Treatment for Flaccid Paralysis

What is Acute Flaccid Paralysis?

Acute flaccid paralysis is a serious neurological condition characterized by sudden onset and loose muscle tone. This condition is characterized by muscle weakness and loss of reflexes as a result of a disorder of the nervous system. In this context, the term “flaccid” refers to muscles being flaccid and without tone, while the word “acute” indicates that symptoms appear rapidly, usually within hours or days. In addition, one of the most common causes is infectious diseases such as poliomyelitis. However, Guillain-Barré syndrome, enterovirus infections, trauma or sudden lesions of the spinal cord can also cause this condition.

The disease usually starts in the legs and can progress upwards, affecting the respiratory muscles, which can be life-threatening. For this reason, the diagnosis is based on clinical evaluation, electromyography (EMG) and cerebrospinal fluid analysis so that the disease can be detected and treated quickly.

Why Does Acute Flaccid Paralysis Occur?

Acute flaccid paralysis is a condition caused by sudden and severe damage to the nervous system and can occur for many different reasons. But the most common cause is viral infections. These viruses, especially enteroviruses such as poliovirus, attack motor nerve cells and impair muscle control. In addition, autoimmune diseases in which the immune system mistakenly attacks nerve cells (e.g. Guillain-Barré syndrome) can also cause acute flaccid paralysis. In this syndrome, the immune system targets peripheral nerves, causing sudden muscle weakness and loss of reflexes. Traumatic spinal cord injuries, exposure to certain toxins (e.g. botulinum toxin), diseases affecting the neuromuscular junction (e.g. Myasthenia Gravis) and sudden metabolic disorders can also cause this picture. Some genetic or congenital diseases of the nervous system, especially in childhood, can also cause acute-onset flaccid paralysis. Therefore, rapid identification of the cause and initiation of treatment is of great importance for the patient's quality of life and vital functions.

Symptoms of Acute Flaccid Paralysis

Flaccid paralysis has many symptoms that vary from person to person. These symptoms do not appear in every patient, but they are present in living patients. If we examine the symptoms of flaccid paralysis, the symptoms are as follows;

• Sudden muscle weakness
• Decreased muscle tone
• Decrease or disappearance of deep tendon reflexes
• Thinning of muscles (atrophy)
• Painless paralysis
• Sudden decrease in mobility
• Asymmetric uptake
• Affected respiratory muscles
• Swallowing and speech difficulties
• Impaired urinary and fecal control

How Can Acute Flaccid Paralysis Be Diagnosed?

Acute flaccid paralysis is diagnosed by careful evaluation of the patient's clinical symptoms and various laboratory and imaging tests to determine the underlying cause. First, a history and physical examination of the patient is performed; during the examination, typical findings such as sudden onset of muscle weakness, loss of reflexes and decreased muscle tone are observed. Electromyography (EMG) and nerve conduction studies are then performed to assess nerve conduction velocity and electrical activity of the muscles. These tests help the diagnosis by showing to what extent the nerves are affected. A lumbar puncture (lumbar puncture) may also be performed to assess cerebrospinal fluid. For example, in Guillain-Barré syndrome, the protein level in this fluid is high while the cell count is normal. If necessary, advanced imaging modalities such as magnetic resonance imaging (MRI) can be used to investigate whether there is a structural defect or inflammatory process in the spinal cord and, if infectious causes are suspected, blood and stool tests can be performed to screen for viruses. Following this comprehensive approach, the cause of acute flaccid paralysis can be clarified and appropriate treatment can be started quickly.

How to Prevent Flaccid Paralysis?

Certain measures can be taken to prevent flaccid paralysis. These measures are detailed below:

• Vaccination against infections such as polio is one of the most important ways to prevent flaccid paralysis. Polio vaccination, especially during childhood, eliminates the risk of paralysis associated with epidemics.
• Viral and bacterial infections (e.g., Guillain-Barré syndrome) can affect the nervous system. Therefore, hands should be washed, food safety should be ensured, and the immune system should be kept healthy.
• To prevent nerve damage resulting from traffic accidents, sports injuries, or workplace accidents, protective equipment must be used, and workplace safety precautions must be followed.
• In cases of sudden weakness, loss of reflexes, or numbness in the muscles, consulting a doctor without delay will ensure that treatment begins before the paralysis progresses.
• Since diseases such as diabetes can cause nerve damage, blood sugar, blood pressure, and cholesterol levels should be monitored regularly and kept under control.
• Additionally, it is important to maintain a balanced and adequate diet. Regular exercise should also be prioritized.
• Finally, it is essential to avoid alcohol and tobacco completely. By doing so, you can eliminate the risk of developing flaccid paralysis.

Acute Flaccid Paralysis Treatment

Treatment of flaccid paralysis depends on the underlying cause, the severity of the disease and the general condition of the patient. The treatment process is usually multifaceted and includes both medical and supportive approaches. The treatments to be applied in this context are as follows;

Treatment for the Underlying Cause

• Plasmapheresis (plasma exchange): Harmful antibodies circulating in the blood are removed.
• Intravenous immunoglobulin (IVIG): Regulates the immune system by giving the body high doses of antibodies.
• For infectious causes (e.g. viral causes such as polio): antiviral drugs may be used. However, in most cases there are no specific antivirals for such infections, so supportive care is the mainstay of treatment.

Supportive Treatment

• Respiratory support: If the respiratory muscles are affected, the patient may be given ventilatory support. This requires monitoring under intensive care conditions.
• Nutrition support: Patients with swallowing difficulties may be fed with a nasogastric tube or PEG.
• Physical therapy and rehabilitation: Physiotherapy should be started early to prevent muscle weakness and atrophy. This is critical for long-term functional recovery.

Symptomatic and Preventive Approaches

• Pain management: Appropriate analgesics are given for muscle and nerve pain.
• Infection prevention: Hygiene and nursing care are important to prevent complications such as pressure sores, lung infections and urinary tract infections in long-term hospitalized patients.
• Psychological support: Especially in prolonged cases, the patient may develop demoralization and depression; in this case, psychological counseling and, if necessary, medication may be applied.
• Gracilis Muscle Transplant: Gracilis muscle transplantation in the treatment of flaccid paralysis is a dynamic surgical method used to restore the function of facial muscles, especially in cases of long-term and permanent facial paralysis. In this method, the gracilis muscle, located on the inner thigh, is removed together with its vascular and nerve connections and transplanted to the paralyzed facial area with microsurgical techniques. In this way, the muscle is usually connected to the masseteric nerve, allowing it to receive nerve impulses again, and the patient learns to make facial expressions such as smiling during the chewing movement over time.
• Facelift for Facial Paralysis: Facelift for facial paralysis in the treatment of flaccid paralysis is a preferred surgical approach, especially in cases where facial muscles have completely lost their function and facial symmetry and aesthetic appearance are impaired. In this approach, although muscle function is not restored, the patient's appearance is improved. Thus, the natural contours of the face are preserved.

Things to Consider Before Acute Flaccid Paralysis Surgery

There are many points to be considered before flaccid paralysis surgery. These points ensure that the operation process goes better. The points to be considered before flaccid paralysis surgery are as follows;

• Before surgery, detailed information about the patient's general health status, past medical history and current medication use should be obtained.
• The accuracy of the diagnosis of acute flaccid paralysis and the extent to which facial muscles are affected should be carefully evaluated by a neurologist or facial surgeon.
• If general anesthesia is to be administered, the patient should be evaluated by an anesthesiologist.
• Before surgery, the patient should be given detailed information about the risks of the procedure, possible complications and the recovery process.
• A plan should be made between the surgeon and the patient about which surgical techniques will be used (for example, gracilis muscle transplantation or nerve transfer).
• Before surgery, medications that may pose a potential risk, such as blood thinners, should be discontinued in line with the doctor's recommendation.
• The surgical process may create emotional and psychological pressure on the patient. It is important to reassure the patient and increase his/her morale and motivation.
• Smoking and alcohol can negatively affect the healing process. These habits should be reduced or, if possible, stopped before surgery.

Things to Consider After Acute Flaccid Paralysis Surgery

Just as there are points to be considered before flaccid paralysis surgery, there are also factors to be considered afterwards. These factors make the postoperative process easier and better. Here are the things you should pay attention to after flaccid paralysis operation;

• For postoperative pain control, painkillers recommended by the doctor should be used regularly.
• After surgery, facial expressions should be done in a controlled manner to avoid excessive strain on the facial muscles.
• To avoid the risk of infection, the surgical site should be treated with care and cleaned with antiseptics recommended by the doctor.
• After surgery, physiotherapy should be started to re-strengthen the facial muscles. There may be swelling and bruising in the facial area after surgery. These usually resolve within a few weeks. However, the decrease in swelling should be monitored during this period.
• Monitor for signs of infection (redness, swelling, fever) and consult a doctor immediately if anything abnormal occurs.
• During the first few weeks after surgery, heavy exercise, excessive use of facial muscles or head trauma should be avoided.
• The healing process should be monitored and professional observation should be made at every stage to prevent complications.

The Importance of Starting Flaccid Paralysis Treatment Early

Starting treatment for flaccid paralysis early on is crucial for preserving nerve and muscle tissue function. The main reason for this is that when nerve transmission is disrupted, muscles weaken and atrophy due to lack of use within a short period of time. In this context, when muscle tissue remains unstimulated for a long time, it loses both its strength and flexibility, leading to motor losses that are difficult or impossible to reverse. Therefore, rehabilitation programs implemented in the early stages support the nerve regeneration process, accelerating recovery and reducing the risk of permanent damage. In addition, passive and active exercises applied to the muscles, as well as methods such as electrotherapy, help the muscles maintain their vitality and the joints retain their mobility. This also supports the circulatory system, increases blood flow, and stimulates the natural healing mechanisms by oxygenating the nerve cells. All these factors make early intervention indispensable for maintaining the patient's quality of life at a high level after flaccid paralysis.

Doctor Be Difference in Acute Flaccid Paralysis Treatment

As one of the best facial paralysis treatment surgeons in Turkey, Doctor Be has extensive experience in flaccid paralysis treatment and at the same time offers the best and most perfect results to his patients by using the latest technology and methods. Thus, by prioritizing patient satisfaction, he has become one of the best facial paralysis treatment clinics in Turkey.