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

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Ministry of Health of Russia dated 05/27/97. No. 170

A new revision (ICD-11) is planned by WHO in 2017 2018.

As amended and supplemented by WHO

Processing and translation of changes © mkb-10.com

Cerebral palsy encoding in ICD

Cerebral palsy is a very serious disorder that manifests itself in a child during the neonatal 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, the leading role is played by brain damage, which causes the patient to have characteristic symptoms. In order to maximize the quality of life of a child with cerebral palsy, it is very important to start diagnosing and treating the disease in a timely manner.

Cerebral palsy in ICD 10

To denote various diseases v international classification diseases of the 10th revision, special codes are used. 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 under the code G80 and, depending on the forms of the disease, there is a code from G80.0 to G80.9.

The reasons for the development of this disease can be:

• premature birth;
• intrauterine infection of the fetus;
• rhesus conflict;
• disorders of cerebral embryogenesis;
• detrimental effect toxic substances on a fetus or child in the early neonatal period.

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

Hemiplegia belongs to the main forms of the disease and is characterized by unilateral limb lesions.

Hemiparesis according to ICD is marked with the G80.2 code, for the treatment of this condition is widely used physiotherapy exercises, massage and drugs that stimulate the activity of the central nervous system.

Cerebral palsy codes according to ICD-10

Infantile cerebral palsy (cerebral palsy) develops mainly due to congenital cerebral anomalies and manifests itself as movement disorders... Such a pathological deviation according to the International Classification of Diseases (ICD) 10 revision has the G80 code. During the diagnosis and treatment, doctors are guided by it, therefore it is extremely important to know the features of the cipher.

Varieties of cerebral palsy according to ICD-10

Cerebral palsy code according to ICD 10 has G80, but it has its own subdivisions, 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 the resulting infection during intrauterine 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 they labor activity excluded;
• 1 Spastic diplegia. This form occurs in 70% of cases of cerebral palsy and is also called Little's disease. 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 of mental retardation and, if possible, to fully work with his hands.

• 2 Hemiplegic appearance. It occurs in premature babies due to hemorrhage in the brain or due to various congenital brain abnormalities. The hemiplegic form manifests itself in the form of unilateral damage to muscle tissues. Social adaptation depends mainly on the severity of motor defects and the presence of cognitive disorders;
• 3 Diskinetic appearance. This variety arises mainly due to hemolytic disease... For the dyskenic type of cerebral palsy, damage is characteristic of the extrapyramidal system and the auditory analyzer. At the same time, mental abilities are not affected, therefore social adaptation is not impaired;
• 4 Ataxic type. It 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. The lesions are localized mainly in the frontal lobe and cerebellum. The 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 depends 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 the development of the disease.

Cerebral palsy

ICD-10 code

Associated diseases

Voluntary movements (for example, walking, chewing) are mainly carried out with the help of skeletal muscles. Skeletal muscle is controlled by the cerebral cortex, which makes up most 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 include 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 increased muscle tone.

Dyskinesias refer to atypical movements caused by insufficient regulation of muscle tone and coordination. This category includes athetoid or choreoathetoid variants of infantile cerebral palsy.

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

Muscles that receive defective impulses from the brain are in constant tension 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 can range from mild or partial paralysis (paresis) to complete loss of control of a muscle or muscle group (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, diplegia in both arms or both legs, hemiplegia in both limbs on one side of the body, and quadriplegia in all four limbs. 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 lower the gestational age at the time of birth and the weight, the higher the risk of cerebral palsy. The risk of this disease of a premature baby (32-37 weeks) is increased by about five times compared to a one born on term. Birth before 28 weeks of gestation has a 50% risk of developing cerebral palsy.

Premature babies have 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 disorders. Secondly, premature birth can be accompanied by complications that subsequently cause neurological deficits in the newborn. The combination of both factors can play a role in the development of cerebral palsy.

Causes

Brain development is very delicate process, which can be influenced by many factors. Extraneous influence can lead to structural abnormalities of the brain, including the conducting system. These lesions can be hereditary, but more often than not, 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 the development of the fetal brain, directly or indirectly, can increase the risk of developing cerebral palsy. In addition, any substance that increases the risk of premature 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 all the 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 detachment of the placenta from the uterine wall, and placental infections pose a certain risk of cerebral palsy.

Certain 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. An equally important factor that indicates a high risk of this pathology is high level cytokines in the blood. Cytokines are proteins associated with inflammation in infectious or autoimmune diseases, they can be toxic to fetal neurons.

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

The infection in the mother is sometimes not passed on to the fetus through the placenta, but is passed on to the baby during childbirth. Herpes infection can lead to severe pathology in newborns, which leads to neurological damage.

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

The incompatibility of the mother's and baby's Rh blood groups (if the mother is Rh negative and the baby is positive) can lead to severe anemia in the baby, resulting in severe jaundice.

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

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

Symptoms

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

Muscle spasticity can lead to serious orthopedic problems, including curvature of the spine (scoliosis), hip dislocation, or contracture. A common manifestation of contracture in most patients with cerebral palsy is equine or equinovarus foot. Spasticity in the hips leads to limb deformity and gait disturbance. Any of the joints in the limbs can be blocked due to the spasticity of the attached muscles.

Athetosis and dyskinesias often occur with spasticity, but are not common in isolation. The same is true for ataxia.

Other neurologic-based symptoms may include the following:

Violation of speech (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, impaired coordination, ataxia, scoliosis are significant disorders that affect the posture and mobility of children and adults with cerebral palsy. The doctor 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 speech is impaired, consultation with a speech therapist is necessary.

Drugs such as diazepam (Valium), dantrolene (Dantrium), and baclofen (Lioresal) are used to prevent contractures and relax muscles. A positive effect is provided by the introduction of botulinum toxin (Botox) into the affected muscle. In the presence of seizures, a group of anticonvulsants is used, and athetosis is treated with drugs such as trihexyphenidyl HCl (Artane) and benztropine (Cogentin).

Treating contractures is primarily a surgical problem. The most commonly used surgical procedure is a tenotomy. The neurosurgeon may also perform a spinal rhizotomy - removal nerve root into the spinal cord to prevent stimulation of spastic muscles.

Cerebral palsy

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

Version: Archive - Clinical protocols MH RK (Order No. 239)

general information

Short description

Cerebral palsy (cerebral palsy) is a group of syndromes that result from brain damage that occurs in the perinatal period.

Cerebral Palsy Protocol

G 80.0 Spastic cerebral palsy

Congenital spastic (cerebral)

G 80.1 Spastic diplegia

G 80.2 Pediatric hemiplegia

Classification

G 80 Cerebral palsy.

Includes: Little's disease.

Excludes: hereditary spastic paraplegia.

G 80.0 Spastic cerebral palsy.

G 80.1 Spastic diplegia.

G 80.2 Pediatric hemiplegia.

G 80.3 Dyskinetic cerebral palsy.

G 80.8 Another type of infantile cerebral palsy.

Mixed cerebral palsy syndromes.

G 80.9 Cerebral palsy, unspecified.

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

1. Double spastic hemiplegia.

2. Spastic diplegia.

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

5. Atonic-astatic form.

By the severity of the lesion: light, moderate, severe form.

Diagnostics

Complaints about a delay in psychoverbal 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 organs of vision (strabismus, atrophy of visual nerves, nystagmus).

The spastic form of cerebral palsy is characterized by:

Increased muscle tone in the central type;

High tendon reflexes with extended reflexogenic zones, clones of the feet and patella;

Pathological reflexes: Babinsky, Rossolimo, Mendel-Bekhterev, Oppenheim, Gordon, Schaeffer. Among them, the Babinsky reflex is most constantly revealed.

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 with ordinary living creatures or are somewhat revitalized, 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 disturbed less 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 muscular hypotonia, the tone in the upper limbs is higher than in the lower limbs, and the movements in the upper 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 have a pronounced decrease in intelligence, speech disorders are cerebellar in nature.

1. General analysis blood.

2. General analysis of urine.

3. Feces on the eggs of the worm.

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

5. Determination of TSH - according to indications.

1. Computed tomography (CT) of the brain: there is a different atrophic process - the expansion of the lateral ventricles, subarachnoid spaces, cortical atrophy, porencephalic cysts and other organic pathology.

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

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 enlarged veins, narrowing of the arteries. In some cases, congenital atrophy is found optic nerve, squint.

Indications for specialist advice:

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

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

3. Orthopedist - identifying contractures, resolving the issue of surgical treatment.

4. Prosthetist - to provide orthopedic care.

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

6. Neurosurgeon - in order to exclude neurosurgical pathology.

7. Exercise therapy doctor - the appointment of individual lessons, styling.

8. Physiotherapist - for prescribing physiotherapy procedures.

Minimum examination for referral to hospital:

1. Complete blood count.

2. General analysis of urine.

3. Feces on the eggs of the worm.

The main diagnostic measures:

1. Complete blood count.

2. General analysis of urine.

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 functional activity of certain parts of the brain is disturbed in a child. The manifestations and symptoms of cerebral palsy are varied. Pathology can cause severe movement disorders or provoke mental abnormalities in a child. In the international classification of diseases, cerebral palsy is designated by the G80 code.

Disease classification

In medicine, cerebral palsy is a broad concept that encompasses many diseases. It is a mistake to believe that cerebral palsy is an exclusively movement disorder in a child. The development of pathology is associated with disturbances in the functioning of the structures of the brain, arising 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 including rare types of cerebral palsy (G80.8) and pathologies of an unspecified nature (G80.9).

Any form of cerebral palsy is triggered by pathologies of nerve cells. 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 influenced by negative factors.

Often, infantile cerebral palsy provokes complications, due to which the patient's condition worsens. In medicine, aggravating diagnoses are compared in a 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 diseases that occur in the prenatal period and cause severe mental and physical disorders.

Reasons for development

Abnormalities in the work of the brain, leading to the development of cerebral palsy, can occur at any stage of the prenatal period. According to statistics, the development of deviations 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.

Possible causes of cerebral palsy:

1. Genetic abnormalities. One of the reasons for the development of cerebral palsy in children is genetic disorders - an abnormal structure of certain genes that have arisen as a result of a mutation. The pathological gene is inherited, but not every child manifests itself. Due to abnormalities in the structure of genes, abnormalities in the development of the brain occur.
2. Lack of oxygen. Acute hypoxia occurs, as a rule, at birth, when the child moves through the birth canal. Also acute form occurs with premature placental abruption or with suffocation resulting from entanglement with the umbilical cord. Chronic oxygen deficiency is a consequence of placental insufficiency, disorders of blood supply to the placenta. Due to a lack of oxygen, the development of the brain is inhibited, and the affected cells can die off without the ability to recover.

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

Cerebral palsy symptoms

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

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

Pathology is accompanied by the following symptoms:

• Delays in the development of motor activity. In pediatrics, the average timing of the onset of certain motor skills in a child has been determined. For example, a child learns early to roll over on his stomach, reach for objects of interest to him, hold his head, and then sit or crawl. A delay in the development of these 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.

Diagnostics 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, in which there are multiple deviations in development (both physical and mental). In rare cases, the patient is prescribed an MRI scan to detect abnormalities in the brain.

Cerebral palsy treatment is a long-term complex process that is aimed at restoring those lost due to brain disorders functions, abilities. It should be noted that pathology does not lend itself complete recovery... The severity of symptoms and their effect on daily life the patient depends on the form of cerebral palsy.

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

It should be noted that the treatment of cerebral palsy involves the development of communication skills in a child. The patient is encouraged to see a psychotherapist regularly. For the purpose of physical rehabilitation, physiotherapy procedures are used, in particular massages. If necessary, drug therapy is prescribed, including drugs to reduce muscle tone, improve cerebral circulation.

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

Cerebral palsy is a group of common diseases provoked by abnormalities in the work of the brain that occur during intrauterine 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.

Cerebral paralysis

Excludes1: 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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3.5.3. CEREBRAL PALSY

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

Cerebral palsy is a severe disabling disease that leads to significantly pronounced disabilities, which is the main reason for the formation 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, diagnosed in 90% of cases before the age of 3 years.

The final diagnosis can usually be made after a year, when movement, speech and mental disorders become evident. Diagnosis criteria: non-progressive course, combination of clinical picture diseases of paralysis and paresis of various distribution, hyperkinetic syndromes, speech, coordination, sensory impairments, 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, diagnosed in 90% of cases before the age of 3 years.

Etiology and pathogenesis: the main causes of 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 the mother and the fetus, antiphospholipid syndrome in the mother), violations of the normal course of pregnancy at various stages of pregnancy (toxicosis, polyhydramnios , threats of termination, pathology of the placenta, multiple pregnancies, surgical interventions, anesthesia during pregnancy, prematurity, premature birth, etc.), intranatal causes (prolonged non-water period, pathology of the birth canal, instrumental obstetrics, operative labor, rapid delivery etc.); postnatal period (neonatal seizures, traumatic and infectious brain lesions, toxic lesions (bilirubin encephalopathy), hypoxia, etc.). In addition, many authors point out a clear connection between cerebral palsy and low birth weight. In the pathogenesis of cerebral palsy, along with direct damage to the motor area of ​​the cerebral cortex, subcortical formations and the pyramidal tract, damage to the periventricular region (PVO) by the type of periventricular leukomalacia is of great importance; as well as atrophic and subatrophic processes in the cerebral cortex (more often in the frontotemporal regions), impaired blood supply to the brain and liquorodynamic disorders [Nikitina MN. , 1999, Mezhenina E.P., Kachesov V.A., 2001].

Classification reflects mainly the features of movement disorders. In our country, 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, seven groups of cerebral palsy (G80) are distinguished, depending on the localization 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 infantile cerebral palsy

Mixed cerebral palsy syndromes

G80.9 Cerebral palsy, unspecified

There are the following stages infantile cerebral palsy: early stage(up to 4-5 months): general serious condition, autonomic disorders, nystagmus, convulsions, intracranial hypertension, movement disorders syndrome; initial chronically residual stage (from 5-6 months to 3-4 years): proceeds 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 severity.

1. Syndrome of statodynamic disorders (spastic paresis, hyperkinesis, ataxia, contracture and joint deformation); during the rehabilitation process, the following are possible: full compensation - movement without support, at a sufficient pace, regardless of distance; limb deformities are absent; subcompensation - movement with limited distance, in the presence of 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 violation of expressive and written speech: dysarthria, alalia, dysgraphia, dyslexia, etc.

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

4. Hypertensive-hydrocephalic syndrome of varying severity;

5. Syndrome of paroxysmal disorders;

6. Syndromes of cognitive disorders (psychoorganic syndrome, etc.);

7. Disorders of conduct and personality disorders (neurosis-like, psychopathic 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 certain forms of cerebral palsy:

Spastic double hemiplegia (tetraplegia) - one of the most severe forms of cerebral palsy, occurs in 2% of cases. It is 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 at the hip joints, bent or, conversely, unbent at the knee joints, rotated inward, the hips are shown. Such children are not able to maintain an upright posture, sit, stand, walk, hold their head, pronounced pseudobulbar symptoms, strabismus, atrophy of the optic nerves, hearing impairment are formed. Due to hypertensive syndrome, contractures of the joints, bone deformities of the trunk and extremities occur. In half of the cases, this disease is accompanied by generalized and partial epileptic paroxysms. This form is prognostically unfavorable.

Spastic diplegia (Little G80.1 disease): the most common form of cerebral palsy (60% of cases), usually due to intraventricular hemorrhage. It is characterized by the development of uneven tetraparesis with a predominant lesion of the lower extremities, sometimes in combination with athetoid and / or choreoathetoid hyperkinesis, ataxia. It is accompanied by strabismus, atrophy of the optic nerves, hearing loss, dysarthria. Intelligence usually does not suffer. In children with this form of cerebral palsy, a pathological motor stereotype is formed. The shock setting of the foot on the support is noted, the amortization function of walking is disturbed, i.e. there is no slight flexion of the legs in the knee joint in the phase of the median support. This increases the shock 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 in terms of overcoming mental and speech disorders.

Pediatric hemiplegia (hemiplegic form G80.2) is characterized by unilateral limb involvement. In children, a violation of static-dynamic functions is formed due to the asymmetry of the posture, the occurrence of paralytic scoliosis, growth retardation of paralyzed limbs, anatomical shortening of the affected arms and legs. This form is accompanied by disorders of speech functions of the type of pseudobulbar dysarthria, mental disorders are possible, the occurrence of epileptic paroxysms.

Dyskinetic cerebral palsy: the hyperkinetic (dyskinetic) form (G80.3.) Is formed, as a rule, after the transferred so-called. "Kernicterus". It is accompanied by disorders of statodynamic functions due to choreic, athetoid, torsion hyperkinesis, speech impairment, mental retardation, hearing loss, impaired functions of the autonomic nervous system. Intelligence in most cases does not suffer, this determines a favorable prognosis for social adaptation and learning.

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

Thus, in patients with cerebral palsy, there are restrictions on life due to violations of vestibular functions (balance, coordination of movements, kinesthesia (disorder of sensation of movement, weakening of proprioception from muscles, tendons, joints)); perception anomalies - 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; violations of expressive and written speech in the form of dysarthria, alalia, dyslexia, dysgraphia, etc.); behavioral and personality disorders (impaired motivation, neurosis-like and psychopathic disorders, hyperactivity, impulsivity); delays in the pace of motor and / or psychoverbal development; symptomatic epilepsy (in% of cases); visual disturbances (strabismus, nystagmus, amblyopia, cortical loss of visual fields); hearing impairment (hearing loss of varying degrees); 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 the limbs, poor posture, scoliosis, joint contractures, etc. - is observed in 50% of children with cerebral palsy.

Required data when sent to the ITU: conclusion of a neurologist, epileptologist, psychiatrist, ophthalmologist (examination of the fundus and visual fields), audiologist, orthopedist, pediatrician, speech therapist; EPO with intelligence assessment; states of mental processes and personality; Echo-EG, EEG, REG (according to indications), 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 a moderate to a significantly pronounced degree; a combination of movement disorders of varying severity with the presence of: persistent moderate and severe violations of expressive and written speech; persistent moderate and severe impairment of sensory functions; lungs (absences, simple partial, myoclonic seizures) and severe seizures (large seizures, secondary generalized partial seizures - Jacksonian, astatic, outpatient automatisms); persistent moderate and severe cognitive impairment (psychoorganic syndrome, etc.); persistent moderate and severe syndromes of the "personality" register (neurosis-like, psychopathic disorders, hyperactivity, impulsivity); intellectual disability of varying degrees; indications for referral to ITU in the presence of mental and paroxysmal disorders, see section - " Medical and social expertise and rehabilitation of disabled children with mental and behavioral disorders ”and in the section“ Epilepsy ”.

Disability criteria: persistent moderate, pronounced or significantly pronounced disorders of neuromuscular, skeletal and movement-related (statodynamic), language and speech, sensory functions, urinary function, etc., leading to a limitation of self-service, independent movement, communication, learning, the ability to control their behavior are defining need social protection child.

The quantitative system for assessing the severity of persistent violations of the functions of the human body in percent is presented in Table 72.

A quantitative system for assessing the severity of persistent violations of the functions of the human body in percent

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

Cerebral palsy is caused by a number of different factors that act at different periods of life - during pregnancy, childbirth, and early childhood. In most cases, cerebral palsy occurs after a brain injury received at the time of birth, with asphyxiation. However, extensive research in the 1980s showed that only 5-10% of cerebral palsy cases are associated with birth trauma. Other possible reasons These include abnormalities in brain development, prenatal factors that directly or indirectly damage neurons in the developing brain, premature birth, and brain injury that occurs in the first few years of life.
Prenatal reasons.
Brain development is a very delicate process that can be influenced by many factors. Extraneous influence can lead to structural abnormalities of the brain, including the conducting system. These lesions can be hereditary, but more often than not, 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 the development of the fetal brain, directly or indirectly, can increase the risk of developing cerebral palsy. In addition, any substance that increases the risk of premature 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 all the 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 detachment of the placenta from the uterine wall, and placental infections pose a certain risk of cerebral palsy.
Certain 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 an 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 neurons in the fetal brain.
Perinatal reasons.
Among perinatal causes, asphyxia, the entanglement of the umbilical cord around the neck, placental abruption and its presentation are of particular importance.
The infection in the mother is sometimes not passed on to the fetus through the placenta, but is passed on to the baby during childbirth. Herpes infection can lead to severe pathology in newborns, which leads to neurological damage.
Postpartum reasons.
The remaining 15% of cases of cerebral palsy are associated with neurological trauma after birth. Such forms of cerebral palsy are called acquired.
The incompatibility of the mother's and baby's Rh blood groups (if the mother is Rh negative and the baby is positive) can lead to severe anemia in the baby, resulting in severe jaundice.
Serious infections that directly affect the brain, such as meningitis and encephalitis, can lead to permanent brain damage and infantile cerebral palsy. Seizures at an early age can lead to cerebral palsy. Idiopathic cases are not diagnosed very often.
As a result of harsh treatment of the child, craniocerebral trauma, drowning, suffocation, physical trauma to the child occurs, often leading to cerebral palsy. In addition, the consumption 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.

RCHD (Republican Center for Healthcare Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2010 (Order No. 239)

Cerebral palsy other type (G80.8)

general information

Short description

Cerebral palsy (cerebral palsy)- a group of syndromes that are a consequence of brain damage that arose in the perinatal period.

A characteristic feature of cerebral palsy is a variety of motor disorders, which are manifested by paralysis, discoordination of movements, often combined with various disorders of speech, psyche, and sometimes epileptic seizures.

Cerebral palsy is a polyetiological disease of the brain that can occur during its intrauterine formation, during childbirth and neonatal, as well as in the postnatal period. Cerebral palsy is the most common cause of childhood disability (30-70%), among which diseases of the nervous system are in the first place. In most cases, the physical condition of patients improves, but restrictions on activity persist: reduced ability to move, speech impairment, and others.

According to the literature, the incidence of cerebral palsy in the population is 2 per 1000 newborns; according to L.O. Badalyan (1987) - from 3 to 6 cases per 1000 births. The main causes of cerebral palsy are associated with the development of pregnancy and childbirth (perinatal period): chronic diseases mothers, infectious diseases, taking medications during pregnancy, premature birth, prolonged labor, hemolytic disease of the newborn, entanglement of the umbilical cord and others.

Protocol"Cerebral palsy"

ICD-10 code:

G 80.0 Spastic cerebral palsy

Congenital spastic (cerebral)

G 80.1 Spastic diplegia

G 80.2 Pediatric hemiplegia

Classification

Classification

G 80 Cerebral palsy.

Includes: Little's disease.

Excludes: hereditary spastic paraplegia.

G 80.0 Spastic cerebral palsy.

Congenital spastic palsy (cerebral)

G 80.1 Spastic diplegia.

G 80.2 Pediatric hemiplegia.

G 80.3 Dyskinetic cerebral palsy.

G 80.8 Another type of infantile cerebral palsy.

Mixed cerebral palsy syndromes.

G 80.9 Cerebral palsy, unspecified.

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

1. Double spastic hemiplegia.

2. Spastic diplegia.

3. Hemiparesis.

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

5. Atonic-astatic form.

By the severity of the lesion: mild, moderate, severe.

Period:

Early recovery;

Late recovery;

Residual period.

Diagnostics

Diagnostic criteria

Complaints for a delay in psychoverbal and motor development, movement disorders, involuntary movements in the limbs, seizures.

History- perinatal pathology (prematurity, birth asphyxia, birth trauma, prolonged conjugational jaundice, intrauterine infections, etc.), transferred neuroinfections, stroke, head injury in early childhood.

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 organs of vision (strabismus, optic atrophy, nystagmus ).

The spastic form of cerebral palsy is characterized by:

Increased muscle tone in the central type;

High tendon reflexes with extended reflexogenic zones, clones of the feet and patella;

Pathological reflexes: Babinsky, Rossolimo, Mendel-Bekhterev, Oppenheim, Gordon, Schaeffer. Among them, the Babinsky reflex is most constantly revealed.

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 with ordinary living creatures or are somewhat revitalized, 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 disturbed less 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 muscular hypotonia, the tone in the upper limbs is higher than in the lower limbs, and the movements in the upper 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 have a pronounced decrease in intelligence, speech disorders are cerebellar in nature.

Laboratory research:

1. Complete blood count.

2. General analysis of urine.

3. Feces on the eggs of the worm.

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

5. Determination of TSH - according to indications.

Instrumental research:

1. Computed tomography (CT) of the brain: there is a different atrophic process - the expansion of the lateral ventricles, subarachnoid spaces, cortical atrophy, porencephalic cysts and other organic pathology.

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

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 enlarged veins, narrowing of the arteries. In some cases, congenital atrophy of the optic nerve, strabismus is found.

Indications for specialist advice:

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

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

3. Orthopedist - identifying contractures, resolving the issue of surgical treatment.

4. Prosthetist - to provide orthopedic care.

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

6. Neurosurgeon - in order to exclude neurosurgical pathology.

7. Exercise therapy doctor - the appointment of individual lessons, styling.

8. Physiotherapist - for prescribing physiotherapy procedures.

Minimum examination for referral to hospital:

1. Complete blood count.

2. General analysis of urine.

3. Feces on the eggs of the worm.

The main diagnostic measures:

1. Complete blood count.

2. General analysis of urine.

3. Speech therapist.

4. Psychologist.

5. Oculist.

6. Orthopedist.

7. Prosthetist.

9. Exercise therapy doctor.

10. Physiotherapist.

11. Computed tomography of the brain.

List of additional diagnostic measures:

1. Neurosonography.

2. Neurosurgeon.

3. MRI of the brain.

4. ELISA for toxoplasmosis.

5. ELISA for cytomegalovirus.

6. Infectionist.

8. Cardiologist.

9. Ultrasound of the abdominal organs.

10. Geneticist.

11. Endocrinologist.

Differential diagnosis

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Treatment

Treatment tactics

It is extremely important to suspect or make a diagnosis in the first year of life, since the child's brain has enormous potential to compensate for the damage received. A child's brain is extremely plastic, so it is necessary to try to stimulate its regenerative capacity. V complex treatment Cerebral palsy includes medications, exercise therapy, orthopedic care, different kinds massages, reflexology, physiotherapy, classes with a speech therapist and a psychologist. Rehabilitation therapy is most effective in patients in the early recovery period, the earlier the prevention or reduction of the development of pathological phenomena is started, the greater the effect of therapeutic measures will be.

Basic principles of cerebral palsy treatment in the recovery period:

1.Using medications a decrease in the excitation zone and a decrease in muscle tone. Fight against delayed tonic reflexes and pathological muscle tone.

2. Achieve formation vertical position child, his movements and manual manipulations, education of standing skills, movement, initially with outside help, and then independently or with the help of crutches, sticks, orthopedic shoes, splints, apparatus.

3. Improving overall mobility and coordination of movements.

4. Assistance in the normalization of joint mobility and muscle performance, elimination of joint contractures.

5. Education and training of support ability and balance.

6. Stimulation of cognitive and psycho-speech development, mental development and education of correct speech.

7. Teaching vital, applied, labor skills, developing self-service skills.

Purpose of treatment:

Improvement of motor and psycho-speech activity;

Prevention of pathological postures and contractures;

Self-service skills acquisition;

Social adaptation, the emergence of motivations;

Relief of seizures.

Non-drug treatment:

1. General massage.

2. Exercise therapy - individual and group lessons.

3. Physiotherapy - ozokerite applications, CMT, magnetotherapy.

4. Conductive pedagogy.

5. Classes with a speech therapist, psychologist.

6. Acupuncture.

7. Costume "Adele".

8. Hippotherapy.

Drug treatment

Recently widely used drugs of the nootropic series - neuroprotectors, in order to improve metabolic processes in the brain. Most nootropic drugs, due to their psychostimulating effect, are prescribed in the first half of the day. The duration of courses of treatment with nootropics is from one to two to three months.

Cerebrolysin, ampoules 1 ml / m, piracetam, ampoules 5 ml 20%, tablets 0.2 and 0.4, ginkgo biloba (tanakan), 40 mg tablets, pyritinol hydrochloride (encephabol), 100 mg dragee, suspension - 5 ml contain 80.5 mg of pyritinol (corresponding to 100 mg of pyritinol hydrochloride).
Encephabol is a minimum of contraindications, it is approved for use from the first year of life. Dosing of the suspension (containing 20 mg of encephabol in 1 ml) for children 3-5 years old, a daily dose of 200-300 mg (12-15 mg of body weight) is prescribed in 2 doses - in the morning (after breakfast) and in the afternoon (after a nap and afternoon snack) ... The duration of the course is 6-12 weeks, a long-term admission is advisable, in which the working capacity and ability to learn increase, the higher mental functions improve.

Actovegin, ampoules 2 ml 80 mg, dragee-forte 200 mg of active substance. A neurometabolic drug containing exclusively physiological components. Children are prescribed in a dragee-forte, taken before meals ½ -1 dragee 2-3 times a day (depending on age and severity of symptoms of the disease), up to 17 hours. The duration of therapy is 1-2 months. Instenon tablets (1 tablet contains 50 mg etamivan, 20 mg hexobendine, 60 mg etofillin). Multicomponent neurometabolic drug. The daily dose is 1.5-2 tablets, it is prescribed in 2 doses (morning and afternoon) after meals. To exclude side effects a gradual increase in dose over 5-8 days is recommended. Duration of treatment is 4-6 weeks.

With spastic forms of cerebral palsy in practice, myospasmolytics are widely used: tolperisone, tizanidine, baclofen.
Tolperisone (midocalm) is a muscle relaxant central action, possesses membrane-stabilizing activity, due to which it suppresses the formation and conduction of action potentials in hyperstimulated motor neurons of the brain stem and in peripheral nerves.
The mechanism of action is associated with a depressing effect on the caudal part of the reticular formation, suppression of pathologically increased spinal reflex activity and exposure to peripheral nerve endings, as well as central n-cholinolytic properties. It also has a vasodilating effect. This leads to a decrease in abnormally high muscle tone, reduces pathologically increased muscle tone, muscle rigidity, and improves voluntary active movements.
Mydocalm suppresses the functions of activating and inhibitory reticulospinal pathways and inhibits conduction in spinal cord mono- and polysynaptic reflexes.
Dosage regimen: children from 3 months. up to 6 years old, midocalm is prescribed orally in daily dose at the rate of 5-10 mg / kg (in 3 divided doses during the day); at the age of 7-14 years - in a daily dose of 2-4 mg / kg; adults 50 mg - 150 mg (1-3 tablets) 3 times a day.

Tizanidine (sirdalud) is a centrally acting myospasmolytic. The main point of application of its action is in the spinal cord. It selectively suppresses polysynaptic mechanisms responsible for increasing muscle tone, mainly by reducing the release of excitatory amino acids from intermediate neurons. The drug does not affect neuromuscular transmission.
Sirdalud is well tolerated and effective for spasticity of cerebral and spinal genesis. It reduces resistance to passive movement, reduces spasms and clonic seizures, and increases the strength of voluntary contractions.

Baclofen is a centrally acting muscle relaxant; agonist of GABA receptors. It inhibits mono- and polysynaptic reflexes, apparently due to a decrease in the release of excitatory amino acids (glutamate and aspartate) and terminals, which occurs as a result of stimulation of presynaptic GABA receptors. Against the background of the use of the drug, the motor and functional activity of patients increases.

Angioprotectors: vinpocetine, cinnarizine.

B vitamins: thiamine bromide, pyridoxine hydrochloride, cyanocobalamide; neuromultivitis - special complex B vitamins with targeted neurotropic action; neurobex.

Vitamins: folic acid, tocopherol, retinol, ergocalciferrol.

Anticonvulsants for epileptic syndrome: valproic acid, carbamzazepine, diazepam, clonazepam, topamax, lamotrigine.

With a combination of cerebral palsy with hydrocephalus, hypertensive-hydrocephalic syndrome, the appointment of dehydration agents is indicated: acetozolamide, furosemide, at the same time potassium preparations: panangin, asparkam, potassium orotate.

With severe anxiety, the syndrome of neuro-reflex excitability, sedatives are prescribed: novo-passit, noofen, a mixture with citral.

In recent years, with spastic forms of cerebral palsy, botulinum toxin has been used to reduce the spasticity of certain muscle groups. The mechanism of action of botulism toxin (dysport drug) is to inhibit the release of acetylcholine in neuromuscular synapses. The injection of the drug leads to relaxation of the spastic muscle.
The main indication for the appointment of dysport in children with different forms Cerebral palsy is an equinovarus deformity of the foot. The introduction of dysport is technically simple and is not accompanied by significant adverse reactions.
The standard dose of dysport per procedure is 20-30 mg per 1 kg of body weight. The maximum allowable dose for children is 1000 units. the average dose for each head of the gastrocnemius muscle is 100-150 units, for the soleus and posterior tibial muscles - 200 units.
Injection technique: 500 units dysport is diluted in 2.5 ml of saline (i.e., 1 ml of solution contains 200 units of the drug). The solution is injected into the muscle at one or two points. The effect of the drug (relaxation of spastic muscles) begins to manifest itself on the 5-7th day after the administration of the drug, with the achievement of the maximum effect by the 10-14th day.
The duration of the muscle relaxant is individual and varies from 3 to 6 months. after the introduction. Dysport should be introduced into the complex scheme as early as possible, before the formation of joint contractures.

Preventive actions:

Prevention of contractures, pathological postures;

Prevention of viral and bacterial infections.

Further management: dispensary registration with a neurologist at the place of residence, regular exercise therapy classes, training parents in massage skills, exercise therapy, orthopedic styling, caring for children with cerebral palsy.

List of essential medicines:

1. Actovegin ampoules of 80 mg, 2 ml

2. Vinpocetine (Cavinton) tablets, 5 mg

3. Piracetam in ampoules of 5 ml 20%

4. Pyridoxine hydrochloride ampoules of 1 ml 5%

5. Folic acid, tablets 0.001

6. Cerebrolysin, ampoules 1 ml

7. Cyanocobalamin 200 mcg and 500 mcg ampoules

Additional medicines:

1. Aevit, capsules

2. Asparkam tablets

3. Acetozolamide tablets 250 mg

4. Baclofen tablets 10 mg and 25 mg

5. Valproic acid, syrup

6. Valproic acid tablets 300 mg and 500 mg

7. Gingo-Biloba 40 mg tablets

8. Glycine, tablets 0.1

9. Hopantenic acid, (Pantocalcin) tablets 0.25

10. Diazepam, ampoules 2 ml 0.5%

11. Dysport, ampoules 500 U

12. Carbamazepine, tablets 200 mg

13. Clonazepam 2 mg tablets

14. Konvulex, capsules 150 mg, 300 mg, 500 mg, solution in drops

15. Lamotrigine 25 mg and 50 mg tablets

16. Magne B6, tablets

17. Neuromidine tablets 20 mg

18. Novo-Passit, tablets, solution 100 ml

19. Noofen tablets 0.25

20. Panangin, tablets

21. Piracetam tablets 0.2

22. Pyritinol, suspension or tablets 0.1

23. Thiamine bromide ampoule, 1 ml 5%

24. Tizanidine (Sirdalud), tablets 2.4 and 6 mg

25. Tolpirizone, (midocalm) ampoules 1 ml, 100 mg

26. Tolpirisone, pills 50 mg and 150 mg

27. Topamax, 15 mg and 25 mg capsules, 25 mg tablets

28. Cinnarizine 25 mg tablets

Treatment effectiveness indicators:

1. Improvement of motor and speech activity.

2. Decreased muscle tone in spastic forms of cerebral palsy.

3. An increase in the volume of active and passive movements in the paretic limbs.

4. Relief of seizures with concomitant epilepsy.

5. Reduction of hyperkinesis.

6. Acquiring self-service skills.

7. Replenishment of active and passive vocabulary.

8. Improving the emotional and mental tone of the child.

Hospitalization

Indications for hospitalization: movement disorders, paresis, paralysis, delayed psychomotor and speech development from their peers, seizures, hyperkinesis, contractures, joint stiffness

Information

Sources and Literature

1. Protocols for the diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 239 dated 04/07/2010)
   1. L.O. Badalyan. Pediatric neurology. 1975 Moscow Handbook of a child psychiatrist and neuropathologist, edited by L.A. Bulakhova. Kiev 1997 L.Z. Kazantsev. Rett syndrome in children. Moscow 1998 Clinical picture and diagnosis of infantile cerebral palsy. Study guide. Zhukabaeva S.S. 2005

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Infantile cerebral palsy (CP) develops mainly due to congenital cerebral abnormalities and manifests itself in the form of movement disorders. Such a pathological deviation according to the International Classification of Diseases (ICD) 10 revision has the G80 code. During the diagnosis and treatment, doctors are guided by it, therefore it is extremely important to know the features of the cipher.

Varieties of cerebral palsy according to ICD-10

Cerebral palsy code according to ICD 10 has G80, but it has its own subdivisions, 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 the resulting infection during intrauterine 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 hands, therefore, their labor activity is excluded;
• 1 Spastic diplegia. This form occurs in 70% of cases of cerebral palsy and is also called Little's disease. 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 of mental retardation and, if possible, to fully work with his hands.

• 2 Hemiplegic appearance. It occurs in premature babies due to hemorrhage in the brain or due to various congenital brain abnormalities. The hemiplegic form manifests itself in the form of unilateral damage to muscle tissues. Social adaptation depends mainly on the severity of motor defects and the presence of cognitive disorders;
• 3 Diskinetic appearance. This variety arises mainly due to hemolytic disease. For the dyskenic type of cerebral palsy, damage is characteristic of the extrapyramidal system and the auditory analyzer. At the same time, mental abilities are not affected, therefore social adaptation is not impaired;
• 4 Ataxic type. It 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. The lesions are localized mainly in the frontal lobe and cerebellum. The 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 depends 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 in order to understand the essence of therapy and know the possible options for the development of the disease.

The main features of central paralysis are muscle hypertension, increased tendon reflexes, the so-called concomitant movements, or synkinesis, and pathological reflexes.
Hypertension, or muscle spasticity, defines another name for central paralysis - spastic. Muscles are tense, tight to the touch; with passive movements, a clear resistance is felt, which is sometimes difficult to overcome. This spasticity is the result of increased reflex tone and is usually unevenly distributed, resulting in typical contractures. With central paralysis, the upper limb is usually brought to the trunk and bent in elbow joint: hand and fingers are also in flexion position. The lower limb is extended at the hip and knee joints, the foot is bent and turned with the sole inward (the leg is straightened and "elongated"). This position of the limbs with central hemiplegia creates a kind of Wernicke-Mann posture, the interpretation of the patterns of occurrence of which from the point of view of the history of the development of the nervous system given by M... I. Astvatsaturov.
The gait in these cases has a "circumferential" character: due to the "lengthening" of the leg, the patient has to (so as not to touch the floor with his toe) "circle" the affected leg.
An increase in tendon reflexes (hyperreflexia) is also a manifestation of increased, disinhibited, automatic activity of the spinal cord. Reflexes from the tendons and periosteum are extremely intense and are easily caused as a result of even minor irritations: the reflexogenic zone expands significantly, i.e. the reflex can be triggered not only from the optimal site, but also from neighboring areas. An extreme increase in reflexes leads to the appearance of clonuses (above).
In contrast to tendon reflexes, skin reflexes (abdominal, plantar, cremasteric) with central paralysis do not increase, but disappear or decrease.
Concomitant movements, or synkinesis, observed with central paralysis, can occur reflexively in the affected limbs, in particular, with the tension of healthy muscles. Their occurrence is based on a tendency to irradiation of excitation in the spinal cord to a number of adjacent segments of its own and opposite sides, which is normally moderated and limited by cortical influences. With disinhibition of the segmental apparatus, this tendency to propagate excitement is revealed with particular force and causes the appearance of "additional" reflex contractions in the paralyzed muscles.
There are a number of synkinesis associated with central paralysis. Here are some of them:
1) if the patient, on assignment, resists the extension in the elbow joint produced by the examiner with his healthy hand, or shakes his hand strongly with his healthy hand, then an accompanying reflex flexion occurs in the paralyzed hand;
2) the same flexion of the affected arm occurs when coughing, sneezing, yawning;
3) under the above conditions, in the paralyzed leg (if the patient sits with the legs hanging over the edge of the couch or table), involuntary extension is observed;
4) the patient lying on his back with outstretched legs is offered to bring and withdraw the healthy leg, in which he is resisted. In the paralyzed leg, an involuntary corresponding adduction or abduction is observed;
5) the most constant of the accompanying movements in central paralysis is a symptom of combined flexion of the hip and trunk. When the patient tries to move from horizontal position in a sitting position (the patient lies on his back with arms crossed on his chest and straightened legs apart), the paralyzed or paretic leg is raised (sometimes it is brought).
Pathological reflexes are a group of very important and persistent symptoms of central paralysis. Of particular importance are the pathological reflexes on the foot, which are observed, of course, in cases where the affected lower limb... The most sensitive are the symptoms of Babinsky (perverted plantar reflex), Rossolimo and Bekhterev. The rest of the pathological reflexes on the foot (above) are less constant. Pathological reflexes on the hands are usually weak and of great importance in practice clinical research not purchased. Pathological reflexes on the face (mainly a group of "oral" reflexes) are characteristic of central paralysis or paresis of the muscles innervated by the cranial nerves, and indicate a bilateral supranuclear lesion of tractus cortico-bulbaris in the cortical, subcortical or trunk regions.
Symptoms such as increased tendon reflexes of the extremities, weakening of abdominal reflexes and Babinsky's symptom are very subtle and early signs of a violation of the integrity of the pyramidal system and can be observed when the lesion is not enough for the occurrence of the paralysis itself or even paresis. Therefore, their diagnostic value is very high. EL Venderovich described the symptom of "ulnar motor defect", indicating a very mild degree of pyramidal lesion: on the affected side, the patient's resistance to violent abduction towards the little finger, which is maximally reduced to the fourth finger, is weaker.