What Causes Paraparesis & How is it Managed?

What is Paraparesis?

Paraparesis refers to a medical condition in which the affected individual has partial paralysis of both lower extremities. The affected individual has gradual weakness and increased spasticity in the lower extremities. There is no age prevalence as to the development of paraparesis. Majority of the people with paraparesis have trouble ambulating and will gradually see a change in their gait pattern as the condition progresses [2].

As to the causes, according to various studies carried out on this condition spinal tuberculosis is believed to be responsible for about 30% cases of paraparesis. Acute transverse myelitis is believed to cause 20% of the cases of paraparesis which is then followed by spinal cord tumors with an incidence rate of 10% of overall case of paraparesis. Along with paraparesis, 63% of people also experienced paresthesias in the lower extremities and 75% of people had back pain. Spasticity was also quite common and seen in about 58% of people with paraparesis [1].

What is Paraparesis?

A spinal cord tumor causing paraparesis can be easily diagnosed with a myelography followed by a CT scan. It is quite a helpful tool for diagnosing spinal cord tuberculosis and other compressive myelopathies. As of now, there is no cure for paraparesis and the treatment is aimed at controlling the symptoms. Majority of the features of paraparesis can be minimized by treatments [1].

This condition does not have bearing on the life expectancy of the individual provided that he or she has no other underlying condition. However, the quality of life of people with paraparesis can be significantly compromised if treatment is not provided. This article highlights some of the potential causes and treatment options for paraparesis [1].

What Causes Paraparesis?

Damage or degeneration of the nerve pathways is what is believed to cause paraparesis. There are two variants of paraparesis which are categorized depending on the cause of it. These include [2]:

Hereditary Spastic Paraparesis: This is a form of paraparesis that is caused due to a genetic defect. The gene defect causes the nerves of the spine to degenerate quickly. The function of these nerves is to control movement and muscle tone in the lower half of the body. Damage to these nerves results in the affected individual having gradual decline in movement [2].

The ambulation gets affected over time and there is a significant change in the gait pattern. There is a 50% chance of the offspring of people with known diagnosis of hereditary spastic paraparesis to get this condition [2].

Tropical Spastic Paraparesis: This form of paraparesis is caused as a result of a viral infection. The symptoms of paraparesis may not be evident immediately after the infection. It can at times take a decade or two for the individual to have onset of symptoms of paraparesis. It is usually caused by infections that affect the spinal cord or those that compromise the immune system of the body [2]. The infection that causes paraparesis will most likely cause muscle weakness and sensory loss in the lower extremities. This form of paraparesis typically affects people living in the tropics. The offending virus responsible for paraparesis is named as HTLV-1. It is a contagious virus and can spread from individual to individual through direct contact or sharing objects [2].

A mother can pass this infection to the baby through breastfeeding. However, studies estimate that not more than 1% of people with HTLV-1 virus go on to develop Tropical Spastic Paraparesis [2].

How is Paraparesis Managed?

Coming to the management options for paraparesis, as of now there is no cure for the condition and treatment is aimed at minimizing the symptoms and improving quality of life. Muscle relaxants and aggressive physical therapy is the mainstay of treatment of the symptoms of paraparesis. A physical therapy is designed to improve flexibility and mobility of the muscles through strengthening exercises. Exercises will also be directed towards increasing the muscle endurance of the patient. This will help in minimizing the episodes of muscle spasticity and cramps [2].

Some people tend to have increased urinary urgency due to paraparesis and thus medications will be given for treating that symptom as well. The patient will be monitored closely and regular neurological examinations will be conducted to check on the status of muscle tone and strength [2].

In conclusion, paraparesis refers to a condition characterized by partial paralysis of the lower extremities. Spinal tuberculosis and spinal cord tumors are believed to be the common causes of paraparesis. An individual with paraparesis will have a gradual decline in the strength of the lower extremities. This will impact the movement and change the gait pattern of the individual [2].

There are two major variants of paraparesis namely hereditary spastic paraparesis and tropical spastic paraparesis. While the former is caused due to gene defects the latter is caused due to a viral infection. The virus responsible for tropical spastic paraparesis is named HTLV-1 which is quite contagious and can spread from person to person [2].

People with a known diagnosis of paraparesis do not have any impact on their life expectancy due to this condition. In fact, more than 25% of people with hereditary spastic paraparesis remains completely asymptomatic. It should also be noted that symptoms of paraparesis in members of the same family can start at different times sometimes to the tune of 40-50 years [2].

This means that if an individual has symptom onset at age 40 then another member of the same family with known paraparesis may have symptoms onset at age 70 or 80. There are many cases where people with paraparesis require no support for moving around. However, on most cases, use of crutches or a walker is required for patients with paraparesis to ambulate around the house or outside. In extremely rare cases, a wheelchair is required by an individual with paraparesis to move around [2].

It is important for people with paraparesis to have diligent followups for the condition and do physical therapy as directed by the physician. This will not only minimize the symptoms but also improve the quality of life of people with significant mobility issues due to paraparesis [2].

References:

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