Paralysis
Paralysis can occur for a variety of reasons. They are based, for example, on nerve injuries or diseases of the central nervous system. These can manifest themselves as complete paralysis of the muscle - or only partially paralyze muscle function. Read here what causes paralysis, how it expresses itself and which therapies can help.
What is paralysis?
The impulse for a movement comes from the brain. It is transmitted via the spinal cord and finally reaches the muscle via peripheral nerves. If this flow of communication is interrupted at one point, paralysis occurs. Then the muscle function fails partially or completely.
The cause is usually damage or disruption to the nerve tracts or the corresponding switching points in the brain. Individual limbs, certain parts of the body or an entire side of the body are then affected by paralysis. The affected muscles and body parts can usually hardly or no longer move.
Attention:
Call an emergency doctor if symptoms of paralysis occur within a short period of time, if they are accompanied by shortness of breath or lack of air, or if you can no longer control the urinary bladder and anal sphincter!
Forms of paralysis and how they manifest themselves
Paralysis is classified according to the causes, the extent and the effects or the affected regions. Depending on how pronounced the paralysis is, doctors basically differentiate between
- Paresis - a partial paralysis or a partial loss of muscle strength
- Paralysis / plegia - a complete paralysis
Plegia and paresis
Medical professionals describe complete paralysis that affects the skeletal muscles as plegia. These include the following phenomena:
Monoplegia only affects a single limb or part of it, such as an arm or just the hand.
In paraplegia (form of paraplegia), the entire lower half of the body is paralyzed - for example as a result of an injury to the spine or a severe herniated disc. The legs, buttocks and lower torso are particularly affected.
Quadriplegia, on the other hand, affects all four extremities, for example after an injury to the spinal cord in the neck area. The patient can control head movements, but arms and legs are paralyzed.
In hemiplegia ("hemiplegia") the body is paralyzed on one side. It occurs, for example, as a result of a stroke.
Note:
If, on the other hand, it is an incomplete paralysis (paresis), then doctors speak - depending on the extent - of monoparesis, paraparesis, tetraparesis or hemiparesis.
Do not move is the motto here - but only if the patient is not unconscious. Read more about first aid for spinal injuries! Learn more
Spastic paralysis (central paralysis)
In spastic paralysis (central paralysis), nerves of the central nervous system - that is, the brain or spinal cord - are damaged. The brain controls the body's muscles via the spinal cord. In the event of damage, the muscle tension (muscle tone) in the affected region increases: the muscles stiffen and the ability to move is restricted. Muscle reflexes are easier to trigger.
Doctors differentiate between the following forms of spastic paralysis:
- Monospasticity: Affected is a leg or arm.
- Paraspasticity: Both legs are affected.
- Hemispasticity: Affected are the arm and leg on one side of the body.
- Tetraspasticity: Both arms and legs are affected, sometimes also the neck and trunk muscles.
Flaccid paralysis (peripheral paralysis)
In flaccid paralysis (peripheral paralysis), the nerve that leads from the spinal cord to the muscles is damaged. As a result, the transmission of impulses to the muscle is weakened or interrupted. In contrast to spastic paralysis, the muscle tone is then reduced or completely eliminated. The reflexes are also reduced or have completely disappeared.
Consequential damage from paralysis
Other symptoms can occur in connection with paralysis:
- Shortened muscles
- Postural damage
- Misalignment, deformation and wear and tear of the joints
- Incoordination
- Difficulty swallowing and speaking
- Squint
- Double vision (diplopia)
In general, paralysis can severely limit the lives of those affected and their relatives. Severe courses may bind paralyzed people to a wheelchair for life. Breathing can also be impaired, sometimes so much that the patient has to be continuously ventilated (home ventilation). Some diseases also progress inexorably, such as amyotrophic lateral sclerosis, which is always fatal.
What causes paralysis?
Symptoms of paralysis occur mainly due to diseases or damage to the brain, the spine, the nerve tracts or the muscles.
With central paralysis, communication between the brain and muscles is disturbed. The cause can then lie directly in the brain or affect the spinal cord. With peripheral paralysis, however, nerves outside the central nervous system are damaged. The paralysis can also be the result of direct muscle disease or damage.
Causes in the brain and spinal cord (CNS)
Possible causes of paralysis that are located in the central nervous system include, for example:
- Injury to the brain or spinal cord from an accident
- Multiple sclerosis (MS)
- (other) inflammations of the brain or spinal cord (e.g. meningitis, myelitis, encephalitis), e.g. due to infections
- stroke
- Cerebral hemorrhage
- disc prolapse
- Tumors in the brain or spinal cord
- Poisoning (e.g. botulism)
- Lack of oxygen (e.g. before or during childbirth or due to an accident)
- Infantile cerebral palsy
- Vitamin B-12 deficiency (funicular myelosis)
Triggers peripheral paralysis
The following clinical pictures mainly affect the peripheral nerves and cause flaccid paralysis:
- Guillain-Barré syndrome (more rarely also centrally possible)
- chronic inflammatory demyelinating polyneuropathy (CIDP)
- Polyneuropathies (e.g. due to diabetes or alcohol)
- Spinal muscular atrophy (and other motor neuron diseases)
- Injuries to the peripheral muscular nerves (e.g. from operations, accidents or cancerous growths)
Mixed forms and other causes of paralysis
Amyotrophic lateral sclerosis affects both the central and peripheral nerves (first and second motor neurons). Therefore, sufferers have both spastic and flaccid paralysis.
With other clinical pictures, both flaccid and spastic paresis and plegia can occur. In the case of acute damage to the spinal cord, flaccid paralysis sometimes occurs first (e.g. spinal shock in the case of accidental spinal cord injuries). Over time, the muscle tone increases to spasticity.
In addition to damage to the central and peripheral nervous system, there are diseases that affect muscles directly, so-called myopathies. They usually trigger muscle weakness up to paresis. This also includes, for example, myasthenia gravis, muscular dystrophies or rheumatic diseases such as poly- and dermatomyositis.
Examinations for paralysis
To diagnose paralysis or its cause, the doctor first conducts a detailed anamnesis discussion. This is followed by a physical exam. He tests mobility, muscle strength, reflexes and sensations (neurological examination).
In order to get to the bottom of the cause of the paralysis, further examinations are often necessary.
- Computed tomography or magnetic resonance imaging can detect pathological changes - for example a stroke or a herniated disc.
- The so-called electromyography (EMG) can be used to determine the electrical activity of the muscles.
- Electronurography (ENG) examines the functionality of the peripheral nerves, such as how quickly they conduct impulses (nerve conduction speed).
- With an examination of the nerve water that doctors obtain at the level of the lower lumbar spine (liquor puncture), diseases such as inflammatory diseases of the central nervous system can be detected.
- With a muscle biopsy, the doctor can determine a disease of the muscle itself as the cause of the paralysis.
This is how you treat paralysis
The treatment of paralysis depends on the cause of the disease. If a bacterial or viral infection causes the paralysis, antibiotics or antivirals can help. Tumors that press on nerve tissue can shrink through radiation, surgery, or chemotherapy.
Spasticity, on the other hand, is usually improved with targeted Botox injections. However, if a nerve is permanently damaged or even severed, it can usually no longer be cured - but accompanying symptoms can be alleviated.
Physiotherapy is an important component of therapy for paralysis. This is especially true for paralysis that occurs as a result of muscle and nerve diseases. Appropriate exercises stretch shortened muscles, improve mobility and blood circulation and slow down muscle breakdown.
Physiotherapeutic measures also alleviate postural damage and malpositions caused by the paralysis. Occupational therapy is also important so that the paralyzed can return to their everyday life and master it.
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