Authors: Dr. Nanritam Chopra1 and Dr. Nandini Dadhich2
- MD (PGR), Dept. of Materia Medica, Dr.M.P.K.Homoeopathic Medical College, Hospital & Research Centre, Jaipur (A constituent unit of Homoeopathy University, Jaipur, Raj. 302029) India.
- MD (PGR), Dept. of Materia Medica, Dr.M.P.K.Homoeopathic Medical College, Hospital & Research Centre, Jaipur (A constituent unit of Homoeopathy University, Jaipur, Raj. 302029) India.
ABSTRACT: Paralysis is a condition which affects an individual in such a way that they are disabled to move, and can barely communicate with other people normally. It is complete loss of motor power which can occur in any muscle group and can majorly affect the quality of life of an individual. The cause of paralysis can due to many different anatomical lesions and aetiologies and therefore also determine its treatment. If a person suffers from a paralytic attack, there are very less chances of complete recovery to normal; however a number of therapeutic interventions and assistive technologies are there to improve the quality of life of such persons.
KEYWORDS: paralysis, types of paralysis, signs and symptoms, examination, management, homoeopathic therapeutics.
INTRODUCTION: Paralysis literal meaning is “the loss of the ability to move (and sometimes to feel anything) in part or most of the body, typically as a result of illness, poison, or injury”. The origin of the word Paralysis is from a Greek word ‘Paralusis’ derived from ‘Paraluesthai’ which means disabled at the side (by merging two words- Para meaning Beside; luein meaning loosen) .
Paralysis, medically, is defined as loss or impairment of voluntary muscular power in an individual. Also commonly known as Palsy, can becaused by structural abnormalities of the nervous system or muscular tissue or by metabolic disturbances hampering the function of the nerves and the muscles. The cause always decides whether the paralysis may affect a specific muscle, group or region of the body or a larger area be involved.
CAUSES ,,: Paralysis can be caused by numerous factors. The diseases which may cause paralysis can be divided into two main groups-
(a) Whether they cause any structural alterations in nervous or muscular tissue or
(b) They lead to metabolic disturbances that interfere in the neuromuscular function.
Some systemically acting diseases may also affect one of the three elements in the motor system (upper neuron, lower neuron, or muscle) more or less extensively and exclusively which may lead to paralysis. However, more often, one element or neighbouring portions of two of the three elements are involved over a limited extent by a single focal lesion which can therefore cause problems with blood flow resulting in difficulty in speech or swallowing, sexual responses, or controlling the urge for micturition depending on where the lesion is and how severe is it.
Paralysis is most often caused by strokes, usually from a blocked artery in the neck or brain and can be caused by damage to the brain or spinal cord . A study also reported that Stroke is the leading cause of paralysis followed by spinal cord injury, then multiple sclerosis and cerebral palsy .
It can also result from certain conditions or diseases linked to specific genes [3,,:
- Demyelinating diseases – These include the overtime damage of the protective coating around the nerve cells, called the myelin sheath, which in turn makes it difficult for the neurons to send signals throughout the body. The most common is multiple sclerosis.
- Motor neuron diseases – Motor neurons are the nerve cells that control the voluntary muscles. The two types: upper motor neurons, which send signals from the brain down to the spinal cord; and lower motor neurons, which receive those signals and send them to the muscles.
- Upper motor neuron diseases – e.g. primary lateral sclerosis affect just the upper motor neurons which makes muscles stiff and spastic. Whereas Lower motor neuron diseases e.g. spinal muscular atrophy, affect only the lower motor neurons resulting in flaccid muscles making them weak and sometimes causing them to twitch uncontrollably.
TYPES OF PARALYSIS ,,: Paralysis can be studied in number of ways according to the area involved or the amount of disability it causes in an individual. Therefore can be of further types:
- Complete paralysis is when the person is not able to move or control the paralyzed muscles at all and may also not be able to feel any sensation in those muscles.
- Partial or incomplete paralysis is when the patient still have some sensation in and possibly some control over the paralyzed muscles also.
- Localized paralysis affects just one specific area of the body, like the face, hands, feet or vocal cords.
- Generalized paralysis is more widespread in the body and is grouped by how much area of the body is affected.
The further sub-type usually depends on where your brain or spinal cord is injured, which includes-
- Monoplegia is a kind of generalized paralysis that affects just one limb.
- Diplegia affects the same area on both sides like both arms, both legs, or both sides of the face.
- Hemiplegia i.e. just one side of your body is affected and is usually caused by a stroke, which damages one side of your brain.
- Quadriplegia (or Tetraplegia) is all four limbs are paralyzed, sometimes may also be along with certain organs.
- Paraplegia is paralysis of whole from the waist down.
- One of the rarest and most severe form of paralysis is also Locked-in syndrome, where a person loses control of all their muscles except the ones that control their eye movements.
There are some other types of paralysis also, which are ,,:
- Periodic paralysis – This involves random attacks of paralysis caused by changes in certain genes and often triggered by something in the person’s diet.
- Sleep paralysis – This type occurs while waking up or falling asleep. Sometimes people who suffer from this will also see things that aren’t there (hallucination); with the sense of suffocating or breathlessness; also transient inability to move in transitions during sleep.
- Bell’s palsy – This occurs due to paralysis or weakness of the facial nerve which makes half of the face appear to droop. It may develop suddenly or in a period of 24 to 48 hrs.
- Todd’s paralysis – This often occurs for a short period after an individual with epilepsy has had a seizure, usually on one side of their body only.
- Tick paralysis and Lyme disease Some ticks have neurotoxins in their spit glands that can cause paralysis, which starts in the feet and legs then move upward. The paralysis goes away once the tick is removed, but if it is left untreated, it can spread to the face and become very serious. Ticks sometimes also carry Lyme disease, which is a bacterial infection that can cause several symptoms, including facial paralysis and numbness in the arms and legs.
- Muscular dystrophy (MD) – The muscles need certain proteins to stay healthy and protect them from damage. MD occurs when changes in genes in these proteins make the muscles weak and lead to their break down over time, may further result in paralysis.
- HTLV-1 associated Myelopathy also called Tropical spastic paraparesis (TSP) – this type of spastic paralysis comes on gradually after an infection with human T-cell leukemia virus. It causes symptoms that are similar to Multiple Sclerosis, but this happens in less than 3% of people infected with the virus.
SYMPTOMS ,: It is usually easy to identify a patient of paralysis. If a person has paralysis, he/she will lose function in a specific or a widespread area of the body. Sometimes there may be tingling or numbing sensation before the total paralysis sets in. Paralysis may also make it difficult or impossible to control muscles in the affected body parts.
EXAMINATION [3,]: A person with paralysis should always have a thorough neurological examination. The neurological exam can be organized into 7 categories:
(1) mental status,
(2) cranial nerves,
(3) motor system,
(5) sensory system,
(7) station and gait.
During the course of the exam it is important to note the distribution of the abnormalities (e.g., proximal vs. distal, arms vs. legs, left vs. right) as it gives an idea about the affected area of the brain or nerve.
CRANIAL NERVES EXAMINATION is mandatory to start with to assess the cranial nerves involvement in cases of paralysis. All the cranial nerves have different tests as per their course of supply, which should be performed accordingly to confirm their involvement.
MOTOR EXAMINATION, include the tests of dexterity and coordination, which are most sensitive to picking up upper motor neuron and cerebellar abnormalities, whereas direct strength testing is more sensitive to lower motor neuron dysfunction. Other aspects of the motor examination include
(1) patterns of muscle atrophy or hypertrophy
(2) assessment of muscle tone (whether it is spastic or clasp knife, rigid or lead pipe, flaccid) with passive movement of joints by the examiner
(3) disturbances in movement (like the slowness and reduced spontaneity of movements in parkinsonism)
(4) endurance of the motor response in the affected area (like the fatigability of myasthenia gravis)
(5) if any spontaneous movements are present or not (e.g. fasciculations or brief twitches within the muscles).
TO CHECK THE REFLEXES: The muscle stretch reflexes (deep tendon reflexes) are obtained by placing the muscle in a state of slight tension and then quickly tapping either the periosteum or the tendon to which the muscle is attached and observing the vigour and briskness of the response. The muscle contraction should be seen and felt and thereby compared side-to-side. The muscle stretch reflexes that are the most relevant, clinically, include the biceps, triceps, knee, and ankle. The superficial (cutaneous) reflexes are elicited by applying a scratching stimulus to the skin.
FOR THE SENSORY SYSTEM RESPONSE should take note of the following while examining the patient: Superficial sensation (i.e. pain and temperature); and Deep sensation (such as pressure, position sense and vibration). There is also Integrative sensation which includes 2-point discrimination test (ability to detect two sharp stimuli that are presented simultaneously at decreasing distance on the skin), double simultaneous stimulation test (ability to detect two stimuli applied simultaneously to opposite sides of the body)
COORDINATION AND GAIT should be tested at rest and with action. Including the trunk (i.e ability to maintain an erect posture) and also the limbs. Impairment of coordination may be detected through simple observation of performing routine acts of the patient. As walking requires proper functioning of the cerebellum and motor, sensory, and vestibular systems as well as a whole host of reflexes ; also assessment of gait can guide the focus of the rest of the neurological exam.
DIAGNOSIS ,: Diagnosing a paralysis patient is often easy as the loss of muscle function or sensation is obvious. Whereas for the internal body parts where paralysis is more difficult to identify, the study of CT scans, MRI scans, or other imaging come into play. In case when the patient suffers from paralysis after a spinal cord injury, myelography may be used to assess the condition. The procedure involves inserting a special dye into the nerves in spinal cord; thus helps to see the nerves more clearly on X-rays. Also an electromyography may be done in which sensors measure electrical activity of the muscles.,
TREATMENT ,: A treatment plan in a case of paralysis depend on the underlying cause as well as the symptoms experienced by the patient. For example, the patient may be prescribed with:
- Surgery or possible amputation,
- Physical therapy
- Occupational therapy
- Mobility aids such as wheelchairs, braces, mobile scooters, or other devices
- Medications such as Botox or muscle relaxers are usually prescribed in cases of spastic paralysis.
Many people with paralysis never regain
mobility or sensation in the affected areas of their bodies.
But even if it is not curable in most of the cases, they can be recommended with assistive technologies, therapeutic interventions, or other strategies to help improve their quality of life.
HOMOEOPATHIC MEDICINES FOR PARALYSIS :
Agaricus muscarius – This medicine is for general paralysis. Stiffness all over. There is uncertain gait with trembling. Neuralgia in locomotor ataxia. Paralysis of lower limbs, with spasmodic condition of arms. Numbness of legs on crossing them. Paralytic pain in left arm followed by palpitation.
Alumina – Pain in back with paralytic weakness. Arms feel paralyzed. Legs feel asleep, especially when sitting with legs crossed. Staggers on walking. Heels feel numb. Soles tender. Pain in shoulder and upper arm. Inability to walk, except when eyes are open or in daytime. Spinal degenerations and paralysis of lower limbs.
Angustura vera – There is great difficulty in walking because of paralysis. Stiffness and tension of muscles and joints. Pain in limbs on walking. Arms feel tired and heavy. Coldness of fingers.
Argentum niricum – The patient cannot walk with eyes closed. Trembling, with general debility. Paralysis, with mental and abdominal symptoms. Walks and stands unsteadily. Numbness of arms. Post-diphtheritic paralysis.
Avena sativa – There is nerve tremors of the aged; chorea, paralysis agitans. Also indicated in post diphtheritic paralysis. Numbness of limbs and strength of hand diminished.
Baryta acetica – For ascending paralysis i.e. beginning in extremities and spreading upwards.
Causticum – It manifests its action mainly in paralytic affections, indicated by progressive loss of muscular strength, tendinous contractures. This weakness progresses until we have gradually appearing paralysis. Local paralysis of vocal cords, muscles of deglutition, of tongue, eyelids, face, bladder and extremities. Paralysis of right side of face. Paralysis of ocular muscles after exposure to cold. Paralysis of tongue, with indistinct speech. Partial paralysis of rectum. Paralysis of single parts.
Cocainum hydrochloricum – Paralysis of muscles of deglutition. Chorea; paralysis agitans; alcoholic tremors and senile trembling. Local sensory paralysis. Formication and numbness in hands and forearms.
Cocculus indicus – Paralysis of facial nerve. Paralysis of muscles preventing deglutition. Paralytic pain in small of the back. One-sided paralysis; worse after sleep.
Conium maculatum – It manifests ascending paralysis, ending in death by failure of respiration, shows the ultimate tendency of many symptoms produced in the provings, for which conium is an excellent remedy, such as difficult gait, trembling, sudden loss of strength while walking, painful stiffness of legs, etc. Paralysis of ocular muscles. Heavy, weary, paralyzed; trembling; hands unsteady; fingers and toes numb. Muscular weakness, especially of lower extremities.
Curare – It is prescribed for muscular paralysis without impairing sensation and consciousness. Threatened paralysis of respiratory muscles on falling asleep. There is also glycosuria with motor paralysis. There is also facial and buccal paralysis. Debility in extremities with paralysis. Arms feel heavy and numb.
Gelsemium sempervirens – It centers its action upon the nervous system, causing various degrees of motor paralysis. Paralysis of various groups of muscles about the eyes, throat, chest, larynx, sphincter, extremities, etc. Post-diphtheritic paralysis. Tongue numb, thick, coated, yellowish, tremble, paralyzed. Partial paralysis of rectum and sphincter. Partial paralysis of bladder with intermittent flow. Loss of power of muscular control. Excessive trembling and weakness of all limbs.
Lathyrus sativus – There is paralytic affections of lower extremities; spastic paralysis; lateral sclerosis; Beri-beri. Tips of fingers numb. Tremulous, tottering gait. Excessive rigidity of legs; spastic gait. Cramps in legs worse cold, and cold feet. Cannot extend or cross legs when sitting. Myelitis, with marked spastic symptoms. Stiffness and lameness of ankles and knees, toe do not leave the floor, heels do not touch floor, Muscles of calves very tense. Patient sits bent forward, straightens with difficulty.
Lobelia purpurascens – There is profound prostration of all the vital forces and of the nervous system; respiratory paralysis. Nervous prostration. Tongue paralyzed. There is superficial respiration as the heart and lungs feel paralyzed and hence respiration slow.
Opium – There is paralysis of brain. Tongue paralyzed. Painless paralysis.
Phosphorus – It inflames spinal cord and nerves, causing paralysis. Paralysis of the insane. Ascending sensory and motor paralysis from ends of fingers and toes. Weakness and trembling, from every exertion. Can scarcely hold anything with his hands. Arms and hands become numb. Can lie only on right side. Post-diphtheritic paralysis, with formication of hands and feet. Joints suddenly give way.
Physostigma venenosum – It produces rigidity of muscles; paralysis. It depresses the motor and reflex activity of the cord and causes loss of sensibility to pain, muscular weakness, followed by complete paralysis, although muscular contractility is not impaired. Paralysis and tremors, chorea. Post-diphtheritic paralysis of eye and accommodation muscles. Numbness in paralyzed parts.
Plumbum metallicum – For lead paralysis chiefly of extensors, forearm or upper limb, from center to periphery with partial anaesthesia or excessive hyperasthesia, preceded by pain. Localized neuralgic pains, neuritis. Also indicated in infantile paralysis. It is also indicated in bulbar paralysis. Paralysis of lower extremities. Paralysis of single muscles. Cannot raise or lift anything with the hand. Extension is difficult. Paralysis from overexertion of the extensor muscles in piano players. Wrist-drop. Stinging and tearing in limbs, also twitching and tingling, numbness, pain or tremor.
Zincum metallicum – This medicine is indicated in impending brain paralysis. In extremities there is lameness, weakness, trembling and twitching of various muscles. Steps with entire sole of foot on floor.
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