Learn now what is Acute Flaccid Paralysis causes, signs and symptoms, treatment, diagnosis, Prevention Care, Cure and Medical Insurance coverage, Myths and Facts, FAQs, Home Natural remedies, Medical Advice and everything you need to know.
All about Acute Flaccid Paralysis
A muscle is the most important indicator of its role in the body which controls all our movements, even those we don’t actually think about, like breathing. Our brain communicates with the muscles to cause us to move. If for some reason this connection is broken, our muscles can’t contract and we even can’t move.
When the muscles no longer can make a person move is called paralysis. Acute flaccid paralysis is a specific type of paralysis where your muscles cannot contract at all forever. This can be a serious problem, as breathing is controlled by the muscle in the diaphragm. This is what basically happens during flaccid paralysis.
What is the Acute Flaccid Paralysis?
Acute Flaccid Paralysis is an abrupt onset of weakness of an individual’s extremities including weakness of the muscles of respiration progressing to maximum severity with loss of functions over a period of 15 days in any child of age under 15 yrs.
The term ‘flaccid’ is indicated as the absence of spasticity or other signs of disorders in central nervous system (CNS) motor tracts such as hyperflexia, clonus, or extensor plantar responses and might be found with polio.
The paralysis can take place at any part of the body like an upper limb, lower limb, trunk, neck or group of muscles such as respiratory and abdominal due to the Brain, Spinal Cord or nerves getting affected. It is called as Monoplegia i.e. one limb, Hemiplegia i.e. one side of the body, Paraplegia i.e. two lower limbs & Quadriplegia i.e. all four limbs as per the involvement.
This acute flaccid paralysis only affects the child’s strength in the affected muscle groups and there is no loss of sensation. The symptoms of the disease depend on which muscles are affected the most.
For example, if your legs muscles are affected, then you will have trouble walking. On the other hand, if it affects your chest, then you may not be able to breathe properly unless you are put on a ventilator.
The Acute Flaccid Paralysis can be associated with
- Sudden loss of consciousness
- Pain/Tingling/Numbness in the limbs
- Regurgitation of feeds (through the nose) or inability to swallow or difficulty in speech
- Rapid progression (from one limb to the other or one part to another.
- unexpected difficulty in breathing
Signs & Symptoms of Acute Flaccid Paralysis
It could be dangerous if you have any of the following symptoms. Talk to your doctor as soon as possible if you notice any of the symptoms in your child for example if your child is not using arm or leg normally. The other symptoms of Acute Flaccid Paralysis may include
- disturbance, weakness, or troubled coordination in
- one or several extremities
- Neck weakness, gait
- Pain/Tingling/Numbness in the limbs
- Inability to move the limbs
- Loss of sensation (of pain, temperature or of urination & defecation)
- Drooping eyelids, dry mouth, slurred speech, blurred vision
Causes of Acute Flaccid Paralysis
Acute flaccid paralysis (AFP) is a medical syndrome which has many infectious and non-infectious causes or damage to the spinal cord or brain. This type of damage prevents messages in the brain from getting to the muscle cause flaccid paralysis. Main causes of acute flaccid paralysis are Polio, botulism, and curare.
Polio and other viruses:
Acute Flaccid Paralysis is the most common sign of acute polio and it is also related to a number of other pathogenic agents like enteroviruses, echoviruses, West Nile virus, and adenoviruses among others.
Botulism
The bacteria called Clostridium botulinum cause botulism. Vegetative cells of Clostridium botulinum may be ingested and may also occur via endospores in a wound. They induce flaccid paralysis when the bacteria are in vivo.
This happens because Clostridium botulinum produces a toxin which blocks the release of acetylcholine thereby faltering postsynaptic activity of the neuromuscular junction. When this occurs, the muscles are unable to contract and other symptoms associated with infection from this neurotoxin include
- double vision
- blurred vision
- drooping eyelids
- slurred speech,
- difficulty swallowing
- dry mouth
- muscle weakness
If its effects reach the respiratory muscles, then it may cause respiratory failure which can lead to death.
Curare
Curare is a plant poison derived from various species belonging to the genus Strychnos. Curare is used medicinally by South Americans to treat madness, dropsy, edema, fever, kidney stones, and bruises.
Curare works as a neuromuscular blocking agent which induces flaccid paralysis. This poison binds to the acetylcholine (ACh) receptors on the muscle, blocking them from binding to acetylcholine.
As a result, acetylcholine builds up within the neuromuscular junction, but since ACh cannot attach to the receptors on the muscle, the muscle cannot be stimulated. This poison work when it enters the bloodstream. If curare affects the respiratory muscles, then it can become life-threatening.
Guillain-Barre syndrome
The Guillain-Barre syndrome is the commonest cause of acute flaccid paralysis (AFP) in healthy children. Over 0.9-1.5 per 100,000 populations less than 15 years are effected by Guillain-Barre syndrome.
Other causes include:
Transverse Myelitis, Traumatic Neuritis, Polio Myelitis & various other diseases of Nervous System like Meningitis, Encephalitis etc, cerebral palsy, embolic stroke, spinal cord injury
Dos and Don’ts of Acute Flaccid Paralysis
It is not possible to cure Acute Flaccid Paralysis but there are some ways to prevent before it occurs. Follow these basic measures to help keep you and your family healthy:
- Wash hands frequently to limit exposure to germs
- Cover coughs or sneezes
- Stay home when sick
- Make sure you and your family is up to date on vaccinations
- Take steps to prevent mosquito bites
- Injections under Medical supervision only or No injections
- Rest to the involved parts
- No massages or oil applications etc
Self-care for Acute Flaccid Paralysis
- If left untreated, Acute Flaccid Paralysis may not only permanent but also lead to death due to the failure of respiratory muscles.
- It is important to start physical and occupational therapies early during the course of recovery.
- Family education is essential during the early recovery period, to develop a strategic plan to deal with the challenges.
Clinical approach
- Complete neurologic examination including assessment of muscle strength, deep tendon reflexes, cranial nerve function, and sensation.
- Look for the abnormalities of meningismus, ataxia, or autonomic nervous system.
- Fasciculation is also a sign of anterior horn cell damage but it may also be present in demyelinating neuropathies.
- Electrophysiologic studies are very essential for determining the diagnosis of lower motor neuron disease.
- Nerve conduction velocity and electromyographic studies in order to differentiate the demyelinating neuropathies from axonal neuropathies.
Medical Advice for Acute Flaccid Paralysis
Each case of Acute Flaccid Paralysis is a medical emergency and requires immediate examination. For all these cases, a detailed clinical description of the symptoms should be attained including fever, distribution, myalgia, timing, and progression of paralysis. You should see the doctor immediately after experiencing any of the mentioned Signs & Symptoms.
Investigations for Acute Flaccid Paralysis
Surveillance of the AFP will lead to the detection of Poliomyelitis (through stool examination) or other diseases through other tests like Nerve Conduction Velocity (NCV)/Electromyography (EMG)
Stool examination, NCV & EMG, CSF examination CT, MRI, blood & Urine examinations etc.
Features assisting diagnosis
Accurate diagnosis of the cause of Acute Flaccid Paralysis has intense implications for therapy and prognosis. The kids with AFP typically have extensive testing to determine what is causing the Acute Flaccid Paralysis, including an MRI, antibody tests, and testing of their cerebrospinal fluid, etc.
Even though it is not always possible to identify a cause, but at least you can rule out many potential suspects, like trauma, polio, and other infections. For diagnosis, Doctors verify
- Age
- History of preceding or warning illness
- History of trauma
- Presence of fever at the time of paralysis.
- Rapidity of progression.
- Cranial nerve findings and sensory findings.
- The examination includes a search of fracture, focal tenderness or swelling and painful limping gait.
- The examination may show UMNL signs.
- Increased reflexes.
- Hypertonicity
- A positive Babinski sign
- Laboratory findings occasionally are diagnostic
Treatment for Acute Flaccid Paralysis
As per the cause (after thorough investigations & under medical supervision) the treatment is given. Some of the therapies used for people with paralysis includes Physical therapy uses treatments such as heat, massage, and exercise to stimulate nerves and muscles and Rest to involved parts.
AFP Surveillance
Acute Flaccid Paralysis surveillance is the four steps gold standard for detecting cases of poliomyelitis. These four steps include
- Finding and reporting children
- Transporting stool samples for analysis
- Isolating and identifying poliovirus in the laboratory
- Determine the origin of the virus strain mapping the virus
The Purpose Of AFP Surveillance
The purpose of (Acute Flaccid Paralysis) AFP Surveillance can be stated as below:
- To detect reliably areas where poliovirus transmission is occurring.
- To identify areas of priority for focusing on immunization activities
- To measure the quality and impact of polio immunization activities
- To provide evidence to the certification committee of the absence of wild poliovirus transmission
- For functioning and sensitive surveillance system for three years after attaining zero polio case status.
Reasons For AFP Surveillance Instead Of Polio Surveillance
Polio surveillance for a case of the disease in a child that “looks like polio” alone is not sufficient because it is impossible to precisely identify all cases of paralytic polio clinically. This is due to confusing and ambiguous clinical signs and variable clinical knowledge and skills of doctors. To ensure that no cases of polio are missed, all cases of AFP are reported and investigated.
The rate at which Non-Polio AFP cases are detected over time as it helps to assess the sensitivity of the surveillance system in each geographic area also. It implies that the surveillance is sensitive enough to pick up polio transmission in that area if it was occurring it means the sufficient AFP cases of the Non-Polio type are being detected for investigation. However, the rate at which non-polio AFP cases occur is popularly known as Non-Polio AFP rate.
FAQs of Acute Flaccid Paralysis
Can acute flaccid paralysis affect the whole body?
Acute flaccid paralysis doesn’t affect the whole body. It only affects the child’s strength in the affected muscle groups and there is no loss of sensation. For example, if it affected just your legs, then you will have trouble walking. On the other hand, if it affects your chest, you will have the problem in breathing.
When to see a doctor?
The acute flaccid paralysis (AFP) is a sudden onset AFP and is the most common sign of acute polio and used for surveillance during a polio outbreak. You should see the doctor immediately after experiencing any of the above-mentioned Signs & Symptoms.
Is flaccid paralysis permanent?
Acute flaccid paralysis can be treated in some cases of and others may be permanent. However, if the infection is left untreated, the person will eventually feel uncomfortable due to paralysis of the muscles that control breathing.
How does acute flaccid paralysis occur?
Acute Flaccid paralysis occurs when your muscles can no longer contract. The communication between the brain and the muscle are interrupted by either infection (like polio), toxins (like botulism or curare) or from the brain and spinal cord injuries.
How to prevent acute flaccid paralysis?
Acute flaccid paralysis can be prevented by taking some care like giving vaccination to children on time, keeping the surroundings clean, etc.
How does acute flaccid paralysis happen?
Acute Flaccid Paralysis is mostly caused by damage in the nervous system, particularly the spinal cord. Other major causes of acute flaccid Paralysis are the stroke, trauma with nerve injury, poliomyelitis, spina bifida, multiple sclerosis, and Guillain–Barré syndrome.
What are the early symptoms of paralysis?
Common initial symptoms of a stroke include:
- Severe headache.
- Impairment or loss of vision.
- Memory loss.
- Loss of balance or coordination.
- Poor balance and dizziness.
- Sudden numbness
- Slurred or abnormal speech.
Can acute flaccid paralysis be cured?
At most, Paralysis is a result of damage to the spinal cord which affects the central nervous system of the body. Though there is no permanent cure for paralysis, it can be controlled through proper treatment which is very similar even if the causes of the condition vary.
What are the types of paralysis?
The types include:
- Monoplegia: It affects only one arm or leg.
- Hemiplegia: It affects one arm and one leg on the same side of your body.
- Paraplegia: It affects both of your legs.
- Quadriplegia or tetraplegia: It affects both of your arms and both of your legs.
Can an acute flaccid paralyzed person feel the effected parts?
People with paraplegia have no feeling of touch or sense in the paralyzed parts of their body. They cannot feel pain and temperature in the affected areas because the skin can no longer recognize injury. Those affected have a risk of burns or injuries from pressure sores.
How do you recover from paralysis?
- Regaining Movement in a Paralyzed Arm or Leg after Stroke.
- Begin Sensory Re-Education (If Necessary).
- Move through Your Range of Motion.
- Begin Passive Exercise to Rewire the Brain.
- Bring In the Electrical Stimulation.
- Visualize Your Paralyzed Limbs Moving.
Can adults get acute flaccid paralysis?
Acute flaccid paralysis is a syndrome that mostly occurs in the children below 15 years.