=Spastic paraplegia= begins as a stiffness in the legs, with no sensory
symptoms, but finally the muscles become rigid and slowly paralyzed.
The reflexes are exaggerated.
It may occur, in a few instances, as a primary disease, “being a
degeneration of the motor neurone, whose body lies in the brain cortex
and whose axone lies in the lateral pyramidal tract.” Usually it is
secondary to tumors, inflammation and softening of the brain. Multiple
sclerosis, hemorrhage, transverse myelitis, syringomyelia and other
diseases of the cord, injury, exposure and overexertion are exciting
causes. Syphilis may be a cause. It generally develops between the ages
of twenty and forty.
=Pathologically=, the degeneration involves the lateral pyramidal
columns of the cord. It begins at the periphery and extends upward
until finally the axones atrophy and neuroglia overgrowth takes place
and sclerosis of the motor tracts results.
=Symptoms.=—Muscular stiffness in one leg is usually the first symptom,
which gradually disturbs both sides. The muscular stiffness increases
to a rigidity, and even cramps, so that it is with considerable
difficulty that the patient moves about. The reflexes are exaggerated.
The joints, as well as the muscles are stiff, so that the toes are
dragged upon the ground and the legs are kept close together, abduction
of the limbs being difficult. On the whole, there is much tiredness,
stiffness, rigidity and hardness of the leg muscles, so that all
motions with them are performed with great effort. Sensory and trophic
symptoms are lacking; control of the bladder and rectum is usually
normal. The progress of the disease is slow. The upper extremities may
be involved in after years, but the common extensive disturbance is
with the legs, so that they may be entirely useless and the muscles
atrophy from disuse, although rigidity and contractures remain.
=Treatment.=—The prognosis is usually unfavorable, though frequently
the patient may be considerably benefited. A few cases that have
been =caused= by =traumatism=, cold or exposure have yielded to
osteopathic treatment and all symptoms disappeared. The treatment is
largely that of locomotor ataxia. The lesions are readily located in
the spinal column. In a few cases a slight posterior curvature of the
dorso-lumbar region is found, but the majority of the lesions are in
the lower dorsal region. Special care should be given to the bladder
and bowels. Prolonged warm baths are beneficial. Treatment of the legs
is always secondary to that of the spine. The diet should be nutritious
and one easily digested. Give the patient plenty of fresh air and
sunlight with cheerful surroundings. E. C. Link[132] reports two cases,
one of over one year’s standing, completely recovered, and another much
improved.