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Symptoms of central palsy and treatment of the disorder. Central paralysis Spastic paralysis symptoms

Central paralysis- dysfunction of a muscle or limb caused by damage to the central motor neuron. This type of paralysis is also called “spastic”, as it occurs against the background of muscle hypertension.

Most often it manifests itself as damage to the extremities. The peculiarity of the course of the condition is the increase in tendon reflexes, muscle tone, and the occurrence of abnormal muscle contractions (syncinesia).

Signs of central palsy may vary and depend on the extent of damage to the pyramidal tract nerve structures. In unfavorable scenarios, loss of function occurs in the upper or lower limb, which is located on the other side in relation to the affected area of the brain.

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Symptoms vary because damage to pyramidal fibers may occur in medulla oblongata, on the bridge, on the legs of the brain. They can affect a single limb or half of the body.

Reasons

It is important to understand the difference between paralysis and paresis. A sign of paralysis is when a person loses control over parts of their body. With paresis, muscles and reflexes noticeably weaken, but do not disappear. In both the first and second cases, the disorders are caused by damage to the nervous system.

Revealed a whole series factors that can negatively affect the state of motor centers and central pathways to their departments, which causes central paralysis.

These include:

traumatic lesions;
infections;
violations metabolic processes caused by various reasons;
genetic predisposition;
congenital disorders;
poisoning;
tumors;
poor nutrition.

People over 45 years of age are more susceptible to central paralysis, but this age is gradually decreasing. In more than half of the cases (60%), the development of these disorders was preceded by a stroke.

Disturbances in the blood supply to the brain can also cause neuronal damage. This may occur due to bleeding or due to a blood clot blocking the blood flow. In children, the main causative factor is hereditary predisposition, and the pathology itself is observed at an early age.

Symptoms

Central paralysis (spastic) has a number of specific signs, so diagnosing it is not difficult.

The main features include:

muscle hypertension;
increase in the area of distribution of reflexes;
increased reflexes;
upward wrinkling of the forehead;
rapid rhythmic contractions of the muscles of the kneecaps and feet.

The condition is accompanied by abnormal muscle tension. When palpated, the density of the muscles is felt, which is combined with their increased resistance, both during passive movement and when exerting influence.

Significant muscle hypertension is accompanied by restrictions on passive movements in the joint - the patient cannot bend or straighten the limb, and it simply freezes in an unnatural position.

An increase in the area of distribution of reflexes causes various visible signs paralysis Muscle contractions(clonuses) are the body’s response to tendon stretching and are the result of an increase in tendon reflexes. Rapid dorsiflexion causes clonus of the feet, and contractions of the patella muscles occur due to a sharp downward abduction of the lower limb.

Carpal foot reflexes, which arise due to disruption of the nervous system, indicate damage pyramid system.

This condition is also characterized by the formation of protective reflexes, which are manifested by twitching of the affected limb after mechanical or temperature exposure.

Against the background of central paralysis, synkinesis develops. Synkinesis are involuntary movements that arise during active directed actions. May be observed various types synkinesis. One of the most common is intense arm movements that accompany walking.

Muscle spasticity resulting from increased reflex tone, spreads unevenly. As a rule, half the body is immediately paralyzed. This condition is characterized by a situation in which upper limb close to the body, fingers and hand are bent, foot is turned inward, and lower limb extended at both the hip and knee joints.

This position is most common in patients with total loss control of limb movements and is called the “Wernicke-Mann posture”. People with this diagnosis can be identified by their characteristic gait: they need to move the affected lower limb far away so that it does not catch the ground. With spastic paralysis facial nerve numbness of the tongue, palate, facial tics, nystagmus (uncontrolled eye movements) occurs.

Another difference between spastic paralysis is a decrease or complete loss of abdominal, cremasteric, and plantar reflexes.

This pathology is not accompanied by pronounced muscle atrophy. However, there are signs that clearly indicate this violation:

the patient is in an unnatural position;
paresis of facial muscles;
phonotoric disorders;
speech disorders;
clonus;
muscle tremors;
gait disturbances;
uncontrolled mouth opening;
blepharospasm (closing of the eyelids);
uncontrollable shrugging of shoulders;
uncontrolled flexion and extension of joints;
muscle hypertonicity upon palpation.

Such specific symptoms make it possible to quickly carry out a differential diagnosis, determining the differences between the spastic form of paralysis and the peripheral one, and also to identify the main area of nerve damage.

Central paralysis in children

Not only adults, but also children experience damage to the central nervous system. Central paralysis in children is associated with brain damage during the prenatal period and at the time of birth. When placental blood flow is disrupted, nutritional disorders and oxygen starvation. It is the combination of this reason with birth trauma and leads to .

There are other reasons: intrauterine infections, some medications a woman can take, hemolytic disease- all this can cause infantile central paralysis. There is increasing evidence that the hereditary factor also plays an important role.

According to statistics, per 1000 births there are 2-3 cases of birth of children with cerebral palsy. The pathology is manifested by disorders affecting various functions: motor, speech, mental. Any violations can vary greatly in strength and can be either minimally expressed or very severe.

At severe forms cerebral palsy child cannot move independently or take care of himself. If pathology is observed medium degree heaviness, the child’s gait is uncertain and the use of assistive devices is often required. At mild degree movement disorders may be practically unnoticeable, but the movements are slow and awkward, characterized by the adoption of pathological poses and impaired fine motor skills.

Diagnostics

A neurologist examines, palpates muscles and collects anamnesis.

There are several tests that can determine the extent of damage to a limb.

Treatment

Since paralysis is not the root cause, but a consequence, efforts must be made to treat the underlying disease that caused it. Treatment of paralysis is aimed at eliminating its individual symptoms.

Mirror therapy

A gradually spreading method of treating paralysis in Western modern medicine is “mirror therapy”.
This method is based on the mobilization of the patient's internal strengths. TO vertical axis A mirror is placed on the edge of the patient's body, which is positioned in such a way that in the reflection he can see a healthy limb.
When a person looks towards his affected hand, he sees a healthy one. Under the guidance of a doctor, the patient tries to perform synchronous movements with both hands, while the specialist helps the affected limb to repeat the movements.
Thus, the patient is given the illusion that the limb is fully functioning, which motivates him and gives him the strength necessary for recovery.

Videos

The performance of such exercises can be recorded on video.
At the same time, the patient also observes how both his hands move.
Watching the video is alternated with attempts to repeat the exercises.
The work is based on the method of self-hypnosis.

Paresis is a decrease in muscle strength caused by injury nerve pathways connecting the brain to a muscle or group of muscles. This symptom occurs as a result of the same reasons as paralysis.

Paresis does not have one clear cause. It can occur with any type of brain injury or spinal cord, peripheral nerves. Depending on the level of damage, there are central(at the level of the brain and spinal cord) and peripheral (at the level of peripheral nerves) paresis.

Central paresis

Central paresis occurs when the brain or spinal cord is damaged. Disorders develop below the site of injury and usually affect the right or left half of the body (this condition is called hemiparesis). Most often, such a picture can be observed in a patient.

Sometimes central paresis causes problems in both arms or both legs ( paraparesis), and in the most severe cases - in all 4 limbs ( tetraparesis).

Main causes of central paresis:

stroke;
traumatic brain injuries, spinal cord injuries;
encephalitis;
tumors of the brain and spinal cord;
osteochondrosis, intervertebral hernia;
cerebral circulatory insufficiency due to atherosclerosis, arterial hypertension or other reasons;
amyotrophic lateral sclerosis;
children's cerebral palsy(cerebral palsy).

With central paresis, a decrease in muscle strength is expressed in varying degrees. In some cases it manifests itself in the form of rapid fatigue and awkwardness, while in others there is an almost complete loss of movement.

With central paresis, the part of the spinal cord below the site of injury remains intact - it tries to compensate for the disturbance. This leads to an increase in the tone of the affected muscles, strengthening of normal reflexes and the appearance of new, pathological ones, which do not occur in healthy person. Thus, in a patient who has suffered a stroke, the tone of the forearm flexor muscles increases. Therefore, the arm is always bent at the elbow. On the contrary, the tone of the extensors on the leg increases – due to this, it bends at the knee worse. Neurologists even have a figurative expression: “the hand asks, but the foot mows.”

Due to increased muscle tone and movement disorders central paresis can lead to contractures (restriction of joint movements).

Peripheral paresis

Peripheral paresis occurs when the nerve is directly damaged. In this case, disorders develop in one group of muscles that this nerve innervates. For example, muscle weakness may occur in only one arm or leg (monoparesis). The larger the nerve is damaged, the larger part of the body the paresis covers.

Main reasons peripheral paresis:

degenerative diseases spine, radiculitis;
demyelinating diseases;
nerve damage due to vasculitis and diseases connective tissue;
compression of the nerves (“ tunnel syndromes»);
nerve injuries;
poisoning with alcohol and other substances.

Peripheral paresis is also called flaccid. Muscle weakness, decreased tone, and weakened reflexes occur. Involuntary muscle twitching is noted. Over time, the muscles decrease in volume (atrophy develops), and contractures occur.

Diagnosis of paresis

Paresis and paralysis are identified by a neurologist during an examination. The doctor asks the patient to do different movements, then tries to bend or straighten the affected limb and asks the patient to resist. A test is performed during which the patient must hold both legs or arms suspended. If muscle strength is reduced in one of the limbs, then after 20 seconds it will noticeably drop down.

After the examination, the doctor prescribes an examination that helps to identify the cause of the paresis.

Treatment and rehabilitation for paresis

Treatment depends on the cause of the paresis. Rehabilitation treatment is of great importance for restoring movements and preventing contractures. Unfortunately, today in many Russian clinics little attention is paid to this issue due to the lack of special equipment and trained specialists.

Rehabilitation treatment for paresis includes:

therapeutic exercises;
massage;
mechanotherapy on special simulators;
use of orthoses;
neuromuscular stimulation;
physiotherapy.

At the Yusupov Hospital, increased attention is paid to the rehabilitation of neurological patients. After all, the restoration of function, performance, and quality of life of the patient in the future depends on this.

Advantages of Yusupov Hospital

The average experience of our neurologists is 14 years. Many have an academic degree and are doctors highest category;
Well-developed area of rehabilitation treatment - modern equipment for mechanotherapy, experienced instructors;
We adhere exclusively to the principles evidence-based medicine and use the best practices of foreign colleagues;
We did everything to make the patient feel comfortable in the clinic, to create positive attitude for recovery.

All this serves one goal - to achieve maximum therapeutic effect for each patient, the fastest and most complete restoration of impaired functions, improving the quality of life.

References

ICD-10 ( International classification diseases)
Yusupov Hospital
Batueva E.A., Kaygorodova N.B., Karakulova Yu.V. The influence of neurotrophic therapy on neuropathic pain and the psychovegetative status of patients diabetic neuropathy// Russian Journal of Pain. 2011. No. 2. P. 46.
Boyko A.N., Batysheva T.T., Kostenko E.V., Pivovarchik E.M., Ganzhula P.A., Ismailov A.M., Lisinker L.N., Khozova A.A., Otcheskaya O .V., Kamchatnov P.R. Neurodiclovit: possibility of use in patients with back pain // Farmateka. 2010. No. 7. pp. 63–68.
Morozova O.G. Polyneuropathy in somatic practice // Internal medicine. 2007. No. 4 (4). pp. 37–39.

Paralysis is the complete loss of voluntary movements in certain muscle groups, paresis is the partial (incomplete) loss of voluntary movements. Let us recall that for the implementation of voluntary movements, the preservation of the cortico-muscular pathway is necessary - a two-neuron pathway connecting the cortex cerebral hemispheres brain with skeletal (striated) muscles. The body of the first (upper, or central) neuron is located in the cortex of the precentral gyrus, its axon is sent to form a synapse with the second (lower, or peripheral) motor neuron located in the spinal cord. The axons of the peripheral motor neuron go directly to the muscle. Paralysis (paresis) occurs when both central and peripheral neurons of the corticomuscular pathway are damaged.

Spastic (central) paralysis occurs when the upper (central) motor neuron of the corticomuscular tract is affected, indicating that the lesion is located in either the brain or the spinal cord. Main characteristic manifestations central paralysis (paresis) are the following [P. Duus, 1995]:

spastic increase in muscle tone (hypertension);

decreased muscle strength combined with loss of the ability to make fine movements;

increased deep (proprioceptive) reflexes;

decrease or loss of exteroceptive reflexes (abdominal, cremasteric, plantar);

the appearance of pathological reflexes (Babinsky, Oppenheim, Gordon, etc.);

absence of degenerative muscle atrophy.

Hypertension, or muscle spasticity, determines another name for central paralysis - spastic. The muscles are tense, dense to the touch; During passive movements, a clear resistance is felt, which is sometimes difficult to overcome. This spasticity is the result of increased reflex tone and is usually unevenly distributed, leading to typical contractures. With central paralysis, the upper limb is usually brought to the body and bent in a elbow joint: The hand and fingers are also in a flexed position. The lower limb is extended at the hip and knee joints, the foot is bent and the sole is turned inward (the leg is straightened and “elongated”). This position of the limbs with central hemiplegia creates a peculiar Wernicke-Mann position, the interpretation of the patterns of its occurrence from the point of view of the history of the development of the nervous system was given by M.I. Astvatsaturov.

The gait in these cases is of a “circumducing” nature: due to the “lengthening” of the leg, the patient has to “circle” the affected leg (in order not to touch the floor with the toe).

Increased tendon reflexes (hyperreflexia) are also a manifestation of increased, disinhibited, automatic activity of the spinal cord. Reflexes from the tendons and periosteum are extremely intense and are easily caused by even minor irritations: reflexogenic zone is expanding significantly, i.e. the reflex can be evoked not only from the optimal area, but also from neighboring areas. An extreme degree of increase in reflexes leads to the appearance of clonus (see above).

In contrast to tendon reflexes, skin reflexes (abdominal, plantar, cremasteric) do not increase with central paralysis, but disappear or decrease.

Concomitant movements, or synkinesis, observed with central paralysis, can occur in the affected limbs reflexively, in particular when healthy muscles are tense. Their occurrence is based on the tendency to irradiate excitation in the spinal cord to a number of neighboring segments of its own and opposite sides, which is normally moderated and limited by cortical influences. When the segmental apparatus is disinhibited, this tendency to spread excitation is revealed with particular force and causes the appearance of “additional” reflex contractions in the paralyzed muscles.

There are a number of synkinesis characteristic of central paralysis. Here are some of them:

1) if the patient, according to the instructions, resists with his healthy hand the extension in the elbow joint produced by the examiner, or strongly shakes his hand with his healthy hand, then a concomitant reflex flexion occurs in the paralyzed arm;

2) the same flexion of the affected arm occurs when coughing, sneezing, or yawning;

3) under the mentioned conditions, involuntary extension is observed in the paralyzed leg (if the patient is sitting with his legs hanging over the edge of the couch or table);

4) the patient lying on his back with his legs extended is asked to adduct and abduct his healthy leg, in which he is resisted. In this case, an involuntary corresponding adduction or abduction is observed in the paralyzed leg;

5) the most constant of the accompanying movements with central paralysis is the symptom of combined flexion of the hip and trunk. When the patient tries to move from a horizontal position to a sitting position (the patient lies on his back with his arms crossed on his chest and straightened legs apart), the paralyzed or paretic leg is raised (sometimes adducted).

Pathological reflexes are a group of very important and persistent symptoms central paralysis. Of particular importance are pathological reflexes on the foot, which are observed, of course, in cases where the lower limb is affected. The most sensitive symptoms are Babinski (perverted plantar reflex), Rossolimo and Bekhterev. The remaining pathological reflexes on the foot (see above) are less constant. Pathological reflexes in the hands are usually weakly expressed and of great importance in practice clinical trial did not purchase. Pathological reflexes on the face (mainly a group of “oral” reflexes) are characteristic of central paralysis or paresis of the muscles innervated cranial nerves, and indicate bilateral supranuclear lesions of the tractus cortico-bulbaris in the cortical, subcortical or brainstem regions.

Central paralysis occurs when the central nutrient neuron is damaged in any part of it (motor zone of the cerebral cortex, brain stem, spinal cord). A break in the pyramidal tract removes the influence of the cerebral cortex on the segmental reflex apparatus of the spinal cord; his own apparatus is disinhibited.

In this regard, all the main signs of central paralysis are in one way or another associated with increased excitability of the peripheral segmental apparatus. The main signs of central paralysis are muscle hypertension, hyperreflexia, expansion of the zone of evoking reflexes, clonus of the feet and kneecaps, pathological reflexes, protective reflexes and pathological synkinesis. The difference between central and peripheral paralysis is characterized by the data presented in table. 1 (see p. 170).

With muscular hypertension, the muscles are tense and dense to the touch; Their resistance during passive movement is felt more at the beginning of the movement. Severe muscle hypertension leads to the development of contractures - a sharp limitation of active and passive movements in the joints, and therefore the limbs can “freeze” in incorrect posture. Hyperreflexia is accompanied by an expansion of the zone of evocation of reflexes. Clonus of the feet, kneecaps and hands are rhythmic muscle contractions in response to stretching of the tendons. They are a consequence of a sharp increase in tendon reflexes. Foot clonus is caused by rapid dorsiflexion of the feet. In response to this, rhythmic twitching of the feet occurs. Sometimes foot clonus is also noted when inducing a reflex from the heel tendon. Patella clonus is caused by sudden downward abduction of the kneecap.

Pathological reflexes appear when the pyramidal tract is damaged at any of its levels. There are hand and foot reflexes. Greatest diagnostic value have pathological reflexes on the foot: reflexes of Babinsky, Oppenheim, Gordon, Schaeffer, Rossolimo, Zhukovsky.

When studying reflexes, it should be taken into account that in a newborn and children early age These reflexes are normally detected.

The Babinski reflex is caused by line irritation of the foot closer to its outer edge. In this case, a fan-shaped spread of the fingers and extension occurs thumb(perverted plantar reflex) (see Fig. 42). A distinct extension of the thumb and a fan-shaped spread of all other fingers occurs when the hand is vigorously drawn from top to bottom along the inner edge of the thumb tibia(Oppenheim reflex) (Fig. 59), pressing calf muscle(Gordon reflex) (Fig. 60), compression of the Achilles tendon (Schaeffer reflex) (Fig. 61). Listed pathological symptoms are an extensor group of pathological reflexes.

There are also flexion reflexes. When the flesh of the tips of the toes is abruptly struck, they bend (Rossolimo reflex) (Fig. 62). The same effect is observed when hitting the dorsum of the foot with a hammer in the area of the base of the II-IV fingers (Bekhterev reflex) (Fig.

63) or in the middle of the sole at the base of the fingers (Zhukovsky reflex) (Fig. 64).

Protective reflexes occur in response to pain or temperature stimulation of a paralyzed limb. At the same time, she involuntarily withdraws.

Synkinesias are involuntary friendly movements that occur accompanied by active movements (for example, waving your arms while walking). With central paralysis, pathological synkinesis is observed. So, when the muscles of a healthy limb on the paralyzed side are tense, the arm is bent at the elbow and brought to the body, and the leg is extended.

Rice. 63. Study of the ankylosing spondylitis reflex

Rice. 64. Study of the Zhukovsky reflex

Rice. 59. Study of the Oppenheim reflex

Rice. 60. Gordon's reflex study

Rice. 61. Study of the Schaeffer reflex

Rice. 62. Study of the Rossolimo reflex

Lesion of the pyramidal tract in the lateral column of the spinal cord causes central paralysis of the muscles below the level of the lesion. If the lesion is localized in the area of the upper cervical segments of the spinal cord, then central hemiplegia develops, and if in thoracic region spinal cord, then central leg plegia.

Damage to the pyramidal tract in the area brain stem leads to central hemiplegia on the opposite side. At the same time, the nuclei or roots of the cranial nerves may be affected. In this case, cross syndromes may occur: central hemiplegia on the opposite side and peripheral paralysis of the muscles of the tongue, face, eyeball on the affected side (Fig. 65). Cross syndromes make it possible to accurately determine the location of the lesion. Lesion of the pyramidal tract in the internal capsule is characterized by central hemiplegia on the opposite side with central paralysis of the muscles of the tongue and face on the same side (Fig. 66, 67). Damage to the anterior central gyrus most often leads to monoplegia on the opposite side.

Rice. 67. Characteristic posture of a patient with capsular paralysis (Wernicke-Mann position)

Central paralysis of the facial muscles differs from the peripheral paralysis observed with neuritis of the facial nerve or with the Miyaoa-Gublep cross syndrome in that only the muscles of the lower half of the face are affected. The patient cannot extend his lips forward and grin his teeth on the affected side. His nasolabial fold is smoothed and the corner of his mouth is lowered. However, the forehead muscles remain intact, palpebral fissure closes completely. There is no lacrimation, hyperacusis or taste disorder.

With central paralysis of the tongue muscles, tongue atrophy does not develop.

It arises as a result of damage to the central motor neuron in any part of it and differs from the peripheral one in a number of ways: pronounced muscles are not characteristic here and there is no degeneration reaction, neither muscle atony nor loss of reflexes is observed.

Symptoms:

The main features of central paralysis are muscle hypertonia, increased tendon reflexes, so-called accompanying movements, or synkinesis, and pathological reflexes.

Hypertension, or muscle spasticity, determines another name for central paralysis - spastic. The muscles are tense, dense to the touch; During passive movements, a clear resistance is felt, which is sometimes difficult to overcome. This spasticity is the result of increased reflex tone and is usually unevenly distributed, leading to typical contractures. With central paralysis, the upper limb is usually brought to the body and bent at the elbow joint: the hand and fingers are also in a flexed position. The lower limb is extended at the hip and knee joints, the foot is bent and the sole is turned inward (the leg is straightened and “elongated”). This position of the limbs with central hemiplegia creates a peculiar Wernicke-Mann position, the interpretation of the patterns of its occurrence from the point of view of the history of the development of the nervous system was given by M.I.　 Astvatsaturov.

The gait in these cases is of a “circumducing” nature: due to the “lengthening” of the leg, the patient has to “circle” the affected leg (in order not to touch the floor with the toe).

Increased tendon reflexes (hyperreflexia) are also a manifestation of increased, disinhibited, automatic activity of the spinal cord. Reflexes from the tendons and periosteum are extremely intense and are easily caused by even minor irritations: the reflexogenic zone expands significantly, i.e. the reflex can be caused not only from the optimal area, but also from neighboring areas. An extreme degree of increase in reflexes leads to the appearance of clonus (see above).

In contrast to tendon reflexes, skin reflexes (abdominal, plantar, cremasteric) do not increase with central paralysis, but disappear or decrease.

There are a number of synkinesis characteristic of central paralysis. Here are some of them:

2) the same flexion of the affected arm occurs when coughing, sneezing, or yawning;

3) under the mentioned conditions, involuntary extension is observed in the paralyzed leg (if the patient is sitting with his legs hanging over the edge of the couch or table);

Pathological reflexes are a group of very important and constant symptoms of central paralysis. Of particular importance are pathological reflexes on the foot, which are observed, of course, in cases where the lower limb is affected. The most sensitive symptoms are Babinski (perverted plantar reflex), Rossolimo and Bekhterev. The remaining pathological reflexes on the foot (see above) are less constant. Pathological reflexes in the hands are usually weakly expressed and have not acquired much significance in the practice of clinical research. Pathological reflexes on the face (mainly a group of “oral” reflexes) are characteristic of central paralysis or paresis of muscles innervated by cranial nerves, and indicate bilateral supranuclear lesions of the tractus cortico-bulbaris in the cortical, subcortical or brainstem regions.

Symptoms such as increased tendon reflexes of the extremities, weakened abdominal reflexes and Babinski's sign are very subtle and early signs violations of the integrity of the pyramidal system and can be observed when the lesion is not yet sufficient to cause paralysis or even paresis. Therefore, their diagnostic value is very great. E.L.　 Venderovich described the symptom of “ulnar motor defect”, indicating a very mild degree pyramidal lesion: on the affected side the patient’s resistance to forcible abduction towards the maximum brought to the fourth finger of the little finger is weaker.

Causes:

Spastic paralysis occurs due to damage to the motor neuron. Since the arrangement of cells and fibers of the pyramidal fascicles is quite close, central paralysis is usually diffuse, spreading to an entire limb or half of the body. Peripheral paralysis may be limited to damage to certain muscle groups or even individual muscles. There may, however, be exceptions to this rule. Thus, a small lesion in the cerebral cortex can cause the occurrence of isolated central paralysis of the foot, face, etc.; conversely, multiple diffuse lesions of the nerves or anterior horns of the spinal cord sometimes cause widespread paralysis of the peripheral type.
The most common causes of spasticity are stroke, traumatic brain and spinal injuries, perinatal (cerebral palsy), etc. The cause of spasticity is an imbalance in nerve impulses. Which are sent nervous system muscles. It leads to increased tone the latter.
Other causes of spasticity:

      * Brain injuries
      * Spinal cord injury
      * Brain damage due to lack of oxygen (hypoxia)
      *
      * (inflammation of brain tissue)
      * (inflammation of the tissue of the meninges)
      * Adrenoleukodystrophy
      * Amyotrophic lateral sclerosis
      *

Treatment:

For treatment the following is prescribed:

There are several treatments for spasticity. They all pursue the following goals:

      * Relief of symptoms of spasticity
      * Reducing pain and muscle spasm
      * Improving gait, daily activity, hygiene and care
      * Facilitation of voluntary movements

Physiotherapeutic methods for treating spasticity:

Physiotherapy is performed to reduce muscle tone and improve movement, strength and muscle coordination.

Drug therapy for spasticity:

Application drug therapy indicated for daily disruption of normal muscle activity. Effective drug treatment involves the use of two or more drugs in combination with other treatment methods. Drugs used for spasticity include:

      * Baclofen
      * Benzodiazepines
      * Datrolene
      * Imidazoline
      * Gabaleptin

Botulinum toxin injections for spasticity:

Botulinum toxin, also known as Botox, is effective in very small quantities when injected into paralyzed muscles. When Botox is injected into a muscle, the action of the neurotransmitter acetylcholine, which helps transmit impulses in nerves, is blocked. This leads to muscle relaxation. The effect of the injection begins within a few days and lasts about 12 – 16 weeks.

Surgical treatment of spasticity:

TO surgical treatment include intrathecal baclofen and selective dorsal rhizotomy.

Intrathecal administration of baclofen. For severe cases of spasticity, baclofen is given by injecting it directly into the cerebrospinal fluid. To do this, an ampoule with baclofen is implanted into the skin of the abdomen.

Selective dorsal rhizotomy. In this operation, the surgeon cuts certain nerve roots. This method is used to treat severe spasticity that interferes with normal walking. In this case, only the sensory nerve roots are crossed.