With residual effects of flaccid paralysis, the drug. Flaccid paralysis or what happens on the periphery of the nervous system

Paralysis and paresis. The reasons for their occurrence

Paralysis is one of the violations motor activity of a person and manifests itself in its complete loss (Greek. paralysis- relaxation). This disease is a symptom of many organic diseases nervous system.

In the case of not complete loss of motor function, but only its weakening to one degree or another, this disorder will be called paresis(gr. paresis- weakening). Moreover, both in the first and in the second case, violations of motor function are the result of damage to the nervous system, its motor centers and/or pathways of the central and/or peripheral parts.

Paralysis should be distinguished from movement disorders that occur with inflammation of the muscles and with mechanical damage to the osteoarticular apparatus.

Paresis and paralysis are movement disorders that are caused by the same reasons.

The main causes of these diseases.

Paralysis is not caused by any one specific factor. Any damage to the nervous system can lead to impaired motor function. Congenital, hereditary and degenerative diseases of the central nervous system are usually accompanied by movement disorders.

Birth trauma is a common cause of cerebral palsy, as well as paralysis due to damage to the brachial plexus. Unfortunately, over 15 million patients with cerebral palsy have already been recorded in the world.

A number of diseases of unknown origin (for example, multiple sclerosis) are characterized by movement disorders varying degrees gravity.

circulatory disorders, inflammatory processes, trauma, tumors of the nervous system can also be the causes of paralysis or paresis.

Often paralysis has a psychogenic nature and is a manifestation of hysteria.

The causes of paralysis can also be divided into organic, infectious and toxic.

Organic reasons include:

1. Malignant neoplasms;
2. Vascular lesions;
3. metabolic disorders;
4. intoxication;
5. Eating disorders;
6. infections;
7. Injuries;
8. Multiple sclerosis;

Infectious causes include:

1. Meningitis;
2. Polio;
3. Viral encephalitis;
4. Tuberculosis;
5. Syphilis.

To toxic reasons relate:

1. Vitamin B1 deficiency;
2. Deficiency of nicotinic acid;
3. Heavy metal poisoning;
4. Alcoholic neuritis.

Paralysis can be observed in one muscle, one limb ( monoplegia), in the arm and leg on the same side ( hemiplegia), in both arms or both legs ( paraplegia) (plegia suffix means - paralysis).

By localization lesions distinguish two groups of paralysis, significantly differing in clinical manifestations: central ( spastic) and peripheral ( sluggish).

Central paralysis occur when the central motor neurons are damaged. They are characterized by:

• hypertonicity (increased muscle tone), for example, the "jackknife" phenomenon;
• hyperreflexia (increased intensity of deep reflexes), especially defiantly with unilateral damage;
• the presence of pathological reflexes (Babinsky, Bekhterev, Astvatsaturov, etc.);
• the appearance of pathological synkinesis (friendly movements), for example, when the patient, arbitrarily squeezing a healthy hand into a fist, does not voluntarily repeat this movement with a sick hand, but with less force;
• the appearance of clonuses (convulsive muscle contractions in response to exposure), for example, clonus of the foot - when the patient, lying on his back, with the affected leg, bent at the hip and knee joints, the doctor performs dorsiflexion of the foot, while the flexor muscles begin to contract involuntarily rhythmically , the rhythm can be kept for a long time or fade out almost immediately.

Peripheral paralysis (flaccid) characterized by a complete lack of movement, a drop in muscle tone, the extinction of reflexes, muscle atrophy. With damage to the peripheral nerve or plexus, which contain both motor and sensory fibers, sensitivity disorders are also detected.

Damage to the subcortical structures of the brain results in extrapyramidal paralysis, automated movements disappear, there is no motor initiative. Muscle tone is characterized by plasticity - the limb is held in a passive position given to it.

Classification

There are two scales for assessing the severity of paralysis (paresis) - according to the degree of decrease in muscle strength and according to the degree of severity of paralysis (paresis), which are inverse to each other:

1. 0 points "muscle strength" - no voluntary movements. Paralysis.
2. 1 point - hardly noticeable muscle contractions, without movements in the joints.
3. 2 points - the range of motion in the joint is significantly reduced, movements are possible without overcoming the force of gravity (along the plane).
4. 3 points - a significant reduction in the range of motion in the joint, the muscles are able to overcome gravity, friction (in fact, this means the possibility of detachment of the limb from the surface).
5. 4 points - a slight decrease in muscle strength, with a full range of motion.
6. 5 points - normal muscle strength, full range of motion.

The most significant features of peripheral paralysis are:

1. atony (decreased tone) of the muscles;

2. muscle atrophy due to a decrease in nervous trophism;

3. fasciculations (involuntary contractions of individual muscle fibers perceived by the patient and visible to the eye of the doctor), which develop when the large alpha motor neurons of the anterior horns are damaged spinal cord.

Determining the stage of paralysis (paresis.)

External examination allows you to detect deformations of the spine, joints, feet, hands, asymmetry in the development of the skeleton, leg length.
Edema of the legs, arms, changes in the trophism of nails, skin, the presence of folding of the skin over the spine, stretch marks, varicose veins veins, areas of skin pigmentation, tumors, scars from burns.

The most common method of examining muscles, bones and joints is palpation. Muscle palpation is the main method for determining their tone.

Hypotension(reduced tone) is observed in purely pyramidal paresis, in violation of musculo-articular sensitivity, in a number of neuromuscular diseases, cataplexy, attacks of a sudden fall, hysterical paralysis, with lesions of the cerebellum, etc.
With hypotension, the muscle is relaxed, flattened, has no contours, the finger easily sinks into the thickness of the muscle tissue, its tendon is relaxed, and greater mobility is noted in the corresponding joint. Hypotension can be mild, moderate, severe.

Atony- absence normal tone skeletal muscles and internal organs, which develops as a result of a lack of general nutrition, disorders of the nervous system, with infectious diseases, disorders of the activity of the endocrine glands. With atony, movement is not possible.

At hypertonicity the muscle is tense, shortened, embossed, compacted, the finger hardly penetrates the muscle tissue, movements in the joint are usually limited in volume.

Spasticity or spastic paresis.

Paresis is characterized by a peculiar selective increase in tone in the adductor muscles of the shoulder, flexors of the forearm, hand, fingers and pronators of the hand. In the leg, hypertonicity is noted in the extensors of the hip and knee joints, adductor muscles of the thigh, plantar flexors of the foot and fingers (Wernicke-Mann posture). With repeated movements, springy muscle resistance may disappear and the spastic posture is overcome - a symptom of the "jackknife".

In conditions of a spinal lesion above the cervical thickening, spastic hemi- or tetraplegia develops, injuries at the level of the thoracic segments cause lower paraplegia.

With spastic paresis, a number of accompanying signs are noted:

1. Tendon-periosteal hyperreflexia with expansion of the reflex zone, clonus of the feet, hands, lower jaw.
2. The most reliable of them is the Babinski reflex, which is caused by a dashed irritation of the outer part of the sole with a handle from the heel to the toes. In response, there is an extension of the first finger and flexion with a fanning out of the remaining fingers.
3. Hoffman reflex - increased flexion of the fingers of the hanging hand in response to pinch stimulation nail phalanx third finger.
4. Protective reflexes - a triple leg flexion reflex when the skin of the foot is irritated by a pinch or a cold object, as well as a leg lengthening reflex in response to a thigh prick.
5. Absence of abdominal reflexes and signs of damage to a peripheral neuron (fibrillar muscle twitching, atrophy) completes the picture of spastic paresis.

Extrapyramidal pseudoparesis, rigidity.

Pseudoparesis manifested by uniform hypertonicity in massive muscle groups - agonists and antagonists, flexors and extensors of the limbs, which leads to a plastic increase in tone, freezing of the limb in an uncomfortable position given to it (wax flexibility).
Stronger flexors give the patient a "beggar" position. - The torso and head are tilted forward, the arms are half-bent in elbow joints and pressed to the body. Movements are slow, awkward, their beginning is especially difficult. In the study of passive movements, intermittent resistance of the muscles during flexion and extension of the limb is noted. Often there is a rhythmic constant tremor of the fingers at rest.

Peripheral paresis (flaccid).

At flaccid paresis peripheral type pathological signs, synkinesis and protective reflexes are absent.
Nerve damage (neuritis, mononeuropathy) leads to selective atrophy of the muscle group innervated by this nerve.
Polyneuritis contribute to symmetrical paresis of the distal muscles (feet, shins, hands, forearms).
Plexus lesion (plexitis) accompanied by unilateral paresis with predominant localization in the upper or lower sections limbs, in the muscles of the pelvic or shoulder girdle.

Mixed paresis.

In some cases, patients have both signs of flaccid paresis and symptoms of damage to the central motor neuron. Such paresis is called mixed.
With it, the cells of the anterior horn and the pyramidal pathway are damaged.
To mixed type paresis refers to the central type of defects after strokes, with tumors (hematomas) with compression on this area. In this category of patients, hemiparkinsonism and spastic hemiparesis are present together.

The treatment of such patients must be approached individually. The remedies for this disease include such as sulfuric and radon baths, segmental and acupressure massage, balance therapy, stem cell treatment. But the main method of treatment is a special therapeutic gymnastics.

Poliomyelitis (infantile paralysis)) is caused by a virus and is highly contagious viral infection. In its most serious form, polio can cause rapid and irreversible paralysis; until the end of the 1950s, it was one of the most dangerous infectious diseases and often occurred in the form of epidemics. Post-polio syndrome or post-polio progressive muscle atrophy can occur 30 years or more after the initial infection, gradually leading to muscle weakness, atrophy, and pain. Polio can be prevented by building up immunity, and has now virtually disappeared in developed countries; however, the risk of disease still exists. Polio is still common in many parts of the world and there is no way to cure it; therefore, until the polio virus is eradicated, vaccination remains the main form of protection.

In summer and early autumn, when polio epidemics are most common, parents first of all remember about it when a child falls ill. The disease, like many other infections, begins with general malaise, fever and headache. Vomiting, constipation, or mild diarrhea may occur. But even if your child has all these symptoms, plus leg pain, don't jump to conclusions. Chances are still high that it's the flu or a sore throat. Of course, in any case, you call a doctor. If he is gone for a long time, you can calm down this way: if the child can lower his head between his knees or tilt his head forward so that his chin touches his chest, he probably does not have polio. (But even if he fails these tests, it is still not proof of illness.)
Despite significant progress in the eradication of poliomyelitis in our country, the problem of diseases accompanied by acute flaccid paralysis (AFP) has not lost its relevance. Pediatricians often have to deal with various infectious diseases of the brain and spinal cord, peripheral nerves. The study of the structure of neuroinfections indicates that lesions of the peripheral nervous system occur in 9.6% of patients, infectious diseases of the spinal cord - in 17.7%. Among the latter, acute infectious myelopathy predominates, while acute paralytic vaccine-associated poliomyelitis, acute myelopathy, and enceare much less common. In this regard, in modern conditions, it is necessary to pay special attention to the differential diagnosis of AFP, monitoring the epidemic situation, which will avoid overdiagnosis, improve treatment results, and reduce the frequency of unjustified registration. post-vaccination complications.

Acute paralytic poliomyelitis is a group of viral diseases united according to the topical principle, characterized by flaccid paresis, paralysis caused by damage to the motor cells in the anterior horns of the spinal cord and the nuclei of the motor cranial nerves of the brain stem.

Etiology. Etiological structure infectious diseases nervous system is diverse. Among etiological factors"wild" polioviruses 1, 2, 3rd type, vaccine polioviruses, enteroviruses (ECHO, Coxsackie), herpesviruses (HSV, HHV type 3, EBV), influenza virus, mumps virus, diphtheria bacillus, borrelia, UPF (staphylococci , Gram-negative bacteria).

Of particular interest is spinal paralysis caused by the "wild" poliomyelitis virus, belonging to the picornavirus family, the genus Enterovirus. The causative agent is small (18-30 nm), contains RNA. Synthesis of the virus and its maturation occur inside the cell.

Polioviruses are not sensitive to antibiotics and chemotherapy drugs. When frozen, their activity persists for several years, in a household refrigerator for several weeks, and at room temperature for several days. At the same time, poliomyelitis viruses are quickly inactivated when treated with formaldehyde, free residual chlorine, they do not tolerate drying, heating, and ultraviolet radiation.

The polio virus has three serotypes - 1, 2, 3. Its cultivation in the laboratory is carried out by infecting various tissue cultures and laboratory animals.

The reasons

Poliomyelitis is caused by a viral infection with one of three forms of the polio virus.

The virus can be transmitted through contaminated food and water, or through infected saliva during coughing or sneezing.

The source of infection is a sick person or a carrier. The greatest epidemiological significance is the presence of the virus in the nasopharynx and intestines, from where it is released into the external environment. In this case, the isolation of the virus with feces can last from several weeks to several months. The causative agent of poliomyelitis is contained in the nasopharyngeal mucus for 1-2 weeks.

The main routes of transmission are alimentary and airborne.

Under conditions of mass specific prophylaxis, sporadic cases were recorded throughout the year. Mostly children under the age of seven were ill, of which the proportion of patients early age reached 94%. The contagiousness index is 0.2-1%. Mortality in the unvaccinated reached 2.7%.

The World Health Organization in 1988 raised the issue of the complete eradication of poliomyelitis caused by the "wild" virus. In this regard, 4 main strategies have been adopted to combat this infection:

1) achieving and maintaining a high level of population coverage with preventive vaccinations;

2) providing additional vaccinations on national immunization days (NIDs);

3) creation and functioning of an effective system of epidemiological surveillance for all cases of acute flaccid paralysis (AFP) in children under 15 years of age with mandatory virological examination;

4) carrying out additional "cleaning up" immunization in disadvantaged areas.

At the time of the adoption of the Global Polio Eradication Program, the number of patients in the world was 350,000. However, by 2003, thanks to ongoing activities, their number had dropped to 784. Three regions of the world are already free from polio: America (since 1994), Western Pacific (since 2000) and European (since 2002). However, in the Eastern Mediterranean, African regions and South-East Asia Poliomyelitis caused by wild poliovirus continues to be reported. India, Pakistan, Afghanistan, Nigeria are considered endemic for poliomyelitis.

Since December 2009, an outbreak of poliomyelitis caused by type 1 poliovirus has been recorded in Tajikistan. It is assumed that the virus came to Tajikistan from neighboring countries - Afghanistan, Pakistan. Taking into account the intensity of migration flows from the Republic of Tajikistan to the Russian Federation, including labor migration and active trade relations, the “wild” polio virus was imported into the territory of our country, cases of poliomyelitis were registered in adults and children.

Russia launched the Global Program for the Eradication of Poliomyelitis on its territory in 1996. Thanks to the maintenance of a high level of vaccination coverage for children of the first year of life (more than 90%), the improvement of epidemiological surveillance, the incidence of this infection in Russia has decreased from 153 cases in 1995 to up to 1 - in 1997. By decision of the European Regional Certification Commission in 2002. Russian Federation has been declared a polio-free area.

Before the switch to the use of inactivated polio vaccine in Russia, diseases caused by vaccine polioviruses (1-11 cases per year) were registered, as a rule, after the introduction of the first dose of live OPV.

Diagnostics

Medical history and physical examination.

Blood tests.

Lumbar puncture (spinal tap).

Laboratory diagnostics. Only based on the results of virological and serological studies, it is possible to establish the final diagnosis of poliomyelitis.

Virological testing for poliomyelitis in the laboratories of regional centers for epidemiological surveillance of poliomyelitis/ AFP is subject to:

- sick children under 15 years of age with symptoms of acute flaccid paralysis;

— contact children and adults from the foci of poliomyelitis and AFP in the case of late (later than the 14th day from the moment of detection of paralysis) examination of the patient, as well as in the presence of persons around the patient who arrived from territories unfavorable for poliomyelitis, refugees and forced migrants (once) ;

— children under the age of 5 who arrived within the last 1.5 months from the Chechen Republic, the Republic of Ingushetia and applied for medical care to medical institutions, regardless of the profile (once).

Patients with clinical signs of poliomyelitis or acute flaccid paralysis are subject to a mandatory 2-fold virological examination. The first sample of faeces is taken within a day from the moment of diagnosis, the second sample - after 24-48 hours. The optimal volume of faeces is 8-10 g. The sample is placed in a sterile special plastic container. If samples are delivered to the Regional Polio/AFP Surveillance Center within 72 hours of collection, the samples are refrigerated at 0 to 8°C and transported to the laboratory at 4 to 8°C (reverse cold). chain). In cases where the delivery of the material to the virological laboratory is planned to be made at a later date, the samples are frozen at -20 °C and transported frozen.

The frequency of virus isolation in the first two weeks is 80%, on the 5-6th week - 25%. No permanent carrier has been identified. From the cerebrospinal fluid, unlike the Coxsackie and ECHO viruses, the polio virus is extremely rare.

At deaths material is taken from the cervical and lumbar extensions of the spinal cord, cerebellum and contents colon. With paralysis lasting 4-5 days, it is difficult to isolate the virus from the spinal cord.

Serological examination is subject to:

- Patients with suspected poliomyelitis;

- children under the age of 5 who arrived within the last 1.5 months from the Chechen Republic, the Republic of Ingushetia and applied for medical care to medical institutions, regardless of their profile (once).

For serological study take two samples of the patient's blood (5 ml each). The first sample should be taken on the day of the initial diagnosis, the second - after 2-3 weeks. Blood is stored and transported at a temperature of 0 to +8 °C.

RSK detects complement-fixing antibodies to N- and H-antigens of poliovirus. In the early stages, only antibodies to the H-antigen are detected, after 1-2 weeks - to H- and N-antigens, in those who have been ill - only N-antibodies.

During the first infection with poliovirus, strictly type-specific complement-fixing antibodies are formed. Upon subsequent infection with other types of polioviruses, antibodies are formed mainly to thermostable group antigens, which are present in all types of polioviruses.

PH detects virus-neutralizing antibodies in the early stages of the disease, it is possible to detect them at the stage of hospitalization of the patient. Virus-neutralizing antibodies can be detected in the urine.

RP in agar gel reveals precipitins. Type-specific precipitating antibodies can be detected during convalescence, circulate long time. To confirm the increase in antibody titers, paired sera are examined at intervals of 3-4 weeks; a serum dilution that exceeds the previous one by 3-4 times or more is taken as a diagnostic increase. The most effective method is ELISA, which allows short time determine the class-specific immune response. It is mandatory to carry out PCR in order to detect RNA viruses in individual feces, cerebrospinal fluid.

Symptoms

Fever.

headache and sore throat.

Fixed neck and back.

Nausea and vomiting.

Muscle pain, weakness, or spasms.

Difficulty in swallowing.

Constipation and retention of urine.

Bloated belly.

Irritability.

extreme symptoms; muscle paralysis; difficulty breathing.

Pathogenesis. The entry gates of infection in poliomyelitis are the mucous membrane of the gastrointestinal tract and upper respiratory tract. The virus multiplies in the lymph nodes rear wall throat and intestines.

Overcoming the lymphatic barrier, the virus enters the bloodstream and spreads throughout the body with its current. Fixation and reproduction of the causative agent of poliomyelitis occurs in many organs and tissues - lymph nodes, spleen, liver, lungs, heart muscle and, especially, in brown fat, which is a kind of virus depot.

Penetration of the virus into the nervous system is possible through the endothelium of small vessels or along peripheral nerves. Distribution within the nervous system occurs along the dendrites of cells and, possibly, through intercellular spaces. When the virus interacts with the cells of the nervous system, the most profound changes develop in motor neurons. The synthesis of polioviruses occurs in the cytoplasm of the cell and is accompanied by suppression of the synthesis of DNA, RNA and proteins of the host cell. The latter dies. Within 1-2 days, the virus titer in the central nervous system increases, and then begins to fall, and soon the virus disappears.

Depending on the state of the macroorganism, the properties and dose of the pathogen, the pathological process can stop at any stage of viral aggression. This creates various clinical forms poliomyelitis. In most infected children, due to an active reaction immune system the virus is eliminated from the body and recovery occurs. Thus, in the inapparent form, the alimentary phase of development takes place without viremia and invasion into the CNS, while in the abortive form, the alimentary and hematogenous phases take place. For clinical variants accompanied by damage to the nervous system, the consistent development of all phases with damage to motor neurons at different levels is characteristic.

Pathomorphology. Morphologically, acute poliomyelitis is most characterized by damage to large motor cells located in the anterior horns of the spinal cord and the nuclei of the motor cranial nerves in the brain stem. In addition, the motor area of ​​the cerebral cortex, the nuclei of the hypothalamus, and the reticular formation may be involved in the pathological process. In parallel with the damage to the spinal cord and brain, the pathological process involves the pia mater, in which acute inflammation. At the same time, the number of lymphocytes and protein content in the cerebrospinal fluid increase.

Macroscopically, the spinal cord looks edematous, the border between the gray and white matter is blurred, in severe cases, gray matter retraction is noted on the transverse section.

Microscopically, in addition to swollen or completely disintegrated cells, there are unchanged neurons. This "mosaic" of nerve cell damage is clinically manifested by an asymmetric, random distribution of paresis and paralysis. At the site of dead neurons, neuronophagic nodules are formed, followed by proliferation of glial tissue.

Classification

According to modern requirements, the standard definition of poliomyelitis and acute flaccid paralysis (AFP) is based on the results of clinical and virological diagnostics (Appendix 4 to the order of the Ministry of Health of the Russian Federation No. 24 of 01/25/99) and is presented as follows:

- acute flaccid spinal paralysis, in which the "wild" polio virus is isolated, is classified as acute paralytic poliomyelitis (according to ICD 10 revision A.80.1, A.80.2);

- acute flaccid spinal paralysis, which occurred no earlier than the 4th and no later than the 30th day after receiving a live polio vaccine, in which the vaccine-derived polio virus was isolated, is classified as acute paralytic poliomyelitis associated with the vaccine in the recipient (according to ICD 10 revision A .80.0);

- acute flaccid spinal paralysis that occurred no later than the 60th day after contact with a vaccinated person, in which vaccine-derived poliovirus was isolated, is classified as acute paralytic poliomyelitis associated with a vaccine in a contact (according to ICD 10 revision A.80.0). Isolation of vaccine-derived poliovirus in the absence of clinical manifestations has no diagnostic value;

- acute flaccid spinal paralysis, in which the examination was not carried out completely (the virus was not isolated) or was not carried out at all, but residual flaccid paralysis is observed by the 60th day from the moment of their occurrence, is classified as acute paralytic poliomyelitis, unspecified (according to ICD 10 revision A .80.3);

- acute flaccid spinal paralysis, in which a complete adequate examination was carried out, but the virus was not isolated and no diagnostic increase in antibodies was obtained, is classified as acute paralytic poliomyelitis of another, non-polio etiology (according to ICD 10, revision A.80.3).

Isolation of a "wild" strain of the virus from a patient with catarrhal, diarrheal or meningeal syndromes without the occurrence of flaccid paresis or paralysis is classified as acute non-paralytic poliomyelitis (A.80.4.)

Acute flaccid spinal paralysis with the release of other neurotropic viruses (ECHO, Coxsackie, herpesviruses) refers to diseases of a different, non-polio etiology.

All these diseases, based on the topical principle (damage to the anterior horns of the spinal cord), appear under common name"Acute poliomyelitis".

Polio classification

According to the severity of the process, mild, moderate and severe forms of poliomyelitis are distinguished. The course of the disease is always acute, and by nature it can be smooth or uneven, depending on the presence of complications (osteoporosis, fractures, urolithiasis disease, contracture, pneumonia, bedsores, asphyxia, etc.).

Clinic. Duration incubation period with poliomyelitis is 5-35 days.

The spinal form of poliomyelitis in children is more common than other paralytic forms. In this case, more often the pathological process develops at the level of the lumbar enlargement of the spinal cord.

During the course of the disease, several periods are distinguished, each of which has its own characteristics.

The preparalytic period is characterized by an acute onset of the disease, worsening general condition, an increase in body temperature to febrile numbers, headache, vomiting, lethargy, weakness, meningeal signs. General infectious, cerebral and meningeal syndromes can be combined with catarrhal or dyspeptic symptoms. In addition, it is noted positive symptoms tension, complaints of pain in the back, neck, limbs, pain on palpation of the nerve trunks, fasciculations and horizontal nystagmus. The duration of the preparalytic period is from 1 to 6 days.

The paralytic period is marked by the appearance of flaccid paralysis or paresis of the muscles of the limbs and trunk. support diagnostic features this stage are:

- sluggish nature of paralysis and their sudden appearance;

- a rapid increase in movement disorders for a short time (1-2 days);

- damage to the proximal muscle groups;

- asymmetric nature of paralysis or paresis;

- absence of violations of sensitivity and function pelvic organs.

At this time, changes in the cerebrospinal fluid occur in 80-90% of patients with poliomyelitis and indicate the development serous inflammation in the soft meninges. With the development of the paralytic stage, the general infectious symptoms fade away. Depending on the number of affected segments of the spinal cord, the spinal form may be limited (monoparesis) or widespread. The most severe forms are accompanied by a violation of the innervation of the respiratory muscles.

The recovery period is accompanied by the appearance of the first voluntary movements in the affected muscles and begins on the 7-10th day after the onset of paralysis. With the death of 3/4 of the neurons responsible for the innervation of any muscle group, the lost functions are not restored. Over time, atrophy increases in these muscles, contractures, ankylosis of the joints, osteoporosis, and limb growth lag appear. The recovery period is especially active during the first months of the disease, then it slows down somewhat, but lasts for 1-2 years.

If after 2 years the lost functions are not restored, then they speak of a period of residual phenomena (various deformations, contractures, etc.).

The bulbar form of poliomyelitis is characterized by damage to the nuclei of 9, 10, 12 pairs of cranial nerves and is one of the most dangerous variants of the disease. In this case, there is a disorder of swallowing, phonation, pathological secretion of mucus in the upper respiratory tract. Of particular danger is the localization of the process in the region medulla oblongata when, due to the defeat of the respiratory and cardiovascular centers, there is a threat to the life of the patient. Harbingers of an unfavorable outcome in this case is the occurrence abnormal breathing, cyanosis, hyperthermia, collapse, impaired consciousness. The defeat of 3, 4, 6 pairs of cranial nerves in polio is possible, but less common.

The pontine form of poliomyelitis is the easiest, but a cosmetic defect can persist in a child for life. The clinical characteristic of this form of the disease is the defeat of the nucleus of the facial nerve. At the same time, immobility of the mimic muscles on the affected side suddenly occurs and lagophthalmos, Bell's symptoms, "sails", pulling the corner of the mouth to the healthy side while smiling or crying appear. The pontine form of poliomyelitis more often than others occurs without fever, general infectious symptoms, and changes in the cerebrospinal fluid.

The meningeal form of poliomyelitis is accompanied by lesions of the pia mater. The disease begins acutely and is accompanied by a deterioration in the general condition, an increase in body temperature to febrile numbers, headache, vomiting, lethargy, weakness, meningeal signs.

Symptoms characteristic of the meningeal form of poliomyelitis are pain in the back, neck, limbs, positive symptoms of tension, pain on palpation of the nerve trunks. In addition, fasciculations and horizontal nystagmus may be seen. An electromyogram revealed a subclinical lesion of the anterior horns of the spinal cord.

When conducting spinal tap liquor usually flows out under pressure, transparent. His research reveals:

- cell-protein dissociation;

- lymphocytic pleocytosis (the number of cells increases to several hundred in 1 mm 3);

- normal or slightly increased content squirrel;

- high sugar content.

The nature of changes in the cerebrospinal fluid depends on the timing of the disease. Thus, the increase in cytosis may be delayed and in the first 4-5 days from the onset of the disease, the composition of the cerebrospinal fluid remains normal. In addition, sometimes, in the initial period, there is a short-term predominance of neutrophils in the CSF. After 2-3 weeks from the onset of the disease, protein-cell dissociation is detected. The course of the meningeal form of poliomyelitis is favorable and ends with complete recovery.

The inapparant form of poliomyelitis is characterized by the absence of clinical symptoms with the simultaneous isolation of the "wild" strain of the virus from feces and a diagnostic increase in the titer of antiviral antibodies in the blood serum.

The abortive form or minor illness is characterized by an acute onset, the presence of general infectious symptoms without involvement of the nervous system in the pathological process. So, children may experience fever, moderate lethargy, loss of appetite, headache. Often, these symptoms are combined with catarrhal or dyspeptic symptoms, which serves as the basis for the erroneous diagnosis of acute respiratory viral or intestinal infections. Usually, the abortive form is diagnosed when the patient is hospitalized from the outbreak and positive results of the virological examination are obtained. The abortive form proceeds benignly and ends with a complete recovery within a few days.

The development of vaccine-associated poliomyelitis is associated with the use of a live oral vaccine for mass immunization and the possibility of reversing the neurotropic properties of individual clones of vaccine virus strains. In this regard, in 1964, a special WHO committee determined the criteria by which cases of paralytic poliomyelitis can be classified as vaccine-associated:

- the onset of the disease is not earlier than the 4th and not later than the 30th day after vaccination. For those in contact with the vaccinated, this period is extended to the 60th day;

- development of flaccid paralysis and paresis without impaired sensitivity with persistent (after 2 months) residual effects;

- lack of progression of the disease;

- isolation of a polio virus similar in antigenic characteristics to the vaccine virus and at least a 4-fold increase in type-specific antibodies.

Treatment

Rest in bed is necessary until severe symptoms subside.

Pain medications may be used to reduce fever, pain, and muscle spasms.

Your doctor may prescribe betanecol to treat urinary retention and antibiotics to treat an associated bacterial infection. urinary canal.

A urinary catheter, a thin tube connected to a urine collection bag, may be needed if bladder control has been lost due to paralysis.

Artificial respiration may be required if breathing is difficult; in some cases, surgery to open the throat (tracheotomy) may be required.

Physiotherapy is necessary in cases of temporary or permanent paralysis. Mechanical aids such as bandages, crutches, a wheelchair, and special boots can help you walk.

A combination of professional and psychological therapy can help patients adjust to the limitations imposed by the disease.

Treatment of poliomyelitis in the acute period should be etiotropic, pathogenetic and symptomatic.

The development of clinical variants of poliomyelitis with damage to the nervous system requires mandatory, as early as possible hospitalization of the patient, ensuring careful care and constant monitoring of basic vital functions. It is necessary to observe a strict orthopedic regimen. The affected limbs are given physiological

position with the help of plaster splints, bandages. The diet should correspond to the age needs of the child in the main ingredients and provides for the exclusion of spicy, fatty, fried foods. Particular attention should be paid to feeding children with bulbar or bulbospinal forms, since due to impaired swallowing, the threat of developing aspiration pneumonia is real. To avoid this formidable complication allows tube feeding of the child.

As far as medical treatment is concerned, important point is maximum limit intramuscular injections, which contribute to the deepening of neurological disorders.

As etiotropic agents for meningeal and paralytic forms, it is necessary to use antiviral drugs(pleconaril, isoprinosine pranobex), interferons (viferon, roferon A, reaferon-EC-lipint, leukinferon) or inducers of the latter (neovir, cycloferon), immunoglobulins for intravenous administration.

Pathogenetic therapy of the acute period provides for the inclusion in complex therapy:

- glucocorticoid hormones (dexamethasone) severe forms according to vital indications;

- vasoactive neurometabolites (trental, actovegin, instenon);

- nootropic drugs (gliatilin, piracetam, etc.);

- vitamins (A, B1, B 6 , B 12 , C) and antioxidants (vitamin E, mexidol, mildronate, etc.);

- diuretics (diacarb, triampur, furosemide) in combination with potassium-containing drugs;

— infusion therapy for the purpose of detoxification (5-10% glucose solutions with electrolytes, albumin, infucol);

- inhibitors of proteolytic enzymes (gordox, amben, contrykal);

- non-narcotic analgesics (with severe pain syndrome);

- physiotherapeutic methods (paraffin or ozocerite applications on the affected limbs, UHF on the affected segments).

The appearance of the first movements in the affected muscle groups marks the beginning of an early recovery period and is an indication for the appointment of anticholinesterase drugs (prozerin, galantamine, ubretide, oxazil). As the pain syndrome is relieved, exercise therapy, massage, UHF, then electrophoresis, electromyostimulation are used. impulse current, hyperbaric oxygen therapy.

After discharge from the infectious diseases department, the course of treatment with the medications described above continues for 2 years. The optimal solution should be the treatment of polio convalescents in specialized sanatoriums.

It is not yet known whether the infection can be stopped once it has begun. On the other hand, many children who become infected do not develop paralysis. Many who are paralyzed for a while then fully recover. Most of those who do not completely recover make a significant improvement.

If mild paralysis is observed after the acute phase of the disease, the child should be under constant medical supervision. Treatment depends on many factors. At each stage, the decision is made by the doctor, and there are no general rules. If the paralysis persists, various operations are possible that restore the mobility of the limbs and protect them from deformation.

Prevention

When there are cases of polio in your area, parents start asking how to keep the child safe. Your physician who knows local conditions, give you best advice. It makes no sense to panic and deprive children of all contact with others. If there are cases of illness in your area, it is wise to keep children away from crowds, especially in closed places such as shops and cinemas, and away from swimming pools that are used by many people. On the other hand, as far as we now know, it is absolutely not necessary to forbid a child to meet close friends. If you take care of him like that all your life, you won't even let him cross the street. Physicians suspect that hypothermia and fatigue increase susceptibility to this disease, but both are best avoided at all times. Of course, the most common case of hypothermia in the summer is when a child spends too much time in the water. When he begins to lose his color, he should be called out of the water before his teeth chatter.
. There are a number of vaccines that are recommended at two months of age, then again at four and 18 months, and a booster when the child enters school (between four and six years of age).

Childhood immunization is the backbone of the polio eradication strategy, with routine immunization coverage of at least 95% among children of decreed ages in accordance with the Immunization Schedule.

national days immunization is the second important component in the polio eradication strategy. The aim of these campaigns is to stop the circulation of "wild" poliovirus by immunizing as soon as possible (within a week) all children belonging to the age group with the most high risk diseases (as a rule, these are children under the age of three years).

In Russia, National Polio Immunization Days covering about 4 million children under the age of 3 years (99.2-99.5%) were held for 4 years (1996-1999). Immunization was carried out in two rounds, with an interval of one month, with a live oral polio vaccine (OPV), with vaccination coverage of at least 95% of the number of children of the indicated age groups located in the given territory.

The main prophylactic drug both in our country and throughout the world is the Sabin live vaccine (ZHA), recommended by WHO. In addition, in Russia registered imported vaccines Imovax Polio (Sanofi Pasteur, France), Tetrakok (Sanofi Pasteur, France). The Pentaxim vaccine (Sanofi Pasteur, France) is under registration. The listed vaccines belong to inactivated polio vaccines. Vaccines are stored at a temperature of 2-8 °C for 6 months. An opened vial should be used within two working days.

Currently, for the immunization of the child population against poliomyelitis, OPV is used - oral types 1, 2 and 3 (Russia), IPV - Imovax Polio - inactivated enhanced (types 1, 2, 3) and Pentaxim (Sanofi Pasteur, France).

Vaccination starts from the age of 3 months three times with an interval of 6 weeks IPV, revaccination - at 18 and 20 months, and also at 14 years - OPV.

The dose of a domestically produced live vaccine is 4 drops per dose. It is administered by mouth one hour before meals. Drinking the vaccine, eating and drinking within an hour after vaccination is not allowed. When spitting up, a second dose should be given.

Contraindications for HPV vaccination are:

- all types of immunodeficiency;

- neurological disorders due to previous ZhPV vaccinations;

- the presence of acute diseases. In the latter case, the vaccine is given immediately after recovery.

Non-severe diseases with fever up to 38 °C are not a contraindication for ZhPV vaccination. In the presence of diarrhea, vaccination is repeated after normalization of the stool.

The oral polio vaccine is considered the least reactogenic. However, its use does not exclude the possibility of an adverse post-vaccination event. The greatest degree of risk is observed with primary vaccination and with contact infection of non-immune children.

It is possible to prevent the occurrence of vaccine-associated poliomyelitis in children, especially from risk groups (IDS, born from HIV-infected mothers, etc.), using inactivated polio vaccine for initial vaccination or after completing a full course of immunization.

According to epidemiological indications, additional immunization is carried out. It is carried out regardless of previous preventive vaccinations against poliomyelitis, but not earlier than 1 month after the last immunization. Children under 5 years of age are subject to a single OPV immunization (the age composition of children may be changed) who communicated in epidemic foci with patients with poliomyelitis, diseases accompanied by acute flaccid paralysis, if these diseases are suspected in the family, apartment, house, preschool educational and medical - a preventive institution, as well as those who communicated with those who arrived from territories unfavorable for poliomyelitis.

Non-specific prevention of polio infection involves hospitalization and isolation of the patient, the establishment of observation for 20 days for contact children under the age of 5 years. According to epidemiological indications, a single virological examination of contacts is carried out. In the epidemic focus of POLYO / AFP, after hospitalization of the patient, final disinfection is carried out.

In adults, polio vaccination is recommended only before traveling to places where polio is common.

Call your doctor immediately if you or your child are experiencing symptoms of polio or if you may have been exposed to the virus and have not yet been vaccinated.

See your doctor to get the polio vaccine if you have not been vaccinated and are going to travel where polio is common.

Attention! Call an ambulance if someone is having difficulty breathing or is paralyzed in a limb.

Peripheral paralysis is the result of damage to peripheral neurons responsible for motor functions. In this case, there is a loss of reflexes, degenerative muscle atrophy and.

In addition, it should be noted that the process of changing the electrical excitability in the affected nerves, which is called rebirth, is also launched. The depth of change in electrical excitability indicates the severity of the disease.

Atony and loss of reflexes occurs due to a break in the work of the reflex arc, and at the same time the muscles lose their tone. This factor does not cause the corresponding reflex. Dissociation of muscles with neurons of the spinal cord and causes their sharp weight loss and atrophy.

From the neurons that are connected to the muscles, the impulses responsible for normal exchange substances in the muscle tissue.

With muscle damage, fibrillar twitches are observed, which look like fast contractions in the field of individual muscle fibers. Basically, these processes occur when chronic form diseases.

Peripheral paralysis occurs when a peripheral nerve is damaged. In this case, sensitivity may be lost, and as a result, they develop in the affected area.

The process of disease development

The development of peripheral paralysis is associated with damage to the neuron responsible for movement and its axon. If only the nuclei of the cranial nerves and anterior horns are affected, then along with flaccid paralysis, it can develop in parallel.

In addition, these two ailments are accompanied by characteristic fascicular twitches. When a peripheral nerve is deformed, there is a high chance that the innervated muscle will be paralyzed.

Peripheral and central paralysis are 2 pathologies that are often mistaken for one disease or completely confused.

But these are different violations. With central paralysis, the motor functions of the whole body are lost, the muscles are in constant tension. In addition, there are no signs of degeneration, and the muscles do not atrophy. In the case of damage to the peripheral departments, the picture is different, or rather completely opposite.

Peripheral paralysis is a disease in which there is a decrease in muscle tone and paralysis of certain parts of the body.

Factors affecting the development of the disorder

Symptoms of flaccid paralysis, such as loss of motor function, are not an independent disease, they are often caused by concurrent ailments.

In fact, paralysis is a disorder in which a person performs involuntary movements. In some cases, patients cannot move a body part or are completely immobilized.

Partial loss of motor functions speaks of. In any case, the violation is evidence, namely the centers that are responsible for the movement, and the peripheral departments. As factors influencing the development of pathology, the following are noted:

Characteristic manifestations

Signs of peripheral paralysis:

• complete or partial loss of motor functions;
• decreased muscle tone in the affected part;
• complete or partial absence of any reaction to sudden irritation of paralyzed muscles;
• there is denervation atrophy, that is, loss of muscle mass;
• there is also a reaction of degeneration or rebirth.

Over time, if a person does not receive proper treatment, peripheral paralysis can go into another form, that is, an acute infectious disease. Often it is found under the name. It is characterized by intoxication, while the nervous system also suffers, paralysis and acute flaccid peripheral paresis develop.

This infection is caused by a filter virus, which is quite stable and has an increased sensitivity to ultraviolet radiation, disinfectants and high temperature.

When a virus enters a neuron, a dystrophic-necrotic process is triggered, which is accompanied by the replacement of all dead neurons with glial tissue and subsequent scarring. In turn, the more neurons die, the faster they form or paralysis.

Diagnostic methods

Diagnostic measures involve the implementation of a whole range of examinations:

• examination by a specialist - a neurologist;
• basic tests are taken (general blood test and toxic);
• instrumental diagnostics ( , and );
• an analysis of the patient's complaints and anamnesis is carried out (the time of muscle inactivity, the causes of complaints and the presence of them in other relatives and what caused such a reaction, that is, the place of work, etc., is revealed);
• often seen by a neurosurgeon.

In addition to the basic methods, specialists conduct differential diagnosis diseases. At the same time, symptoms are identified that are very easy to confuse with signs of central paralysis.

In addition, do not forget that in some cases, the lack of motor functions can be caused by any kind of injury and not always such a symptom is a sign of peripheral paralysis. Therefore, carried out full inspection patient for such injuries.

Health care

First of all, treatment is aimed at getting rid of the causes contributing to the development of the disease. In some cases, which are particularly complex, specialists resort to surgical intervention.

In this case, only that part of the spinal cord on which the damaged muscles are located is affected. But do not forget that peripheral paralysis may not be the result of some other disease, but its development as an independent form of pathology is quite likely.

Treatment involves a range of activities. In this case, both medications and more common methods, such as and are used.

The main task of specialists is the complete return of the patient's motor functions. If this is done, the chance of developing other processes leading to deformation against this background is significantly reduced.

All this time, the patient must be under the supervision of a neurologist and follow all his instructions, including taking individually prescribed medications.

Among the drugs that are quite often prescribed to patients suffering from flaccid paralysis, it is noted:

In addition, physical therapy is currently being actively used. This process takes quite a long time, but, nevertheless, this type of treatment is the most effective. If only this type of treatment is used, motor functions may not fully return, so a whole range of measures is required.

Why is the disease dangerous?

If the treatment is prescribed incorrectly or all the specialist's prescriptions are not followed, some complications and quite adverse consequences may occur.

The most common are:

• in the muscles there may be a decrease or complete absence of strength, and on an ongoing basis;
• stiffening of the joint and hardening of the muscles.

Preventive actions

In order to avoid the development of a violation, experts recommend the following instructions:

• contacting a doctor at the slightest symptoms of the disease and any other problems;
• blood pressure should always remain under control;
• treating infectious diseases in the early stages, preventing them from causing more serious problems;
• it's best to exclude everything bad habits, - alcohol and smoking contribute to the development of many health problems, not only peripheral paralysis;
• effective prevention is healthy lifestyle life (proper nutrition, rest, adherence to the regime and physical activity).

During the campaign to eradicate poliomyelitis, the identification of all diseases that occur with symptoms of acute flaccid paralysis, among which there may be people with undiagnosed poliomyelitis, becomes especially importance.

ACUTE FLEXIBLE PARALLY

Diagnosis of PM is a complex process, including clinical, laboratory (virological) and special (ENMG) confirmation of the diagnosis with observation of paralysis for at least 2 months and requires certain experience and skills

An accurate diagnosis of PM in rural areas and in outpatient settings is sometimes an impossible task.

Therefore, the control of suspected cases of PM is focused on the identification of AFP, which, according to clinical symptoms similar to PM

ACUTE FLEXIBLE PARALLY

When making a diagnosis of AFP, the following is taken into account:

History of present illness and previous life

Clinical symptom complex:

- hectic period

- meningo-radicular syndrome

- the time of appearance and development of paralysis and paresis,

- the nature of the paralysis (flaccid or spastic).

- neurological status (reflexes, tone, sensitivity, pelvic functions, muscle atrophy and other symptoms),

- duration of paralysis, etc.

Sample Collection Time and Results

Time of vaccinations and contact with vaccinated persons

Results of additional studies

ACUTE FLEXIBLE PARALLY

Characteristics of acute flaccid paralysis

The presence of paresis (limitation) or paralysis (lack of range of motion in the limbs)

Low muscle tone

Low or no tendon reflexes

Absence of pathological reflexes

Signs of damage to the anterior horns of the spinal cord

Diseases occurring with acute flaccid

I. polyradiculoneuropathy

paralysis

II. traumatic neuropathy

III. musculoskeletal dysplasia IV. myelitis

V. Poliomyelitis VI. tumors

VII. other diseases (hematomyelia, spinal epidural abscess, myelin and myelopathy, and others)

Polyradiculoneuropathy

(Guillain-Barre syndrome, Landry, Strol, Miller-Fischer,

acute polyradiculoneuritis)

Children get sick with a frequency of 1.1 per 100,000 population. The disease is often preceded by infections of the respiratory and

gastrointestinal tract

Etiology:

Campylobacter jejuni (30%)

cytomegalovirus (15%)

Epstein-Barr virus (10%)

Mycoplasma pneumoniae (5%), etc.

Polyradiculoneuropathy

There are 4 main clinical forms:

acute inflammatory demyelinating polyneuropathy (AIDP),

acute motor axonal neuropathy (OMAN),

acute motor-sensory axonal neuropathy (AMSAN),

Miller-Fischer syndrome

Polyradiculoneuropathy

occur without a rise in temperature against the background of a general satisfactory condition

gradual (within 1-2 weeks) development of neurological symptoms

in children with a temperature debut of the disease, the development of paresis / paralysis occurs against the background of normal temperature

paresis / paralysis begins with the distal extremities

are symmetrical

there are sensory disorders such as "stocking" and "gloves"

in CSF, an increase in protein numbers is often noted with normal cytosis

by the end of the 3rd week of illness, 85% of patients show signs of segmental demyelination and/or axonal degeneration on ENMG examination

Traumatic neuropathies

Post-injection mononeuropathies are the most common. When collecting an anamnesis, it is possible to identify an association with an intramuscular injection that preceded the development of neuropathy.

Other causes are less commonly identified: falls and injuries of the spine, compression of the limb with a tight bandage, infringement of the limb in the crib or playpen

Neuromuscular diseases

The "flaccid child" syndrome can be observed in a number of diseases:

congenital muscular dystrophy

spinal progressive muscular atrophies (Verdnig-Hoffmann, Fazio-Londe, etc.)

atonic form of cerebral palsy

benign form of congenital hypotension

some other diseases

This group includes persons with diseases of the peripheral nervous system (including those with degenerative-dystrophic changes in the spine), the consequences of poliomyelitis and central hemiparesis, not accompanied by an increase in muscle tone. By the nature of the indicated restorative measures, this group also includes patients with mild muscle spasticity, in whom, with the help of the above-described therapeutic measures, it was possible to reduce the pathologically increased muscle tone. After the successful reduction of spasticity, further restorative treatment is indicated to gradually eliminate the neuromuscular loss present in such patients.

The main objectives of the rehabilitation treatment of patients in this group are the disinhibition of inactive cells in the central nervous system, the regeneration of fibers in the trunks of peripheral nerves and roots, the normalization of muscle functioning and the restoration of active life of patients on the basis of dosed training and labor adaptation, and the main methods are the use of electrical muscle stimulation, therapeutic gymnastics, massage and occupational therapy.

Electrical stimulation is carried out using sinusoidal modulated or pulsed exponential currents. First of all, the most weakened, hypotonic muscles are stimulated: on the upper limb - extensors of the hand and fingers, arch supports, muscles that abduct the hand outward, on the lower - dorsal flexors of the foot and extensors of the toes. As a rule, electro-gymnastics is carried out according to a bipolar method with the participation of volitional tension of the exercised muscles by the patient. Such active electrical stimulation according to Obrosov - Liventsev is very important for the restoration of voluntary movements, and in the future - for the resumption of purposeful labor acts. A slight increase in muscle tone is not an obstacle for electro-gymnastics of antagonists of spastic muscles. The course of treatment includes 15 - 30 procedures performed daily or every other day.

Simultaneously with electrical stimulation, it is necessary to prescribe therapeutic exercises that improve the functionality of atrophic muscles, joints and the sensitive apparatus of the joints, tendons, muscles (proprioreceptors), as well as coordination of movements. With flaccid paralysis, all types of movements are used: passive, active with help and in lightweight starting positions, completely independent, and as the function of the paretic muscles improves, exercises with increasing effort: with weights with projectiles and overcoming resistance. Hydrokinesitherapy (therapeutic exercises in water) is also shown, especially in case of damage to the spinal cord, polyradiculoneuritis and polyneuritis.

Therapeutic gymnastics should be accompanied by a massage of the muscles of the paretic limbs. While maintaining a slight increase in tone, a selective massage is performed: an inhibitory technique acupressure spastic muscles and stimulating massage of their antagonists. In the case of flaccid paralysis, it is necessary to prescribe a deep massage using kneading, tapping, vibration and exciting point-by-point massage techniques, as well as an underwater massage shower.

Already in the early phases of rehabilitation treatment, occupational therapy is regularly carried out, which is of a diverse nature and includes a gradual increase in physical activity, degree of complexity and differentiation of the exercises performed. At the initial stage of treatment, elementary exercises related to self-service and the implementation of simple labor processes are used, which gradually become more complicated, accompanied by training on special simulators. In the future, patients go to work in special medical and labor workshops on writing and counting machines, carpentry, drilling, turning, and other equipment. In the treatment of lesions of individual nerve trunks of the upper extremities, separate occupational therapy complexes developed by L. A. Lasskaya, G: A. Pavlova and R. M. Golubkova are recommended (they are described in chapter III).

The background of the rehabilitation treatment of patients with flaccid paralysis are drugs and physiotherapy procedures that improve regeneration. nervous tissue facilitating the conduction of nerve impulses and disinhibiting inactive neurons, as well as activating psychotherapy.

Of the drugs, the most commonly used are anticholinesterase drugs (prozerin, galantamine, oxazil, nibufin), B vitamins (B1, B6, B12, calcium pantothenate) and C, dibazol, pyrimidine derivatives (pentoxyl, methyluracil), glutamic acid, phosphorus and potassium (ATP, MAP, panangin, etc.). To speed up the process of regeneration of nervous tissue, biogenic stimulants are prescribed (aloe extract, gumizol, rumolon, plasmol, pyrogenal, etc.), and to disinhibit inactive nerve cells, drugs of the strychnine group (strychnine, securinine, etc.). In order to activate the regeneration of nerve fibers, galvanic current is widely used, more often in the form of electrophoresis on the paretic limb of novocaine, anticholinesterase agents (prozerin, galantamine), dibazol, vitamin B15 iodine, applications on the limb and the corresponding segments of the spine of paraffin, ozokerite or mud at a temperature of 42 - 46 ° in the absence of pain and 36 - 40 ° - in its presence. Local exposure to centimeter and decimeter waves in a weak dose, general or local hydrogen sulfide, radon, carbon dioxide and oxygen baths are also used.

In accordance with the described basic provisions, restorative treatment of patients with lesions of the facial nerve is also performed. It should only be remembered about the easily occurring contractures of the mimic muscles of the face, in connection with which the use galvanic current and electrical stimulation in the rehabilitation treatment of patients with neuritis of the facial nerve should be carried out with great care.

Psychotherapy in patients with a predominance of symptoms of neuromuscular prolapse is carried out in the form of explanatory conversations aimed at developing faith in the possibility of restoring the lost motor function, but only if the necessary volitional and physical efforts are mobilized to achieve this goal. In addition, it is used special technique autogenic training, aimed at eliminating the existing motor defect and activating voluntary movements. In patients with severe loss of motor functions, the system of gradual positive emotions is important: each, even a small improvement in the patient's condition, is presented to him as a significant achievement, which, however, is only one of the stages on the way to a more complete use of available opportunities.

In the implementation of stimulating rehabilitation treatment, a certain sequence of therapeutic measures is advisable. At the beginning of the day, the patient is given drugs that facilitate the conduction of nerve impulses and promote the resumption of the activity of inhibited nerve cells (anticholinesterase drugs, dibazol, strychnine group drugs, B vitamins), after which he is sent for a psychotherapy session. After 1 - 1.5 hours after the administration of drugs, an electrical stimulation procedure is performed, after a 15 -20-minute rest - therapeutic exercises with stimulating massage and an occupational therapy session.

In a significant part of cases, diseases of the peripheral nervous system are secondary and are associated with degenerative-dystrophic changes (osteochondrosis) in the spine. Restorative therapy of patients with spinal lesions retains all the main features inherent in the treatment of flaccid paresis, but also has its own specific features. First of all, it includes such a pathogenetic method of influence as various methods traction of the spine: vertical, on an inclined plane and horizontal, "dry" and in water.

Another feature of the treatment of patients with spinal osteochondrosis is a special set of gymnastic exercises aimed at reducing pathological impulses from the spine to the upper or lower limbs and restoring the full range of motion. In case of damage to the cervical spine, a complex of therapeutic exercises according to Z. V. Kasvande is prescribed, which is carried out with the obligatory immobilization of the cervical vertebrae with a cotton-gauze collar of the Shants type and includes exercises for the muscles of the limbs and strengthening the muscular corset of the neck, alternating with relaxation exercises and breathing exercises. With lumbosacral localization of osteochondrosis, a gymnastic complex according to V.N. Moshkov is used with predominant movements in the hip and knee joints, in lightweight initial positions - at the beginning of treatment, with a consistent increase muscle tension, and gradual learning to walk.

For cervical and lumbosacral radiculitis, plexitis and radiculoneuritis, absorbable agents are used: biyoquinol and lidase; lidase and some biogenic stimulants (aloe, vitreous body) can also be administered by electrophoresis to the affected area of ​​the spine or limb. Ultrasound also has a resolving and analgesic effect, the effect of which can be enhanced by the introduction of analgesics and anti-inflammatory drugs (ultraphonophoresis of analgin, anestezin, hydrocortisone) with its help.

Pain syndromes in vertebrogenic lesions of the peripheral nervous system require the appointment of analgesics (amidopyrine, analgin, butadion, reopyrin), preparations from the venom of bees and snakes (venapiolin, apizartron, vipraksin, viperalgin, etc.), ganglion blockers (benzohexonium, pentamin, pyrilene and etc.) and physiotherapy procedures. Local effects on the cervical spine are carried out with diadynamic and sinusoidal modulated currents, ultrasound, erythemal doses of ultraviolet rays; electrophoresis of novocaine (according to I. G. Shemetylo, it is better to administer novocaine using sinusoidal modulated currents), analgesics, ganglioblockers, preparations of bee and snake venom, as well as the use of vibration and turpentine baths. With damage to the peripheral nervous system, especially accompanied by pain syndrome, shows the use of acupuncture, which not only reduces pain, but also improves motor, sensory and trophic functions.

Expressed degenerative changes in the spine, leading to the formation of a hernia intervertebral disc and accompanied by signs of increasing compression of the nerve roots or spinal cord, are, in the absence of the effect of complex therapy, indications for neurosurgical surgery to remove a herniated disc and stabilize the spine. After spinal surgery, patients should also receive comprehensive rehabilitation treatment.

The peculiarity of the treatment of patients with polyneuritis of infectious and infectious-allergic origin is the inclusion of anti-inflammatory, analgesic and reducing intoxication in the restorative complex medicines and physiotherapy procedures. A 40% solution of urotropin, a 20-40% solution of glucose with ascorbic acid is injected intravenously, antibiotics are prescribed orally a wide range actions - terramycin, tetracycline, etc., antihistamines (diphenhydramine, diprazine, suprastin) and painkillers (analgin, amidopyrine, reopyrin). Of the physiotherapeutic procedures, the following are used: inductothermy of the extremities, four-chamber, general or local hydrogen sulfide baths, long-term (40-60 minutes) general wet wraps, ultraviolet irradiation of the hands, forearms, feet and legs in an erythemal dosage, mud, ozocerite or paraffin applications in the form of stockings or gloves. Restorative treatment of patients with vegetative polyneuritis will be described below.

Rehabilitation measures in patients with poliomyelitis are carried out in the recovery and residual periods of the disease. In addition to the treatment prescribed for all types of flaccid paralysis, various methods are used to combat an increase in the tone of antagonists of weakened muscles: alcohol-novocaine blockades, thermal procedures, and in severe cases, corrective surgical interventions. Anti-inflammatory physiotherapeutic procedures are shown with an effect on the spine, according to the level of damage (UHF or inductothermy - transverse technique) and longitudinally on paretic limbs, as well as mud (40 - 42 °), paraffin or ozocerite (45 - 48) applications on the same areas, electrophoresis iodine and calcium on the spine, general salt and hydrogen sulfide baths. It has some features and treatment of patients with trigeminal neuralgia. Of the drugs, the anticonvulsant and ganglion blocking agent carbomazepine (tegretol) is the most effective, the course of treatment for which is 40 days. Antidepressant drugs are also used - morpholep and nialamide, phenothiazine derivatives (especially chlorpromazine), ganglioblockers (pahikarpine, pyrilene and pentamine), analgesics (amidopyrine, analgin, etc.), vitamins (B1, B6, B12), ATP. From physiotherapeutic procedures, the appointment of diadynamic and sinusoidal modulated currents, or ultrasound in a pulsed mode, is shown at the exit points of the corresponding branches of the trigeminal nerve, electric field UHF in a low-teil dosage or darsonvalization on the affected area, as well as electrophoresis using a Bergonier half mask of aconitine, novocaine, analgin, amidopyrine or iodine.

Demidenko T. D., Goldblat Yu. V.

"Restorative complex for the treatment of patients with flaccid paralysis" and others