PARALYSIS, Spastic.
This type belongs to the group of cerebral or centric paralyses which include a number of different organic lesions produced by disease of the neurons in some portion of the upper motor tract, though the lower extremities are most frequently the seat of the tonic spasm.
The treatment of Spastic Paraplegia (primary lateral sclerosis), which may he taken as the most typical example of this group, until recently has remained in a most unsatisfactory state. Rest is essential whilst the disease is passing through any of its stages of severe spasmodic activity. Massage is desirable, as is also passive movement. Both these agents must, however, he most gently applied. and never to the extent of inducing fatigue. Electricity and Strychnine. so useful in the treatment of the flaccid and simple functional types of spinal paralysis. are as a rule harmful, and should he always avoided as a routine in the treatment of the cerebral, type of palsy with spasticity. As primary spastic paraplegia is of long duration and does not tend to shorten life, the various deformities which arise from contractures will require treatment by approved orthopedic methods as tenotomy, tendon transplantation. the application of splints, &c., to enable the patient to keep moving about as long as possible. This remark especially applies to the type of spastic paralysis appearing soon after birth, and known as Little's Disease, in which the primary lesion is probably a cerebral meningeal haemorrhage. which eventually may cause a spastic condition of the upper extremities in addition to cross-legged progression and athetosis. Well-regulated gymnastic exercises with passive movements and massage may for a long time stave off the necessity for severe orthopaedic or root resection operations in such cases.
The secondary spastic paralysis which supervenes upon chronic myelitis, caries of the spine, ataxic paraplegia, disseminated sclerosis and injuries of the pyramidal tract must be treated upon the above-mentioned plans, electricity, strychnine and active gymnastic or resistance movements being avoided.
In severe degrees of spastic paralysis two methods of late years have been practised which promise to afford relief in what has been hitherto regarded as a condition practically beyond the reach of curative agents. Schwab and Allison inject strong alcohol into the nerve trunks going to the spastic muscles—a plan of destroying the conductivity of the nerves which has proved successful in the treatment of severe neuralgia of the different divisions of the fifth. The results in several cases have been satisfactory but transient.
Spiller's operation of resecting the posterior roots of the spinal nerves has given satisfactory results in Little's Disease and in other forms of spastic paralysis as in primary lateral sclerosis, and the spastic paraplegia which follows myelitis and spinal caries, and the rigidity which sometimes accompanies long-standing hemiplegia and other cerebral lesions.
The operation is most clearly indicated when there is evidence that the degenerative process has already reached its limits as in Little's Disease, and where locomotion is impossible or when severe involuntary spasmodic movements (athetosis) exist. Laminectomy having been performed, resection of the posterior roots of the second, third and fifth lumbar nerves is carried out in cases of paraplegia, and resection of the posterior roots of several of the cervical nerves when the upper extremities are involved. If orthopaedic measures are at the same time carried out, patients who have been unable to stand or walk for years may be enabled to move about after the spasticity has thus been removed by the division of the posterior roots.