paresis is

Spastic paresis of the lower limbs occurs more often in infancy and is characterized by increased muscle tone. The child's leg is difficult to bend in the hip and knee joints. He also has difficulty assuming a relaxed position. Increased reflexes may occur, such as: B. the plantar reflex.

Familial spastic paraplegia: symptoms and treatment

Familial spastic paraplegia or Struempel's disease is a hereditary disease in which motor function of the lower limbs is impaired as a result of bilateral pathological lesions in the anterior and lateral columns of the spinal cord (usually the lumbar spine). This pathology is rare and occurs in about three cases per 100,000 inhabitants. The clinical manifestations and treatment of Struempel's disease are described below.

First-class care: what modern diapers can do

How does familial spastic paraplegia manifest itself?

As already mentioned, the main symptom of Struempel's disease is paraplegia of the lower limbs.

• If the disease manifests itself in early childhood, the child begins to walk late, trying to support himself on his toes.
• In old age, the disease manifests itself as difficulty walking and occasional falls. The muscle tone of the lower limbs is increased, the muscles may be stronger during motor activity and weaker at rest. In most cases both legs are affected, but sometimes only one extremity.

Familial spastic paraplegia develops gradually. Reduced muscle strength in the legs is only noticed after a long period of time.

Sensory disorders are often also present. These can manifest themselves as numbness, goosebumps, burning, etc. Symptoms increase with secondary peripheral nerve damage.

As a result of the significant decrease in muscle strength, atrophic changes in the legs can be noted in the later stages of this pathological condition. In some cases, the condition may be accompanied by reduced muscle strength in the arms and involuntary urination.

Neurological disorders also occasionally occur. These may include cognitive impairment, seizures, speech and coordination problems, hearing loss, etc.

Causes of leg muscle paralysis

• Impaired circulation in the blood vessels and nerve fibers of the brain and spinal cord
• Destruction of molecules of the substance that forms the protective myelin sheath;
• Pathological inflammatory processes in the cerebral cortex and spinal cord;
• Damage to brain structures – trauma, bruises, purulent inflammation, edema, skull fractures;
• Acute poisoning caused by toxic, alcoholic, industrial substances and poisons;
• immuno-inflammatory diseases of the limbs, soft tissues and internal organs;
• acute and chronic diseases of the nervous system, psychiatric and psychogenic disorders;
• Spinal cord injuries with damage to the nerve endings of the central and peripheral nervous systems;
• Complications after complex operations on the spine or brain;
• congenital anomalies and anomalies in the complete development of the lower limbs;
• Decreased or absent motor reflexes, muscle tone and responses to stimuli;
• Severe abnormalities of the cerebral center and circulatory system;
• Lack or excess of enzymes in the body;
• Multiple sclerosis, myelitis, encephalitis, inflammation of the brain and spinal cord;
• Infectious diseases of the legs, blood vessels, nerves;
• chronic infections of the blood, soft and bone tissue and internal organs;
• allergies to a vaccine or a vaccine component;
• polyneuropathic disorders;
• autonomic disorders;
• metabolic disorders;
• vitamin B6 and B1 deficiency;
• botulism, polio;
• Meningitis;
• Tuberculosis;
• Epilepsy;
• Stroke.

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Types of leg muscle paralysis

Paralysis of the leg muscles is divided into several types:

• Monoplegia. Immobility of one, left or right leg.
• Paraplegia. Immobility or peripheral paresis of both limbs.
• Triplegy. Lack of motor function in both legs and arms.
• Quadriplegia. Complete immobilization of all limbs of the body.
• Myoplegia. The rarest case of this symptom, which is genetically transmitted from relatives.
• Obstetric paralysis. Loss of muscle tone and sensitivity due to hip dislocation at birth.

This type of pathology is characterized by the inability to make conscious movements, walk and sometimes sit. Parts of a muscle group or all of them can be affected at the same time. Paralysis of both legs is usually congenital or occurs after a complicated form of an infectious disease.

Depending on the focus of the lesion, paralysis is present:

• flaccid or peripheral. It develops as a result of infection of the vessels and fibers of the peripheral nervous system, without reflex reactions or sounds.
• Spastic or central. Caused by an attack on the CNS tissues and nerves that occurs as a result of pathological injuries to the spinal root function in the chest and neck.

Peripheral paresis

Peripheral paresis occurs when there is direct nerve damage. In this case, the disorder develops in a group of muscles that are innervated by a specific nerve. For example, muscle weakness can only occur in one arm or leg (monoparesis). The larger the damaged nerve, the larger the part of the body affected by the paralysis.

The main causes of peripheral paresis are.

• Degenerative diseases of the spine; Sciatica;
• demyelinating diseases;
• Nerve damage due to vasculitis and connective tissue diseases;
• nerve compression ('tunnel syndrome');
• nerve injuries;
• Intoxication by alcohol and other substances.

Peripheral paresis is also called flaccid paresis. There is muscle weakness, reduced tension and impaired reflexes. Involuntary muscle twitches are noticeable. Over time, the muscles become smaller (atrophy) and contractures occur.

Diagnosis of hemiparesis

The neurologist diagnoses the paresis and paralysis during an examination. The doctor asks the patient to perform various movements and then tries to bend or straighten the affected limb and asks the patient to resist. A test is performed in which the patient has to keep both legs or arms balanced. If the muscle strength in one of the limbs is reduced, it drops noticeably after 20 seconds.

After the test, the doctor will recommend tests to determine the cause of the paralysis.

gymnastics

The first exercise is based on balance reflexes. When standing, the patient leans back as far as possible and even falls. A physiotherapist standing behind him prevents the person from falling to the ground. If the exercise is done correctly, the tendon of the long toe develops.

The second exercise is the pedal rotation. If necessary, the foot is attached to the pedal itself. This helps passively flex the top of both feet.

The third exercise is performed by the patient in a kneeling position. The patient kneels back as far as possible without the buttocks touching the heels. This exercise develops the support reaction reflex.

The patient sits on a high table without his feet touching the floor. The instructor places the skis on the patient's feet and attaches a counterweight to the back. In this position, the patient 'walks' alternately with his feet.

You can try to maintain balance by standing on the affected leg and using your hands to support yourself on the handrail. The hand must be gradually removed from the handrail and the affected leg must stand without support. Rehabilitation therapists recommend using a ladder. After climbing a rung, the affected leg should hang down so that it does not touch the ground. Stay in this position for some time.

One exercise is to walk in special shoes with the heel lower than the toes. To do this, a stop (a wooden plate) is attached to the front of the shoe and the heel is lowered. All physiotherapy exercises for foot paralysis depend on muscle strength. Before starting the exercises, rehabilitation specialists at Yusupov Hospital examine the patient and determine muscle strength using a special scale.

The specialists at the rehabilitation clinic select the rehabilitation therapy individually for each patient. If there is paralysis of the left foot or right foot, treatment is carried out using the same methods. Call Yusupov Hospital for effective foot paresis rehabilitation.

Symptoms of hemiparesis of the lower limbs (feet)

The symptoms of foot paresis can vary in severity depending on the degree of damage to the structures of the nervous system. With slight compression of the motor nerve fibers, the patient may experience slight muscle weakness, increased fatigue, occasional cramps and paresthesia (feeling of goosebumps).

For serious health problems, symptoms of lower limb paresis may include:

1. Appearance of areas of skin insensitivity (usually along the course of the affected main nerve);
2. the appearance of pronounced muscle weakness or increased tension;
3. frequent muscle cramps in the thighs and calves, both tonic and clonic;
4. Inability to move freely (e.g. squatting or climbing stairs);
5. pallor of the skin;
6. Imbalance in the tone of blood vessels, which can lead to clinical signs of trophic disorders (protracted wounds and abrasions, trophic ulcers, dilated veins, etc.).

If such symptoms occur, a neurologist should be urgently consulted. Through a radiological examination, the doctor can rule out damage to the intervertebral disc structure. Narrowing of the spinal canal must then be ruled out. An experienced doctor will immediately rule out the possibility that it is a cerebral circulatory disorder or a stroke.

It is important to make an accurate diagnosis before starting treatment. Paresis of the lower limbs is not an independent disease. It is a clinical symptom that can only be resolved if the underlying pathology is properly treated. If it is an intervertebral fracture, the fracture should be reduced and the integrity of the fibrous ring restored. If spinal stenosis is detected, measures should be taken to correct it.

Treatment of paralysis of the lower limbs

Chiropractic techniques can effectively treat lower limb paralysis when it is due to abnormal innervation in various parts of the central and peripheral nervous systems. Before lower limb paralysis can be treated, an accurate diagnosis must be made. The underlying disease is then treated. When treating neurological symptoms, it is important to restore the conduction of nerve impulses as quickly as possible.

Spinal traction, massage, kinesiotherapy and osteopathy can be used. The method is determined individually by the doctor who makes the initial diagnosis.

Treatment for foot paresis is tailored to each patient depending on the severity of the lesions. An experienced neurologist first determines the area of axonal motor damage. A technique is then developed to relieve the pressure. Once blood flow to the affected area is restored, the natural regeneration process begins. A special therapeutic exercise program in combination with massage and reflex therapy allows full recovery of motor activity even after a stroke or spinal cord injury. In complex cases, laser therapy, physiotherapy and electromyostimulation of muscle fibers are also used for rehabilitation.

If you need rehabilitation and treatment for lower limb paralysis, you can make an appointment for a free initial consultation with a neurologist at our chiropractic clinic. An experienced doctor will examine you, make an accurate diagnosis and make individual recommendations for comprehensive therapy.

Doctor of Medicine, Chief Physician

Causes of paresis of the lower limbs

Now let's take a closer look at the possible causes of lower limb paralysis and what diseases and conditions can lead to this serious condition. The first thing that should always be ruled out is that the diseases are of central origin. Damage to brain structures can occur. These include hemorrhagic and ischemic strokes, tumors and inflammatory diseases, hemodynamic disorders inside the skull, severe infections, etc.

Paresis of the lower limbs can be caused by the following diseases

• lumbosacral spinal trauma (particular care should be taken in the elderly with possible osteoporosis, osteomalacia and osteopenia);
• degenerative dystrophic disc disease (osteochondrosis) and its complications such as prolapse, protrusion, extrusion and intervertebral hernia;
• Instability of the vertebral bodies and their periodic sliding against each other in the form of antelisthesis, laterolisthesis or retrolisthesis;
• Prolapse of the dorsal intervertebral hernia, especially its sequestration (detachment from the nucleus pulposus);
• deforming degenerative intervertebral joint disease;
• sclerosis of the lamina;
• Narrowing of the spinal canal, including as a result of a neoplastic or metastatic process, an amputated fracture, post-traumatic or post-inflammatory scar deformation;
• Posture errors and curvature of the spine, including those complicated by malposition or twisting of the pelvic ring bones;
• deformed arthrosis of the hip and hip joints;
• Cauda equina syndrome – there is an entrapment of the main nerve plexus, which consists of the terminal fibers of the spinal cord and the radial branches of the sacral nerves;
• piriformis muscle syndrome;
• Inflammation (inflammation, compression or ischemia) of the lumbosacral plexus, etc.

Symptoms of paraparesis of the lower limbs

The first symptoms of paraparesis of the lower limbs in spinal problems may be subtle. It is an intermittent muscle weakness. It may not be dependent on physical exertion. At times it may feel as if the legs are spinning out of control. The stiffness is particularly pronounced in the morning and gradually subsides.

The clinical picture worsens as the paresis progresses:

• Muscle paralysis occurs so that the affected person can no longer move;
• There are foci of sensory disturbances in the skin;
• Paresthesia, a crawling feeling, may occur;
• Decreased muscle mass – it looks like the legs are losing weight quickly;
• Skin color changes - it becomes pale and venous patterns may appear;
• Decreased arterial pulsation at the inner arch of the foot;
• Decreased intensity of tendon reflexes.

For a diagnosis, it is worth making an appointment with a neurologist or chiropractor. The doctor will carry out an initial examination and make a preliminary diagnosis. Subsequently, x-rays of the lumbosacral spine, MRI, CT, USDG, ultrasound of the abdominal organs, etc. may be required.

The causal factors are controversial...

To date, the etiology of the syndrome remains unclear, and physicians have never been able to fully determine the causes of Todd's palsy.

Even the best medical research is inconclusive. Some doctors simply assume that inhibitory processes in the central nervous system are the cause of this pathological symptom.

Other experts are convinced that the cause of this condition is a lack of neurotransmitters and depletion of brain function.

• An epileptic condition characterized by frequent seizures lasting 30 minutes;
• cerebral fatigue;
• brain tumors;
• herpes encephalitis;
• viral encephalitis;
• Disorders of lipid metabolism;
• decreased cholesterol levels in combination with increased triglycerides;
• ischemic heart disease;
• ischemic brain disease.

What it looks like: symptoms and manifestations

After epileptic seizures, the main symptom indicating Todd's palsy is a complete block of motor functions of the arms and legs, which may be accompanied by hemiparesis or hemiparesis.

Hemiparesis is a loss of muscle strength in a unilateral arm or leg. Monoparesis is muscle weakness in one of the arms or legs. Muscle weakness can range from incomplete to complete paralysis.

Todd's palsy is a central paresis with increased muscle tone and decreased sensation in the affected limb.

The duration of this condition can be one to two days. Afterwards, the patient's muscle strength and voluntary motor skills gradually return.

In some cases, the recurrent episodes are not characterized by resolution of paralysis and residual motor deficits are observed.

In combination with the above symptoms, doctors have observed visual and speech disorders in patients in some cases.

When epileptic symptoms first appear, such a picture can be mistaken for a stroke. However, it should be noted that paralysis usually resolves within 1 to 2 days, whereas a stroke does not resolve as quickly.

Diagnostic procedure

A series of medical examinations is required to correctly diagnose paralysis and its causes. The following examinations are usually carried out:

• Initial examination by a neurologistThe doctor analyzes the situation, determines the symptoms and the degree of loss of muscle strength;
• Blood count, biochemical and toxicological examinations;
• ENMG – Electroneuromyography. This technique determines the speed of the nerve impulse and the electrical activity of muscle tissue;
• MRI and CT scans.;
• EEG – The electroencephalogram evaluates the functionality of parts of the brain;
• MRA – Magnetic resonance angiography – a test that can identify brain tumors and determine the integrity of the cerebral arteries.

High quality treatment approach

At the beginning of its development, hemiparesis seems like a minor discomfort that many people simply do not pay attention to. However, minor discomfort can develop into paralysis.

If there is an acute abnormality, the paralysis progresses quickly. The first thing the doctor must do in the event of an unexpected attack is to eliminate the cause of the paralysis.

A patient diagnosed with motor disability must be aware that it is not an independent condition, but the consequence of another, possibly more serious, pathology. Therapeutic measures are therefore aimed at eliminating the underlying disease:

• if the paralysis was provoked If the paralysis was caused by a strokeIf the paralysis was caused by a stroke, the patient must undergo rehabilitation treatment;
• If If trauma or injury Peripheral nerves require suturing;
• Removal of tumorsnerve branches that press on the nerves;
• In order to prevent muscle loss, it is necessary that Massage sessions.

In addition to the above measures, the patient can also be treated with aerotherapy and multivitamin complexes.

The doctor must mentally prepare the patient for recovery before treating him with medication. Without a positive attitude, the body will not be able to mobilize all of its internal resources.

Not only the paresis needs to be treated, but also the accompanying pathologies that caused the disease. Catalysts of cellular respiration (cytochrome C, cytoflavin) are used to stimulate the metabolic processes in the patient's tissue. These drugs help reduce the lack of oxygen in muscle tissue.

Drugs that improve metabolism in tissues:

Prescribing these medications increases glucose excretion and stimulates brain cells to consume oxygen.

From a neurologist's office

For example, in the treatment of paraplegia of the lower limbs due to a spinal cord injury in a young patient, multimedia therapy proved to be very effective:

• Actovegin – Intravenous injection;
• Trental – Intravenously;
• Proserin;
• Vitamin B12 Intramuscular;
• Massage of the lower limbs In combination with therapeutic exercises;
• Acupuncture and electrical myostimulation extensor muscles

It is a complex of remedies prescribed in addition to self-directed shoulder exercises and early learning to get up in bed, the psychotherapeutic sessions of which helped to overcome anxiety.

This combination also led to satisfactory results:

• Myorelaxant Midocalm;
• which has a combined sedative, antispasmodic and anti-anxiety effect Sibazone;
• Pentoxifylline – an agent that improves microcirculation;
• Milgamm – B vitamin complex;
• ATP – Tissue energy stimulant;
• Cerebrolysin – a drug with nootropic effects.

Possible complications and prognosis

The prognosis of flaccid and spastic flexion paraplegia is less favorable than that of spastic extension paraplegia. Inability to develop manual skills due to leg muscle weakness is also an unfavorable prognosis for the patient.

Complications include complete loss of mobility due to progression of pathology, disability and the development of pelvic discomfort and pressure ulcers.

There are currently no proven, reliable treatments for spinal cord injury.

Only traditional Chinese medicine in the form of acupressure, reflexology, acupuncture, electric needles, a lamp with Chinese herbs, drinking fresh herbal decoctions, individually prescribed herbal bolus and similar therapies shows relatively good results.

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