What is acute flaccid paralysis and what are the causes?

Peripheral paralysis is the result of damage to peripheral neurons responsible for motor functions. In this case, there is a loss of reflexes, degenerative muscle atrophy, etc.

In addition, it should be noted that the process of changing electrical excitability in the affected nerves, which is called degeneration, also starts. The severity of the disease is indicated by the depth of changes in electrical excitability.

Atony and loss of reflexes occurs due to a break in work reflex arc, and at the same time the muscles lose tone. This factor prevents the corresponding reflex from being evoked. Disconnection of muscles from neurons spinal cord and causes their sharp weight loss and atrophy.

From neurons that are connected to muscles, impulses responsible for normal metabolism in the area of ​​muscle tissue flow through the peripheral nerve.

When muscles are damaged, fibrillar twitching is observed, which looks like rapid contractions in the area of ​​individual muscle fibers. Basically, such processes occur when chronic form diseases.

Peripheral paralysis occurs when there is a lesion peripheral nerve. In this case, sensitivity may be lost, and as a result they develop in the affected area.

Disease development process

The development of peripheral paralysis is associated with damage to the neuron responsible for movement and its axon. If only the nuclei of the cranial nerves and anterior horns are affected, then flaccid paralysis can develop in parallel.

In addition, these two ailments are accompanied by characteristic fascicular twitching. In case of peripheral nerve deformation, big chance that the innervated muscle will be paralyzed.

Peripheral and central paralysis are 2 pathologies that are often mistaken for one disease or even confused.

But this various disorders. With central paralysis, motor functions of the entire body are lost, the muscles are in constant voltage. In addition, there are no signs of degeneration and the muscles do not atrophy. In the case of damage to the peripheral parts, the picture is different, or rather completely opposite.

Peripheral paralysis is a disease in which there is a decrease in muscle tone and paralysis of individual parts of the body.

Factors influencing the development of the disorder

Symptoms of flaccid paralysis, such as loss of motor function, are not an independent disease; they are often caused by concurrent illnesses.

Essentially, paralysis is a disorder in which a person makes involuntary movements. In some cases, patients cannot move part of the body or are completely immobilized.

Partial loss of motor functions indicates... In any case, the violation is evidence, namely, of the centers that are responsible for movement and the peripheral parts. The following factors are noted as influencing the development of pathology:

Characteristic manifestations

Signs of peripheral paralysis:

• complete or partial loss of motor functions;
• decline muscle tone in the affected part;
• complete or partial absence of any reaction to sudden irritation of paralyzed muscles;
• denervation atrophy is observed, that is, loss of muscle mass;
• a reaction of degeneration or degeneration is also observed.

Over time, if a person does not receive proper treatment, peripheral paralysis can develop into another form, that is, an acute infectious disease. It is often found under the name. It is characterized by intoxication, while the nervous system also suffers, paralysis and acute flaccid peripheral paresis develop.

This infection is initiated under the influence of a filter virus, which is quite resistant and has increased sensitivity to ultraviolet radiation, disinfectants and high temperature.

When the virus penetrates a neuron, a dystrophic-necrotic process is triggered, which is accompanied by the replacement of all dead neurons with glial tissue and subsequent scarring. In turn, the more neurons die, the faster they form or paralysis.

Diagnostic methods

Diagnostic measures involve performing a whole range of examinations:

• examination by a specialist – neurologist;
• basic tests are taken ( general analysis blood and toxic);
• instrumental diagnostics (, and);
• an analysis of the patient’s complaints and medical history is carried out (the time of muscle inactivity is identified, the causes of complaints and the presence of these in other relatives and what caused such a reaction, that is, place of work, etc.);
• Often you are examined by a neurosurgeon.

In addition to the basic methods, specialists carry out differential diagnosis of the disease. At the same time, symptoms are identified that are very easily confused with signs of central paralysis.

In addition, do not forget that in some cases, the lack of motor functions can be caused by any kind of injury and such a symptom is not always a sign of peripheral paralysis. Therefore, a complete examination of the patient is carried out to identify such injuries.

Health care

First of all, treatment is aimed at getting rid of the causes contributing to the development of the disease. In some cases, which are particularly complex, specialists resort to surgical intervention.

In this case, only the part of the spinal cord on which the damaged muscles are located is affected. But we should not forget that peripheral paralysis may not be a consequence of some other disease, but it is quite likely that it will develop as an independent form of pathology.

A whole range of measures is used in treatment. In this case they are used as medications, as well as more common methods such as and .

The main task of specialists is to fully restore the patient’s motor functions. If this is done, the chance of developing other processes leading to deformation against this background is significantly reduced.

All this time, the patient must be under the supervision of a neurologist and follow all his instructions, including taking individually prescribed medications.

Among the medications that are often prescribed to patients suffering from flaccid paralysis are:

In addition, physiotherapeutic treatment is now actively used. This process takes quite a while for a long time, but, nevertheless, this type of treatment is the most effective. If only this type of treatment is used, motor functions may not fully return, so a whole range of measures is required.

How dangerous is the disease?

If the treatment is prescribed incorrectly or all the specialist’s instructions are not followed, some complications and quite unfavorable consequences may occur.

The most common are:

• a decrease or complete absence of strength may be observed in the muscles, and on an ongoing basis;
• joint immobility and muscle hardening are formed.

Preventive actions

In order to avoid the development of disorders, experts recommend following the following instructions:

• see a doctor when the slightest symptoms diseases and any other problems;
• blood pressure should always remain under control;
• treatment of infectious diseases early stages preventing them from causing more serious problems;
• It's best to exclude everything bad habits, - alcohol and smoking contribute to the development of many health problems, not only peripheral paralysis;
• effective prevention is maintaining healthy image life ( proper nutrition, rest, adherence to routine and physical activity).

Flaccid paralysis is a dangerous complication after infectious diseases. The pathology is characterized by the progressive death of neurons in the peripheral nervous system. This leads to 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? The answers to these questions can be found in the article.

Description of the pathology

In peripheral nerves, these cells are located and are equipped with long processes (axons) that transmit signals from nervous system into 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 flow of signals from the nervous system to the muscles stops. As a result, the person cannot move the affected part of the body. Over time, muscle atrophy occurs, tendon reflexes are lost, and muscle tone deteriorates. Weakness of the limbs increases and progresses.

If the motor function of the affected area is completely lost, then doctors call this pathology paralysis. If movements are weakened and difficult, then experts talk about muscle paresis.

The following pathological conditions do not include flaccid paralysis and paresis:

• movement disorders after injuries and injuries (including birth injuries);
• paresis and paralysis of the facial muscles.

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 infectious pathologies caused by enteroviruses. In most cases, this type of movement disorder develops after polio.

In the past it's dangerous viral disease was widespread. It often led to death and disability of the patient. Nowadays, thanks to mass vaccination, only isolated cases of pathology are observed. However, the risk of infection cannot be completely excluded. An unvaccinated person has a high risk of infection. Cases of imported infections are periodically recorded. Get dangerous virus It is also possible when traveling to polio-affected regions.

The polio virus is transmitted in several ways: airborne droplets, contact, and through utensils. In addition, the microorganism can live in environment. Children under 15 years of age are especially susceptible to infection.

The virus enters motor neurons and causes dystrophic changes. Nerve cell dies and is replaced by glial tissue. Subsequently, a scar forms in its place. The more motor neurons that die in 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 as a result of other diseases:

1. Inflammatory process in the spinal cord (myelitis). In half of the cases, this disease is caused 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 penetrated the spinal cord through the wound. With myelitis, the supply of impulses from the central nervous system to the peripheral nerves is disrupted, which becomes the cause of paralysis.
2. Poly- and mononeuropathies. These diseases are also caused various viruses. In polyneuropathy, it affects simultaneously a large number of peripheral nerves. Mononeuropathy is characterized by pathological changes in neurons in a separate area, most often in one of the upper limbs.
3. Guillain-Barre syndrome. The disease occurs as an autoimmune complication after viral pathologies: mononucleosis, mycoplasmosis, cytomegaly, infection with Haemophilus influenzae. The infectious process leads to disruptions in the functioning of the immune system. Protective antibodies begin to attack peripheral nerve cells, which leads to flaccid paralysis.
4. Coxsackie virus infection. 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 the skeletal muscles. The consequence of this pathology can be acute flaccid paralysis in children. Adults are infected much less frequently.

Currently appeared the new kind enterovirus (type 70 strain). Most often it causes severe form conjunctivitis. But there are also atypical forms diseases that are similar in symptoms to polio. This pathology can also cause damage to peripheral nerves.

Difference from central paralysis

It is necessary to distinguish between flaccid and these two pathological conditions accompanied by motor dysfunction. However, they differ in etiology, pathogenesis and symptoms:

1. Spastic form 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.
2. In spastic paralysis there is no damage to motor neurons.
3. In the peripheral form of paralysis, there are no flexion and extension reflexes, and muscle weakness is noted. For pathology central genesis the muscles are tense, involuntary muscle contractions are noted, reflex movements are preserved.
4. Central paralysis can impair 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 comprehensive examination.

Symptoms

Impaired motor function most often appears suddenly and increases rapidly. The following symptoms of flaccid paralysis can be distinguished:

• impossibility or difficulty of movements;
• severe weakness muscles in the affected area;
• lack of response of paralyzed muscles to mechanical stress;
• asymmetrical lesion;
• muscle atrophy (a paralyzed leg or arm becomes thinner than a healthy one).

If paralysis develops against the background of polio, then the patient’s general signs infectious pathology. Usually, shortly before the onset of movement disorders, the temperature drops, muscle pain and spasms subside.

A fairly common form of pathology is lower flaccid paralysis. It is characterized by damage to the spinal cord roots. As a result, the patient experiences paralysis of one of the lower limbs. Most often, the innervation of the muscles of the feet is disrupted. A person cannot move his feet and it becomes very difficult for him to walk. The onset of paralysis is preceded by strong pain in the lower back. IN severe cases defeat goes to cervical region, and the patient is paralyzed on the right or left hand.

Features of pathology in a child

Flaccid paralysis is more common in children than in adults. A child is much more susceptible to infection with enteroviruses. Polio is quite rare these days. The main danger to a child is represented by other types of enteroviruses that affect peripheral nerves.

Manifestations of flaccid paralysis in children are the same as in adults. However, the child more often experiences damage to the neurons responsible for the functioning of the respiratory and swallowing muscles. Sick children breathe quickly and shallowly, which leads to hypoxia. As a result, frequent headaches, lethargy, and difficulty falling asleep occur. The child finds it difficult to swallow and often chokes on food. Children often lose weight due to lack of nutrition.

Complications

If left untreated, flaccid paralysis causes severe complications. This pathology can lead to the following dangerous consequences:

1. Ankylosis. Lack of movement in a paralyzed limb leads to fusion of bones in the articular joints.
2. Muscle contractures. Over time, the muscles in the affected area shorten and harden.
3. 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 tissue atrophy becomes irreversible.

If the patient has already developed such complications, then restore motor function conservative methods is no longer possible. In most cases, it is necessary to resort to surgical treatment methods.

Diagnostics

A neurologist is involved in the treatment and diagnosis of this pathology. Since paralysis is usually caused 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, they carry out the following types examinations:

1. Neurological examination. The doctor examines the patient's muscle strength, tendon reflexes, and swallowing function.
2. Clinical and biochemical tests blood. Indicates the presence of pathology increase in ESR and increased creatine kinase concentrations.
3. Virological examination of stool. This test is performed if polio is suspected.
4. Blood toxicology test. Helps distinguish peripheral paralysis from motor dysfunction caused by chemical poisoning.
5. Electromyography. This test helps evaluate muscle electrical conductivity.
6. Test with proserine. The test allows you to distinguish paralysis from myasthenia gravis.

Drug therapy

Treatment of flaccid paralysis requires an integrated approach. The main goal of therapy is to restore the normal functioning of motor neurons. Patients are prescribed nootropic and antioxidant drugs V high doses Oh:

• "Piracetam."
• "Actovegin".
• "Mexidol".
• "Trental."
• "Cerebrolysin".

These medications help normalize metabolism in damaged nerves and protect neurons from harmful effects.

A course of injections of the drug "Proserin" is indicated. This remedy 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 the drugs are administered intramuscularly. For treatment, vitamins B 1 and B 12 are used, which have a positive effect on the condition nerve tissue.

Physiotherapy and rehabilitation

Restoring movements is impossible without physiotherapy. This is the main part of the treatment peripheral paralysis. It is impossible to get rid of motor function disorders only using medicinal methods. It is necessary to develop damaged muscle groups to avoid their complete atrophy.

Patients are prescribed galvanization sessions. Electrodes are applied to the affected areas and a constant electricity low voltage. This helps improve tissue metabolism and restore damaged neurons, as well as increase muscle tone. Also shown are baths with mineral waters. This allows you to influence peripheral nerves through skin receptors.

Such procedures can only be carried out after cupping acute symptoms 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, using kneading and rubbing of the damaged muscles. But it is very important to prevent injury to muscle tissue. Therefore, this procedure should only be trusted by a qualified specialist. It is useful to combine classic and acupressure.

Exercise therapy for flaccid paralysis is a mandatory part of treatment. However, it must be taken into account that patients have weakened muscles and joints. Therefore on initial stage passive movements using support are shown. For example, the patient rests 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 using the muscles of the trunk, leaning on his hands. As the movements develop, the exercises are performed while kneeling.

Gymnastics in water is very useful. Exercises for the limbs can be combined with medicinal baths.

If hand movements are impaired, the patient must be taught simple household skills. For this purpose, tables with special stands are used in physiotherapy rooms. The patient learns to fasten buttons independently, press the switch button, and turn the key in the lock. Restore fine motor skills brushes help with modeling from plasticine.

Surgical methods

In severe cases and in the presence of complications, surgical treatment is indicated. The most commonly used types of operations are:

• transfer healthy muscles to the atrophied area;
• elimination of joint deformation due to ankylosis (osteotomy);
• plastic surgery by thickening of the lower leg (with severe muscle atrophy).

After surgery, movements are restored much faster than with conservative treatment.

Forecast

The prognosis of the disease depends on the degree of neuronal damage. If diagnosis and treatment were carried out in a timely manner, then it is quite possible to restore movement. However, this will require a long time complex therapy and rehabilitation. Typically, the process of restoring motor function takes about 2 years. After surgical treatment movements return to normal after about 1 year.

IN advanced cases It is no longer possible to restore movement even with surgery. If a patient has lost more than 70% of 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, you must follow the following recommendations:

• Get vaccinated against polio on time;
• avoid contact with sick people enteroviral infections;
• strengthen immune system;
• cure promptly and completely infectious diseases;
• After suffering from polio, regularly visit a neurologist for 6-12 months.

These measures will help avoid dangerous complications infectious pathologies and maintain motor function.

With the development of flaccid paralysis healing procedures are aimed at restoring (if possible) the work of a peripheral neuron, and in addition to preventing the process of muscle tissue atrophy and possible appearance contractures.

Medicines

To improve the functioning of nervous tissue, treatment with vasoactive and neurotropic drugs is necessary:

• nootropil or piracetam (tablet/capsule at a dosage of 0.4-0.8 g 3 times/day or 20% solution at a dosage of 5-10 ml IM or IV);
• Cerebrolysin (in a dosage of 3-5 ml IM or IV);
• Actovegin (in a dosage of 5-10 ml IM or IV through a dropper 1-2 times/day; 1 ml of the drug contains 40 mg of the active ingredient);
• trental (dragées in a dosage of 0.1 g 3 times / day or intravenously through a dropper 1 time / day in a dosage of 5 ml; 1 ml of medicine contains 0.02 g of the active ingredient).

Vitamins

Vitamins are also taken:

• vitamin B1 (solution 2.5% (thiamine chloride) or 5% (thiamine bromide), 3% or 6% at a dosage of 1 ml IM every day 1 time/day);
• vitamin B12 (dose 400 mcg 1 time/2 days IM, can be combined with vitamin B1, but they cannot be mixed in one syringe).

Physiotherapeutic treatment

Acute flaccid paralysis can be effectively treated with electrotherapy and other physical therapy methods. Basically, for this disease, balneotherapy and galvanization are prescribed.

Massage for flaccid paralysis

In case of flaccid paralysis, massage is performed to stimulate muscular system, which is why when performing it, deep kneading is used, and along with it rubbing with high intensity, and in addition to this, the massage therapist actively influences the so-called segmental zones. But at the same time, you cannot massage paretic muscles with excessive force - the procedure should be short and moderate. It must be carried out over many months (short breaks should be taken between treatment courses). If you perform rough, painful techniques, the muscle, on the contrary, may begin to weaken.

In addition, acupressure is performed using a tonic technique. In this case, it is necessary to press the necessary points with the tip of your finger in order to cause quick short vibrating irritations that will stimulate the necessary movement.

Traditional and herbal treatment

There are several recipes for traditional treatment:

Roots of the evasive peony. You need to take 1 tsp. dry ingredients and pour boiling water (3 cups), then cover the container and leave for 1 hour, then strain. You need to drink the tincture three times a day. 1 tbsp each before meals (15 minutes before). Alcohol tincture should be taken in a dosage of 30-40 drops. 3 rubles/day before eating.

Dying or tanning sumac (used fresh leaves). Take 1 tsp. ingredient and pour boiling water (1 cup), cover the container and leave for 1 hour, then strain. Drink 3-4 times a day. 1 tbsp each

Rosehip fruits and roots. A decoction of the roots is used externally - in case of paralysis, you need to bathe your feet in a bath with it.

Surgical treatment

In case of destruction of the anatomical integrity in the peripheral nerve system, the patient may be prescribed a neurosurgical operation.

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Differential diagnosis of acute flaccid paralysis

In the paralytic and early recovery stages, poliomyelitis can be mixed with various diseases, occurring with paralysis, especially of a flaccid nature, as well as with pseudoparalysis caused by damage to joints, muscles and bones.

Of great importance differential diagnosis between polio and polyradiculoneuropathies of various etiologies. Clinical picture This syndrome (often called Guillain-Barré syndrome or ascending Landry's palsy) consists of motor disorders, changes in the reflex, sensory and autonomic spheres. The disease develops at any time of the year, 1-2 weeks after any rise in body temperature, catarrhal symptoms, intestinal disorders or hypothermia.

The disease begins with the patient complaining of pain in the legs, less often in the arms. Small children refuse to stand on their feet and look for a gentle position. Objectively, symptoms of tension and sensitivity disorders of the “stockings” and “gloves” type are noted.

Paresis and paralysis in polyradiculoneuropathies, as well as in poliomyelitis, are of a sluggish nature, but they are usually symmetrical, diffuse, more often expressed in the distal parts of the extremities, the type of distribution of paresis is predominantly ascending; their intensity is mostly expressed moderately. Tendon reflexes decrease or disappear, abdominal pain is not caused only with widespread paralysis of the muscles of the trunk and limbs, urination may be occasionally impaired, which does not happen with polio. Sometimes lungs may appear, quickly passing, pyramidal symptoms, but damage to the cranial nerves is common. The most typical is symmetrical damage to the facial muscles, followed by frequency of involvement in pathological process there are IX, X, then III, IV, VI pairs, less often VII and XII.

Table 5

Diagram of types of breathing disorders

	Type of disorder breathing quality	What is affected	Breathing pattern			Breathing type	Airway condition	Features of development
				amplitude
		Paralysis of respiratory muscles (diaphragm, intercostal)	Correct			Paradoxical breathing, often shallow.	Available	Gradual rise	Long lasting artificial breath
	geal	Paralysis of the muscles of the pharynx, larynx and tongue (impaired swallowing, phonation, speech)	Incorrect	figurative	Increased frequency blurry	bubbling, whistling, retraction jugular fossa	Filled mucus, saliva, vomiting by the masses	Sudden Appearance	Mucus suction, drainage position, intubation. Hardware artificial respiration Contraindicated in case of airway obstruction
	Bulbar	Damage to the bulbar respiratory centers	Disorderly	figurative		Pathological types of breathing (Chayne-Stokes, Grocco, periodic, etc.)	Available	Sudden Appearance	Massive oxygen therapy, heartfelt, intubation
	Combined bath for bulbar spinal forms	Paralysis of the respiratory muscles. Paralysis of the muscles of the pharynx, larynx and tongue, respiratory and vasomotor center	More often incorrect	Most often small		Various combinations of spinal and pharyngeal	More often filled with mucus, saliva, etc. -	More often gradual build-up	First you need to provide Free access air in Airways and then artificial respiration

At bulbar syndrome, as with deep paralysis of the respiratory muscles, life-threatening respiratory disorders occur.

Autonomic disorders occur in a number of patients in the form of cyanosis, swelling of soft tissues, sweating, and coldness of the extremities. Mild diffuse muscle atrophy is also noted, mainly in the distal extremities. From the first days of the disease, more often in the second week in cerebrospinal fluid detect protein-cell dissociation, mainly due to a significant increase in protein content.

The disease has a favorable course, with almost full restoration lost functions due to paralysis.

Bulbar forms of poliomyelitis can be mistaken for diphtheria neuritis, polyneuritis, diphtheria croup and vice versa. For differential diagnosis What is important is the fact that with diphtheria there is often selective damage to the fibers of the glossopharyngeal nerve, sometimes a violation of accommodation, which is not typical for: polio. Neuritis in diphtheria is often accompanied by toxic myocarditis. The diagnosis of diphtheria is confirmed by a high titer of diphtheria antitoxins in the patient’s blood serum.

Availability muscle weakness, hypotension, decreased reflexes are observed in myopathies that develop out of connection with the infectious process, without pain. With myopathy, the disease progresses over a long time: a “duck walk”, atrophy of the muscles of the trunk, shoulder and pelvic girdle appear, muscle tone and strength decrease, mask-like appearance of the face, and pseudohypertrophy of the muscles of the lower legs.

Typical for myasthenia increased fatigue, weakness, “flickering” paresis - weakening of symptoms during the day, followed by their intensification after fatigue. The diagnosis can be confirmed by a positive proserine test: after administration of proserine, muscle weakness decreases or disappears.

In exclusively in rare cases flaccid paralysis may occur in children vaccinated with live polio vaccine. The approximate risk is 1 case of paralytic disease per 2-3 million doses of vaccine. The disease can develop not only in vaccine recipients, but also in people who have had close contact with vaccinated people. The greatest risk of paralysis occurs after the first dose of oral polio vaccine.

WHO introduced the concept of vaccine-associated polio. According to WHO recommendations, vaccine-associated polio includes cases when:

1) the disease begins from the 5th to the 30th day after taking the live oral polio vaccine (for those who have had contact with the vaccinated, the period is extended to 60 days);
2) the development of flaccid paralysis or paresis without sensory impairment persists for more than 2 months;
3) there is no progression of the disease;
4) a vaccine strain of the polio virus is isolated from the patient and, over the course of the disease, antibody titers to it increase by at least 4 times.

If these conditions do not exist, then the disease resulting from oral polio vaccine is recorded as a vaccine reaction. The course of vaccine-associated poliomyelitis is favorable.
Kharkov - 1993

The textbook was compiled by: Ph.D., Associate Professor K.K. Makarenko (Head of the Department of Children's Infectious Diseases, KhIUV), Ph.D. V.A. Mishchenko (Associate Professor of the Department of Children's Infectious Diseases;: KHIUV, I.D. Osadchaya (pediatric neurologist, consultant at the Kharkov Regional Children's Infectious Diseases Clinical Hospital).

Paralysis and paresis. The reasons for their occurrence

Paralysis is one of the types of violation motor activity person and manifests itself in its complete loss (Greek. paralysis- relaxation). This disease is a symptom of many organic diseases of the nervous system.

If not complete loss motor function, but only its weakening to one degree or another, this disorder will be called paresis(Greek paresis- weakening). Moreover, in both the first and second cases, motor dysfunction is the result of damage to the nervous system, its motor centers and/or pathways of the central and/or peripheral parts.

Paralysis should be distinguished from movement disorders that occur due to muscle inflammation and mechanical damage osteoarticular apparatus.

Paresis and paralysis are movement disorders that are caused by the same reasons.

The main causes of these diseases.

Paralysis is not caused by any one specific factor. Any damage to the nervous system can lead to impaired motor function. Congenital, hereditary and degenerative diseases central nervous system are usually accompanied by movement disorders.

Birth injuries - common reason children's cerebral palsy, as well as paralysis due to damage to the brachial plexus. Unfortunately, over 15 million patients with cerebral palsy have already been recorded in the world.

A number of diseases of unknown origin (for example, multiple sclerosis) is characterized by movement disorders varying degrees gravity.

Circulatory disorders inflammatory processes, trauma, tumors of the nervous system can also cause paralysis or paresis.

Often paralysis is of a psychogenic nature and is a manifestation of hysteria.

The causes of paralysis can also be divided into organic, infectious and toxic.

Organic causes include:

1. Malignant neoplasms;
2. Vascular lesions;
3. Metabolic disorders;
4. Intoxication;
5. Eating disorders;
6. Infections;
7. Injuries;
8. Multiple sclerosis;

TO infectious causes relate:

1. Meningitis;
2. Polio;
3. Viral encephalitis;
4. Tuberculosis;
5. Syphilis.

TO toxic reasons relate:

1. Vitamin B1 deficiency;
2. Nicotinic acid deficiency;
3. Heavy metal poisoning;
4. Alcoholic neuritis.

Paralysis can be observed in one muscle, one limb ( monoplegia), in the arm and leg on one side ( hemiplegia), in both arms or both legs ( paraplegia) (the suffix plegia means paralysis).

By localization lesions distinguish two groups of paralysis, significantly different clinical manifestations: central ( spastic) and peripheral ( sluggish).

Central paralysis occur when central motor neurons are damaged. They are characterized by:

• hypertonicity (increased muscle tone), for example, the “jackknife” phenomenon;
• hyperreflexia (increased intensity of deep reflexes), especially demonstrably with unilateral damage;
• the presence of pathological reflexes (Babinsky, Bekhterev, Astvatsaturov, etc.);
• the appearance of pathological synkinesias (friendly movements), for example, when a patient voluntarily clenches a healthy hand into a fist and does not voluntarily repeat this movement with the affected hand, but with less force;
• the appearance of clonus (convulsive muscle contractions in response to an impact), for example, foot clonus - when a patient lying on his back, with the affected leg bent at the hip and knee joints, the doctor performs dorsal extension of the foot, and the flexor muscles begin to involuntarily contract rhythmically , the rhythm can persist for a long time or fade out almost immediately.

Peripheral paralysis (flaccid) characterized complete absence movements, loss of muscle tone, extinction of reflexes, muscle atrophy. With damage to the peripheral nerve or plexus, which contains both motor and sensory fibers, sensitivity disorders are also detected.

When the subcortical structures of the brain are damaged, extrapyramidal paralysis, automated movements disappear, motor initiative is absent. Muscle tone is characterized by plasticity - the limb is held in a passive position given to it.

Classification

There are two scales for assessing the severity of paralysis (paresis) - by the degree of decrease in muscle strength and by the degree of severity of paralysis (paresis), which are the opposite of each other:

1. 0 points “muscle strength” - no voluntary movements. Paralysis.
2. 1 point - barely noticeable muscle contractions, without movements in the joints.
3. 2 points - the range of movements in the joint is significantly reduced, movements are possible without overcoming the force of gravity (along the plane).
4. 3 points - a significant reduction in the range of movements in the joint, the muscles are able to overcome the force of gravity and friction (in fact, this means the possibility of tearing the limb off the surface).
5. 4 points - slight decline muscle strength, with full range of motion.
6. 5 points - normal muscle strength, full range of movements.

Most significant features peripheral paralysis are:

1. atony (decreased tone) of muscles;

2. muscle atrophy due to decreased nerve trophism;

3. fasciculations (involuntary contractions of individual muscle fibers, perceived by the patient and visible to the doctor’s eye), which develop when large alpha motor neurons of the anterior horns of the spinal cord are damaged.

Determination of the stage of paralysis (paresis.)

An external examination can detect deformities of the spine, joints, feet, hands, asymmetry of skeletal development, and leg length.
Swelling of the legs, arms, changes in the trophism of the nails, skin, folding of the skin over the spine, stretch marks, varicose veins veins, areas of skin pigmentation, tumors, burn scars.

The most common method of examining muscles, bones and joints is palpation. Palpation of muscles is the main method of determining their tone.

Hypotension(decreased tone) is observed with pure pyramidal paresis, with impaired muscle-articular sensitivity, with a number of neuromuscular diseases, cataplexy, attacks of sudden falling, hysterical paralysis, with lesions of the cerebellum, etc.
With hypotension, the muscle is relaxed, spread out, has no contours, the finger easily sinks into the thickness of the muscle tissue, its tendon is relaxed, and greater mobility is noted in the corresponding joint. Hypotension can be mild, moderate, or severe.

Atony- lack of normal skeletal muscle tone and internal organs, developing as a result of insufficiency general nutrition, disorders of the nervous system, with infectious diseases, disorders of the glands internal secretion. With atony, movement is not possible.

At hypertonicity the muscle is tense, shortened, prominent, compacted, the finger has difficulty penetrating the muscle tissue, movements in the joint are, as a rule, limited in scope.

Spasticity or spastic paresis.

Paresis is characterized by a peculiar selective increase in tone in the adductor muscles of the shoulder, flexors of the forearm, hand, fingers and pronators of the hand. In the leg, hypertonicity is noted in the hip extensors and knee joints, adductor muscles of the thigh, plantar flexors of the foot and toes (Wernicke-Mann position). With repeated movements, the springy muscle resistance may disappear and the spastic posture is overcome - a “jackknife” symptom.

In conditions of a spinal lesion above the cervical thickening, spastic hemi- or tetraplegia develops; damage at the level of the thoracic segments causes lower paraplegia.

With spastic paresis, a number of accompanying symptoms are noted:

1. Tendon-periosteal hyperreflexia with expansion of the reflex zone, clonus of the feet, hands, and lower jaw.
2. The most reliable of them is the Babinski reflex, which is caused by streak irritation of the outer part of the sole with a pen from the heel to the toes. In response, the first finger extends and the remaining fingers flex and fan out.
3. Hoffman reflex - increased flexion of the fingers of the hanging hand in response to pinch irritation of the nail phalanx of the third finger.
4. Protective reflexes - a triple flexion reflex of the leg when the skin of the foot is irritated by a pinch or a cold object, as well as a reflex of lengthening the leg in response to a thigh prick.
5. The absence of abdominal reflexes and signs of peripheral neuron damage (fibrillary muscle twitching, atrophy) complements the picture of spastic paresis.

Extrapyramidal pseudoparesis, rigidity.

Pseudoparesis manifests itself as uniform hypertonicity in massive muscle groups- agonists and antagonists, flexors and extensors of the limbs, which leads to a plastic increase in tone, freezing of the limb in an uncomfortable position given to it (waxy flexibility).
Stronger flexors give the patient a “petitioner” posture. - The torso and head are tilted forward, the arms are bent in elbow joints and pressed to the body. Movements are slow, awkward, and their initiation is especially difficult. When studying passive movements, intermittent muscle resistance is noted during flexion and extension of the limb. Rhythmic constant tremor of the fingers at rest is often observed.

Peripheral paresis (flaccid).

At flaccid paresis peripheral type pathological signs, synkinesis and protective reflexes are absent.
Nerve damage (neuritis, mononeuropathy) leads to selective atrophy of the muscle group innervated by this nerve.
Polyneuritis contribute to symmetrical paresis of the distal muscles (feet, legs, hands, forearms).
Plexus lesion (plexite) accompanied by unilateral paresis with predominant localization in the upper or lower limbs, in the muscles of the pelvic or shoulder girdle.

Mixed paresis.

In some cases, patients have both signs of flaccid paresis and symptoms of damage to the central motor neuron. This type of paresis is called mixed.
It causes cell damage anterior horn and the pyramid path.
TO mixed type Paresis includes central type defects after strokes, with tumors (hematomas) with compression on this area. This category of patients presents together with hemiparkinsonism and spastic hemiparesis.

The treatment of such patients must be approached individually. Treatments for this disease include sulfur and radon baths, segmental and acupressure massage, balance therapy, and stem cell treatment. But the main method of treatment is special therapeutic exercises.