses) with a further increase in the daily dosage to 12-14 mg (divided into 3-4 doses). Side effects may occur during treatment with sirdalud: a slight decrease in blood pressure, loss of strength, sleep disorders.

Diazepam (or Valium) mitigates the effects 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 noticeable sedative effect and negative impact on cognitive functions. Its use begins with a dosage of 2 mg per day and gradually increases it to 60 mg per day, distributed into 3-4 doses.

Muscle relaxants that are effective in treating spasticity of spinal origin include dantrolene. The drug affects the actin-myosin complex, which is responsible for muscle contraction. Since dantrolene causes less calcium to be released from the sarcoplasmic reticulum, this reduces the contractility of muscle tissue. Dantrolene does not interfere with the spinal mechanisms that regulate muscle tension. It has a stronger effect on muscle fibers, reducing the manifestations of phasic reflexes to a greater extent and tonic reflexes to some extent.

It gives the best results in the treatment of spasticity of cerebral genesis (paralysis after a stroke, cerebral palsy) and has little effect on cognitive functions. The drug is taken at a low dose - 25-50 mg per day, then increased to 100-125 mg. Consequences and complications associated with taking dantrolene: loss of strength, dizziness and nausea, disruption of the digestive system. In 1 out of 100 cases, patients show signs of liver damage, so dantrolene should not be taken in chronic liver diseases. The drug is also contraindicated in case of heart failure.

The choice of drug for the treatment of spastic paralysis is determined by the origin of the disease, the degree of muscle hypertonicity and the specific mechanism of action of each drug.

In addition to the described drugs, it is also recommended to take general strengthening drugs: B vitamins, metabolic drugs and drugs that activate blood circulation.

Physiotherapy treatment

Popular physiotherapeutic methods include local application of cold or, conversely, heat, as well as electrical stimulation of peripheral nerves.
Local application of cold helps reduce hypertrophic tendon reflexes, increase the range of joint mobility, and improve the work of antagonist muscles. A cold compress reduces hypertonus for a short time, most likely due to a temporary decrease in the sensitivity of skin receptors and slow nerve conduction. A similar result is achieved by using 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 application of heat is also aimed at reducing muscle hypertonicity. For this purpose, paraffin or ozokerite applications are used, which are applied in the form of wide strips, gloves, socks. At this time, the patient must take a position so that the affected muscle is stretched as much as possible. The temperature of ozokerite or paraffin should be within 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 high blood pressure, the pressure should be monitored.

Electrical stimulation was first used to treat spasticity a long time ago - about 150 years ago. Nowadays, superficial, subcutaneous, epidural application of electrodes, and even implantation are used to relieve muscle hypertonicity. Electrical stimulation of peripheral nerves is usually used for spastic paralysis of the legs in a standing position, while walking and during physical activity. Superficial electrical stimulation is effective in treating patients who have suffered paralysis as a result of a stroke.

The mechanism of electrical stimulation is explained by neurotransmitter modulation at the level of certain areas. The tone decreases for a short time - literally, for several hours. The parameters of electrical stimulation are selected taking into account the causes, location of the lesion and the stage of paralysis. In case of spasticity, electrogymnastics of antagonist muscles is recommended: the impact on spastic muscles can lead to an even stronger tone. Electrical stimulation is usually performed using high-frequency currents: low-frequency currents strongly irritate the skin and can be painful, which also increases hypertonicity.

Massage

Special massage for spastic paralysis is designed to relax the muscles with hypertonicity as much as possible. Therefore, massage techniques are limited to stroking, shaking, and gentle and leisurely warming up. Sharp techniques that cause pain, on the contrary, lead to increased tone. In addition to classical massage, point massage techniques are used. The braking technique of this type of massage is performed with a gradual increase in finger pressure on certain points. When the optimal pressure is reached, the finger is held for some time, and then the pressure is gradually reduced until it stops completely. Work with each point lasts from 30 seconds to 90 seconds.

Physiotherapy

Physical therapy for spastic paralysis consists of exercises designed to relax muscles, suppress pathological synkinesis, and develop the extensibility of the affected muscles. Moderate muscle stretching helps to reduce hypertonicity for a while and provide increased joint mobility. The mechanism of such an effect of these exercises has not been fully studied. Probably, the exercises affect the mechanical characteristics of the muscle-tendon apparatus and modulation of synaptic transmission. The tone decreases for a short time, so the kinesiotherapist strives to make maximum use of this period to work on those movements that were limited by spasticity.

Physical therapy for spastic paralysis has its own characteristics:

• the session must be suspended if muscle tone increases above the initial level;
• to avoid synkinesis, work on combined movements, where more than one joint is involved, is carried out only when clear movements in a separate joint have been achieved (first it is developed in one direction and plane, at the next stage - in different ones);
• implementation of the rule of "partial" volumes - work on the muscle at the initial stage is carried out in the zone of small amplitudes, and only when the muscle is sufficiently strong, the amplitude is increased to the physiological level;
• the earliest possible transition from "abstract" muscle development to the development of skills needed in everyday life;
• During the exercises, breathing is monitored: it should be even, without difficulty or shortness of breath.

If you teach the patient autogenic training exercises and introduce these elements into a therapeutic exercise session, the best result will be achieved.

Homeopathy

Homeopathic preparations are advisable to use in the recovery period. They will help restore the functions of nerve impulse conduction and the work of the pelvic organs. Preparations are selected by a homeopath taking into account the patient's condition, the degree of damage and concomitant diseases.

The most commonly used drugs are:

• Lachesis activates blood circulation in the brain. The drug is most effective in strokes with left-sided manifestations.
• Bothrops also activates cerebral circulation, fights blood clots, and is effective in right-sided paralysis.
• Lathyrus sativus is indicated for spastic gait, when the knees hit each other while walking and it is not possible to assume a position with crossed or, on the contrary, extended legs in a sitting position.
• Nux vomica improves the conductivity of brain impulses, shows noticeable results in spastic paralysis of the legs. Beneficial effect on the functioning of the pelvic organs.

Surgical treatment

If other treatments have proven ineffective, the possibility of expanding the patient's motor functions through surgery is considered. Many factors are taken into account when deciding on surgical intervention:

• How long has the nervous system been affected? Surgical treatment is resorted to only if all methods of restoring motor functions have been exhausted (not earlier than six months after a 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 the legs while walking in cerebral palsy). The static nature of spastic paralysis appears as a result of a prolonged increase in muscle tone, causing the formation of contractures, which are equally pronounced both at rest and in motion. Sometimes, in order to determine the nature of spasticity, it is necessary to use nerve blockades with anesthetics.
• Sensitivity of the limb, the degree of its deformation. An operation on an arm or leg may not give results if the patient has obvious impairments in the ability to perform purposeful movements.
• Damage to the musculoskeletal system (fractures, dislocations, arthritis). If these conditions are not taken into account, the favorable prognosis of surgical intervention may not be justified.

Folk remedies

Traditional medicine has its own means for treating spasticity:

• A teaspoon of crushed roots of peony is brewed with a glass of boiling water. After an hour, the decoction is ready. It is filtered and drunk 1 tablespoon up to 5 times a day.
• Bay oil. To prepare it, pour 30 g of bay leaves with 200 g of sunflower oil and leave to infuse in a warm place for 55-60 days. Then filter the oil and heat it to boiling. The affected areas are treated with this oil every day.
• Green tea, if brewed correctly, helps to recover from paralysis due to stroke.
• A decoction of rose hip roots is prepared for taking baths. A full course of baths is 20-30 procedures.

Paralyzed muscles are treated with a volatile ointment. It is prepared very simply: alcohol and sunflower oil are mixed in a 1:2 ratio. Ether can also be used to prepare the ointment, but it should be remembered that it easily catches fire.

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Herbal treatment

• The herbal infusion is prepared from chamomile flowers (2 parts), lemon balm (1 part), hop cones (1 part), and wormwood root (1 part). Drink 100 ml of the infusion three times a day half an hour before meals.
• Infusion of mountain arnica flowers. To do this, pour 1 teaspoon of flowers with a glass of boiling water, let it brew for a while, and strain. Drink the infusion 1 tablespoon 3 times a day. Arnica reduces excitability, helps relieve pain and cramps.
• White acacia flowers are used to make an alcohol tincture. They rub the affected muscles with it. To make the tincture, you will need 4 tablespoons of flowers and 200 ml of vodka. After a week, strain the tincture and drink 1 teaspoon 3 times a day.

Including folk remedies in the treatment complex is possible only with the consent of the attending physician. It is not worth making independent decisions in such matters: spastic paralysis is a serious disease that requires a comprehensive approach to treatment to restore motor functions. If doctors, relatives and the patient himself make every effort, in many cases a complete cure or partial restoration of lost functions is quite possible.

Prevention

The main measure for preventing spastic paralysis is the prevention of diseases that cause such consequences and complications. First of all, this concerns cardiovascular diseases: paralysis as a consequence of a stroke is the most common case.

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