Flaccid paralysis

Last updated
Flaccid paralysis
Pronunciation
Specialty Neurology   OOjs UI icon edit-ltr-progressive.svg

Flaccid paralysis is a neurological condition characterized by weakness or paralysis and reduced muscle tone without other obvious cause (e.g., trauma). [1] This abnormal condition may be caused by disease or by trauma affecting the nerves associated with the involved muscles. For example, if the somatic nerves to a skeletal muscle are severed, then the muscle will exhibit flaccid paralysis. When muscles enter this state, they become limp and cannot contract. This condition can become fatal if it affects the respiratory muscles, posing the threat of suffocation. It also occurs in the spinal shock stage in complete transection of the spinal cord occurring in injuries such as gunshot wounds. [2]

Contents

Causes

Polio and other viruses

The term acute flaccid paralysis (AFP) is often used to describe an instance with a sudden onset, as might be found with polio. [3]

AFP is the most common sign of acute polio, and used for surveillance during polio outbreaks. AFP is also associated with a number of other pathogenic agents including enteroviruses other than polio, echoviruses, West Nile virus, and adenoviruses, among others. [4]

Botulism

The Clostridium botulinum bacteria are the cause of botulism. Vegetative cells of C. botulinum may be ingested. Introduction of the bacteria may also occur via endospores in a wound. When the bacteria are in vivo, they induce flaccid paralysis. This happens because C. botulinum produces a toxin that blocks the release of acetylcholine. Botulism toxin blocks the exocytosis of presynaptic vesicles containing acetylcholine (ACh). [2] When this occurs, the muscles are unable to contract. [5] Other symptoms associated with infection from this neurotoxin include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Botulism prevents muscle contraction by blocking the release of acetylcholine, thereby halting postsynaptic activity of the neuromuscular junction. If its effects reach the respiratory muscles, then it can lead to respiratory failure, leading to death. [6]

Curare

Curare is a plant poison derived from – among other species – Chondrodendron tomentosum and various species belonging to the genus Strychnos , which are native to the rainforests of South America. Certain peoples indigenous to the region – notably the Macushi – crush and cook the roots and stems of these and certain other plants and then mix the resulting decoction with various other plant poisons and animal venoms to create a syrupy liquid in which to dip their arrow heads and the tips of their blowgun darts. Curare has also been used medicinally by South Americans to treat madness, dropsy, edema, fever, kidney stones, and bruises. [7] Curare acts as a neuromuscular blocking agent that induces flaccid paralysis. This poison binds to the acetylcholine (ACh) receptors on the muscle, blocking them from binding to ACh. As a result, ACh accumulates within the neuromuscular junction, but since ACh cannot bind to the receptors on the muscle, the muscle cannot be stimulated. This poison must enter the bloodstream for it to work. If curare affects the respiratory muscles, then its effects can become life-threatening, placing the victim at risk for suffocation. [2]

Other

Flaccid paralysis can be associated with a lower motor neuron lesion. This is in contrast to an upper motor neuron lesion, which often presents with spasticity, although early on this may present with flaccid paralysis. [8]

Included in AFP's list are poliomyelitis (polio), transverse myelitis, Guillain–Barré syndrome, enteroviral encephalopathy, [9] traumatic neuritis, Reye's syndrome, etc.

An AFP surveillance programme is conducted to increase case yield of poliomyelitis. This includes collection of two stool samples within fourteen days of onset of paralysis and identification of virus, and control of the outbreak and strengthening immunization in that area.[ citation needed ] [10]

Historical records from the 1950s, modern CDC reports, and recent analysis of patterns in India suggest that flaccid paralysis may be caused in some cases by oral polio vaccinations. [11] [12]

Venomous snakes that contain neurotoxic venom such as kraits, mambas, and cobras can also cause complete flaccid paralysis. [13] Some chemical warfare nerve agents such as VX can also cause complete flaccid paralysis. [14]

In some situations, prominently in those of oriental descent [15] hyperthyroidism can affect the consumption and restoration equilibrium of potassium ions in neurons resulting in hypokalaemic paralysis.

Related Research Articles

<span class="mw-page-title-main">Polio</span> Infectious disease caused by poliovirus

Poliomyelitis, commonly shortened to polio, is an infectious disease caused by the poliovirus. Approximately 75% of cases are asymptomatic; mild symptoms which can occur include sore throat and fever; in a proportion of cases more severe symptoms develop such as headache, neck stiffness, and paresthesia. These symptoms usually pass within one or two weeks. A less common symptom is permanent paralysis, and possible death in extreme cases. Years after recovery, post-polio syndrome may occur, with a slow development of muscle weakness similar to that which the person had during the initial infection.

<span class="mw-page-title-main">Botulism</span> Human and animal disease

Botulism is a rare and potentially fatal illness caused by a toxin produced by the bacterium Clostridium botulinum. The disease begins with weakness, blurred vision, feeling tired, and trouble speaking. This may then be followed by weakness of the arms, chest muscles, and legs. Vomiting, swelling of the abdomen, and diarrhea may also occur. The disease does not usually affect consciousness or cause a fever.

<span class="mw-page-title-main">Botulinum toxin</span> Neurotoxic protein produced by Clostridium botulinum

Botulinum toxin, or botulinum neurotoxin, is a highly potent neurotoxic protein produced by the bacterium Clostridium botulinum and related species. It prevents the release of the neurotransmitter acetylcholine from axon endings at the neuromuscular junction, thus causing flaccid paralysis. The toxin causes the disease botulism. The toxin is also used commercially for medical and cosmetic purposes.

<i>Clostridium botulinum</i> Species of endospore forming bacterium

Clostridium botulinum is a Gram-positive, rod-shaped, anaerobic, spore-forming, motile bacterium with the ability to produce the neurotoxin botulinum.

<span class="mw-page-title-main">Acetylcholine</span> Organic chemical and neurotransmitter

Acetylcholine (ACh) is an organic compound that functions in the brain and body of many types of animals as a neurotransmitter. Its name is derived from its chemical structure: it is an ester of acetic acid and choline. Parts in the body that use or are affected by acetylcholine are referred to as cholinergic.

<span class="mw-page-title-main">Coxsackievirus</span> Virus that causes digestive upset and sometimes heart damage

Coxsackieviruses are a few related enteroviruses that belong to the Picornaviridae family of nonenveloped, linear, positive-sense single-stranded RNA viruses, as well as its genus Enterovirus, which also includes poliovirus and echovirus. Enteroviruses are among the most common and important human pathogens, and ordinarily its members are transmitted by the fecal–oral route. Coxsackieviruses share many characteristics with poliovirus. With control of poliovirus infections in much of the world, more attention has been focused on understanding the nonpolio enteroviruses such as coxsackievirus.

<span class="mw-page-title-main">Post-polio syndrome</span> Human disease

Post-polio syndrome is a group of latent symptoms of poliomyelitis (polio), occurring at about a 25–40% rate. These symptoms are caused by the damaging effects of the viral infection on the nervous system. Symptoms typically occur 15 to 30 years after an initial acute paralytic attack. Symptoms include decreasing muscular function or acute weakness with pain and fatigue. The same symptoms may also occur years after a nonparalytic polio (NPP) infection.

<span class="mw-page-title-main">Cholinesterase</span> Esterase that lyses choline-based esters

The enzyme cholinesterase (EC 3.1.1.8, choline esterase; systematic name acylcholine acylhydrolase) catalyses the hydrolysis of choline-based esters:

<span class="mw-page-title-main">Edrophonium</span>

Edrophonium is a readily reversible acetylcholinesterase inhibitor. It prevents breakdown of the neurotransmitter acetylcholine and acts by competitively inhibiting the enzyme acetylcholinesterase, mainly at the neuromuscular junction. It is sold under the trade names Tensilon and Enlon.

<span class="mw-page-title-main">Neuromuscular junction</span> Junction between the axon of a motor neuron and a muscle fiber

A neuromuscular junction is a chemical synapse between a motor neuron and a muscle fiber.

<span class="mw-page-title-main">Pulse Polio</span> Indian governmental immunisation campaign

Pulse Polio is an immunisation campaign established by the government of India to eliminate poliomyelitis (polio) in India by vaccinating all children under the age of five years against the polio virus. The project fights polio through a large-scale, pulse vaccination programme and monitoring for poliomyelitis cases.

<i>Enterovirus</i> Genus of viruses

Enterovirus is a genus of positive-sense single-stranded RNA viruses associated with several human and mammalian diseases. Enteroviruses are named by their transmission-route through the intestine.

<span class="mw-page-title-main">Curare</span> Group of chemical substances used as poison

Curare is a common name for various alkaloid arrow poisons originating from plant extracts. Used as a paralyzing agent by indigenous peoples in Central and South America for hunting and for therapeutic purposes, curare only becomes active when it contaminates a wound. These poisons cause weakness of the skeletal muscles and, when administered in a sufficient dose, eventual death by asphyxiation due to paralysis of the diaphragm. Curare is prepared by boiling the bark of one of the dozens of plant sources, leaving a dark, heavy paste that can be applied to arrow or dart heads. In medicine, curare has been used as a treatment for tetanus and strychnine poisoning and as a paralyzing agent for surgical procedures.

<span class="mw-page-title-main">Tubocurarine chloride</span> Obsolete muscle relaxant

Tubocurarine is a toxic benzylisoquinoline alkaloid historically known for its use as an arrow poison. In the mid-1900s, it was used in conjunction with an anesthetic to provide skeletal muscle relaxation during surgery or mechanical ventilation. Safer alternatives, such as cisatracurium and rocuronium, have largely replaced it as an adjunct for clinical anesthesia and it is now rarely used.

<span class="mw-page-title-main">Neuromuscular-blocking drug</span> Type of paralyzing anesthetic including lepto- and pachycurares

Neuromuscular-blocking drugs, or Neuromuscular blocking agents (NMBAs), block transmission at the neuromuscular junction, causing paralysis of the affected skeletal muscles. This is accomplished via their action on the post-synaptic acetylcholine (Nm) receptors.

A cholinergic crisis is an over-stimulation at a neuromuscular junction due to an excess of acetylcholine (ACh), as a result of the inactivity of the AChE enzyme, which normally breaks down acetylcholine.

Neuromuscular junction disease is a medical condition where the normal conduction through the neuromuscular junction fails to function correctly.

<span class="mw-page-title-main">Enterovirus 68</span> Species of virus

Enterovirus D68 (EV-D68) is a member of the Picornaviridae family, an enterovirus. First isolated in California in 1962 and once considered rare, it has been on a worldwide upswing in the 21st century. It is suspected of causing a polio-like disorder called acute flaccid myelitis (AFM).

<span class="mw-page-title-main">Acute flaccid myelitis</span> Condition of the spinal cord with symptoms of rapid onset of arm or leg weakness

Acute flaccid myelitis (AFM) is a serious condition of the spinal cord. Symptoms include rapid onset of arm or leg weakness and decreased reflexes. Difficulty moving the eyes, speaking, or swallowing may also occur. Occasionally, numbness or pain may be present. Complications can include trouble breathing.

A notifiable disease is one which the law requires to be reported to government authorities.

References

  1. ↑ Alberta Government Health and Wellness (2005) Acute Flaccid Paralysis Public Health Notifiable Disease Management Guidelines.
  2. 1 2 3 Saladin, Kenneth S. Anatomy & Physiology: The Unity of Form and Function. McGraw-Hill. 6th Edition. 2012.
  3. ↑ "GPEI-Polio + Prevention" . Retrieved 2022-11-18.
  4. ↑ Kelly H, Brussen KA, Lawrence A, Elliot E, Pearn J, Thorley B (June 2006). "Polioviruses and other enteroviruses isolated from faecal samples of patients with acute flaccid paralysis in Australia, 1996–2004". Journal of Paediatrics and Child Health. 42 (6): 370–6. doi:10.1111/j.1440-1754.2006.00875.x. PMID   16737480. S2CID   23585402.
  5. ↑ "Disease Listing, Botulism, General Information – CDC Bacterial, Mycotic Diseases".
  6. ↑ "flaccid paralysis – definition of flaccid paralysis in the Medical dictionary – by the Free Online Medical Dictionary, Thesaurus and Encyclopedia". Medical-dictionary.thefreedictionary.com. Retrieved 2014-02-26.
  7. ↑ "Curare – Chondrodendron tomentosum". Blueplanetbiomes.org. Retrieved 2014-02-26.
  8. ↑ Javed, Kinaan; Daly, Daniel T. (2022), "Neuroanatomy, Lower Motor Neuron Lesion", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   30969636 , retrieved 2022-11-18
  9. ↑ Idris M, Elahi M, Arif A (Jan–Mar 2007). "Guillain Barre syndrome: the leading cause of acute flaccid paralysis in Hazara division". Journal of Ayub Medical College, Abbottabad. 19 (1): 26–8. PMID   17867475.
  10. ↑ Tangermann, Rudolf (May 2017). "The critical role of acute flaccid paralysis surveillance in the Global Polio Eradication Initiative". International Health. 9 (3): 156–163. doi:10.1093/inthealth/ihx016.
  11. ↑ "Public Health Dispatch: Acute Flaccid Paralysis Associated with Circulating Vaccine-Derived Poliovirus – Philippines, 2001". MMWR. Morbidity and Mortality Weekly Report. 50 (40): 874–5. October 12, 2001.
  12. ↑ Vashisht, Neetu; Puliyel, Jacob; Sreenivas, Vishnubhatla (February 2015). "Trends in Nonpolio Acute Flaccid Paralysis Incidence in India 2000 to 2013". Pediatrics. 135 (Supplement 1): S16–S17. doi: 10.1542/peds.2014-3330DD .
  13. ↑ GJ Müller; H Modler; CA Wium; DJH Veale; C J Marks (October 2012). "Snake bite in southern Africa: diagnosis and management". Continuing Medical Education. 30 (10): 362–381. Retrieved 2 March 2015.
  14. ↑ Sidell, Frederick R. (1997). "Chapter 5: Nerve Agents" (PDF). Medical Aspects of Chemical and Biological Warfare. p. 144ff.
  15. ↑ Burrow, Gerard; Oppenheimer, Jack; Volṕe, Robert (1989). Thyroid function & disease. Philadelphia : W.B. Saunders. ISBN   9780721621906.

Further reading

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.