What is the management of paralysis?

Management of Paralysis

The management of paralysis should focus on identifying the underlying cause, providing appropriate medical treatment, and implementing supportive care measures to prevent complications and improve quality of life. 1

Diagnosis and Assessment

Identifying the Type and Cause of Paralysis

• Facial paralysis (Bell's palsy):

  • Perform thorough clinical evaluation to exclude identifiable causes of facial paralysis 2, 1
  • Avoid routine laboratory testing in new-onset Bell's palsy 1
  • Avoid routine diagnostic imaging for new-onset Bell's palsy 1
  • Electrodiagnostic testing is not recommended for incomplete facial paralysis but may be useful in complete paralysis 1

• Other types of paralysis:

  • Determine if paralysis is peripheral or central in origin
  • Assess for traumatic, vascular, inflammatory, infectious, or neoplastic causes
  • Document distribution (focal, multifocal, or generalized)
  • Note onset pattern (acute, subacute, or chronic)

Treatment Approaches

Medical Management

1. For Bell's palsy:

   • Administer oral corticosteroids within 72 hours of symptom onset for patients 16 years and older 2, 1
   • Do not prescribe antiviral therapy alone 1
   • Consider combination therapy (corticosteroids plus antivirals) in select cases 1

2. For other causes of paralysis:

   • Treat underlying condition (infection, inflammation, etc.)
   • Consider neuromuscular blockers only in critical care settings with appropriate sedation and analgesia 3
   • For periodic paralysis, carbonic anhydrase inhibitors like acetazolamide may be effective 4

Neuromodulation for Spinal Cord Injury

• Epidural stimulation has shown promise in enabling voluntary movement in patients with complete paralysis 5
• This approach can help patients with chronic complete paralysis regain some voluntary control of paralyzed muscles

Supportive Care

1. Eye protection for facial paralysis:

   • Implement eye protection for Bell's palsy patients with impaired eye closure 2, 1
   • Use artificial tears, ocular ointment, and eye patching/taping to prevent corneal damage 1

2. Physical therapy and rehabilitation:

   • May benefit patients with more severe paralysis 1
   • Focus on maintaining range of motion and preventing contractures
   • Consider specialized rehabilitation based on the type and extent of paralysis

3. Psychological support:

   • Address emotional and psychological needs of patients and families 3
   • Encourage touch and verbal communication with paralyzed patients 3

Follow-up and Monitoring

• Reassess or refer to specialists for:

  • New or worsening neurologic findings 2
  • Development of ocular symptoms 2
  • Incomplete recovery after 3 months 2, 1

• Monitor for complications:

  • Respiratory distress (reported in some paralysis cases) 4
  • Permanent myopathy 4
  • Cardiac abnormalities during crises 4

Prognosis

• Bell's palsy: 70-94% of patients recover completely without treatment 1
• Cranial nerve paralysis due to vascular disease (diabetes, atherosclerosis, hypertension): 71% temporary 6
• Prognosis is worse for paralysis caused by aneurysm, trauma, and neoplasm 6
• Initial severity is a strong predictor of outcome - patients with incomplete paralysis (paresis) have better outcomes than those with complete paralysis 7

Special Considerations

• Distinguishing paresis from paralysis: Patients with incomplete palsy (paresis) have significantly better outcomes and recovery times compared to those with complete paralysis 7

• Potential complications: Although often considered benign, paralysis can lead to serious complications including respiratory distress, permanent myopathy, and even death during paralysis episodes 4

• Surgical options: For persistent Bell's palsy, reconstructive procedures such as eyelid weights, brow lifts, and facial slings may improve function and appearance 2