Paresis is usually called a feeling of weakness of individual muscle groups caused by a violation of their connection with the central nervous system.
Such conditions are the results of various disorders of brain functioning. In this case, the cause may be instability in the functioning of peripheral nerves if they lose the ability to transmit brain impulses aimed at activating the work of muscle tissue.
There are two main types of paraparesis. This may be an organic or functional form of the disorder.
Organic paraparesis is caused by the influence of certain factors, as a result of which the nerve impulse does not reach the muscle tissue. In the functional form, disorders of inhibition, balance, as well as excitation and maneuverability are observed in the cerebral cortex itself.
Often this type of disease is characterized by an increase in muscle tone or the appearance of reflexes. The symptoms may be related to the formation of pathological reflexes, as well as some other unnatural movements.
Let's understand the concepts and manifestations
Lower paraparesis is extremely rare. Only a few have ever heard of this type of disease. Be that as it may, knowledge about such disorders must be acquired by every attending physician, as well as by parents raising small children.
This disease manifests itself in the form of a mild form of paralysis of the lower limbs. Symptoms may only appear in certain areas. The legs are never completely affected.
You need to understand that this disease is classified as very serious, but the intensity of its manifestation can be severe or have a mild form. At the same time, paraparesis is characterized by development in a wide variety of variants, which implies the need for individual courses of treatment.
When spastic paraparesis develops, the patient may not perceive tactile sensations in the affected areas. A person can receive physical injuries, as well as burns, but not feel anything. Therefore, such people always require special care and supervision. This condition can mostly occur as a result of damage to the spine in the thoracic region.
You can often hear the name “plegia” when referring to paraparesis. Such a replacement of concepts cannot be called correct, since plegia is a complete paralysis, which means the loss of the ability to perform targeted movements of a certain group of muscle tissues.
Paresis, in turn, implies only a partial loss of the ability to move, while the damaged tissues become flaccid and unable to bear the same loads.
Muscle strength and the number of active movements are thus significantly reduced. Depending on the location, the disease can be divided into several types:
- tetraparesis extends to all limbs;
- when triparesis , only three limbs may be paralyzed;
- paraparesis is characterized as a disease of both arms or legs;
- hemiparesis of one lower and upper limb;
- monoparesis paralyzes the muscle tissue of one limb.
Flaccid paraparesis is characterized by a state of relaxation and slight atrophy of the muscle tissue of the arms or legs without significant overexertion, as well as shortening. In this case, reflexes may gradually fade away.
Spastic paresis is characterized by a decrease in physical capabilities with accompanying muscle spasms, as well as tension.
Symptoms
With paraparesis, depending on the type of pathology, a whole complex of various symptoms may be present, the main symptom being muscle weakness.
Spastic paraparesis of the lower extremities has the following symptoms:
- there is increased muscle tone, the lower limbs cannot be straightened;
- tendon reflexes are strengthened;
- no superficial reflexes are observed.
As a result of peripheral damage:
- muscle tone is very low or absent;
- tendon reflexes are depressed;
- hypotrophy of the lower extremities is observed;
- twitching of individual muscle fibers occurs.
These disorders lead to uncertain movements of the lower extremities and frequent falls. Additional symptoms:
- sensitivity decreases;
- swelling of the lower extremities is noted;
- difficulty in working the lower leg;
- reflexes worsen;
- there is a feeling of discomfort when bending the legs.
If there is no therapy, the neurological syndrome worsens, complete paralysis is possible, which leads to complete loss of ability to work - the person becomes disabled. The recovery rate in children is much higher than in adults.
Why does he take away his legs...
The most common cause of paraparesis of the lower extremities is considered to be damage to spinal tissues or myelopathy.
In this case, it is the cervical spine that is most often exposed to harmful effects. The very occurrence of myelopathy can be caused by the progression of osteochondrosis or spondylosis, as well as various injuries and pressure exerted by neoplasms. Typically, the result of exposure to such factors is lower paraparesis.
One of the common causes of the syndrome is trauma. Each injury can be either partial or expressed as a complete rupture of spinal tissue. In this case, compression of the spinal cord often occurs as a result of displacement of the vertebrae. This may cause partial paralysis.
An equally common causative factor is a neoplasm that can put pressure on spinal tissue in certain areas.
As a result, this can lead to a deterioration in the process of innervation conduction. Paraparesis in such a condition may not be developed in any case, and its progression can occur suddenly or gradually over a certain period of time.
Paresis of the facial nerve can be caused by diseases such as influenza, adenoviruses, herpes, rubella, chicken pox, and also CVM.
It should be borne in mind that such relationships have not been fully proven, so exceptions are possible. In most situations, accidents are the determining factors.
How is spastic paraplegia classified?
If we talk about how such a disease manifests itself, we should talk about various kinds of features, and here everything is directly dependent on the level of damage and how pronounced the pathology is. All this must be determined by the doctor when examining the patient. The pathology process can take place in different ways, which is why it is classified differently: paresis can be central or spastic, as well as flaccid and peripheral.
If we talk about the first options, then they occur when the first neuron of the motor pathway is damaged. Moreover, such ailments start in the motor part of the cerebral cortex, that is, directly in the forehead, and the pathology ends in the anterior part of the spinal cord. If flaccid type paresis is observed, then we are talking about a violation of the second motor neuron.
Pathological changes are expressed in different ways, but it is still possible to describe a general classification:
- light form;
- moderate form;
- deep form.
If we talk about how the degree of reduction in strength functions is achieved, then for this there is a clinical assessment, for which a medical examination of the patient is carried out. Moreover, such an examination should be carried out regardless of what forms of pathology we are talking about, that is, both for central and peripheral injuries. When a medical examination is carried out, the first thing you need to do is find out how susceptible the nervous system is to damage and how much the strength functions of the muscles of the lower extremities are reduced. This is how pathology is classified.
Clinical picture
Lower paraparesis is characterized by individual manifestations, which are a significant factor in the procedure for diagnosing neurological diseases. The main symptoms include:
- deterioration of sensitivity of the skin of the lower extremities;
- pain and swelling in the legs;
- weakening of muscle tissue;
- difficulty working the lower leg;
- sensations of discomfort during flexion and extension of the hip joint;
- worsening knee reflexes;
- while walking it is impossible to step on the heel normally;
- uncertain movement.
Such symptoms always appear very quickly and can have a long duration of action. In difficult situations, paraparesis in adults is combined with difficulties in the functioning of the pelvic organs.
In this case, a serious feeling of weakness in the muscles can be diagnosed, apathy is clearly expressed in the patient’s behavior, the person may hardly eat and sleep very poorly. In such situations, fever, mood swings, and disruption of normal bowel function often occur.
Due to the deterioration of the protective mechanisms in the human body, infection begins to develop at an accelerated pace.
In children's bodies, such diseases are often diagnosed after injury during childbirth. But there are cases when the diagnosis is determined incorrectly even in the real absence of a specific disease.
When the child becomes older, the established diagnosis must be confirmed or removed. Usually these issues are dealt with by a neurologist. In this case, several main degrees of paresis are determined:
- insignificant;
- moderate pathology;
- expressed;
- pronounced.
As the patient progresses to lower spastic paraparesis, tactile sensations deteriorate in the affected limbs. Therefore, patients with symptoms manifesting themselves in this way require special attention, as well as proper care. This condition mostly progresses when the spine in the chest area is damaged.
Lower flaccid paraparesis is the result of damage not only to the lumbar area, but also to the thoracic area.
Causes of pathology
Paraparesis of the lower extremities develops in patients for a variety of reasons. If disturbances are observed in the cerebral or spinal circulation, this becomes the cause of the disease.
Lower spastic paraparesis develops against the background of tumors of the spinal cord and brain, which are benign or malignant. The disease appears against the background of:
- Abscess;
- Brain injuries;
- Inflammation of the brain.
Paraparesis of the lower extremities is diagnosed in patients with demyelinating diseases, during which an acceleration of the process of protein breakdown is observed.
If a person is poisoned by poison or alcoholic beverages, this becomes the cause of pathology. People with epilepsy, which is characterized by impaired brain function, are at risk.
Paraparesis of the lower extremities is diagnosed in immunoinflammatory diseases, which are accompanied by a decrease in muscle strength.
The pathological process is observed in myasthenia gravis. This is a disease in which there is constant muscle fatigue and weakness. The cause of the disease is myopathy, which disrupts metabolism.
The disease develops with botulism. This is a pathological process in which breathing is impaired, difficulties in speech and discomfort in the abdominal area arise. If motor neuron diseases occur in a person’s body, then he is at risk.
There are many causes of lower paraparesis, so the patient is advised to be careful about his health.
Diagnostic features
In most cases, diagnosis is performed only by clinical methods without the use of additional technologies.
A comparative description of the muscle strength of the left and right extremities during the development of hemiparesis is derived. In this case, standard resistance testing procedures are carried out, and a classic testing technique called the Barre test is also used.
The essence of the procedure is the need to keep the limbs suspended for some time. If the paresis progresses, the outstretched limbs will slowly fall after 20 seconds.
To determine the factors causing the development of paraparesis of the limbs, the following hardware and laboratory testing methods are used:
- MRI of spinal and brain tissues, as well as CT diagnostics;
- analysis of the state of liquor fluid;
- electromyography;
- general blood test and testing using biochemical agents;
- electroneuromyography;
- determination of the amount of substance B12, as well as folic acid;
- identification of genetic predisposition or possible oncological tumors.
Features of the development of childhood paraparesis
With the general normal development of the child, you can notice that he walks on tiptoes. Naturally, this becomes a cause of serious concern for parents. If a child moves independently, this does not mean that he has paraparesis.
Walking on tiptoes may be due to the fact that only some groups of leg muscles may be in good tone, which is not in all cases a symptom of paraparesis. Most often, in such situations, doctors recommend massage, as well as performing therapeutic restorative physical exercises.
In the event of a disorder, restoration processes in the children's nervous system, due to its plasticity, proceed much more actively than in the developed organisms of adults.
Therefore, the results of any significant disorders, hypoxia and birth trauma may very soon cease to appear.
If paraparesis is diagnosed in a child, it is necessary to ensure continuous monitoring by a neurologist. Observation should be accompanied by drug treatment, as well as physiotherapeutic procedures and orthopedic examination. Acupuncture can significantly contribute to the positive effect of treatment.
Spastic paraparesis of the lower extremities. Treatment
Usually, the patient and the doctor are faced with two tasks at once. The first is that it is necessary to cure the cause of the disease. And the second task is aimed at treating directly paralyzed limbs. If therapy is carried out in two directions at once, then the treatment will be effective. Then the patient can count on a positive result.
If the prescribed course of treatment does not bring the desired results, the person will be asked to undergo surgical intervention in his body. Then, through surgery, try to return him to normal functioning. We must not forget that a surgical operation always carries the risk of any complications, both at the time of its implementation and after. But there are cases when surgery is the only chance that can return sensation to a person’s legs. A surgical treatment method can remove the reason that a person’s legs have become paralyzed. After the operation is performed, the patient will be prescribed a rehabilitation course. It includes physical therapy. As a result, a person can fully recover and return to a normal lifestyle.
Treatment and prevention
To treat paraparesis of the lower and upper extremities, an integrated approach is always necessary. It is mandatory to use treatment for the disease that provokes the syndrome, causing muscle weakness, as well as immediate intensive treatment of symptoms.
To make muscle tissue contract better, gymnastics and massage procedures are used. Over time, exercise requires more activity and increased stress on the muscles. In this case, each action performed must be strictly monitored by the attending physician.
Subsequent stages of treatment include exercise therapy courses, water treatments, physiotherapy, as well as electromyostimulation and the use of magnetic fields, acupuncture, individual massage procedures, and acupuncture.
Remarkable results continue to be demonstrated by the use of various psychotechniques and various trainings designed to improve the psychological state of patients.
Surgery is used extremely rarely. For the most part, such measures are necessary to eliminate diseases that cause paraparesis.
Water procedures are considered one of the most effective methods of preventing paresis of the upper and lower extremities.
