Pediatric paraplegia

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Pediatric paraplegia is a neurological condition which may has acute or gradual presentation. In addition, it may be caused by hereditary or acquired diseases.

What does paediatric paraplegia mean?

Paraplegia means paralysis of both lower limbs

Paraplegia It is a condition in which a person experiences weakness then paralysis of both lower limbs secondary to spinal cord disease or trouble in nerves supplying muscles of lower limbs. In addition, may be secondary to muscle pathology.

It results from impairment or loss of motor and/or sensory function in the thoracic, lumbar, or sacral segments of the spinal cord.

Pediatric paraplegia

What are the causes of pediatric paraplegia?

Paraplegia can be due to a variety of causes.

Sudden onset paraplegia:

Mostly, it is caused by:

Infections for instance: transverse myelitis,

Fracture of spinal vertebrae secondary to trauma to the spinal cord

Clot in the blood vessel supplying the spinal cord.

Gradual onset paraplegia:

Acquired:

Spastic paraplegia is caused by acquired brain disorders for example: perinatal hypoxia or infections early in life resulting in cerebral palsy.

In addition, there are rare disorders including structural, infectious (for example: tuberculosis and poliomyelitis), demyelinating (For instance: Guillain Barre Syndrome), and metabolic disorders, or tumors (neuroblastoma extending into the epidural space from a paravertebral origin).

Moreover, paraplegia may be the presentation of cerebral palsy

Hereditary:

Rarely, paraplegia can occur due to genetic diseases such as hereditary spastic paraplegia

What are the symptoms of pediatric paraplegia?

Acute paraplegia ( is an emergency because acute compressive lesions of the cord are reversible.

Symptoms:

Acute paraplegia usually manifests itself by refusal to stand or walk.

The weakness may progress to complete paraplegia within hours or days.

Signs:

Flaccid paraplegia, distended urinary bladder, and exaggerated tendon reflexes in the legs, but sensations are difficult to test.

Spastic pediatric paraplegia: is present at birth and causes severe, progressive spasticity and muscle weakness, especially in the lower limbs.

Infants have very low muscle tone. In addition, they develop spasticity later on(tight, stiff muscles that make movement difficult), together with cognitive deficits.

What are the symptoms of  the hereditary spastic parapalegia?

Hereditary spastic paraplegia is a heterogeneous group of disorders in which the main clinical feature is progressive lower limb spasticity secondary to pyramidal tract dysfunction

All those children have:

  • Poor or absent speech
  • Microcephaly , that’s to say smaller than normal head   
  • Cognitive abnormality therefore, learning disability
  • Increasing spasticity (in another word stiffness) and paralysis in the lower limbs in early childhood
  • Delayed development of the motor skills
  • A “floppy” appearance in infancy due to low muscle tone

Less commonly is associated with:

  • Involuntary muscle contractions, in other word dystonia
  • Delayed walking therefore, loss of the ability to walk independently
  • Convulsions
  • Short stature

What are the complications of paediatric paraplegia?

Because of progressive leg spasticity, children with sapstic pediatric paraplegia often lose their ability to walk independently, requiring a walker or wheelchair whereas others can walk with a waddling gait.

What are the lines of managing pediatric paraplegia?

Certainly, the management will vary according to the cause of the pediatric paraplegia.

For instance, Guillain Barre Syndrome needs immediate hospitalization in order to keep eyes on the patient and follow his vital signs, because he may be indicated for mechanical ventilation at any time.

Other measures of treatment: intravenous immunoglobulin or steroids may be given.

Patients with transverse myelitis, GBS and demyelination have good recovery usually.

On the other hand, tuberculosis and other infections need specific treatment to the causative infection.

Hereditary spastic paraplegia: no specific treatment for it. However, physical, occupational and speech therapies can help children develop and preserve motor and communication skills.

Muscle relaxants as well as Botox injections can help reduce stiffnes of the muscles

Patients with paraplegia need to undergo physiotherapy to improve the power in the affected muscles. Moreover, patient may need urinary catheter and enemas may required if there is constipation.

The patient may require aids for instance, wheel chairs and walking sticks in order to increase mobility.

Trauma or fracture of the spinal cord need bracing and surgery to decompress the spinal cord, moreover, spinal cord tumors need surgical incision

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