What is Bell’s palsy. How does it affect facial muscles. What are the main symptoms of Bell’s palsy. What causes this condition. How is Bell’s palsy diagnosed and treated. Can Bell’s palsy be prevented or avoided. What is the typical recovery process for Bell’s palsy.

Understanding Bell’s Palsy: A Temporary Facial Paralysis

Bell’s palsy is a condition that causes temporary paralysis or weakness of the facial muscles, typically affecting one side of the face. This neurological disorder occurs when the facial nerve, also known as the 7th cranial nerve, becomes damaged or inflamed. While the exact cause remains unclear in many cases, Bell’s palsy can significantly impact a person’s facial expressions, speech, and ability to eat or drink.

The condition usually develops suddenly, with symptoms worsening over a 48-hour period. Although it may seem alarming at first, Bell’s palsy is generally not a long-term condition and often resolves on its own within a few weeks to months.

Who is at risk for Bell’s palsy?

Bell’s palsy can affect individuals of any age, but it is most commonly observed in:

• People between 15 and 60 years old
• Pregnant women
• Individuals with diabetes
• Those with recent upper respiratory infections

The condition affects approximately 1 in 5,000 people, with equal prevalence among men and women. While it’s rare to experience Bell’s palsy more than once, those who have had it before have a slightly higher risk of recurrence.

Recognizing the Symptoms of Bell’s Palsy

The symptoms of Bell’s palsy can be quite striking and may initially be mistaken for those of a stroke. It’s crucial to seek immediate medical attention if you experience sudden facial weakness or paralysis to rule out more serious conditions.

Common symptoms of Bell’s palsy include:

• Drooping on one side of the face
• Difficulty smiling or making facial expressions
• Trouble closing one eye
• Dry eye on the affected side
• Twitching of facial muscles
• Difficulty eating or drinking
• Impaired speech
• Altered sense of taste
• Pain around the jaw or behind the ear
• Increased sensitivity to sound
• Headache

These symptoms typically affect only one side of the face and appear rapidly, reaching their peak within a couple of days. In rare cases, both sides of the face may be affected.

Unraveling the Causes of Bell’s Palsy

While the exact cause of Bell’s palsy remains unknown in many cases, researchers believe it may be triggered by viral infections that cause inflammation and swelling of the facial nerve. This swelling can compress the nerve against the surrounding bone, disrupting its function and leading to facial weakness or paralysis.

Several factors may increase the risk of developing Bell’s palsy:

1. Viral infections, such as herpes simplex, influenza, or the common cold
2. Diabetes
3. High blood pressure
4. Lyme disease
5. Mononucleosis
6. Autoimmune disorders, including HIV
7. Sarcoidosis
8. Head trauma

Is Bell’s palsy related to stress?

While stress is not directly listed as a cause of Bell’s palsy, some studies suggest that periods of high stress may weaken the immune system, potentially making individuals more susceptible to viral infections that could trigger the condition. However, more research is needed to establish a clear link between stress and Bell’s palsy.

Diagnosing Bell’s Palsy: What to Expect

Diagnosing Bell’s palsy involves a careful evaluation of symptoms and medical history. There is no specific test to definitively diagnose the condition, but healthcare providers use various methods to rule out other potential causes of facial paralysis.

The diagnostic process may include:

• Physical examination of facial muscles
• Review of medical history
• Neurological tests to assess nerve function
• Imaging studies such as X-rays or MRI to exclude other conditions
• Blood tests to check for underlying infections or disorders

How is Bell’s palsy differentiated from a stroke?

Distinguishing Bell’s palsy from a stroke is crucial for proper treatment. While both conditions can cause facial weakness, a stroke typically affects other parts of the body as well. In Bell’s palsy, the forehead muscles are usually involved, whereas in a stroke, these muscles often remain unaffected. Additionally, stroke symptoms tend to develop more gradually compared to the sudden onset of Bell’s palsy.

Treatment Options for Bell’s Palsy

While Bell’s palsy often resolves on its own within 1 to 2 months, various treatments can help manage symptoms and potentially speed up recovery. The primary goals of treatment are to reduce inflammation, protect the affected eye, and support the healing process.

Common treatment approaches include:

1. Corticosteroids: These medications help reduce inflammation of the facial nerve.
2. Antiviral drugs: If a viral infection is suspected, antivirals may be prescribed.
3. Eye care: Artificial tears and eye patches can help protect the affected eye from drying out.
4. Physical therapy: Facial exercises may help maintain muscle tone and stimulate nerve function.
5. Pain management: Over-the-counter pain relievers can help alleviate discomfort.
6. Alternative therapies: Some patients find relief through acupuncture or massage, although scientific evidence for these treatments is limited.

What is the role of electrical stimulation in treating Bell’s palsy?

Electrical stimulation has been explored as a potential treatment for Bell’s palsy, with the aim of maintaining muscle tone and preventing atrophy. However, its effectiveness remains controversial, and more research is needed to determine its true benefits. Some studies suggest it may be helpful in certain cases, particularly when combined with other therapies, but it is not universally recommended as a standard treatment.

Living with Bell’s Palsy: Coping Strategies and Self-Care

Dealing with Bell’s palsy can be challenging, both physically and emotionally. However, there are several strategies that can help manage symptoms and support recovery:

• Protect your eyes: Wear sunglasses outdoors and use eye drops to prevent dryness.
• Practice facial exercises: Gentle facial movements can help maintain muscle tone.
• Manage stress: Relaxation techniques may help reduce stress and support overall health.
• Maintain a healthy diet: Proper nutrition can support the healing process.
• Get adequate rest: Sufficient sleep is crucial for recovery.
• Seek support: Joining a support group or talking to others with Bell’s palsy can provide emotional comfort.

How can facial massage help in Bell’s palsy recovery?

Facial massage may offer several benefits for individuals with Bell’s palsy. It can help improve blood circulation to the affected area, reduce muscle tension, and potentially stimulate nerve function. Gentle massage techniques, when performed correctly, may also help prevent muscle atrophy and maintain facial symmetry during the recovery process. However, it’s important to consult with a healthcare provider or physical therapist before starting any massage regimen to ensure it’s appropriate for your specific case.

Long-Term Outlook and Potential Complications

The prognosis for Bell’s palsy is generally favorable, with most people experiencing complete recovery within 3 to 6 months. However, recovery time can vary depending on the severity of nerve damage. In rare cases, some individuals may experience lasting effects or complications.

Potential long-term issues may include:

• Synkinesis: Involuntary facial movements when trying to move specific muscles
• Partial recovery of facial strength
• Chronic dry eye
• Facial asymmetry
• Crocodile tears syndrome: Tearing while eating due to misdirected nerve regeneration

Can Bell’s palsy recur?

While recurrence of Bell’s palsy is relatively uncommon, it is possible. Approximately 7-8% of individuals who have had Bell’s palsy may experience a recurrence, either on the same side or the opposite side of the face. The risk of recurrence is slightly higher in those with a family history of the condition or in people with certain underlying health issues, such as diabetes.

Preventing Bell’s Palsy: Is It Possible?

Unfortunately, there is no known way to prevent Bell’s palsy, as its exact cause remains unclear in many cases. However, maintaining overall health and managing underlying conditions that may increase the risk of Bell’s palsy can be beneficial.

Strategies that may help reduce the risk of developing Bell’s palsy include:

1. Managing stress levels
2. Maintaining good overall health through diet and exercise
3. Controlling chronic conditions such as diabetes and hypertension
4. Practicing good hygiene to reduce the risk of viral infections
5. Protecting against tick bites to prevent Lyme disease
6. Seeking prompt treatment for any infections or illnesses

Do vaccines play a role in preventing Bell’s palsy?

While some concerns have been raised about a potential link between certain vaccines and Bell’s palsy, extensive research has found no significant increased risk associated with vaccination. In fact, vaccines that protect against viral infections may indirectly help reduce the risk of Bell’s palsy by preventing conditions that could trigger it. As always, it’s important to discuss any concerns about vaccines with a healthcare provider.

Bell’s palsy, while often alarming when it first occurs, is generally a temporary condition with a good prognosis. Understanding its symptoms, causes, and treatment options can help individuals navigate the recovery process more effectively. By seeking prompt medical attention and following appropriate care strategies, most people with Bell’s palsy can expect significant improvement or complete recovery of facial function over time.

Bell’s Palsy – familydoctor.org

What is Bell’s palsy?

Bell’s palsy is a condition that temporarily paralyzes the side of your face. It can affect all or part of the muscles in your face. In rare cases, both sides of your face may be affected. Bell’s palsy occurs when your facial nerve (or 7th cranial nerve) is damaged. The facial nerve carries signals for movement, taste, and other information to and from your face. When this nerve is damaged, the signals between your face and brain do not work as well. While it may seem scary at the time, Bell’s palsy usually doesn’t last long.

Symptoms of Bell’s palsy

The symptoms of Bell’s palsy are very similar to the symptoms of a stroke. That is why it is important to get evaluated immediately to rule that out.

If you have Bell’s palsy, you may have some of the following symptoms:

• Drooping that makes your face look uneven
• Loss of facial expression
• Twitching
• Trouble eating or drinking
• Trouble speaking
• Total or partial loss of taste
• Ear pain
• Ringing in your ear(s)
• Headache
• Sensitivity to sound
• Trouble closing your eye
• Dry eye

These symptoms usually affect one side of your face. They appear quickly and reach their worst in a couple of days.

What causes Bell’s palsy?

All causes of Bell’s palsy are not known. It may occur when a virus, such as the common cold, makes your facial nerve swell. The swollen nerve presses against the bone around it. This pressure can stop the nerve from working correctly.

You may be more likely to get Bell’s palsy if you are between 15 and 60 years of age or have one of the following:

• Herpes simplex
• Diabetes
• A common cold
• The flu
• High blood pressure
• Lyme disease
• Mononucleosis
• HIV or another autoimmune disorder
• Sarcoidosis
• Head trauma

Bell’s palsy affects about 1 in every 5,000 people. Once you have had Bell’s palsy, you have a slightly higher chance of getting it again.

How is Bell’s palsy diagnosed?

There is no specific test to diagnose Bell’s palsy. Your doctor will ask questions about your symptoms and medical history. A stroke, injury, or tumor also can cause facial paralysis. Your doctor will check to see what condition is causing your symptoms. They may do tests, such as an X-ray or magnetic resonance imaging (MRI).

Can Bell’s palsy be prevented or avoided?

You can’t prevent or avoid Bell’s palsy. Contact your doctor when symptoms first begin to start treatment.

Bell’s palsy treatment

Bell’s palsy often goes away on its own within 1 to 2 months. Your chances of full recovery are improved with a course of steroid medicine. Your doctor can prescribe this. Your doctor may also prescribe you an anti-viral medicine, too.

At home, you can take simple steps to help your recovery. Eat well and get plenty of rest so you can heal. Protect your eyes with sunglasses when you’re outdoors. Be careful to keep your eyes moist, especially when you’re working at a computer. Wearing an eye patch can help keep your eyes closed at night. Apply low heat, such as a gel pack or heating pad, to help relieve pain and swelling. Gently massage the area. Talk to your doctor if you have severe pain.

Living with Bell’s palsy

Your recovery time will depend on how badly your facial nerve is damaged. If it takes a long time to improve, you may have a few lasting effects. For example, you may have facial movements you can’t control, or your eyes may water or tear.

Questions to ask your doctor

• Will my Bell’s palsy go away?
• How long will I have symptoms?
• What medicines treat Bell’s palsy? What are their side effects?
• Are there exercises I can do, or lifestyle changes I can make to improve symptoms?
• Does Bell’s palsy indicate other health conditions?
• If I have had Bell’s palsy, is there anything I can do to prevent it from happening again?

Resources

National Institute of Neurological Disorders and Stroke: Bell’s Palsy

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Bell’s Palsy | Johns Hopkins Medicine

What is Bell’s palsy?

Bell’s palsy is an unexplained episode of facial muscle weakness or paralysis. It begins suddenly and worsens over 48 hours. This condition results from damage to the facial nerve (the 7th cranial nerve). Pain and discomfort usually occur on one side of the face or head.

Bell’s palsy can strike anyone at any age. It occurs most often in pregnant women, and people who have diabetes, influenza, a cold, or another upper respiratory ailment. Bell’s palsy affects men and woman equally. It is less common before age 15 or after age 60.

Bell’s palsy is not considered permanent, but in rare cases, it does not disappear. Currently, there is no known cure for Bell’s palsy; however, recovery usually begins 2 weeks to 6 months from the onset of the symptoms. Most people with Bell’s palsy recover full facial strength and expression.

What causes Bell’s palsy?

The cause of Bell’s palsy is not known. It is thought that it may be due to inflammation that is directed by the body’s immune system against the nerve controlling movement of the face. Bell’s palsy is sometimes associated with the following:

• Diabetes
• High blood pressure
• Injury
• Toxins
• Lyme disease
• Guillain-Barré syndrome
• Sarcoidosis
• Myasthenia gravis
• Multiple sclerosis
• Infection, especially following a viral infection with Herpes simplex virus (a virus that is related to the cause of the common “cold sores” of the mouth)

What are the symptoms of Bell’s palsy?

These are the most common symptoms of Bell’s palsy:

• Disordered movement of the muscles that control facial expressions, such as smiling, squinting, blinking, or closing the eyelid
• Loss of feeling in the face
• Headache
• Tearing
• Drooling
• Loss of the sense of taste on the front two-thirds of the tongue
• Hypersensitivity to sound in the affected ear (hyperacusis)
• Inability to close the eye on the affected side of the face

The symptoms of Bell’s palsy may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.

How is Bell’s palsy diagnosed?

Your healthcare provider can usually diagnose Bell’s palsy by looking at your symptoms. There are no specific tests used to diagnose Bell’s palsy. However, your healthcare provider may order tests to rule out other conditions that can cause similar symptoms and to determine the extent of nerve involvement or damage. These tests may include:

• Electromyography (EMG) to determine the extent of the nerve involvement
• Blood tests to determine if another condition such as diabetes or Lyme disease is present
• Magnetic resonance imaging (MRI) or computed tomography (CT) to determine if there is a structural cause for your symptoms.

It is important that your healthcare provider rule out the presence of a stroke or tumor that may cause symptoms similar to Bell’s palsy.

How is Bell’s palsy treated?

If a specific cause for Bell’s palsy is identified, such as infection, that cause will be treated. Otherwise, the symptoms are treated as needed.

One uniformly recommended treatment for Bell’s palsy is protecting the eye from drying at night or while working at a computer. Eye care may include eye drops during the day, ointment at bedtime, or a moisture chamber at night. This helps protect the cornea from being scratched, which is crucial to the management of Bell’s palsy.

Your healthcare provider will prescribe other treatment for your condition based on the severity of your symptoms and your health history. Other treatment options include:

• Steroids to reduce inflammation
• Antiviral medicine, such as acyclovir
• Analgesics or moist heat to relieve pain
• Physical therapy to stimulate the facial nerve

Some people may choose to use alternative therapies in the treatment of Bell’s palsy, but there is no proof they make a difference in recovery. Such treatment may include:

• Relaxation
• Acupuncture
• Electrical stimulation
• Biofeedback training
• Vitamin therapy, including B12, B6, and the mineral zinc

What are the complications of Bell’s palsy?

Bell’s palsy usually resolves in time and causes no long-term complications. However, during the illness most people with Bell’s palsy are unable to close their eye on the affected side of their face. It is, therefore, important to protect the eye from drying at night or while working at a computer. Eye care may include eye drops during the day, ointment at bedtime, or a moisture chamber at night. This helps protect the cornea from being scratched.

Living with Bell’s palsy

Bell’s palsy usually resolves in time and causes no long-term complications. It is important, however, to take medicines as directed. It is also crucial that you protect the affected eye from drying. Use of eye drops during the day and ointment at bedtime can protect the cornea from scratching.

When should I call my healthcare provider?

Bell’s palsy usually starts to improve in 2 weeks but may take 3 to 6 months to return to normal. If there is no improvement or if any symptoms worsen, it is important to tell your healthcare provider.

Key points about Bell’s palsy

• Bell’s palsy is an unexplained episode of facial muscle weakness or paralysis that usually resolves on its own and causes no complications.
• The cause of Bell’s palsy is unknown but is thought to be caused by inflammation affecting the body’s immune system. It is associated with other conditions such as diabetes.
• Symptoms of facial weakness or paralysis get worse over the first few days and start to improve in about 2 weeks.
• It can take 3 to 6 months to fully resolve.
• Medicine and eye care are important in treating Bell’s palsy.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

Parkinson’s disease – what is it, symptoms, diagnosis and treatment of parkinsonism

What causes Parkinson’s disease (pathogenesis)

Another name for this disease is idiopathic parkinsonism syndrome. It occurs when nerve cells (neurons) in an area of ​​the brain called the substantia nigra become damaged or die. These cells normally produce dopamine, a chemical (neurotransmitter) that helps brain cells communicate. When these nerve cells become damaged or die, they produce less dopamine. The loss of dopamine causes certain motor symptoms seen in people with Parkinson’s disease.

In addition, patients with this diagnosis also lose another neurotransmitter – norepinephrine. This chemical is essential for the proper functioning of the sympathetic nervous system. It controls some of the autonomic functions of the body, such as digestion, heart rate, blood pressure, and respiration. The loss of norepinephrine causes other symptoms of Parkinson’s disease that are not related to movement.

There is no consensus among scientists about the reasons that kill the neurons that produce these neurotransmitters.

Manifestation of Parkinson’s disease

Signs of parkinsonism can be different. Moreover, the earliest of them often go unnoticed for a long time.

The most common symptoms:

• Tremor. Specific trembling that usually starts in the hands or fingers.

• Slowness of movement (bradykinesia). Over time, Parkinson’s disease makes it difficult to perform simple tasks. For example, steps may become shorter while walking, and the legs may seem to be dragging, and it is also sometimes more difficult to even just get up from a chair.

• Rigidity (muscle stiffness). It can occur anywhere in the body, causing pain and limiting range of motion.

• Violation of posture and balance. One of the consequences of Parkinson’s disease is a pronounced stoop and problems with coordination.

• Loss of automatic movements. The ability to perform unconscious movements (blinking, smiling, or waving the arms while walking) may also be reduced.

• Change in speech. Often a person hesitates before speaking. Speech may become more slurred, fast, or monotonous.

• Handwriting change. As a rule, it becomes smaller and less legible.

Less obvious signs of tremor palsy include:

• depression and anxiety;

• problems with chewing and swallowing, drooling;

• problems with urination;

• Difficulty remembering information;

• constipation;

• Sleep disorders, including restless leg syndrome;

• Apathy and increased fatigue;

• Low blood pressure.

Classification

There are two types of Parkinson’s disease, which differ from each other in the causes that contributed to the onset of the disease:

• primary parkinsonism. It can be associated with family heredity, genetic disorders, neurodegenerative process, and may also be of vascular origin, due to cerebral palsy.

• Secondary parkinsonism occurs as a result of medication or other pathology. Causes can be, for example, infectious diseases, metabolic disorders or repeated head injuries.

Stages of development

Parkinson’s disease has a progressive, very individual course, with five stages:

• Stage 1: unilateral disease, no or minimal impairment.

• Stage 2: bilateral disease or damage to the head and trunk, no violations of stability and balance.

• Stage 3: initial balance disorders, for example, when turning over, walking with eyes closed, positive propulsive or retropulsive test, moderate functional disorders with still complete independence and conditional ability to work. Disability from mild to moderate severity.

• Stage 4: Fully developed syndrome, beginning need for assistance with daily activities, almost impossible to walk without support.

• Stage 5: Patient unaided in a wheelchair or bedridden.

About 25% of patients become disabled within five years and about 80% after five to nine years.

Possible complications

Parkinson’s disease is often accompanied by the following additional problems:

• Thinking disorders. Cognitive problems (dementia) occur in later stages.

• Depression and emotional changes. Depression can appear in the early stages. Other treatable emotional conditions may also occur, such as fear, anxiety, or loss of motivation.

• Swallowing problems. As the disease progresses, swallowing difficulties develop.

• Problems with chewing and eating. In the later stages, the muscles of the mouth are affected, making chewing difficult. This can cause suffocation and malnutrition.

• Sleep problems and sleep disorders. People with Parkinson’s often have trouble sleeping. They often wake up in the middle of the night or early in the morning.

• Problems with the bladder. Parkinson’s disease can cause incontinence or difficulty urinating.

• Constipation. Many people with Parkinson’s get constipated because their digestive system is slower.

• Changes in blood pressure. Manifested as a feeling of dizziness, for example, when trying to stand up, caused by a sudden drop in blood pressure (orthostatic hypotension).

• Smell dysfunction. Some odors may be difficult to identify or distinguish.

• Fatigue. Decreased energy and feeling tired, especially at the end of the day.

• Pain. Some patients with Parkinson’s disease experience pain either in specific areas or throughout the body.

• sexual dysfunction. In some cases, patients report a decrease in sexual desire or sexual activity.

Diagnostics

Parkinson’s disease is a neurodegenerative disease that is not easy to diagnose. There are no specific laboratory tests to determine it. In addition, early symptoms are easily confused with other diseases.

In order to exclude them, the doctor may prescribe a CT scan (computed tomography) or MRI (magnetic resonance imaging).

To diagnose Parkinson’s disease, the patient is usually asked about a family history of neurological disorders, as well as current symptoms and possible exposure to toxins. The doctor will look for signs of tremors and muscle stiffness, observe gait and posture, and check the patient’s coordination.

Methods of treatment

The main treatment for parkinsonism today is medication. The doctor selects drugs, depending on the stage of the disease and the individual characteristics of the person.

Commonly used drugs are:

• Helps nerve cells in the brain to produce dopamine;

• Mimic the effects of dopamine on the brain;

• Block the enzyme that breaks down dopamine in the brain;

• Reduce the manifestation of specific symptoms of Parkinson’s disease.

Most patients can maintain a good quality of life with medication. However, for some people, at some point they cease to be effective.

In such situations, options for the use of surgical methods may be considered. For example, deep brain stimulation. It involves implanting electrodes in the brain that deliver electrical impulses that block or alter abnormal activity that causes symptoms of Parkinson’s disease.

This method can deal with tremors, slowness of movement and muscle stiffness. However, it does not improve memory or eliminate depression and many other symptoms of parkinsonism.

Neurodegenerative diseases, including Parkinson’s disease, are something that is receiving a lot of attention in anti-aging medicine today. Specialists in this area are able to offer patients effective treatment prevention schemes that significantly improve their condition. Basically, they are based on the alignment of the most important biochemical processes in the body.

Forecast

An important role in Parkinson’s disease is played by the age at which it began. The course and prognosis depend on whether the disease occurs at a relatively young or older age. After about ten years of disease progression, life expectancy in Parkinson’s disease declines slightly.

In the last stages of the disease, there is often a need for care. However, as a rule, this occurs only after a long course of the disease, starting at about 20 years. In most cases, the cause is dementia, as well as a combination of severe symptoms.

Prevention

Since the causes of idiopathic parkinsonism are unknown, there are no specific measures to prevent the disease.

At the experimental level, some substances have shown that they can protect certain groups of neurons from death, but to date, no drug has been able to reproduce this neuroprotective effect in patients.

However, despite the lack of preventive treatment, after the first symptoms appear and the diagnosis of Parkinson’s disease is confirmed, there are measures that can improve the patient’s general condition and a milder course of the disease. These measures are based on comprehensive patient care, including both pharmacological treatment of previously indicated symptoms or other non-motor symptoms such as mood swings, sleep disturbances, etc., and non-pharmacological treatment: exercise, adequate nutrition, physiotherapy, which allow the patient be as independent as possible.

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Bibliography

1. Parkinsonism and substantia nigra. The fate of the great discovery: Monograph (Series “Motor disorders”). Illarioshkin S.N., Levin O.S., Fedotova E.Yu., Kolokolov O.V., 2019.
2. Let’s talk about Parkinson’s disease. A guide for patients and their families. John Vine, 2017.
3. Parkinson’s disease and Parkinson’s syndrome. Yu.N. Vasiliev, 2013.

4. Louis ED, Levy G, Côte LJ, et al. Clinical correlates of action tremor in Parkinson’s disease. Arch Neurol 2001; 58:1630.

5. Jain S, Lo SE, Louis ED. Common misdiagnosis of a common neurological disorder: how are we misdiagnosing essential tremor? Arch Neurol 2006; 63:1100.

6. Shulman LM, Singer C, Bean JA, Weiner WJ. Internal tremor in patients with Parkinson’s disease. Mov Disord 1996; 11:3.

Treatment of limb paralysis

Movement disorders – a diagnosis that hundreds of patients hear every day. Diseases of the motor system dramatically affect a person’s life. The right choice of a companion in the fight against illness is the right step to restore health.

Disorders of motor function are divided into several types:

• Paralysis resulting from damage to motor neurons and neurons.
• Coordination disorders (ataxia) developed from damage to the fibers of the cerebellar system.
• Movement disorders caused by damage to the extrapyramidal system.
• Non-paralytic disorders of purposeful movements or apraxia.

Paralysis is one of the types of motor disorders that require serious correction. With paralysis, the muscles lose their ability to contract, as the motor pathways from the brain to the muscle fibers are interrupted. Paralysis, or plegia, in everyday medical practice is a partial or absolute loss of motor function. If the impairment of motor function is moderate, doctors talk about paresis. One of the important functional shortcomings, in addition to weakness, is the loss of smooth movements.

Examination for paralysis

First of all, the paralyzed limb is examined by a doctor. Particular attention is paid to its position, the presence or absence of muscle hypotrophy, twitching. Moderate muscle hypotrophy can be caused by the incapacity of the limbs, for example, due to the occurrence of pain, prolonged immobility, or the development of paralysis. The occurrence of severe atrophy is due exclusively to prolonged denervation of the muscles, which lasts more than several weeks.

The next stage of the examination is an assessment of the strength and dexterity of movements of various muscle groups. For this, the patient is asked to perform some exercises. The doctor makes a study of the volume of passive movements in the joints. The results of the examination show a change in muscle tone, hypotension, spasticity or rigidity. These manipulations make it possible to establish the presence of dislocations, ankylosis and joint damage.

The neurologist then examines the reflexes: assessment of the jaw reflex (pronounced in patients with pseudobulbar palsy), radial reflex, Achilles tendon reflexes and reflexes of the biceps, triceps and quadriceps muscles. They also conduct studies of two skin reflexes: abdominal and plantar.

In the absence of symptoms of damage to peripheral and central motor neurons, but the performance of some movements is not in full, disturbances in the sense of position, cerebellar disturbance, rigidity with changes in movements and posture should be excluded. In the absence of violations, the patient is examined, paying attention to independent movements and the execution of certain commands.

It can be difficult to diagnose a disorder such as hysterical paralysis. Hysterical paralysis is characterized by the involvement in the pathological process of one upper or one lower limb, or half of the body. The main symptom of diagnostic value is hysterical gait. Often, all types of sensitivity (tactile, pain, vision, smell, hearing) disappear on the paralyzed side, which does not happen in patients with organic brain damage.

When the patient performs several movements of the affected limb, their discontinuity and slowness are noted, alternate or simultaneous contraction of agonists and antagonists occurs. To differentiate hysterical from organic hemiplegia, a neurologist conducts a study of Hoover’s symptoms and Babinski’s test.

To detect Hoover’s symptom, the patient lies on his back, raises the lower limb with artificial resistance. When examining the Babinsky symptom with combined leg flexion, the patient needs to sit down without helping himself with his hands. This symptom is not observed in patients with hysterical hemiplegia.

In order to determine the nature of plegia or paresis, to identify the cause of their occurrence, it is necessary to establish a diagnosis of the underlying pathology. For diagnosis, clinical, laboratory, radiological, electrophysiological and other types of studies are used.

Methods for the correction of plegia and paralysis

Plegia of some muscles are indications for emergency medical intervention. Urgent hospitalization in the neurology department is also indicated for persons with such movement disorders associated with strokes, encephalitis, myelitis and other acute conditions.

With central and peripheral plegia associated with injuries of the spinal cord or brain, nerves and plexuses, patients should be hospitalized in the departments of neurosurgery or traumatology for the correction of movement disorders.

Given the chronic nature of most movement disorders, any acute movement disorder should be an indication for hospitalization.

Conservative correction

Conservative correction of patients with plegia is aimed not only at the treatment of the underlying diseases (acute or chronic) that led to the development of the movement disorder, but also at the treatment of the paralysis itself. Correction of movement disorders with the help of conservative therapy includes taking medications, the action of which is aimed at increasing the speed of nerve impulses, increasing synaptic conduction, improving metabolism in nerve tissues, and normalizing muscle tone.

As components of the complex treatment of paralysis, patients are prescribed balneotherapy, massage, physiotherapy exercises and orthopedic treatment.

With the help of balneotherapy, the motor function of the affected muscles is restored, inflammation is reduced, pain syndrome is stopped, regenerative processes are stimulated, the development of atrophy of the affected muscles and the formation of contractures are prevented, and muscle tone is normalized.

Patients with peripheral plegia and paresis at the beginning of treatment for the correction of disorders, it is advisable to use UHF therapy on the affected limbs, microwave therapy, pulsed currents, ultrasound, drug electrophoresis with painkillers, UV irradiation.

Electrophoresis

Used electrophoresis with drugs. The choice of technique is carried out in accordance with the nature of the trauma or stroke, the state of the cardiovascular system and the age of the patient. With lesions of the central nervous system of an inflammatory nature, the use of microwave therapy and UHF can be prescribed.

With the help of physiotherapy, impaired motor function is restored, spasticity is reduced, pain syndrome and contractures that impede movement are eliminated.

Improving the conductivity and excitability of the affected neuromuscular apparatus allows electrophoresis, an alternating high-frequency magnetic field, ozokerite, paraffin therapy, combinations of these methods with electrical stimulation of the affected muscles and segments of the spinal cord.

Electrical stimulation

Electrical stimulation, which causes muscle contraction, improves their trophism and blood supply, prevents muscle atrophy, increases afferent impulses, thereby restoring muscle dysfunction. Parameters of impulse currents for electrical stimulation are selected in accordance with the state of excitability of the neuromuscular apparatus and the severity of paralysis.

Electrostimulation is applied with impulse currents of low and high frequencies, which are generated by a single- or multi-channel device. Stimulation is directed primarily at antagonists of spastic muscles. At the same time, during the procedure, it is important to carefully select the motor points, parameters and force of impact so as not to increase spasticity. Patients with such a disorder as mild spasticity are prescribed 1-2 courses of electrical stimulation, with moderate and severe – 2-3 courses. The intervals between courses should be at least 3 weeks. For persons with a slight increase in tone, a combination of electrical stimulation and electrophoresis with prozerin or dibazol is used.

In the late recovery and residual period, as well as with an early increase in muscle tone, electrical stimulation is combined with muscle relaxants.

To reduce muscle tone, before applying electrical stimulation, treatment is carried out with heat or cold (the paralyzed limb is in a horizontal position). The cryotherapy method is especially effective for elderly patients with pronounced spasticity with contractures.

To reduce the pain syndrome, the use of sinusoidal modulated or dynamic currents, electrophoresis with novocaine is prescribed. To eliminate joint and muscle contracture, it is effective to use thermal procedures (paraffin, mud, ozocerite applications, local warm baths), electrophoresis with drugs, ultrasound, pulsed currents.

Sanatorium-and-spa treatment

To correct motor disorders, sanatorium-and-spa treatment is indicated, for which patients are sent to local neurological sanatoriums, mud and balneological resorts with radon, sulfide, sodium, sodium chloride and nitrogen-silicon thermal waters or to specialized sanatoriums for the treatment of lesions of the spinal cord. For patients with peripheral plegia and paresis, sanatorium treatment is prescribed 2-6 months after the acute period, with central paralysis and paresis – after 4-6 months.

In the late recovery and residual period, the use of mud therapy and mineral baths (sodium chloride, sulfide, nitrogen-silicon thermal, radon, etc.) is effective, thanks to which regeneration processes are stimulated.

For patients with central plegia and paresis, balneotherapy as a component of complex correction is prescribed in the early rehabilitation period:

1. With cerebral circulation disorders – at 3-5 weeks;
2. With injuries of the brain and spinal cord – at 2-3 weeks;
3. With inflammatory lesions of the central nervous system – at 3 weeks.

This method of correction of movement disorders helps to improve blood circulation in the affected area, stimulate the activity of nerve elements.

Therapeutic physical training and massage improve trophism and blood circulation of muscles in the affected limbs, prevent the occurrence of contractures, restore motor function, stimulate the development of compensatory motor skills, and improve the general condition of patients. These measures are prescribed in the early period of the disease.

Special positioning of paralyzed limbs is used from the first days. With hemiplegia and hemiparesis, which arose as a result of ischemic stroke, treatment with the position begins on the second day of the disease, with cerebral hemorrhages – on day 6.

Massage

Positional treatment combined with massage. During the massage, the following techniques are used: stroking, rubbing, light kneading, continuous vibrations. Patients with central paralysis are prescribed selective massage: massaging muscles with increased tone, slow strokes, for their antagonists – faster strokes, light rubbing and shallow kneading.

Patients with peripheral paralysis first stroke the entire limb, then massage the paralyzed muscles and stroke the antagonists. Massage sessions should be daily, the therapeutic course is from 30 to 40 sessions. It is also effective to conduct acupressure and reflex-segmental massage.

The massage is recommended to be combined with passive movements. They should be carried out separately for each joint: they begin with the proximal limb on the affected and healthy side. Passive movements can be carried out both under the supervision of a specialist, and independently, using a healthy limb for help.

Therapeutic exercise

Active gymnastics help restore motor function. Patients with central plegia and paresis should start it on the 7th day after the onset of the disease (with ischemic strokes) and on the 15-20th day (with cerebral hemorrhages). Active gymnastics begins with exercises aimed at holding a limb in a given position. After achieving success in these exercises, active gymnastics begins for muscles whose tone is not increased. For the development of active movements, lightweight exercises are carried out, for which special devices are used: spring traction, frames with a system of hammocks and blocks, slippery surfaces, gymnastic equipment.

Then active free exercises begin, both for healthy and affected limbs, for which special devices are used for unbuttoning and fastening buttons, untying and tying shoelaces, etc. a day after the onset of the disease, with cerebral hemorrhages – after 3-4 weeks.

Patients begin to prepare for walking first in the supine position, then in the sitting position. Exercises that mimic walking are used. After the condition of the patients allows them to get out of bed, they begin to learn to stand on both legs, walk in place, with a methodologist, later in a special wheelchair, and also using a three-point crutch.

The course of physical therapy for patients with central paralysis also includes exercises that help eliminate pathological synkinesis. Doctors recommend gymnastic exercises for peripheral paralysis in a warm bath or pool.

The course of physical therapy in each individual case has its own duration. It can last 3-4 weeks, and maybe more, if there are indications for this. The choice of duration depends on the nature of the pathological process, as a result of which paralysis or paresis developed.

Orthopedic therapy

Orthopedic therapy can be conservative or surgical. Conservative orthopedic correction of movement disorders can be an independent treatment if there is no evidence of a break or compression of the nerve trunk. For its implementation, prosthetic and orthopedic devices, plastic, plaster and other removable splints, special beds, shoes and other means are used. This type of correction of motor disorders is aimed at partially compensating for the lost motor function.

Correction of plegia and paralysis by surgical methods

Surgical methods of treatment of plegia are performed in cases of anatomical rupture of the nerve (partial or complete), crushing or compression of the nerve trunk, or if previous conservative treatment was ineffective. Operations are performed on the nerves, applying a primary or secondary nerve suture, conducting neurolysis.

On muscles and tendons, transplantation, muscle plastics, transossal tenodesis are used, on joints – surgical correction, during which the joint is fixed in a permanent fixed position, and an artificial bone brake is formed, which limits mobility in the joint.

Orthopedic surgical correction is recommended for people with persistent nerve prolapse more than two years after the injury, and also in cases where surgical interventions on the nerves are impossible or ineffective.

For children who have reached the age of six, myolausanoplasty of the trapezius muscle is performed to replace the function of the paralyzed deltoid muscle. During surgical correction, the trapezius muscle is cut off from the scapular spine and clavicle simultaneously with the periosteum, a lavsan prosthesis is sutured to it, and its other end is fixed in the upper third of the humerus.

Pronation contracture of the limb is corrected by detorsion osteotomy of the shoulder and forearm bones. Persons with peripheral paralysis of the limbs in some cases produce a tenodesis of the wrist joint.

In the case of a high lesion of the sciatic nerve, there is a loss of muscle function, for the innervation of which the tibial and common peroneal nerves are responsible. At the same time, there is a weakening of the ligamentous apparatus of the foot, the onset of pronounced atrophy of the bones and excessive mobility in the ankle and small joints of the foot. To restore the support ability of the limbs, arthrosis, arthrodesis, tenodesis of the joints of the feet are used.

Pronounced valgus or varus foot placement requires surgical correction, during which the ankle joint is fixed in a completely immobile state (arthrodesis), sometimes subtalar arthrodesis is performed simultaneously.

When the superficial peroneal nerve is affected, function of the peroneal muscle group may be lost. To correct this disorder, the tibial tendon is transplanted to the outer edge of the foot.

If the patient is affected by the deep peroneal nerve, the function of the muscles that unbend and supinate the foot drops out. In order to compensate for them, the tendon of the long peroneal muscle is transplanted to the inner edge of the foot.

If, as a result of a lesion of the common peroneal nerve, the function of the muscles that extend, supinate, pronate the foot is lost, it is necessary to perform tenodesis from the tendon of the paralyzed muscles themselves.

Recovery period

In the postoperative period, the limb is immobilized using splints, splints, functional orthopedic devices, in some cases compression devices are used. During immobilization, the limb should be fixed with minimal tension on the operated nerves, tendons, and muscles. The duration of this position is determined depending on how quickly these formations are fused, ankylosis or callus is formed (during surgical interventions on the bones).

The effectiveness of the rehabilitation period after the correction of motor disorders depends on the nature of the pathological process, the depth and extent of the damage to the motor analyzer, and how great the compensatory capabilities of the patient’s body are.

An increase in range of motion in patients with central paralysis and paresis, which developed as a result of circulatory disorders, occurs as blood flow is restored.

Correction of movement disorders in patients with central paralysis and paresis resulting from a cortical lesion takes place in a shorter time and more effectively compared to paralysis that developed as a result of damage to the internal capsule.

Motor function in patients with peripheral plegia and paresis, the development of which was the result of injuries of the brachial plexus during childbirth, is restored within 1 to 2 years.

Patients with peripheral paralysis and paresis resulting from damage to the peripheral nerves, if the conservative correction of the movement disorder was ineffective, a reconstructive operation is prescribed.