flaccid paralysis

{{short description|Weakness, paralysis, and reduced tone in a muscle due to nerve damage}}

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Flaccid paralysis is a neurological condition characterized by weakness or paralysis and reduced muscle tone without other obvious cause (e.g., trauma).Alberta Government Health and Wellness (2005) [http://www.health.gov.ab.ca/professionals/ND_Acute_Flaccid_Paralysis.pdf Acute Flaccid Paralysis] Public Health Notifiable Disease Management Guidelines. 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.Saladin, Kenneth S. Anatomy & Physiology: The Unity of Form and Function. McGraw-Hill. 6th Edition. 2012.

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.{{Cite web |title=GPEI-Polio + Prevention |url=https://polioeradication.org/polio-today/polio-prevention/ |access-date=2022-11-18 |language=en-GB}}

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.{{cite journal | vauthors = Kelly H, Brussen KA, Lawrence A, Elliot E, Pearn J, Thorley B | title = Polioviruses and other enteroviruses isolated from faecal samples of patients with acute flaccid paralysis in Australia, 1996–2004 | journal = Journal of Paediatrics and Child Health | volume = 42 | issue = 6 | pages = 370–6 | date = June 2006 | pmid = 16737480 | doi = 10.1111/j.1440-1754.2006.00875.x | s2cid = 23585402 }}

=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). When this occurs, the muscles are unable to contract.{{cite web|url=https://www.cdc.gov/NCIDOD/DBMD/diseaseinfo/botulism_g.htm|title=Disease Listing, Botulism, General Information – CDC Bacterial, Mycotic Diseases}} 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.{{cite web|url=http://medical-dictionary.thefreedictionary.com/flaccid+paralysis |title=flaccid paralysis – definition of flaccid paralysis in the Medical dictionary – by the Free Online Medical Dictionary, Thesaurus and Encyclopedia |publisher=Medical-dictionary.thefreedictionary.com |access-date=2014-02-26}}

=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.{{cite web|url=http://www.blueplanetbiomes.org/curare.htm |title=Curare – Chondrodendron tomentosum |publisher=Blueplanetbiomes.org |access-date=2014-02-26}}

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.

= 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.{{Citation |last1=Javed |first1=Kinaan |title=Neuroanatomy, Lower Motor Neuron Lesion |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK539814/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30969636 |access-date=2022-11-18 |last2=Daly |first2=Daniel T.}}

Included in AFP's list are poliomyelitis (polio), transverse myelitis, Guillain–Barré syndrome, enteroviral encephalopathy,{{cite journal | vauthors = Idris M, Elahi M, Arif A | title = Guillain Barre syndrome: the leading cause of acute flaccid paralysis in Hazara division | journal = Journal of Ayub Medical College, Abbottabad | volume = 19 | issue = 1 | pages = 26–8 | date = Jan–Mar 2007 | pmid = 17867475 }} 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.{{cn|date=October 2020}}{{Cite journal |last=Tangermann |first=Rudolf |date=May 2017 |title=The critical role of acute flaccid paralysis surveillance in the Global Polio Eradication Initiative |url=https://doi.org/10.1093/inthealth/ihx016 |journal=International Health |volume=9 |issue=3 |pages=156–163|doi=10.1093/inthealth/ihx016 |doi-access=free }}

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.{{cite journal|title=Public Health Dispatch: Acute Flaccid Paralysis Associated with Circulating Vaccine-Derived Poliovirus – Philippines, 2001 |journal=MMWR. Morbidity and Mortality Weekly Report |date=October 12, 2001 |volume=50 |issue=40 |pages=874–5|url= https://www.cdc.gov/mmwr/preview/mmwrhtmL/mm5040a3.htm}}{{cite journal|first1=Neetu |last1=Vashisht|first2= Jacob |last2=Puliyel|first3= Vishnubhatla |last3=Sreenivas|title= Trends in Nonpolio Acute Flaccid Paralysis Incidence in India 2000 to 2013|journal= Pediatrics|date= February 2015|volume= 135 |issue= Supplement 1|pages=S16–S17|url= http://pediatrics.aappublications.org/content/135/Supplement_1/S16.2|doi=10.1542/peds.2014-3330DD|doi-access=free|url-access=subscription}}

Venomous snakes that contain neurotoxic venom such as kraits, mambas, and cobras can also cause complete flaccid paralysis.{{cite journal|author1=GJ Müller|author2=H Modler|author3=CA Wium|author4=DJH Veale|author5=C J Marks|title=Snake bite in southern Africa: diagnosis and management|journal=Continuing Medical Education|date=October 2012|volume=30|issue=10|pages=362–381|url=http://www.ajol.info/index.php/cme/article/viewFile/83137/73222|access-date=2 March 2015}} Some chemical warfare nerve agents such as VX can also cause complete flaccid paralysis.{{cite book |title=Medical Aspects of Chemical and Biological Warfare |chapter=Chapter 5: Nerve Agents |chapter-url=https://ke.army.mil/bordeninstitute/published_volumes/chemBio/Ch5.pdf |first1=Frederick R. |last1=Sidell |date=1997 |page=144ff}}

In some situations, prominently in those of oriental descent{{cite book |last1=Burrow |first1=Gerard |last2=Oppenheimer |first2=Jack |last3=Volṕe |first3=Robert |title=Thyroid function & disease |date=1989 |publisher=Philadelphia : W.B. Saunders |isbn=9780721621906}} hyperthyroidism can affect the consumption and restoration equilibrium of potassium ions in neurons resulting in hypokalaemic paralysis.

References

External links

[https://web.archive.org/web/20071011210804/http://www.whoipd.org/ WHO Programme for Immunization Preventable Diseases (IPD)] A Collaboration between World Health Organization and Government of Nepal

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| ICD10 = {{ICD10|G|81|0|g|80}}, {{ICD10|G|82|0|g|80}}, {{ICD10|G|82|3|g|80}}

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Category:Symptoms and signs: Nervous and musculoskeletal systems

Category:Enterovirus-associated diseases