What is Paraparesis?
Paraparesis is a neurological condition affecting the lower limbs from the pelvic area and legs. This condition is also called Spastic Paraplegia and causes spastic movements, stiffness and weakness in the legs. Signs of the disease begin to appear between the ages of 20 and 40, but can be seen in younger people and children. It can also cause incontinence of urine and feces since it involves the nerves to the pelvic region. There are many different symptoms associated with this disorder.
Paraparesis causes the breakdown of the communication between the upper motor neurons and the lower motor neurons that control the voluntary movement of the lower body. (See Figure 1) The long nerves in the spinal cord are also affected and can eventually cause problems with speech, swallowing and even total paralysis. It is a progressive disease and there is no cure.
Figure 1: Motor Neurons
Courtesy of: SP Foundation
This condition is believed to be genetic, but there is one type that is caused by a tropical virus.
Causes of Paraparesis
- FSP – Familial Spastic Paraparesis
- HSP – Hereditary Spastic Paraplegia
- HTLV – 1 – Human T-Lymphotropic Virus Type 1
When Paraparesis is familial, no two family members tend to experience the same symptoms and the disease tends to affect them in varying levels of severity. One family member may have mild symptoms, while another is completely debilitated. The genetic risk for family members of people with this disorder is about 50%. Genetic testing is available on a limited basis and couples with the gene in their family should be tested if they are planning a family. You can usually find genetic testing at local children’s hospitals.
When Paraparesis is of the viral type, also has no cure but the symptoms are treatable with steroids and possibly Plasmaphereses to clean the virus out of the blood. It is found mostly in tropical areas and is usually transmitted by blood-borne contact.
There are no blood tests for actual diagnosis, but genetic testing can be done if it runs in the family. MRI can show lesions on the neurons and compression to the spinal cord. Most of the diagnosis comes from ruling out other conditions that cause the symptoms. They are eliminated first and when all other neurological conditions are ruled out, a diagnosis of Paraparesis is made. This is simpler when a family member has the disease such as; brother, sister, mother or father. (See Figure 2)
Figure 2: Genetic Chart for Paraparesis
Courtesy of SP Foundation
Symptoms of Paraparesis
The symptoms of Paraparesis are the same for both genetic and viral types. They affect lower limbs, pelvic area and can even sometimes migrate to other parts of the body. The most common symptoms are:
- Changes in Walking; shuffling gait, falling, stubbing the toes excessively.
- Changes in reflexes; Babinski’s sign (fanning of the toes) and hyperactive reflexes.
- Urinary incontinence, frequency and urgency/Fecal incontinence
- Loss of balance
- Muscle spasms in the legs and feet
In some forms of this disorder, the symptoms may migrate to other areas of the body depending on the severity and the person. These symptoms are more rarely found:
- Skin issues
- Speech Issues
- Swallowing Issues
- Breathing Difficulties
- Eye Problems (Retinopathy)
- Hearing problems
- Sexual dysfunction
Symptoms appear gradually over time as the motor neurons deteriorate and cease to work properly. The upper motor neurons are the first to break down and miscommunicate signals to the neurons in the lower half of the body. Over time, the disorder spreads to the lower motor neurons and they degenerate, sometimes to the point of total paralysis.
Treatments for Paraparesis
While there is no cure for Paraparesis, there are treatments that can help reduce the symptoms affect on the body. This begins with actually working with the areas affected physically, offering pain relief and drugs that reduce muscle spasms. There are even some forms of natural supplementation that have shown good evidence that they may help slow the progression of the disease.
Physical treatments include;
- Physical Therapy
- Range of Motion Exercises
- Water Therapy
- Speech Therapy
- Occupational Therapy
- Application of a TENS unit (Electrical stimulation of the muscles)
- Tools; Walker, Cane, Pelvic Braces, Wheelchair, Shoe Inserts
Drug Treatments include;
- Anti-Inflammatory medications
- Muscle Relaxers
- Pain Medications
- Medications for bowel and bladder control
Doctors may also order adaptive diets for people with chewing and swallowing difficulties. There are also research studies that certain nutrients in the diet may help to slow progression of the disease such as; creatine, vitamin E and beta-carotene.
Alternative treatments like; massage, yoga, acupuncture and chiropractic treatments may be helpful. There are also biofeedback techniques to help relieve stress and tension that have shown to increase muscle response in some patients.
Outlook for Paraparesis
People who suffer from Paraparesis can expect to live a normal life span just like everyone else. The only fatalities reported from this condition are caused by other issues due to the disease. There is a higher risk of fractures from falls, bladder infections from urinary issues, skin breakdown from incontinence, hip fractures and immobility. It is very important to address these issues promptly with a physician and treat them as soon as they occur.
Paraparesis can be dealt with by joining a community support group, attending physical therapy regularly and taking any prescribed medications. Regular activities are important and people with this condition should go on regular outings with friends and family to avoid social isolation. It is not uncommon for people to experience withdrawal and depression due to their physical limitations. Use of tools provided by a physical therapist like; canes, walkers and wheelchairs can enable the sufferer to be mobile in and outside the home.
As with any disorder, good medical care from a physician is necessary, along with proper diet, exercise and healthy lifestyle.