Flaccid paralysis /ˈflæksɪd pəˈræləsɪs/ is a clinical manifestation
characterized by weakness or paralysis and reduced muscle tone without other
obvious cause. This abnormal condition may be caused by disease or by trauma
affecting the nerves associated with the involved muscles. For example, if the
somatic nerves to a skeletal muscle are severed, then the muscle will exhibit
flaccid paralysis. When muscles enter this state, they become limp and cannot
contract. This condition can become fatal if it affects the respiratory
muscles, posing the threat of suffocation.
Causes = Polio=
The term acute flaccid paralysis is often used to describe a sudden onset,
as might be found with polio. AFP is the most common sign of acute
polio, and used for surveillance during polio outbreaks. AFP is also associated
with a number of other pathogenic agents including enteroviruses, echoviruses,
and adenoviruses, among others. = Botulism=
The Clostridium botulinum bacteria are the cause of botulism. Vegetative cells
of C. botulinum may be ingested. Introduction of the bacteria may also
occur via endospores in a wound. When the bacteria are in vivo, they induce
flaccid paralysis. This happens because C. botulinum produces a toxin which
blocks the release of acetylcholine. Botulism toxin blocks the exocytosis of
presynaptic vesicles containing Acetylcholine. When this occurs, the
muscles are unable to contract. Other symptoms associated with infection from
this neurotoxin include double vision, blurred vision, drooping eyelids,
slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Botulism
prevents muscle contraction by blocking the release of ACh, thereby halting
postsynaptic activity of the neuromuscular junction. If its effects
reach the respiratory muscles, then it can cause respiratory failure, leading
to death. = Curare=
Curare is a poison that comes from a plant grown in the rainforests of South
America. The people of South America crush and cook the roots and stems of
curare and then mix it with venom from other plants and animals to create a
poisonous syrup mixture that they put on the tips of their arrows. This poison
has also been used by South Americans to treat madness, dropsy, edema, fever,
kidney stones, and bruises. Curare acts as a neuromuscular blocking agent which
induces flaccid paralysis. This poison binds to the Acetylcholine receptors on
the muscle, blocking them from binding to ACh. As a result, ACh accumulates
within the neuromuscular junction, but since ACh cannot bind to the receptors
on the muscle, the muscle cannot be stimulated. This poison must enter the
bloodstream for it to work. If curare affects the respiratory muscles, then
its effects can become fatal, placing the victim at risk for suffocation.
= Other= Flaccid paralysis can be associated with
a lower motor neuron lesion. This is in contrast to an upper motor neuron
lesion, which often presents with spasticity, although early on this may
present with flaccid paralysis. Included in AFP's list are Poliomyelitis,
Transverse myelitis, Guillain-Barré syndrome, enteroviral encephalopathy,
traumatic neuritis, Reye's syndrome, etc. An AFP Surveillance programme is
conducted to increase case yield of poliomyelitis. This includes collection
of 2 stool samples within 14 days of onset of paralysis and identification of
virus. and control of the outbreak and strengthening immunisation in that area.
Venomous snakes that contain neurotoxic venom such as kraits, mambas, and cobras
can also cause complete flaccid paralysis.
References External links
Approach to Acute Flaccid Paralysis WHO Programme for Immunization
Preventable Diseases A Collaboration between World Health Organization and
Government of Nepal ACUTE FLACCID PARALYSIS information from
the IPD National Polio Surveillance Project of
India "Progress towards poliomyelitis
eradication, Nepal, 1996-1999". Wkly. Epidemiol. Rec. 74: 349–53. October
1999. PMID 10895300. Centers for Disease Control and
Prevention. "Acute flaccid paralysis syndrome associated with West Nile virus
infection—Mississippi and Louisiana, July–August 2002". MMWR Morb. Mortal.
Wkly. Rep. 51: 825–8. PMID 12353741. Sejvar JJ, Leis AA, Stokic DS et al..
"Acute Flaccid Paralysis and West Nile Virus Infection". Emerging Infect. Dis.
9: 788–93. doi:10.3201/eid0907.030129. PMC 3023428. PMID 12890318.
Saeed M, Zaidi SZ, Naeem A et al.. "Epidemiology and clinical findings
associated with enteroviral acute flaccid paralysis in Pakistan". BMC
Infect. Dis. 7: 6. doi:10.1186/1471-2334-7-6. PMC 1804272.
PMID 17300736.