health of the nervous system

Spastic Paraparesis Symptoms

Definition

Spastic paraparesis is a form of cerebral palsy due to lesions of the pyramidal system (part of the brain used for motor control).

This condition can manifest itself following complications arising during childbirth, such as infections, brain injury due to trauma, effects of lack of oxygen (hypoxic-ischemic encephalopathy) and prolapse of umbilical cord.

In premature infants, spastic paraparesis may develop due to an intracranial hemorrhage, periventricular leukomalacia (lesion of the white substance of ischemic origin) and cerebral dysgenesis (malformation linked to an error in the first formation of the central nervous system).

In children born at term, the etiology can be multifactorial. Spastic paraparesis can also have a hereditary origin: the genetic bases are varied and, for many forms, are unknown.

A particular clinical picture is tropical spastic paraparesis, associated with T-lymphotropic human retrovirus (HTLV-1) infection; this immune-mediated disease is characterized by a slow and progressive degeneration due to inflammation of the gray and white substance of the spinal cord. HTLV infection is contracted through sexual contact and exposure to infected blood, through the use of intravenous drugs or from the mother to the baby with breastfeeding. Tropical spastic paraparesis most frequently affects hemodialysis patients, prostitutes and drug addicts in endemic areas, such as the equatorial regions, southern Japan and some areas of South America.

Most common symptoms and signs *

  • Asthenia
  • Ataxia
  • athetosis
  • Convulsions
  • Korea
  • Muscle cramps
  • Learning difficulties
  • Bladder dysfunction
  • Arm pain
  • Articolar pains
  • Muscle pains
  • hyperreflexia
  • Hearing loss
  • weakness
  • Paraplegia
  • Paresthesia
  • Loss of coordination of movements
  • pollakiuria
  • Reduced vision
  • Joint stiffness
  • Growth delay
  • Mental delay
  • Muscle spasms
  • Tetraplegia
  • Tremors

Further indications

Spastic paraparesis is a neurodegenerative disease characterized by moderate or severe impairment of both sides of the body, with prevalent involvement of the lower limbs. This can manifest itself with weakness and spasticity (increased muscle tone at rest, with stiffness or spasms) slowly progressive. This leads to more or less marked problems in walking: affected individuals have a characteristic "scissor-like" gait and are delayed in reaching certain stages of development (such as the ability to sit or remain upright).

Over time, the constant spasticity produces hyperreflexia in the lower limbs, joint pain and deformity of the bone structures adjacent to the hypertensive muscles.

The disease can also be associated with other manifestations, such as intellectual disability, convulsions and alterations of bladder emptying (urinary urgency and urinary incontinence). Spastic paraparesis can also involve extramedullary neurological deficits, such as optic atrophy, retinal degeneration, ataxia, deafness, dementia and polyneuropathy.

In most cases, spastic paraparesis is diagnosed before the child's third year of life based on clinical tests. The treatment is symptomatic and can include physiotherapy, drugs to promote muscle relaxation and orthopedic surgery for functional rehabilitation.

Tropical spastic paraparesis / myelopathy-associated with HTLV-1

The onset of tropical spastic paraparesis is usually slow and chronically progressive. During the course of the disease, a spastic weakness gradually develops in both legs, with plantar responses in extension (Babinski sign) and bilateral symmetrical loss of the vibratory sensitivity of the feet. Achilles tendon reflexes are often absent. Urinary incontinence and urgency are frequent. Usually, the symptoms progress for several years.

Diagnosis is established by serological and polymerase chain reaction (PCR) tests on serum and cerebrospinal fluid. Treatment includes the use of immunosuppressive drugs, corticosteroids, botulinum toxin and supportive measures.