Spastic diplegia ICD code 10. Cerebral palsy in children. Share on social networks

Cerebral palsy is a complex of diseases in which the child’s functional activity of certain functions is impaired. The manifestations and symptoms of cerebral palsy are varied. The pathology can cause severe movement disorders or provoke mental disorders in the child. IN international classification diseases of cerebral palsy are designated by code G80.

In medicine, cerebral palsy is a broad concept that covers many diseases. It is a mistake to believe that cerebral palsy is exclusively a motor disorder in a child. The development of pathology is associated with disturbances in the functioning of brain structures that arise even in the prenatal period. A feature of cerebral palsy is its non-progressive chronic nature.

Spastic cerebral palsy (G80.0)
Spastic diplegia (G80.1)
Pediatric hemiplegia (G80.2)
Dyskinetic cerebral palsy (G80.3)
Ataxic CPU (G80.4)

In addition, the cerebral palsy group includes diagnoses that include rare types of cerebral palsy (G80.8) and pathologies of an unspecified nature (G80.9).

Any form of cerebral palsy is provoked by pathologies of nerve cells. The deviation occurs during the prenatal period of development. The brain is an extremely complex structure, and its formation is a long process, the course of which can be affected by negative factors.

Often, cerebral palsy provokes complications that cause the patient’s condition to worsen. In medicine, aggravating diagnoses are compared in false progression - a pathological process in which the symptoms of cerebral palsy are aggravated due to concomitant diseases.

Thus, the ICD 10 classification of cerebral palsy identifies several types of disease that occur during the prenatal period and cause severe mental and physical disorders.

Reasons for development

Deviations in brain function leading to the development of cerebral palsy can occur at any stage of the prenatal period. According to statistics, the development of abnormalities most often occurs between 38 and 40 weeks of pregnancy. There are also cases when the pathological process develops in the first days after birth. During this period, the child’s brain is extremely vulnerable and can suffer from any negative impact.

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Possible causes of cerebral palsy:

In general, in medicine there are various reasons Cerebral palsy associated with disturbances during the pregnancy process or negative effects on the child’s body after birth.

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Symptoms of cerebral palsy

The main manifestation of cerebral palsy is a violation motor activity. Psychical deviations The child is diagnosed much later, when the active development of cognitive processes occurs. Unlike movement disorders, which can be diagnosed immediately after birth, mental disorders are diagnosed at the age of 2-3 years.

Diagnosing cerebral palsy after birth is quite difficult, since the child has virtually no motor skills during this period. Most often, the diagnosis is confirmed at the residual stage, starting at 6 months.

The pathology is accompanied by the following symptoms:

In general, there are various symptoms Cerebral palsy that occurs at an early stage of pathology.

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Diagnosis and treatment

There are no specific methods for diagnosing cerebral palsy, since early age The nature of the development of basic motor skills is individual. To confirm the diagnosis, long-term observation of the child is required, during which multiple developmental abnormalities (both physical and mental) are noted. In rare cases, the patient is prescribed an MRI to detect abnormalities in the brain.

Treatment of cerebral palsy is a long-term complex process that is aimed at restoring what is lost due to brain disorders functions, abilities. It should be noted that the pathology cannot be completely cured. The severity of symptoms and their impact on daily life the patient depends on the form of cerebral palsy.

The greatest efforts on the part of parents are required during the period of 7-8 years, when accelerated brain development is noted. During this period, impaired brain functions can be restored due to unaffected brain structures. This will allow the child to successfully socialize in the future and practically not differ from others.

It should be noted that treatment of cerebral palsy involves the development of the child’s communication skills. The patient is advised to visit a psychotherapist regularly. With the aim of physical rehabilitation Physiotherapeutic procedures are used, especially massages. If necessary, drug therapy is prescribed, including drugs to reduce muscle tone and improve cerebral circulation.

Thus, cerebral palsy cannot be completely cured, but with the right approach the symptoms of the pathology become less pronounced, thanks to which the patient is able to live a full life.

Cerebral palsy is a group of common diseases caused by cerebral palsy that occur during fetal development, during childbirth or in the first days of life. Clinical manifestations, the method of treatment and prognosis depend on the form and severity of the pathology.

Dec 27, 2017 Violetta Doctor

Cerebral palsy, contrary to widespread and popular belief, is not a separate disease. This is a whole complex of neurological and mental disorders that are congenital in nature. They arise during the intrauterine development of the fetus as a result of any negative influences on it. The whole point is that the brain structure of the child is damaged even at the stage of pregnancy.

Cerebral palsy is not a progressive disease, but it is difficult to cure. Typically, neurological disorders that exist at birth remain with a person for life, which makes social adaptation, daily self-care, and development difficult.

Cerebral palsy may consist of several various types violations nervous system– it depends on which brain tissues and areas are affected. Unsteadiness of gait, impaired coordination of movements, delays in the mental, social, creative, and intellectual development of the child are observed, which are immediately visible to the naked eye. Due to disruptions in the central nervous system, irreversible changes occur in the baby’s muscles even in the first year of life - their tone is lost, muscle mass can quickly atrophy and be subject to unusual wear.

They feel the effects of cerebral palsy and autonomic functions. The child’s attention, logical thinking, and memory are impaired; he lags behind his peers in academics and intellectual development. Cerebral palsy can cause other pathologies in the human body, the most common of which is epilepsy. Epileptic seizures, convulsions, fainting, tremors - all this accompanies cerebral palsy with sufficient frequency.

If a person is sick, the presence and constant presence of close relatives is very important; he needs help related to everyday life. Unfortunately, people suffering from cerebral palsy usually must have direct contact with hospitals and clinics throughout their lives, namely, undergo regular clinical examinations and listen to the advice of a doctor on taking certain medications and engaging in other types of therapy to relieve symptoms.

The permanent, non-progressive nature of the disease is associated with morphological lesions of individual areas of the brain, which do not spread and do not affect neighboring tissues. This is not a tumor that grows in size, causing damage to blood vessels and brain cells.

Cerebral palsy is not rare disease, and despite the achievements latest technologies, the number of children suffering from the disease cannot be reduced to the very minimum in percentage terms. According to statistics, boys are susceptible to cerebral palsy more often than girls, but despite this, science has not traced the influence of the baby’s gender on the occurrence of the pathology.

The International Classification of Diseases assigned the number ICD-10 to cerebral palsy - G80. According to the document, cerebral palsy is divided into seven types, each of which depends on the structural and morphological pathology in a particular area of the brain. The main and practically the only criterion for the type of cerebral palsy is the localization of anomalies that occurred during intrauterine development.

Types of illness:

spastic diplegia;
double
childhood hemiplegia;
ataxic cerebral palsy;
mixed form of cerebral palsy;
dyskinetic CP;
unspecified cerebral palsy.

According to statistics, spastic diplegia is more common. It is expressed in the strong influence of the disease on muscles and coordination of movements. Disturbances in the nervous system affect both the lower and the upper limbs. They lose tone and strength. The muscles of the whole body also suffer and can atrophy.

This form is characterized by involuntary and unhealthy movements of the limbs. The abnormalities are especially noticeable in the legs - the gait deteriorates due to lack of synchronization of movements, the feet are deformed due to abnormal functionality. The patient's legs are constantly tense - they can cross, stand on tiptoes or, on the contrary, on their heels, and diverge in different directions.

Movement disorders develop in parallel with delayed mental and mental disorders. Pathologies of autonomic functions do not manifest themselves clearly. The main feature of this form is unhealthy movements of the legs, arms and facial muscles, which cause eye twitching, facial expression disorders, deterioration of vision and attention.

In people suffering from this form of cerebral palsy, speech defects are observed, as well as handwriting impairment. Speech may sometimes not suffer too much, however, it is almost always blurry, hasty, and does not stand out with clarity.

Despite all these points, some people suffering from this form integrate well into society without any problems, find the desired profession and live like ordinary healthy individuals.

Double hemiplegia is serious and dangerous guy cerebral palsy, characterized by pronounced mental retardation, which sometimes turns into mental retardation. Movement of the limbs in double hemiplegia is also impaired, with the arms especially affected. The patient cannot physically stand up; it is difficult for him to even be in a sitting position.

The muscles of the body are always tense, movement disorders are regular, so people develop deformed joints, develop spinal diseases, and constantly feel aches in their bones. Autonomic disorders include deterioration of vision and hearing, and speech defects. All symptoms appear from birth. With double hemiplegia, doctors talk about a disappointing prognosis - most often the patient remains disabled, requiring care and supervision. In this case, it is important when relatives help him live and fight the symptoms.

Childhood hemiplegia is manifested by unilateral paresis, they cover the left or right side of the body. In this case, all four limbs suffer, but two of them are most severely affected. With this form, mental retardation is noticeable compared to healthy peers. Childhood hemiplegia is characterized by periodic convulsions and seizures.

Ataxic cerebral palsy has many similarities to a separate disease, ataxia, characterized by erratic, involuntary movements of the limbs. Their development simultaneously with cerebral palsy occurs when the cerebellum and neighboring brain tissues are damaged. Ataxic disorders are the main component of this form, with gait and accuracy of movements significantly affected, and tremors of the limbs are observed. Mental impairment may be completely absent, or reach such a degree that it develops into a fundamentally different pathology. This depends directly on the individual characteristics of the body and the capabilities of the immune system.

Dyskinetic cerebral palsy is manifested by numerous hyperkinesis - involuntary movements of certain muscle groups. With cerebral palsy, unhealthy facial expressions, grimaces, rolling of the eyes, loud screams or moans are observed. It should be remembered that all these actions are not special; the patient does not control their occurrence.

Living with hyperkinesis leads to disruption of muscle function and changes in the shape of joints. However, with this type of cerebral palsy, intelligence, thinking, and logic usually do not suffer.

A mixed form of cerebral palsy is diagnosed if a person has several groups of symptoms characteristic of different types other cerebral palsy. It is the most unpredictable, although with a certain frequency and repetition of the same manifestations, close people may already know what to expect from the patient.

Symptoms of cerebral palsy depend strictly on the form of cerebral palsy, or in other words, on the area of the brain affected. Each area is responsible for a specific set of body functions, the loss of which is irreversible.

Causes

Modern medicine cannot accurately answer the question of what is the specific and root cause in the occurrence of such a pathology as cerebral palsy. However, based on numerous studies, it is possible to identify those factors that provoke the onset of of this disease. It is known that all of them are closely related to the intrauterine development of the fetus; any deviations can affect the brain of the unborn baby.

intrauterine infection;
discrepancy between the expectant mother and fetus according to the Rh factor;
toxoplasmosis;
jaundice;
birth injuries;
premature birth leading to prematurity of the child;
epilepsy and dementia;
significant endocrine disorders;
bad habits – alcohol, smoking;
intoxication with narcotic and chemical substances.

All these points indicate the possibility of hypoxia of the child’s brain, its abnormal development from the very beginning, and cases of suffocation in the womb. This is the notorious risk factor for the unborn baby.

Diagnostics

The child is usually examined by a pediatric neurologist, checking him for the presence of certain types of reactions, thinking abilities and intelligence. He also conducts a clinical examination of the baby’s entire body, motor activity and synchrony of limbs. It is important that parents are present during the examination and will help the doctor with questions about complaints and symptoms.

When diagnosing cerebral palsy, it is imperative to use the latest methods such as electroencephalography and electroneurography, which recognize pathological changes state of biocurrents in the brain. Procedures such as MRI or CT can help identify the possible origin of other abnormalities.

Treatment of cerebral palsy

Cerebral palsy cannot be cured and the functioning of damaged nerve cells cannot be restored. The patient needs to be regularly monitored by a doctor, who will individually recommend a specific type of therapy that will alleviate the symptoms:

courses from a psychologist and speech therapist;
massage;
physical exercise;
taking medications - Baclofen, Sirdalud;
orthopedic treatment, sometimes through surgery.

Cerebral palsy is caused by a number of different factors that act in different periods life - during pregnancy, childbirth, early childhood. In most cases, cerebral palsy occurs after a brain injury received during birth due to asphyxia. However, extensive research in the 1980s showed that only 5-10% of cases of cerebral palsy are associated with birth trauma. Other possible reasons include abnormalities of brain development, prenatal factors that directly or indirectly damage neurons in the developing brain, premature birth, and brain injuries that occur in the first few years of life.
Prenatal reasons.
Brain development is very delicate process, which can be influenced by many factors. External influences can lead to structural abnormalities of the brain, including the conduction system. These lesions can be hereditary, but most often real reasons unknown.
Maternal and fetal infections increase the risk of cerebral palsy. In this regard, rubella, cytomegalovirus (CMV) and toxoplasmosis are important. Most women are immune to all three infections by the time they reach childbearing age, and a woman's immune status can be determined by testing for TORCH infections (toxoplasmosis, rubella, cytomegalovirus, herpes) before or during pregnancy.
Any substance that can affect fetal brain development, directly or indirectly, may increase the risk of developing cerebral palsy. In addition, any substance that increases the risk of preterm birth and low birth weight, such as alcohol, tobacco or cocaine, may indirectly increase the risk of cerebral palsy.
Due to the fact that the fetus receives everything nutrients and oxygen from the blood that circulates through the placenta, anything that interferes with the normal function of the placenta can negatively affect the development of the fetus, including its brain, or possibly increase the risk of premature birth. Structural abnormalities of the placenta, premature separation of the placenta from the uterine wall and placental infections pose a certain risk of cerebral palsy.
Some diseases in the mother during pregnancy can pose a risk to the development of the fetus. Women with elevated antithyroid or anti-phospholipid antibodies are at increased risk for cerebral palsy in their children. Also important factor, which points to high risk this pathology is high level cytokines in the blood. Cytokines are proteins associated with inflammation during infectious or autoimmune diseases, they can be toxic to fetal brain neurons.
Perinatal reasons.
Among perinatal causes, asphyxia, entanglement of the umbilical cord around the neck, placental abruption and placental previa are of particular importance.
The infection in the mother is sometimes not transmitted to the fetus through the placenta, but is transmitted to the baby during childbirth. Herpetic infection can lead to severe pathology in newborns, which entails neurological damage.
Postpartum causes.
The remaining 15% of cerebral palsy cases are associated with neurological trauma after birth. Such forms of cerebral palsy are called acquired.
Incompatibility of the Rh blood types of mother and child (if the mother is Rh negative and the child is Rh positive) can lead to severe anemia in the child, which leads to severe jaundice.
Serious infections that directly affect the brain, such as meningitis and encephalitis, can lead to permanent brain damage and cerebral palsy. Seizures at an early age can lead to cerebral palsy. Idiopathic cases are not diagnosed as often.
As a result of harsh treatment of a child, traumatic brain injuries, drowning, suffocation, physical trauma occurs to the child, often leading to cerebral palsy. In addition, ingestion of toxic substances such as lead, mercury, other poisons, or certain chemical substances may cause neurological damage. Accidental overdose of some medicines may also cause similar damage to the central nervous system.

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document to take into account morbidity, reasons for the population’s appeals to medical institutions all departments, causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Coding of cerebral palsy in the ICD

Cerebral palsy is a very serious disorder that manifests itself in a child during the newborn period. Specialists in the field of neurology and psychiatry often use the ICD code for cerebral palsy if the diagnosis is fully confirmed.

In the pathogenesis of this disease, brain damage plays a leading role, causing the patient to have characteristic symptoms. To maximize the quality of life of a child with cerebral palsy, it is very important to begin prompt diagnosis and treatment of the disease.

Cerebral palsy in ICD 10

To indicate various diseases the International Classification of Diseases, 10th revision, uses special codes. This approach to the classification of pathologies makes it easier to take into account the prevalence of various nosological units in different territories and simplifies statistical research. In ICD 10, cerebral palsy is coded G80 and, depending on the form of the disease, the code ranges from G80.0 to G80.9.

The reasons for the development of this disease may be:

premature birth;
intrauterine infection of the fetus;
Rhesus conflict;
disorders of brain embryogenesis;
harmful effects of toxic substances on the fetus or child in the early neonatal period.

Cerebral palsy in children is considered one of the most common diseases of the nervous system; in some cases, an unspecified form of pathology is noted, in which it is not possible to accurately determine the cause.

Hemiplegia is one of the main forms of the disease and is characterized by unilateral damage to the limbs.

Hemiparesis according to the ICD is marked with code G80.2; physical therapy, massage and drugs that stimulate the activity of the central nervous system are widely used to treat this condition.

Cerebral palsy codes according to ICD-10

Cerebral palsy (CP) develops mainly due to congenital brain abnormalities and manifests itself in the form of motor disorders. Such a pathological deviation according to the International Classification of Diseases (ICD) 10th revision has code G80. During diagnosis and treatment, doctors focus on it, so knowing the features of the code is extremely important.

Types of cerebral palsy according to ICD-10

The cerebral palsy code according to ICD 10 is G80, but it has its own subsections, each of which describes a certain form of this pathological process, namely:

0 Spastic tetraplegia. It is considered an extremely severe type of cerebral palsy and occurs due to congenital anomalies, as well as due to hypoxia and resulting infection during fetal development. Children with spastic tetraplegia have various defects in the structure of the trunk and limbs, and the functions of the cranial nerves are also impaired. It is especially difficult for them to move their arms, so their work activity is excluded;
1 Spastic diplegia. This form occurs in 70% of cases of cerebral palsy and is also called Little's disease. The pathology manifests itself mainly in premature babies due to hemorrhage in the brain. It is characterized by bilateral muscle damage and damage to the cranial nerves.

The degree of social adaptation is quite high in this form, especially in the absence mental retardation and, if possible, work fully with your hands.

2 Hemiplegic appearance. It occurs in premature babies due to bleeding in the brain or due to various congenital brain abnormalities. The hemiplegic form manifests itself in the form of unilateral damage to muscle tissue. Social adaptation depends primarily on the severity of motor defects and the presence of cognitive disorders;
3 Dyskinetic appearance. This type arises mainly due to hemolytic disease. The dyskenitic type of cerebral palsy is characterized by damage to the extrapyramidal system and auditory analyzer. Mental capacity at the same time they are not affected, therefore social adaptation is not impaired;
4 Ataxic type. Develops in children due to hypoxia, abnormalities in the structure of the brain, and also due to trauma received during childbirth. This type of cerebral palsy is characterized by ataxia, low muscle tone and speech defects. Damage is localized mainly in the frontal lobe and cerebellum. Adaptation of children with the ataxic form of the disease is complicated by possible mental retardation;
8 Mixed type. This variety is characterized by a combination of several types of cerebral palsy at the same time. The brain damage is diffuse. Treatment and social adaptation depend on the manifestations of the pathological process.

The ICD 10 revision code helps doctors quickly determine the form of the pathological process and prescribe the correct treatment regimen. For ordinary people this knowledge can be useful to understand the essence of therapy and know possible options for the development of the disease.

Cerebral palsy

ICD-10 code

Associated diseases

Voluntary movements (eg, walking, chewing) are mainly carried out with the help of skeletal muscles. Skeletal muscles are controlled by the cerebral cortex, which makes up the majority of the brain. The term paralysis is used to describe muscle disorders. Thus, cerebral palsy covers any movement disorder caused by dysfunction of the cerebral cortex. Cerebral palsy does not involve similar symptoms due to progressive disease or brain degeneration. For this reason, cerebral palsy is also called static (non-progressive) encephalopathy. Also excluded from the cerebral palsy group are any muscle disorders that arise in the muscles themselves and/or the peripheral nervous system.

Classification

The spastic type of cerebral palsy affects the upper and lower extremities as hemiplegia. Spasticity means the presence of increased muscle tone.

Dyskinesia refers to atypical movements caused by insufficient regulation of muscle tone and coordination. The category includes athetoid or choreoathetoid variants of cerebral palsy.

The ataxic form refers to disturbances in the coordination of voluntary movements and includes mixed forms Cerebral palsy.

Muscles that receive defective impulses from the brain are constantly tense or have difficulty with voluntary movements (dyskinesia). There may be a lack of balance and coordination of movements (ataxia).

In most cases, spastic or mixed variants of cerebral palsy are diagnosed. Muscle disorders may vary from mild degree or partial paralysis (paresis) to complete loss of control over a muscle or group of muscles (plegia). Cerebral palsy is also characterized by the number of limbs involved in the pathological process. For example, if muscle damage is observed in one limb, monoplegia is diagnosed, in both arms or both legs - diplegia, in both limbs on one side of the body - hemiplegia, and in all four limbs - quadriplegia. The muscles of the trunk, neck and head may be affected.

About 50% of all cases of cerebral palsy are diagnosed in premature babies. The younger the child's gestational age and weight, the higher the risk of cerebral palsy. The risk of this disease in a premature baby (32-37 weeks) increases approximately five times compared to a full-term baby. Birth before 28 weeks of gestation carries a 50% risk of developing cerebral palsy.

In premature babies, there are 2 main risk factors for the development of cerebral palsy. First, premature babies have a higher risk of complications such as intracerebral hemorrhage, infections, breathing problems. Secondly, premature birth may be accompanied by complications that subsequently cause neurological deficits in the newborn. The combination of both factors may play a role in the development of cerebral palsy.

Causes

Brain development is a very delicate process that can be influenced by many factors. External influences can lead to structural abnormalities of the brain, including the conduction system. These lesions can be hereditary, but most often the true causes are unknown.

Maternal and fetal infections increase the risk of cerebral palsy. In this regard, rubella, cytomegalovirus (CMV) and toxoplasmosis are important. Most women are immune to all three infections by the time they reach childbearing age, and a woman's immune status can be determined by testing for TORCH infections (toxoplasmosis, rubella, cytomegalovirus, herpes) before or during pregnancy.

Any substance that can affect fetal brain development, directly or indirectly, may increase the risk of developing cerebral palsy. In addition, any substance that increases the risk of preterm birth and low birth weight, such as alcohol, tobacco or cocaine, may indirectly increase the risk of cerebral palsy.

Because the fetus receives all its nutrients and oxygen from the blood that circulates through the placenta, anything that interferes with the normal function of the placenta can negatively affect the development of the fetus, including its brain, or possibly increase the risk of premature birth. Structural abnormalities of the placenta, premature separation of the placenta from the uterine wall and placental infections pose a certain risk of cerebral palsy.

Some diseases in the mother during pregnancy can pose a risk to the development of the fetus. Women with elevated antithyroid or anti-phospholipid antibodies are at increased risk for cerebral palsy in their children. Another important factor that indicates a high risk of this pathology is a high level of cytokines in the blood. Cytokines are proteins associated with inflammation in infectious or autoimmune diseases and can be toxic to fetal brain neurons.

Among perinatal causes, asphyxia, entanglement of the umbilical cord around the neck, placental abruption and placental previa are of particular importance.

The infection in the mother is sometimes not transmitted to the fetus through the placenta, but is transmitted to the baby during childbirth. Herpetic infection can lead to severe pathology in newborns, which entails neurological damage.

The remaining 15% of cerebral palsy cases are associated with neurological trauma after birth. Such forms of cerebral palsy are called acquired.

Incompatibility of the Rh blood types of mother and child (if the mother is Rh negative and the child is Rh positive) can lead to severe anemia in the child, which leads to severe jaundice.

Serious infections that directly affect the brain, such as meningitis and encephalitis, can lead to permanent brain damage and cerebral palsy. Seizures at an early age can lead to cerebral palsy. Idiopathic cases are not diagnosed as often.

As a result of harsh treatment of a child, traumatic brain injuries, drowning, suffocation, physical trauma occurs to the child, often leading to cerebral palsy. In addition, ingestion of toxic substances such as lead, mercury, other poisons, or certain chemicals can cause neurological damage. Accidental overdose of certain medications can also cause similar damage to the central nervous system.

Symptoms

Although the defect in brain function seen in cerebral palsy is not progressive, symptoms of the disease often change over time. Most symptoms relate to problems with muscle control. The severity of motor dysfunction is also an important characteristic. Spastic diplegia, for example, is characterized by continuous muscle tension, while athetoid quadraparesis is characterized by uncontrolled movements and muscle weakness in all four limbs. Spastic diplegia occurs more often than athetoid quadraparesis.

Muscle spasticity can lead to serious orthopedic problems, including spinal curvature (scoliosis), hip dislocation, or contractures. General manifestation The contracture in most patients with cerebral palsy is the equinovarus or equinovarus foot. Spasticity in the hips leads to limb deformation and gait disturbance. Any of the joints in the limbs can become blocked due to spasticity of the adjacent muscles.

Athetosis and dyskinesias often occur with spasticity, but do not often occur in isolation. The same applies to ataxia.

Other neurologically based symptoms may include the following:

Speech impairment (dysarthria).

These problems may have a greater impact on a child's life than physical impairments, although not all children with cerebral palsy suffer from these problems.

Diagnostics

Treatment

Spasticity, muscle weakness, lack of coordination, ataxia, and scoliosis are significant disorders that affect the posture and mobility of children and adults with cerebral palsy. The physician works with the patient and family to maximize the function of the affected limbs and normalize posture. Assistive technologies are often required, including wheelchairs, walkers, shoe inserts, crutches, and special braces. If there is a speech disorder, consultation with a speech therapist is necessary.

To prevent contractures and relax muscles, medications such as diazepam (Valium), dantrolene (Dantrium) and baclofen (Lioresal) are used. Positive effect gives the injection of botulinum toxin (Botox) into the affected muscle. If seizures are present, a group of anticonvulsants is used, and athetosis is treated with medications such as trihexyphenidyl HCl (Artane) and benztropine (Cogentin).

Treatment of contractures - first of all surgical problem. The most commonly used surgical procedure is tenotomy. The neurosurgeon may also perform a dorsal rhizotomy—removal nerve root V spinal cord to prevent stimulation of spastic muscles.

Cerebral palsy

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)

Version: Archive - Clinical protocols Ministry of Health of the Republic of Kazakhstan (Order No. 239)

general information

Short description

Cerebral palsy (CP) is a group of syndromes that are a consequence of brain damage that occurs during the perinatal period.

Protocol "Cerebral Palsy"

G 80.0 Spastic cerebral palsy

Congenital spastic (cerebral)

G 80.1 Spastic diplegia

G 80.2 Childhood hemiplegia

Classification

G 80 Cerebral palsy.

Included: Little's disease.

Excluded: hereditary spastic paraplegia.

G 80.0 Spastic cerebral palsy.

G 80.1 Spastic diplegia.

G 80.2 Childhood hemiplegia.

G 80.3 Dyskinetic cerebral palsy.

G 80.8 Another type of cerebral palsy.

Mixed syndromes of cerebral palsy.

G 80.9 Cerebral palsy, unspecified.

Classification of cerebral palsy (K. A. Semenova et al. 1974)

1. Double spastic hemiplegia.

2. Spastic diplegia.

4. Hyperkinetic form with subforms: double athetosis, athetotic ballism, choreathetous form, choreic hyperkinesis.

5. Atonic-astatic form.

According to the severity of the lesion: mild, moderate, severe.

Diagnostics

Complaints about delays in psycho-speech and motor development, movement disorders, involuntary movements in the limbs, seizures.

Physical examinations: movement disorders - paresis, paralysis, contractures and stiffness in the joints, hyperkinesis, delay in psycho-speech development, intellectual disability, epileptic seizures, pseudobulbar disorders (impaired swallowing, chewing), pathology of the visual organs (strabismus, atrophy optic nerves, nystagmus).

The spastic form of cerebral palsy is characterized by:

Increased muscle tone according to the central type;

High tendon reflexes with expanded reflexogenic zones, clonus of the feet and patella;

Pathological reflexes: Babinsky, Rossolimo, Mendel-Bekhterev, Oppenheim, Gordon, Schaeffer. Among them, the Babinski reflex is the most consistently detected.

The hyperkinetic form of cerebral palsy is characterized by: hyperkinesis - choreic, athetoid, choreoathetoid, double athetosis, torsion dystonia.

At the age of 2-3 months, “dystonic attacks” appear, characterized by a sudden increase in muscle tone during movements, with positive and negative emotions, loud sounds, bright light; accompanied by a sharp cry, pronounced autonomic reactions - sweating, redness of the skin and tachycardia.

Tendon reflexes in most patients are normal or somewhat animated; pathological reflexes are not detected.

Hyperkinesis in the muscles of the tongue appears at the age of 2-3 months of life, earlier than hyperkinesis in the muscles of the trunk - they appear at 4-6 months and become more pronounced with age. Hyperkinesis is minimal at rest, disappears during sleep, intensifies with voluntary movements, is provoked by emotions, and is more pronounced in the supine position and standing. Speech disorders are hyperkinetic in nature - dysarthria. Mental development is less impaired than in other forms of cerebral palsy.

The atonic-astatic form of cerebral palsy is characterized by:

1. Muscle tone is sharply reduced. Against the background of general muscle hypotonia, the tone in the upper extremities is higher than in the lower extremities, and movements in the upper part of the body are more active than in the lower.

2. Tendon reflexes are high, pathological reflexes are absent.

3. Recurvation in the knee joints, planovalgus feet.

4. In the mental sphere, 87-90% of patients experience a pronounced decrease in intelligence; speech disorders are of a cerebellar nature.

1. General analysis blood.

2. General urine analysis.

3. Feces on worm eggs.

4. ELISA for toxoplasmosis, cytomegalovirus - according to indications.

5. Determination of TSH - according to indications.

1. CT scan(CT) of the brain: various atrophic processes are observed - expansion of the lateral ventricles, subarachnoid spaces, cortical atrophy, porencephalic cysts and other organic pathology.

2. Electroencephalography (EEG) - reveals general rhythm disorganization, low-voltage EEG, peaks, hypsarrhythmia, generalized paroxysmal activity.

3. EMG - according to indications.

4. MRI of the brain - according to indications.

5. Neurosonography - to exclude internal hydrocephalus.

6. Oculist - examination of the fundus reveals dilation of the veins and narrowing of the arteries. In some cases, congenital atrophy of the optic nerve and strabismus are found.

Indications for specialist consultations:

1. Speech therapist - identification of speech disorders and their correction.

2. Psychologist - to clarify mental disorders and their correction.

3. Orthopedist - identifying contractures, deciding on surgical treatment.

4. Prosthetist - to provide orthopedic care.

5. Oculist - examination of the fundus, identification and correction of eye pathology.

6. Neurosurgeon - to exclude neurosurgical pathology.

7. Exercise therapy doctor - prescribing individual classes, styling.

8. Physiotherapist - to prescribe physiotherapeutic procedures.

Minimum examination when referred to a hospital:

1. General blood test.

2. General urine analysis.

3. Feces on worm eggs.

Basic diagnostic measures:

1. General blood test.

2. General urine analysis.

11. Computed tomography of the brain.

List of additional diagnostic measures:

Cerebral palsy ICD 10: classification of cerebral palsy

Cerebral palsy is a complex of diseases in which the child’s functional activity of certain parts of the brain is impaired. The manifestations and symptoms of cerebral palsy are varied. The pathology can cause severe movement disorders or provoke mental disorders in the child. In the international classification of diseases, cerebral palsy is designated by code G80.

Classification of the disease

Spastic cerebral palsy (G80.0)
Spastic diplegia (G80.1)
Pediatric hemiplegia (G80.2)
Dyskinetic cerebral palsy (G80.3)
Ataxic CPU (G80.4)

In addition, the cerebral palsy group includes diagnoses that include rare types of cerebral palsy (G80.8) and pathologies of an unspecified nature (G80.9).

Any form of cerebral palsy is provoked by pathologies of nerve cells. The deviation occurs during the prenatal period of development. The brain is an extremely complex structure, and its formation is a long process, the course of which can be affected by negative factors.

Thus, the ICD 10 classification of cerebral palsy identifies several types of disease that occur during the prenatal period and cause severe mental and physical disorders.

Reasons for development

Possible causes of cerebral palsy:

Genetic abnormalities. One of the reasons for the development of cerebral palsy in children is genetic disorders– an abnormal structure of certain genes resulting from mutation. The pathological gene is inherited, but does not appear in every child. Due to abnormalities in the structure of genes, disturbances in brain development occur.
Lack of oxygen. Acute hypoxia occurs, as a rule, at birth, when the child moves through the birth canal. Also acute form occurs when the placenta is abruptly separated or when suffocation occurs due to entanglement in the umbilical cord. Chronic oxygen deficiency is a consequence of placental insufficiency, impaired blood supply to the placenta. Due to a lack of oxygen, brain development is inhibited, and affected cells may die without the ability to recover.

In general, in medicine there are various causes of cerebral palsy associated with disturbances during the gestation process or negative effects on the child’s body after birth.

Symptoms of cerebral palsy

The main manifestation of cerebral palsy is impaired motor activity. Mental disorders in a child are diagnosed much later, when cognitive processes are actively developing. Unlike movement disorders, which can be diagnosed immediately after birth, mental disorders are diagnosed at the age of 2-3 years.

Diagnosing cerebral palsy after birth is quite difficult, since the child has virtually no motor skills during this period. Most often, the diagnosis is confirmed at the residual stage, starting at 6 months.

The pathology is accompanied by the following symptoms:

Delays in the development of motor activity. In pediatrics, the average time for a child to develop certain motor skills has been determined. For example, a child early learns to roll over on his stomach, reach for objects of interest to him, hold his head up, and later sit or crawl. A delay in the development of such skills indicates the possibility of cerebral palsy.

Other physical activity

In general, there are various symptoms of cerebral palsy that occur at an early stage of the pathology.

Diagnosis and treatment

There are no specific methods for diagnosing cerebral palsy, since at an early age the nature of the development of basic motor skills is individual. To confirm the diagnosis, long-term observation of the child is required, during which multiple developmental abnormalities (both physical and mental) are noted. In rare cases, the patient is prescribed an MRI to detect abnormalities in the brain.

Treatment of cerebral palsy is a long-term complex process that is aimed at restoring functions and abilities lost due to brain disorders. It should be noted that the pathology cannot be completely cured. The severity of symptoms and their impact on the patient’s daily life depends on the form of cerebral palsy.

It should be noted that treatment of cerebral palsy involves the development of the child’s communication skills. The patient is advised to visit a psychotherapist regularly. For the purpose of physical rehabilitation, physiotherapeutic procedures, especially massages, are used. If necessary, assigned drug therapy, including drugs to reduce muscle tone and improve cerebral circulation.

Thus, cerebral palsy cannot be completely cured, but with the right approach, the symptoms of the pathology become less pronounced, thanks to which the patient is able to live a full life.

Cerebral palsy is a group of common diseases caused by abnormalities in the functioning of the brain that occur during fetal development, during childbirth or in the first days of life. Clinical manifestations, treatment method and prognosis depend on the form and severity of the pathology.

Cerebral paralysis

Excludes: hereditary spastic paraplegia (G11.4)

Spastic cerebral palsy, quadriplegia

Spastic cerebral palsy, tetraplegia

Spastic cerebral palsy, diplegia

Congenital spastic palsy (cerebral)

Spastic cerebral palsy NOS

Spastic cerebral palsy, hemiplegia

Dyskinetic cerebral palsy

Ataxic cerebral palsy

Another type of cerebral palsy

Cerebral palsy, unspecified

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Medical and social examination

3.5.3. CEREBRAL PALSY

Cerebral palsy (CP) (paralysis cerebralis infantilis) is a collective term that unites a group of chronic non-progressive syndromes resulting from brain damage in the prenatal, perinatal and early neonatal periods. Cerebral palsy is characterized by persistent pronounced motor, speech, behavioral disorders, delay mental development, the formation of a pathological postural stereotype.

Cerebral palsy is a severe disabling disease that leads to significant limitations in life activity and is the main cause of disability in the child population. The prevalence of this pathology is 2-2.5 cases per 1000 children. The number of cases is steadily increasing every year. The disease is 1.3 times more common among boys and is diagnosed in 90% of cases under the age of 3 years.

A definitive diagnosis can usually be made after a year of motor, speech and mental disorders become obvious. Diagnosis criteria: non-progressive course, combination of clinical picture diseases of paralysis and paresis of various distributions, hyperkinetic syndromes, speech, coordination, sensory disturbances, cognitive and intellectual decline.

Epidemiology: The prevalence of this pathology is 2-2.5 cases per 1000 children. The disease is 1.3 times more common among boys and is diagnosed in 90% of cases under the age of 3 years.

Etiology and pathogenesis: the main reasons for the development of cerebral palsy are antenatal causes (maternal age, extragenital diseases, drug therapy and occupational hazards, alcoholism and smoking of parents, immunological incompatibility of mother and fetus, antiphospholipid syndrome in the mother), disturbances in the normal course of pregnancy at various stages (toxicosis, polyhydramnios , threats of miscarriage, pathology of the placenta, multiple pregnancy, surgical interventions, anesthesia during pregnancy, prematurity, premature birth, etc.), intrapartum causes (long water-free period, pathology birth canal, instrumental obstetrics, operative childbirth, rapid labor, etc.); postnatal period (neonatal seizures, traumatic and infectious lesions of the brain, toxic lesions (bilirubin encephalopathy), hypoxia, etc.). In addition, many authors point to a clear connection between cerebral palsy and low birth weight. In the pathogenesis of cerebral palsy, along with direct damage to the motor zone of the cerebral cortex, subcortical formations and pyramidal tract, great importance has damage to the periventricular region (PVO) of the type of periventricular leukomalacia; as well as atrophic and subatrophic processes in the cerebral cortex (usually in the frontotemporal regions), impaired blood supply to the brain and liquorodynamic disorders [Nikitina M.N. , 1999, Mezhenina E.P., Kachesov V.A., 2001].

Classification reflects mainly the characteristics of movement disorders. In our country, the classification according to K. A. Semenova (1978) is often used, according to which they distinguish: spastic diplegia, double hemiplegia, hyperkinetic form, atonic-astatic form, hemiplegic form.

According to ICD-10, there are seven groups of cerebral palsy (G80) depending on the location of the affected structures (hereditary spastic paraplegia is excluded - G11.4):

G80.0 Spastic cerebral palsy

Congenital spastic palsy (cerebral)

G80.1 Spastic diplegia (Little's disease);

G80.3 Dyskinetic cerebral palsy

Athetoid cerebral palsy

G80.4 Ataxic cerebral palsy

G80.8 Other type of cerebral palsy

Mixed syndromes of cerebral palsy

G80.9 Cerebral palsy, unspecified

The following are distinguished: stages cerebral palsy: early stage(up to 4-5 months): general severe condition, autonomic disorders, nystagmus, convulsions, intracranial hypertension, movement disorder syndrome; initial chronic-residual stage (from 5-6 months to 3-4 years): occurs against the background of residual phenomena. Persistent neurological disorders are formed - persistent muscle hypertension (with spastic forms); late residual stage (after 3 years). Characterized by the formation of persistent maladaptive syndromes varying degrees expressiveness.

1. Syndrome of static-dynamic disorders (spastic paresis, hyperkinesis, ataxia, contractures and joint deformities); during the rehabilitation process the following are possible: full compensation - movement without support, at a sufficient pace, regardless of distance; there are no limb deformities; subcompensation - movement with limited distance, with additional support; partial compensation - abruptly limited opportunity movement, often only within the apartment; decompensation or lack of compensation - complete inability to move.

2. Syndromes of impaired expressive and written speech: dysarthria, alalia, dysgraphia, dyslexia, etc.

3. Impaired sensory functions: visual impairment (strabismus, nystagmus, amblyopia, cortical loss of visual fields); hearing impairment (various degrees of hearing loss);

4. Hypertensive-hydrocephalic syndrome of varying severity;

5. Syndrome of paroxysmal disorders;

6. Syndromes of cognitive disorders (psycho-organic syndrome, etc.);

7. Behavioral disorders and personality disorders (neurosis-like, psychopathic-like disorders, hyperactivity, impulsivity);

8. Intellectual decline (various degrees of mental retardation);

9. Dysfunction of the pelvic organs (weakening or lack of control).

Clinical characteristics of individual forms of cerebral palsy:

Spastic double hemiplegia (tetraplegia) is one of the most severe forms Cerebral palsy occurs in 2% of cases. Clinically characterized by spastic tetraparesis, while due to high muscle tone a pathological posture is formed: the arms are bent at the elbow and wrist joints, brought to the body, the legs are bent in hip joints, bent or, conversely, extended at the knee joints, rotated inward, hips adducted. Such children are unable to maintain an upright posture, sit, stand, walk, or hold their head up; pronounced pseudobulbar symptoms, strabismus, optic nerve atrophy, and hearing impairment are formed. As a result of hypertensive syndrome, joint contractures and bone deformities of the trunk and limbs occur. In half of the cases, this disease is accompanied by generalized and partial epileptic paroxysms. This form is prognostically unfavorable.

Spastic diplegia (Little's disease G80.1): the most common form of cerebral palsy (60% of cases), usually develops as a result of intraventricular hemorrhages. Characterized by the development of uneven tetraparesis with a predominant lesion lower limbs sometimes in combination with athetoid and/or choreoathetoid hyperkinesis, ataxia. Accompanied by strabismus, atrophy of the optic nerves, hearing loss, and dysarthria. Intelligence, as a rule, does not suffer. Children with this form of cerebral palsy develop a pathological motor stereotype. The impact of the foot on the support is noted, the shock-absorbing function of walking is disrupted, i.e. there is no slight flexion of the legs in knee joint in the mid-support phase. This increases the impact load on the joints of the lower extremities, which leads to the early development of arthrosis of the joints (dysplastic arthrosis). This form is favorable for overcoming mental and speech disorders.

Childhood hemiplegia (hemiplegic form G80.2) is characterized by unilateral damage to the limbs. In children, a violation of statodynamic functions is formed due to asymmetry of posture, the occurrence of paralytic scoliosis, retardation in the growth of paralyzed limbs, and anatomical shortening of the affected arms and legs. This form is accompanied by disorders of speech functions such as pseudobulbar dysarthria; mental disorders and the occurrence of epileptic paroxysms are possible.

Dyskinetic cerebral palsy: the hyperkinetic (dyskinetic) form (G80.3.) is formed, as a rule, after suffering the so-called. "kernicterus" Accompanied by disorders of statodynamic functions due to choreic, athetoid, torsion hyperkinesis, speech impairment, delay mental development, hearing loss, dysfunction of the autonomic nervous system. In most cases, intelligence is not affected; this leads to a favorable prognosis for social adaptation and learning.

Ataxic cerebral palsy (ataxic form G80.4) is characterized by the following manifestations: muscle hypotonia, ataxia, various symptoms of cerebellar asynergia, intention tremor, dysarthria.

Thus, patients with cerebral palsy experience limitations in their ability to live due to disturbances in vestibular functions (balance, coordination of movements, kinesthesia (disorder of the sense of movement, weakening of proprioception from muscles, tendons, joints)); abnormalities of perception - ignoring the affected limbs in 50% of children with hemiplegia; cognitive impairment (impaired attention, memory, thinking, emotional sphere) in 65% of children; mental retardation in more than 50% of children with cerebral palsy; disorders of expressive and written speech in the form of dysarthria, alalia, dyslexia, dysgraphia, etc.); behavioral disorders and personality disorders (impaired motivation, neurosis-like and psychopathic-like disorders, hyperactivity, impulsivity); delays in the rate of motor and/or psycho-speech development; symptomatic epilepsy (in% of cases); visual impairment (strabismus, nystagmus, amblyopia, cortical loss of visual fields); hearing impairment (various degrees of hearing loss); hypertensive-hydrocephalic syndrome; diffuse osteoporosis; disorders of the cardiovascular and respiratory systems; urological disorders (hyperreflexia Bladder, detrusor-sphincter dyssynergia), developing in 90% of patients; orthopedic pathology: shortening of limbs, poor posture, scoliosis, joint contractures, etc. – observed in 50% of children suffering from cerebral palsy.

Required data when sending to ITU: conclusion of a neurologist, epileptologist, psychiatrist, ophthalmologist (examination of the fundus and visual fields), audiologist, orthopedist, pediatrician, speech therapist; EPO with intelligence assessment; state of mental processes and personality; Echo-EG, EEG, REG (if indicated), CT and (or) MRI of the brain.

Indications for referral to ITU: the presence of a persistent motor defect (spastic paresis, hyperkinesis, ataxia, contractures and joint deformities) from moderate to significantly pronounced; a combination of motor disorders of varying severity with the presence of: persistent moderate and severe impairments of expressive and written speech; persistent moderate and severe sensory dysfunction; mild (absence seizures, simple partial, myoclonic seizures) and severe seizures (grand seizures, secondarily generalized partial seizures - Jacksonian, astatic, ambulatory automatisms); persistent moderate and severe cognitive impairment (psycho-organic syndrome, etc.); persistent moderate and severe syndromes of the “personality” register (neurosis-like, psychopathic-like disorders, hyperactivity, impulsivity); intellectual disability of varying degrees; indications for referral to medical examination in the presence of mental and paroxysmal disorders, see section - “ Medical and social examination and rehabilitation of disabled children with mental disorders and behavioral disorders" and in the section - "Epilepsy".

Disability criteria: persistent moderate, severe or significantly pronounced disorders of neuromuscular, skeletal and movement-related (statodynamic), language and speech, sensory functions, urinary function, etc., leading to limitation of self-care, independent movement, communication, learning, ability to control one’s behavior, determining necessity social protection child.

A quantitative system for assessing the severity of persistent dysfunctions of the human body as a percentage is presented in Table 72.

Quantitative system for assessing the severity of persistent dysfunctions of the human body in percentage

Clinical and functional characteristics of the main persistent disorders of body functions

Cerebral palsy in ICD 10

The International Classification of Diseases, 10th Revision, uses special codes to designate various diseases. This approach to the classification of pathologies makes it easier to take into account the prevalence of various nosological units in different territories and simplifies the conduct of statistical studies. In ICD 10, cerebral palsy is coded G80 and, depending on the form of the disease, the code ranges from G80.0 to G80.9.

The reasons for the development of this disease may be:

premature birth;
intrauterine infection of the fetus;
Rhesus conflict;
disorders of brain embryogenesis;
harmful effects of toxic substances on the fetus or child in the early neonatal period.

Hemiplegia is one of the main forms of the disease and is characterized by unilateral damage to the limbs.

Hemiparesis according to the ICD is marked with code G80.2; physical therapy, massage and drugs that stimulate the activity of the central nervous system are widely used to treat this condition.