Spastic paralysis

Description:

Spastic (central) paralysis results from damage of the central motor neuron in any its department and differs from peripheral признаов:здесь nearby the expressed atrophies of muscles are not characteristic and there is no reaction of degeneration, neither the atony of muscles, nor loss of reflexes is observed.

Symptoms of Spastic paralysis:

The main lines of the central paralysis are the hypertension of muscles, increase in tendon jerks, the so-called accompanying movements, or synkineses, and pathological reflexes.

The hypertension, or spasticity of muscles, defines other name of the central paralysis — spastic. Muscles are strained, dense to the touch; at the passive movements the clear resistance which hardly manages to be overcome sometimes is felt. This spasticity is result of increase in a reflex tone and is distributed usually unevenly that leads to typical contractures. At the central paralyzes the upper extremity is usually given to a trunk and bent in an elbow joint: the brush and fingers also are in the provision of bending. The lower extremity is unbent in coxofemoral and knee joints, foot is bent and turned by a sole inside (the leg is straightened and "extended"). Such position of extremities at the central hemiplegia creates a peculiar pose of Vernike — Mann which interpretation of patterns of emergence from the point of view of history of development of a nervous system of a danom.a. 　 Astvatsaturov.

Gait in these cases has "tsirkumdutsiruyushchy" character: because of "lengthening" of a leg it is necessary the patient (not to touch with a floor sock) "to lead round" the affected leg.

Increase in tendon jerks (hyperreflexia) is also manifestation of the strengthened, stirred up, automatic activity of a spinal cord. Reflexes from sinews and a periosteum are extremely intensive and are caused easily as a result even insignificant irritation: the reflexogenic zone considerably extends, i.e. the reflex can be caused not only from the optimum site, but also from the neighboring areas. Extreme extent of increase in reflexes leads to emergence of clonuses (see above).

Contrary to tendinous, cutaneous reflexes (belly, bottom, kremasterny) at the central paralysis do not raise, and disappear or go down.

The accompanying movements, or the synkineses observed at the central paralysis can arise in the affected extremities reflex, in particular at a tension of healthy muscles. Them the bent to irradiation of excitement in a spinal cord on a number of the next segments of the and opposite parties normal moderated and limited by cortical influences is the cornerstone of emergence. At counterinhibition of the segmented device this bent to spread of activation comes to light with a special force and causes emergence of "additional", reflex reductions in the paralyzed muscles.

There is a number of a synkinesis, characteristic of the central paralysis. Let's bring some of them here:

1) if the patient on a task shows a healthy hand resistance to the extension in an elbow joint made investigating or strongly shakes hands with it a healthy brush, then in the paralyzed hand there is an accompanying reflex bending;

2) the same bending of the affected hand happens at cough, sneezing, yawning;

3) under the mentioned conditions in the paralyzed leg (if the patient sits with the shins which are hanging down for edge of a couch or table) involuntary extension is observed;

4) suggest to bring and allocate for the patient lying on spin with the extended legs a healthy leg in what show it resistance. In the paralyzed leg involuntary corresponding reduction or assignment is observed at the same time;

5) the most constant of the accompanying movements at the central paralysis is the symptom of the combined bending of a hip and trunk. In attempt of the patient to pass from horizontal position in sedentary (the patient lies on spin with the hands and the divorced straightened legs crossed on a breast), the paralyzed or paretic leg rises (sometimes and it is brought).

Pathological reflexes are group of very important and constant symptoms of the central paralysis. The pathological reflexes on foot which are observed have special value it is clear when struck there is the lower extremity. Babinsky's symptoms (the perverted bottom reflex), Rossolimo and Bekhterev are the most sensitive. Other pathological reflexes on foot (see above) are less constant. Pathological reflexes on hands are expressed usually poorly and did not gain great value in practice of clinical trial. Pathological reflexes on a face (mainly group of "oral" reflexes) are characteristic of the central paralysis or paresis of the muscles innervated by cranial nerves and indicate bilateral nadjyaderny defeat of tractus cortico-bulbaris in cortical, subcrustal or trunk departments.

Such symptoms as increase in tendon jerks of extremities, weakening of belly reflexes and Babinsky's symptom, are very thin and precursory symptoms of disturbance of an integrity of pyramidal system and can be observed when defeat still is not enough for developing of the paralysis or even paresis. Therefore their diagnostic value is very big. E.L. 　 Venderovich described the symptom of "ulnarny motive defect" indicating very easy extent of pyramidal defeat: on the struck party the patient's resistance to violent assignment is weaker than the little finger which is most given to the IV finger aside.

Reasons of Spastic paralysis:

Spastic paralysis arises because of damage of a motor neuron. As the arrangement of cells and fibers of pyramidal bunches quite close, the central paralyzes usually of a diffuzna, extend to the whole extremity or a half of a body. Peripheral paralyzes can be limited to defeat of some muscular groups or even separate muscles. From this rule, however, there can be also exceptions. So, the small ochazhok in a cerebral cortex can cause developing of the isolated central paralysis of foot, the person и　т.д.; and vice versa, multiple diffusion damage of nerves or front horns of a spinal cord causes sometimes widespread paralyzes of peripheral type.
Most often the stroke, craniocereberal and spinal injuries, perinatal encephalopathy (cerebral palsy) and multiple sclerosis result in spasticity. The imbalance in nervous impulses is the reason of spasticity. Which go a nervous system to muscles. It conducts to the raised tone of the last.
Other reasons of spasticity:

    * Brain injuries
    * Injury of a spinal cord
    * Damage of a brain in view of shortage of oxygen (hypoxia)
    * Stroke
    * Encephalitis (brain tissue inflammation)
    * Meningitis (inflammation of fabric of covers of a brain)
    * Adrenoleykodistrofiya
    * Amyotrophic side sclerosis
    * Fenilketonuriya

Treatment of Spastic paralysis:

There are several methods of treatment of spasticity. All of them pursue the following aims:

    * Spasticity relief of symptoms
    * Reduction of pain and muscular spasm
    * Improvement of gait, daily activity, hygiene and leaving
    * Simplification of autokinesias

Physiotherapeutic methods of treatment of spasticity:

The physical therapy is carried out for the purpose of reduction of a muscle tone, improvement of movements, force and coordination of muscles.

Medicamentous therapy of spasticity:

Use of medicamentous therapy is shown at daily disturbance of normal activity of muscles. Effective drug treatment includes use of two and Bol of drugs in combination with other methods of treatment. Treat the drugs used at spasticity:

    * Baclofenum
    * Benzodiazepines
    * Datrolen
    * Imidazoline
    * Gabaleptin

Injections of botulinum toxin at spasticity:

The botulinum toxin known also as Botox, is effective in very small quantities at introduction to the paralyzed muscles. At introduction to the Botox muscle action of a neurotransmitter of acetylcholine, h by the help of which is carried out momentum transfer in nerves, blocked. It leads to relaxation of muscles. Action of an injection begins within several days and about 12 - 16 weeks last.

Surgical treatment of spasticity:

Intrathecal introduction of Baclofenum and the selection dorsal rhizotomy belong to surgical treatment.

Intrathecal introduction of Baclofenum. At hard cases of spasticity Baclofenum is appointed by introduction directly to cerebrospinal fluid. For this purpose the ampoule with Baclofenum is implanted into skin of a stomach.

The selection dorsal rhizotomy. At this operation the surgeon crosses certain nervous roots. This method is used for treatment of heavy spasticity which prevents normal walking. At the same time only sensitive nervous roots are crossed.