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Quadriplegia

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Description: Quadriplegia, also known as tetraplegia, is a condition where an individual experiences partial or complete paralysis in all four limbs (both arms and legs), often due to damage to the cervical spinal cord.
Type: Quadriplegia, also known as tetraplegia, is typically not classified as a genetic condition. It is primarily caused by spinal cord injuries or diseases affecting the spinal cord, such as trauma, lesions, infections, or degenerative diseases. Therefore, it does not have a specific type of genetic transmission.
Signs And Symptoms: Although the most obvious symptom is impairment of the limbs, functioning is also impaired in the trunk and pelvic organs. This can lead to loss or impairment of controlling bowel and bladder, sexual function, digestion, breathing and other autonomic functions. Furthermore, sensation is usually impaired in affected areas. This may manifest as numbness, reduced sensation or neuropathic pain. Secondarily, because of their depressed functioning and immobility, tetraplegics are often more vulnerable to pressure sores, osteoporosis and fractures, frozen joints, spasticity, respiratory complications, infections, autonomic dysreflexia, deep vein thrombosis, and cardiovascular disease.The severity of the condition depends on both the level at which the spinal cord is injured and the extent of the injury. An individual with an injury at C1 (the highest cervical vertebra, at the base of the skull) will probably lose function from the neck down and be ventilator-dependent. An individual with a C7 injury may lose function from the chest down but still retain use of the arms and much of the hands. An individual in between, with a C5 injury may lose some function from the chest down and fine motor skills in his/her hands but still have flexion and extension abilities of certain muscles around the back or arm area.
The extent of the injury is also important. A complete severing of the spinal cord will result in complete loss of function from that vertebra down. A partial severing or even bruising of the spinal cord results in varying degrees of mixed function and paralysis. A common misconception with tetraplegia is that the victim cannot move legs, arms, or any other major body regions; this is often not the case. Some tetraplegics can walk and use their hands, as though they did not have a spinal cord injury, while others may use wheelchairs and retain some functions in their arms and fingers; again, this varies based on the degree of damage to the spinal cord and is mostly seen with incomplete tetraplegia.It is common to have partial movement in limbs, such as the ability to move the arms but not the hands, or to be able to use the fingers but not to the same extent as before the injury. Furthermore, the deficit in the limbs may not be the same on both sides of the body; either side may be more affected, depending on the location of the lesion on the spinal cord.Another important factor is the possibility that the patient may exhibit sporadic movement in the affected areas. One of the main causes for this would be myoclonus, or muscle spasms. "After a spinal cord injury, the normal flow of signals is disrupted, and the message does not reach the brain. Instead, the signals are sent back to the motor cells in the spinal cord and cause a reflex muscle spasm. This can result in a twitch, jerk or stiffening of the muscle."
Prognosis: Delayed diagnosis of cervical spine injury has grave consequences for the victim. About one in 20 cervical fractures are missed and about two-thirds of these patients have further spinal-cord damage as a result. About 30% of cases of delayed diagnosis of cervical spine injury develop permanent neurological deficits. In high-level cervical injuries, total paralysis from the neck can result. High-level tetraplegics (C4 and higher) will likely need constant care and assistance in activities of daily living (ADLs), such as getting dressed, eating, and bowel/bladder care. Individuals with C5 injuries retain some function in their biceps, deltoids, and other muscles; they typically can perform many ADLs including feeding, bathing, and grooming but require total assistance with bowel/bladder care. The C6 level adds function in the extensor carpi radialis, longus, and other muscles allowing for wrist extension, scapular abduction, and wrist flexion; typically, these patients have modified independent feeding and grooming with adaptive equipment, independent with dressing, can use both a manual and power wheelchair but require assistance with some activities of daily living. The C7 level is where function is retained in the triceps allowing for arm extension; C7 is considered the key level at which most activities can be performed independently with a wheelchair and assistive devices; activities include feeding, grooming, dressing, light meal preparation, and transfers on level surfaces. Even in complete spinal cord injury, it is common for individuals to recover up to 1 level of motor function.Even with "complete" injuries, in some rare cases, through intensive rehabilitation, function can be regained through "rewiring" neural connections, as in the case of actor Christopher Reeve.In the case of cerebral palsy, which is caused by damage to the motor cortex either before, during (10%), or after birth, some people with incomplete tetraplegia are gradually able to learn to stand or walk through physical therapy.Tetraplegics can improve muscle strength by performing resistance training at least three times per week. Combining resistance training with proper nutrition intake can greatly reduce co-morbidities such as obesity and type 2 diabetes.
Onset: Quadriplegia, also known as tetraplegia, typically onset occurs suddenly, usually as a result of a traumatic injury to the spinal cord or brain. This can happen due to events such as motor vehicle accidents, falls, sports injuries, or acts of violence. The precise time frame of onset can vary depending on the severity and nature of the injury, but it is generally immediate or occurs within a short period following the incident.
Prevalence: The prevalence of quadriplegia varies depending on the region and the cause. It is often a result of spinal cord injuries, which affect approximately 17,730 new people each year in the United States. Overall, there are about 291,000 people living with spinal cord injuries in the U.S., with a significant portion experiencing quadriplegia. Global prevalence rates are more difficult to ascertain due to variations in data collection and reporting.
Epidemiology: There are an estimated 17,700 spinal cord injuries each year in the United States; the total number of people affected by spinal cord injuries is estimated to be approximately 290,000 people.In the US, spinal cord injuries alone cost approximately $40.5 billion each year, which is a 317 percent increase from costs estimated in 1998 ($9.7 billion).The estimated lifetime costs for a 25-year-old in 2018 is $3.6 million when affected by low tetraplegia and $4.9 million when affected by high tetraplegia. In 2009, it was estimated that the lifetime care of a 25-year-old rendered with low tetraplegia was about $1.7 million, and $3.1 million with high tetraplegia.About 1,000 people are affected each year in the UK (~1 in 60,000—assuming a population of 60 million).
Intractability: Quadriplegia, also known as tetraplegia, involves paralysis of all four limbs and the torso, typically resulting from spinal cord injury. While various treatments and therapies can improve quality of life and functionality, there is currently no cure for complete spinal cord injuries that cause quadriplegia. Therefore, the condition is generally considered intractable.
Disease Severity: Disease severity for quadriplegia can vary significantly. It depends on the location and extent of the spinal cord injury. Quadriplegia results in partial or total loss of use of all four limbs and torso. Severity ranges from slight movement or sensation loss to complete paralysis.
Healthcare Professionals: Disease Ontology ID - DOID:12835
Pathophysiology: Quadriplegia, also known as tetraplegia, involves paralysis of all four limbs and often the torso. The primary pathophysiological cause is damage to the cervical spinal cord. This damage disrupts the transmission of neural signals between the brain and the body below the site of injury. Common causes include traumatic injury (e.g., car accidents, falls), but tumors, infections, and degenerative diseases can also result in such spinal cord damage. The extent of paralysis and loss of sensory and motor function depends on the level and completeness of the spinal cord injury.
Carrier Status: Quadriplegia is not typically associated with a carrier status, as it often results from spinal cord injury or disease rather than inherited genetic conditions. It leads to partial or total loss of use of all four limbs and torso.
Mechanism: Quadriplegia, also known as tetraplegia, is paralysis caused by illness or injury that results in the partial or total loss of use of all four limbs and torso. The primary mechanism involves damage to the spinal cord, particularly in the cervical (neck) region.

### Mechanism:
1. **Traumatic Injury**: Common causes of quadriplegia include traumatic injuries such as car accidents, falls, sports injuries, or acts of violence, which can fracture or dislocate vertebrae and compress the spinal cord.
2. **Non-Traumatic Causes**: Diseases that can cause quadriplegia include multiple sclerosis, amyotrophic lateral sclerosis (ALS), spinal cord tumors, and infections like transverse myelitis.

### Molecular Mechanisms:
1. **Axonal Damage**: Damage to the spinal cord disrupts axonal integrity, impairing communication between the brain and affected limbs.
2. **Inflammatory Response**: Injury to the spinal cord triggers an inflammatory response, releasing cytokines and other inflammatory mediators that can exacerbate damage.
3. **Cell Death**: Loss of neurons and glial cells occurs due to direct trauma, inflammatory cytokines, and excitotoxicity from excessive glutamate release.
4. **Myelin Sheath Disruption**: The insulating myelin sheath around the axons may be damaged, impairing nerve signal conduction.
5. **Oxidative Stress**: Reactive oxygen species (ROS) generated during the injury process can damage cellular components, leading to further neuronal death.
6. **Secondary Injury Mechanisms**: Processes such as ischemia, edema, and further inflammatory cell infiltration can expand the initial area of damage.

Recent research into molecular pathways involved in cell death and regeneration (e.g., apoptosis, necrosis, autophagy) show potential targets for therapies to promote recovery and mitigate damage post-injury.
Treatment: Upper limb paralysis refers to the loss of function of the elbow and hand. When upper limb function is absent as a result of a spinal cord injury it is a major barrier to regain autonomy. People with tetraplegia should be examined and informed concerning the options for reconstructive surgery of the tetraplegic arms and hands.
Compassionate Use Treatment: Quadriplegia, also known as tetraplegia, is the paralysis of all four limbs and the torso, usually due to spinal cord injury or disease. Here are some treatments that fall under compassionate use, off-label, or experimental categories:

1. **Stem Cell Therapy**: Experimental treatments using stem cells aim to repair or regenerate damaged spinal cord tissues.

2. **Neurostimulation Devices**: Off-label use of devices like epidural stimulators can be explored to enhance motor function and improve quality of life.

3. **Robotic Exoskeletons**: Certain robotic exoskeletons are in experimental stages, intended to enable mobility and assist in physical rehabilitation.

4. **Pharmacological Agents**: Drugs like Riluzole have been explored off-label for their neuroprotective properties, though they are primarily approved for other conditions like ALS.

5. **Gene Therapy**: Experimental gene therapy has shown potential in early studies to promote neural repair and functional recovery.

6. **Hydrogel Injections**: Research into injectable hydrogels is being conducted to support spinal cord repair and facilitate nerve growth.

These treatments are often in clinical trials and may not be widely available. Patients interested in these options should consult with a medical professional for eligibility and potential participation in trials.
Lifestyle Recommendations: Lifestyle recommendations for individuals with quadriplegia typically focus on improving quality of life and maintaining health. Here are some key suggestions:

1. **Physical Therapy**: Regular physical therapy can help maintain muscle strength, prevent atrophy, and improve circulation.
2. **Occupational Therapy**: This assists in learning new ways to perform daily activities and can involve adaptive equipment.
3. **Healthy Nutrition**: Balanced diet to manage weight, promote healing, and maintain overall health.
4. **Skin Care**: Prevent pressure sores by regularly changing positions, using specialized cushions, and maintaining skin hygiene.
5. **Bladder and Bowel Management**: Follow recommended routines and use prescribed medications or devices to prevent infections and maintain function.
6. **Mental Health Support**: Engage in counseling or support groups to manage emotional well-being and build a support network.
7. **Exercise**: Adaptive exercises can improve health and wellness; consult with healthcare providers to design a suitable program.
8. **Assistive Technology**: Use specialized equipment like electric wheelchairs, voice-activated devices, and environmental control systems to enhance independence.
9. **Education and Advocacy**: Staying informed about new treatments and technologies and advocating for personal needs and rights.

By integrating these practices, individuals with quadriplegia can enhance their independence and quality of life.
Medication: Quadriplegia, also known as tetraplegia, is paralysis affecting all four limbs and the torso. Medications used in managing quadriplegia are not designed to cure it but to address symptoms and complications. These may include:

1. **Antispasmodics**: Medications like Baclofen, Tizanidine, and Diazepam to reduce muscle spasticity.
2. **Pain Management**: Analgesics such as acetaminophen, NSAIDs, and opioids, depending on severity.
3. **Antidepressants**: Medications like SSRIs or SNRIs to manage depression, which is common among individuals with quadriplegia.
4. **Bladder Control**: Anticholinergics like Oxybutynin to manage bladder spasticity and incontinence.
5. **Bowel Management**: Laxatives and stool softeners to maintain regular bowel movements.
6. **Blood Thinners**: Anticoagulants to prevent blood clots, especially in the early stages after injury.
7. **Other**: Medications for blood pressure regulation, if autonomic dysreflexia is a concern.

Always consult a healthcare provider for a treatment plan tailored to individual needs.
Repurposable Drugs: Quadriplegia, also known as tetraplegia, is the paralysis of all four limbs and the torso, typically caused by spinal cord injury or disease. There are currently no specific drugs approved exclusively for the treatment of quadriplegia. However, several drugs originally developed for other conditions are sometimes repurposed to manage certain aspects of quadriplegia:

1. **Baclofen** - Originally used to treat muscle spasticity in multiple sclerosis, it can help reduce muscle spasms in quadriplegic patients.
2. **Gabapentin** and **Pregabalin** - Both are anticonvulsants used to treat neuropathic pain, which is a common issue in individuals with spinal cord injuries.
3. **Oxybutynin** - Used for bladder control issues, which are often experienced by quadriplegic patients due to disrupted nerve signals.
4. **Tamsulosin** - Originally for benign prostatic hyperplasia, it can assist with urination difficulties related to neurogenic bladder.
5. **Anticoagulants** - Such as heparin or warfarin, to prevent deep vein thrombosis (DVT), a common complication due to immobility.

It is important to note that these drugs address symptoms and complications rather than the underlying cause of quadriplegia.
Metabolites: Quadriplegia, also known as tetraplegia, is paralysis of all four limbs, often caused by damage to the spinal cord. Metabolites associated with quadriplegia aren't specific to the condition itself but may involve metabolic changes due to reduced mobility, altered muscle function, and secondary complications such as infections. These can include altered glucose metabolism, increased muscle breakdown products like creatinine, and changes in lipid profiles. Regular monitoring and tailored interventions are crucial for managing these metabolic changes in quadriplegic patients.
Nutraceuticals: Quadriplegia, or tetraplegia, refers to paralysis of all four limbs caused by injury or illness. Nutraceuticals refer to foods or supplements that provide medical or health benefits beyond basic nutrition.

While there is no specific nutraceutical that can cure quadriplegia, certain supplements may support overall health and potentially improve quality of life for individuals with this condition. Key nutraceuticals that might be considered include:

1. **Omega-3 Fatty Acids**: Found in fish oil and flaxseed, they may support nerve health and reduce inflammation.
2. **Vitamin D**: Important for bone health, which can be compromised in individuals with limited mobility.
3. **Antioxidants**: Vitamins C and E, as well as selenium, can help reduce oxidative stress, which may enhance overall cellular health.
4. **Magnesium**: Supports muscle function and may help reduce muscle spasms or cramps.
5. **B Vitamins**: Essential for nerve health and energy metabolism, potentially supporting nerve repair and reducing neuropathic pain.

Always consult a healthcare professional before starting any new supplement regimen, as needs can vary based on individual health conditions.
Peptides: Quadriplegia, also known as tetraplegia, is paralysis that affects all four limbs and the torso, typically caused by damage to the spinal cord in the cervical region. In terms of treatments involving peptides and nanotechnology, research is ongoing:

1. Peptides: Certain peptides are being studied for their potential neuroprotective and regenerative properties. For example, peptides that mimic neural growth factors could potentially help in promoting nerve cell repair and regeneration.

2. Nanotechnology: Nanomaterials are being explored for targeted drug delivery to the spinal cord. Nanoparticles can be designed to cross the blood-brain barrier and deliver therapeutic agents directly to the site of injury, potentially improving outcomes by reducing inflammation and promoting healing.

Both approaches are still largely experimental and under research, with the goal of finding effective treatments to improve function and quality of life for individuals with quadriplegia.