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Paraparesis

Paraparesis refers to a neurological disorder which causes partial paralysis or weakness in the legs. The condition can be caused due to various reasons. It is generally incurable; however, the symptoms can be controlled, and sufferers can get assistance to preserve the muscle tone in their lower limbs and to help enhance the quality of life.Patients of paraparesis may also ask for government disability funds so as to cope up with the challenges they may encounter during their lifetime.

Affected individuals may also experience paralysis or weakness due to nerve damage resulting from injury or trauma, including different kinds of spinal cord infections. As per level of nerve damage experienced, the affected person may be able to carry out light physical tasks; or may require additional devices like walkers, canes, or wheelchairs to move from one place to another. Affected individuals may consult a specialist or a physical therapist to get to know all the available options.

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One type of paraparesis is familial paraparesis. It is also referred to as hereditary spastic paraplegia, or familial spastic paraparesis. This form of the disorder is hereditary and identified by progressive degeneration of nerves. The patient may at first experience symptoms such as tingling feelings, mild weakness, and numbness. Over a period of time the condition will progressively become worse. Individuals with a family history of the disorder are at greater risk to developing it. They can also pass it to their kids.

Tropical spastic paraparesis(TSP) is another type of paraparesis. It is caused due to infection of the spinal cord by HTLV-1 or the human t-lymphotropic virus. Such infection eventually leads to nerve damage. It may be noted that the nerve damage remains progressive and permanent even after successful control of the infection. The symptoms of this type of paraparesis may take as long as thirty years after the original contagion to become evident. Thus, individuals who have visited tropical regions may not immediately identify the link between their travels and the current neurological disorder. This can result in difficult and prolonged diagnosis as well as delayed treatment.

Paraparesis can be diagnosed by a neurologist. He/she will also find out the cause and provide the relevant treatment options. Patients may be suggested to undergo physical therapy to avoid additional disabilities, to maintain the strength in the muscles, and to prevent painful contractures. Inflammation and other similar symptoms can be managed with the use of medications.

It is essential for individuals affected by paraparesis to undergo regular neurological tests for the remainder of their lives. It will help in monitoring the progress of the disorder, and also in detecting any complications that may arise. Such complications can then be treated on time before it deteriorates into a serious condition. Some patients may also be affected by fecal or urinary incontinence, which then needs to be controlled.

Symptoms of paraparesis

TSP does not elicit any symptoms after initial infection. The symptoms may occur just a few months after infection, or it can take several decades. Some of the signs and symptoms of paraparesis are listed below:

  • Slow onset of weakness in the legs
  • Urinary dysfunction or incontinence
  • Lack of sensation to pin or needle pricks
  • Dysfunction of the bowel in certain cases
  • Erectile dysfunction may be seen in some cases
  • Back pain may be present. It can radiate to the lower limbs
  • Psoriasis or dermatitis may be observed

Upper motor neurone signs include:

  • Hyper-reflexia which affects the lower limbs and sometimes upper limbs. Increased leg tone, extensor plantar response, and clonus
  • Paraplegia or spastic paraparesis
  • Weakness of the muscles in the lower limbs. Most visible sign is proximal weakness
  • Loss of position sense and vibration. It is more apparent in lower limbs. The origins of sensory loss appear to be in the central nervous system, as opposed to the peripheral nerves. The latter may also be affected.

Other rarer symptoms of paraparesis include:

  • Optic atrophy
  • Cerebellar symptoms like intention tremor
  • Nil or lowered ankle reflex
  • Nystagmus
  • Lesions in the cranial nerve
  • Deafness
  • Tremor of the hands
  • Uveitis, infectious dermatitis, arthritis, Polymyositis, pulmonary lymphocytic alveolitis, and keratoconjunctivitis sicca

Causes of paraparesis

Familial spastic paraparesis is a genetic condition. Tropical spastic paraparesis is caused due to infection of the spinal cord by thehuman t-lymphotropic virus.

The varied risk factors associated with paraparesis are listed below:

  • Living in a region where the human t-lymphotropic virus-1 is endemic. These regions include equatorial Africa, Caribbean, South America, southern Japan and the Seychelles.
  • Women are more vulnerable to the infection and resultant paraparesis, as compared to men
  • People belonging to the lower classes are at greater risk
  • People in their 30s and 40s are more susceptible

Treatment of paraparesis

There is no specific way to treat paraparesis. It has no known cure. However, the symptoms can be managed with physical therapy, medications, and self-care to prevent urinary infections.

It may be noted that despite being a progressive neurological condition, paraparesis is not life-threatening. Patients can continue to live for many years after diagnosis, provided they follow all the treatment guidelines.

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