Paraparesis

What is Paraparesis?

Paraparesis is a condition when both the legs of a person are paralyzed. Spasms are experienced in the legs, and the person feels progressive weakness. Symptoms can occur anytime in life and most paraparesis patients will face difficulty in walking and their gait will also change. This disorder is classified into two types, namely, HSP and TSP.

Image Source: en.wikipedia.org

Causes & Types of Paraparesis

Hereditary spastic paraplegia or HSP

Genetic in nature, the parent experiences some weakness or numbness in the extreme, i.e., tertiary muscles. The nerves will degenerate gradually, and the child will inherit paralysis from both or either of the parents. HSP is also called pure HSP. Around ten two twenty thousand Americans suffer from pHSP.

Symptoms can appear any time, but typically they are noticeable between ten to forty years of age. This class of disease is also called Strumpell-Lorrain syndrome and familial spastic paraplegia (SLS and FSP). The odds of developing the condition for the children of HSP parents are fifty percent. When HSP is accompanied by some additional symptoms, described later in this article, it is known as complicated HSP.

Tropical spastic paraplegia or TSP

Caused by a Human T lymphotropic or HTL virus infection affecting the spinal cord, it gradually infects the nerves and slowly damages their functions. The initial symptoms will be noticeable anytime between thirty to forty years of age. TSP usually occurs in individuals living near the equator such as the Caribbean, southern Japan, equatorial Africa, and South

America. Around ten to twenty million people bear the HTLV-1 virus globally, and less than two percent of those persons will develop TSP eventually. Women are more prone to this disease when compared to men. The HTLV-1 virus spreads via breastfeeding, sharing hypodermic needles, and unprotected coitus. HTLV-1 cannot spread through casual contact including shaking hands, sharing a washroom, or hugging.

Symptoms of Paraparesis

Pure HSP

• Gradual stiffening and weakening of the legs
• Trouble in balancing
• Cramps in leg muscles
• High foot arches
• Fluctuation in sensation in feet
• Urinary problems like frequency and urgency
• Erectile dysfunction

Complicated HSP

• Loss of muscle control
• Seizures
• Impaired cognition
• Dementia
• Auditory or vision problems
• Locomotory disorders
• Peripheral neuropathy resulting in numbness, weakness, and pain
• Ichthyosis, leading to a thick, dry, and scaling skin

TSP

• Gradual stiffening and weakening of the legs
• Back pain radiating down one’s legs
• Paresthesia, i.e., or prickling or burning sensation
• Bowel function or urinary problems
• Erectile dysfunction
• Inflammatory skin diseases like psoriasis or dermatitis

In rare and exceptional instances, this disease is also known to cause:

• Eye inflammation
• Arthritis
• Lung inflammation
• Muscle inflammation
• Persistent dry eye

Diagnosis of Paraparesis

HSP

Paraparesis can be diagnosed in most cases provided the following criteria are met:

• An MRI scan
• Patient has the mobility symptoms and gait exclusive to paraparesis
• Nearest kin has a history of paraparesis
• Other treatable diseases with identical symptoms are ruled out

The doctor examines the patient and inquires about the medical history of eliminating other causative conditions. The registered medical practitioner may also suggest a few diagnostic tests such as:

• Nerve conduction studies or NCS
• Electromyography or EMG
• Magnetic resonance imaging or MRI scans of the spinal cord and the brain
• Blood work
• Genetic testing is also available for a few types of HSP

Treatable diseases with identical symptoms for Paraparesis include:

• Vitamin B12 deficiency
• Genetic movement disorder or dopa-responsive dystonia
• Structural disorders of the spinal cord

Multiple sclerosis, hereditary motor neuron disorder, and cerebral palsy must also be ruled out before a successful diagnosis.

TSP

The diagnosis is based on the probability that the patient was exposed to HTLV-1 and also on the symptoms of that person. The specialist may also ask about the use of intravenous drugs and inquire about the sexual history of the patient. The consulting doctor may prescribe an MRI of the spinal cord or suggest the one-time application of a spinal tap for collecting the cerebrospinal fluid of the patient. The blood and the spinal fluid of the person suffering from TSP will both be evaluated for the virus and its antibodies, and the test is known as lumbar puncture test.

Risk factors

The disease is gradually progressive, and though it is not life-threatening on its own, a complication of any infection or immobility may lead to death. For instance:

• Septicemia from infected pressure sores or urinary infections
• Pulmonary emboli and Pneumonia secondary to immobility

A person can typically live up to ten to forty years after detection of the disease.

Complications of Paraparesis

HSP

Some HSP patients happen to experience mild symptoms, but others can develop disability over the passage of time.

• The tightness of calf muscles
• Cold feet
• Fatigue
• Pain in the knees and back
• Depression and stress

TSP

TSP usually gets worse with time, but it is anything but rarely fatal. Most persons live for many decades after their diagnosis. Preventing skin sores and UTI or urinary tract infections help to improve the quality and length of the TSP patients.

One serious complication of the HTLV-1 infection happens to be the growth of the adult T-cell lymphoma or leukemia. Though less than five in every hundred individuals suffering from this viral infection succumb to adult T-cell lymphoma or leukemia, one should be informed about the possibility.

Preventions of Paraparesis

Prevention is geared towards reducing the risk of transmitting the HTLV-1 virus by adhering to the following rules.

• Safer sexual practices
• Screening blood and its products

Treatments for Paraparesis

Though this disease cannot be cured, it can be managed very well. It typically has no effect on life expectancy. Treatment for TSP and HSP concentrates on providing symptomatic relief through exercise, physical therapy, and assistive tools.

• Physical therapy helps the patient maintain and improve the range of motion and the muscle strength. It also helps to avoid pressure sores. With the progression of the disease, a person can use a cane, an ankle-foot brace, wheelchair or walker for assistance.
• Medications reduce muscle stiffness, pain, spasticity, bladder infections, and urinary problems.
• Corticosteroids like prednisone, sold under the trade name of Rayos, may soothe an inflamed spinal cord in patients suffering from TSP. However, they will not alter with the long-term repercussions of the disease.

The present research is focused on the usage of interferon and antiviral medications for TSP, but the drugs are not yet available commercially.

When to see the doctor?

If one or more than one of the aforementioned symptoms start to appear, the patient should seek emergency medical care as early as possible.