2024-11-26 22:00:00
L’hypotension is often one of the symptoms of neurological, neuromuscular, muscular or even tissue pathologies. It is often the source of motor disability more or less important sometimes from early childhood. There physiotherapy and other supportive care are essential to preserve autonomy and improve the quality of life of patients, sometimes from a very young age.
Definition: what is muscular hypotonia?
Hypotonia is defined by a pathological deficit in muscle tone. It results in a reduction or even absence of movement. Hypotonia can lead to more or less severe motor disability and hamper patients’ quality of life.
Hypotonia may be detected just after birth or as the child grows, or as he learns to walk, sit, or hold his head. Sometimes it is detected later in life. Doctor Donia Mahjoub, neurologist.
The causes of hypotonia are diverse: “the most common causes are a central involvement (such as cerebral palsy or certain forms of Down syndrome), a muscle disease (like muscular dystrophies) or even a tissue pathology (like Marfan syndrome)”, according to the practitioner.
What are the different types of hypotonia?
First of all, it must be remembered that hypotonia can be active (the person has difficulty lifting their leg for example) or passive (it manifests itself when the person is inactive, in a lying position for example). “L’hypotension axial concerns the trunk. It results, for example, in difficulty holding your head and remaining in a sitting position. Conversely, peripheral hypotony concerns the muscles of the limbs” underlines Doctor Donia Mahjoub. Finally, let us add that all the muscles of the human body can be affected by hypotonia. This is the case, for example, of muscles of the intestine or perineum. There is also a pyelic hypotoniawhich translates into a renal pelvis weakness and one urinary tract laziness. L’ocular hypotonyfor its part, is characterized by a decrease in eye pressure linked to a drop in aqueous humor production following an infection or trauma. It can cause abnormal eye movements and reduced vision.
What are the causes of muscular hypotonia?
The control of muscle tone begins at the motor cortex. The latter gives a signal to the spinal cord which then diffuses it peripherally towards the muscular junctions. Any abnormality affecting this circuit can cause hypotonia. Doctor Donia Mahjoub, neurologist.
Muscle hypotonia can be linked to:
An abnormality of the central or peripheral nervous system: brain damage, motor neuron disease (such as early infantile spinal muscular atrophy), damage to the neuromuscular junction (or myasthenia gravis), nerve pathology (or neuropathy), etc.A muscular abnormality (we are talking about myopathy). A tissue disease like the Marfan syndrome.
Why is a baby or child hypotonic?
Hypotonia is most often the consequence of a disease such as:
A cerebral palsy ; L’early infantile spinal muscular atrophy ; A muscular dystrophy, myopathy or myotonique (like the Duchenne muscular dystrophy For example) ; Marfan syndrome; A Prader-Willi syndrome ; A Tay-Saches disease ; And syndrome de Down (or Down syndrome).
When linked to this type of pathology, hypotonia is detected at birth or in early childhood. “The baby is then a little soft. The axes and limbs are much more relaxed than for a healthy baby. He can quickly present abnormalities such as difficulty holding his head, sitting or even respiratory signs (in the event of a decrease in the tone of the respiratory and intercostal muscles),” according to the neurologist.
At the pregnant womantaking anxiolytics or alcohol consumption during pregnancycan cause a transient hypotonia in infants at birth.
What explains a lack of muscle tone in adults?
When hypotonia occurs within a few minutes, it is often due to a vascular accident (CVA) or to a trauma.
A deficit that progresses over several hours or days corresponds to a pathological process such as Guillain-Barré syndrome.
In the event of slower progression, several weeks or months, we rather think of a multiple sclerosis or peripheral neuropathy.
Be careful, it happens that certain medications cause a transient muscular hypotonia. This is the case of antipsychotics (neuroleptics), cure and some anesthetics.
What are the symptoms of muscular hypotonia?
More concretely, muscular hypotonia can result in the following symptoms:
A partial or mild paralysis of certain members; A decreased muscle strength ; A feeling of sluggishness ; Of the abnormal movements (we are talking about chorea) ; An inability to maintain oneself in any position stand or sit ; Of the frequent falls ; Of the difficulty speaking and eating ; A mouth remaining open with the tongue sticking out; A loss of gag reflex ; Difficulties in carrying out everyday activities.
What signs should prompt urgent consultation?
Attention, a rapidly worsening motor deficit should encourage you to consult quickly. The same applies if hypotonia affects the respiratory muscles, leading to difficulty breathing. Other signs that are considered an emergency include: inability to lift the head against gravity, loss of walkingof the difficulty chewing or speaking.
A sudden loss of tone can also be the consequence of a chute or a AVC. In the latter case, the deficit only concernsonly one side of the body. In the case of trauma, paralysis is the consequence of compression or injury to the spinal cord.
Diagnosis: how to detect hypotonia?
In babies and childrenhypotonia can be a symptom of a disease that begins early in life. A clinical examination in order to assess muscle tone is necessary (whether at rest or during movement). Of the additional examinations (dosage of certain markers by blood test, images…) must be carried out in order to identify the pathology in question. In adultshypotonia is assessed during a clinical examination and a neurological examination including a electromyogram and images. Additional examinations (analyzed the song, lumbar puncture…) are also necessary to know the cause of hypotonia.
If a stroke is suspected, the scanner helps define the type of stroke involved (ischemic or hemorrhagic). It can be supplemented by a magnetic resonance imaging (MRI) examination in the event of a small stroke.
It is always urgent to confirm the diagnosis of muscular hypotonia which can be life-threatening and functional. The diagnosis is established by a genetic investigation, an investigation during pregnancy, a search for family history and metabolic and inflammatory assessments. Doctor Donia Mahjoub, neurologist.
Treatments: how to treat hypotonia?
The management of hypotony first goes through a accurate diagnosis and the basic treatment of the causal pathology. Also, a multidisciplinary care is necessary to limit the loss of autonomy and improve the quality of life of patients.
Most often, the medical team is made up of a general practitioner or a pediatrician who orchestrates care. Other health professionals are often essential to preserve the patient’s comfort despite the loss of muscle tone: physiotherapist, speech therapist, occupational therapist, dietitian, etc.
The physiotherapy is essential, particularly in infants, to ensure motor development and the acquisition of movements such as walking on all fours then standing, sitting, turning around, etc.
L’occupational therapy allows you to preserve autonomy in everyday activities. It is used in both adults and children.
L’speech therapy is recommended for patients who suffer from muscle weakness in the mouth and jaw. Exercises help improve language, swallowing and even breathing.
The dietitian recommends menus intended to preserve muscle tone: the diet must be sufficiently rich in calories and in proteins.
Some equipment may also be necessary to facilitate travel and progressive acquisitions. “In certain patients with tendon or trunk damage, surgical solutions can allow the support of the back, for example. In severe cases, respiratory devices, gastrostomies and gastric feeding tubes may be offered,” according to Doctor Donia Mahjoub.
Sources
Interview with Donia Mahjoub, neurologist.
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