Parkinson's disease diagnosis code according to ICD 10

Parkinsonism is rightfully considered one of the most mysterious diseases of the human body.
This disease has not been studied because it is associated with such a complex and not yet fully understood nervous system.

Scientists have not yet fully discovered the pathogenesis of the disease, and the exact preventive measures are not known.

Symptoms and signs

The disease manifests itself in the form of the following symptoms:

• disturbances of consciousness of varying severity (cholinergic syndrome);
• decreased physical activity of the patient;
• depressive states;
• impoverishment of facial expressions and gestures;
• various mental disorders;
• predominantly bent or semi-bent position of the upper and lower extremities;
• urinary incontinence;
• trembling of the limbs (tremor), which subsides during moments of active action.

The primary and most obvious signs are tremors and stiffness of movement, which appear even in the earliest stages, when cognitive functions are not yet affected.

The movements themselves, even if they remain normal, may slow down noticeably. At the same time, muscle activity can remain normal in a supine position. A patient with vascular parkinsonism can be easily identified by the lack of emotion on his face.

Over time, not only motor functions are impaired, but also muscle strength weakens, and if it is necessary to fix the body or limbs in a certain position, muscle strength may be excessive.

In half of the cases, the patient exhibits all the signs of hypertension.

Parkinsonism is either combined with it, or is the cause, or vice versa, a consequence of hypertension, but in most cases, such a disorder is a harbinger of Parkinson’s disease and is diagnosed several years before the development of parkinsonism.

Types of pathology

Parkinsonism is characterized by the occurrence of four types of movement disorders:

1. Tremor (shaking). This is the most typical symptom by which pathology can be accurately identified.
2. Muscle stiffness. Muscle tone is greatly increased, rigidity is of the plastic type, that is, difficulties arise with flexion and extension of the limbs.
3. Hypokinesia. The patient's spontaneous motor activity is impaired: his movements are slow, his facial expressions are unexpressed, and his speech is devoid of emotion.
4. Postural instability. It is difficult for a person to start a movement and difficult to complete what he has started. When walking, the legs cannot keep up with the body, so patients often lose their balance.

The above symptoms formed the basis for the classification of Parkinson's disease. According to this classification, the following forms of the disease are distinguished:

• rigid,
• akinetic-rigid,
• rigid-trembling,
• trembling-rigid,
• akinetic,
• trembling,
• mixed.

Rigid

The basis of this type is stiffness of movement resulting from increased muscle tone. The patient's arms and legs freeze in a given position.

This syndrome is called “plastic wax flexibility”. It results in the limb being unable to return to its original position after flexion.

A patient with a rigid type is characterized by the following external signs:

1. Cogwheel syndrome. The movements are not made smoothly, but in jerks.
2. The pose of a supplicant. A person walks in small steps, leaning slightly forward.
3. The Westphal phenomenon. After bending the leg at the ankle joint, the limb remains in this position.

At the onset of the disease, the change in tone is unilateral.

Stiffness is more pronounced after emotional or physical stress and decreases after rest. As the pathology progresses, pain appears in the back and joints of the limbs.

Akinetic-rigid

This is a type of rigid form, which is characterized by the appearance of bradykinesia. Distinctive features of this type:

1. Weakened facial expressions, mask-like face.
2. Reduced arm span when walking. Elbows pressed to the body.
3. Walking in small steps (“doll gait”).
4. Micrographia (handwriting becomes small and illegible).

Akinetic-rigid parkinsonism leads to the development of postural instability.

The patient gradually loses the ability to self-care. This type of disease is the most unfavorable prognostically.

Rigid trembling

In this case, muscle tone is combined with a slight tremor. However, signs of rigidity predominate.

Because of this, muscle contracture develops, that is, the patient is unable to fully straighten or bend the joint.

Trembling-rigid

Tremor, which is combined with muscle stiffness, comes to the fore here. Trembling disappears at rest and reappears when moving. Tremors usually occur in the distal extremities.

Akinetic

This form is characteristic of the later stages of the disease.
A distinctive feature is akinesia - a change in the volume of voluntary movements.

Sometimes patients develop an akinetic crisis.

The person cannot make any movements; he is diagnosed with dysarthria, dysphonia, and confusion.

Autonomic disorders often occur: tachycardia, pressure surges, urinary incontinence, increased sweating. The result of akinesia is the inability to eat independently and the patient’s complete immobility.

Trembling

Occurs no more often than in 7% of cases. The main symptom is tremor. In this case, muscle tone is normal or slightly increased.

The shaking starts with one hand, then moves to the head and chin. Tremor can be bilateral or unilateral.

Trembling of the limbs causes a lot of trouble for the patient: the inability to hold cutlery, fasten clothes, or perform actions that require the use of fine motor skills.

From the point of view of prognosis, the trembling appearance is the most favorable, as it progresses slowly and responds well to symptomatic therapy.

Mixed

The mixed type of parkinsonism is the most complex. It combines all movement disorders. Usually, at the initial stage, a trembling or rigid form is diagnosed, then, as the disease develops, other symptoms occur and the diagnosis changes.

Find out more about Parkinson's disease:

• about the causes and hereditary factors in the development of the disease,
• disability and other consequences and complications,
• the patient’s lifestyle, the need to follow a diet,
• disease prevention.

Diseases that cause parkinsonism

Parkinsonism syndrome has a mechanism for the appearance of symptoms similar to PD, occurring as a secondary manifestation of other diseases.
Most often, its causes are acute or chronic infectious processes of the nervous system (Lyme disease, tick-borne encephalitis).

Parkinsonism can be caused by neoplasms of the central and peripheral nervous system, traumatic brain lesions, as well as acute and chronic pathology of cerebral circulation.

Parkinsonism syndrome with characteristic motor disorders is a consequence of the toxic effects of medications (long-term use of medications of the phenothiazine group - triftazine, aminazine) and narcotic drugs. The cause of its development is often exposure to occupationally harmful factors - acute and chronic poisoning with manganese or carbon monoxide.

Another large group of pathologies with clinical manifestations of parkinsonism is represented by neurodegenerative diseases affecting the central nervous system (Wilson-Konovalov disease, corticobasal degeneration, systemic atrophy).

Classifications according to disease manifestations

There are several classifications affecting the external manifestations of the disease. These include systematization of the disease by form, severity and manifestations, as well as speed of development.

Clinical forms

Based on external manifestations, the following forms of Parkinson's disease are distinguished.

Akinetic-rigid form. Detected in 15-20% of cases. It is considered the most unfavorable. It is characterized by increased muscle tone and a high risk of muscle contractures. The speed of active movements is slowed down to such an extent that early complete immobility is possible.

Trembling. Found in 5-10% of patients. Of the basic symptoms, tremor of medium or large amplitude with preservation or a slight increase in muscle tone is more common. Tremor affects the head as a whole, lower jaw, and limbs.

Trembling and rigid. It appears in 5-10% of patients and looks like trembling of the lower extremities. As the patient's condition worsens, voluntary movements become stiff.

Hypokinetic-rigid-tremor or mixed. Affects up to 70% of patients and is a combination of previous forms.

As it progresses, one clinical form may change into another.

Classification by severity

This classification of Parkinson's disease is more often used in clinical practice. It is internationally recognized and used to determine the severity of movement disorders. Its second name is the Hyun-Yar scale.

The first version of the scale demonstrated the division of the disease into five stages. Then the classification was supplemented with several more subclasses: 0; 1.5; 2.5. The detailed version is used mainly by narrow specialists.

Detailed classification according to Hyon-Yar

Classification according to the rate of development of the disease

According to this typology, there are three types of Parkinson's disease.

Fast. It is characterized by a high rate of change of stages. The disease passes from one stage to another within two years.

Moderate. The change of stages takes place over a period of two to five years.

Slow. More than five years pass from one stage to another.

Classification by degree of manifestation

According to this classification, there are four forms of Parkinson's disease:

• Stage I - slight bradykinesia, slight increase in muscle tone, tremor of the fingers;
• II - moderate manifestations of bradykinesia, rigidity, tremor of the hand and foot is added to trembling of the fingers;
• III - pronounced rigidity and bradykinesia, the amplitude of the tremor increases, the tremor moves to the legs and forearms;
• IV - deterioration of general condition, pronounced changes in muscle tone; the addition of symptoms of “sticky ductility”, “cogwheel”, development of tremor of the head, lower jaw, tongue, the appearance of flexion of the feet.

Changes in tone most often begin from the right half of the body and gradually move to the left.

Forms and stages

Today, the following forms of this disease are distinguished:

1. Primary , arising as a result of organic disorders in the nervous system, in particular, its central link - the brain and spinal cord.
2. Secondary , accompanying other diseases (stroke, hypertensive crisis, etc.) and being their consequence. To treat this type of parkinsonism, the doctor needs to find the cause that caused it.

There are the following stages of Parkinson's disease:

• zero stage . There are no noticeable changes;
• first stage . Manifestations of the disease from one system of the body;
• second stage . Bilateral manifestations;
• third stage . Moderate impairment of motor coordination, but the patient does not need help from other people;
• fourth stage . Loss of motor skills, but the patient in most cases is still able to move independently;
• fifth stage . The patient is unable to move without assistance and is confined to a chair or bed without assistance.

What is the difference between parkinsonism and Parkinson's disease?

According to the international classification of diseases, Parkinson's disease is only one of the varieties of parkinsonism, the so-called primary parkinsonism.

The primary form of this disease occurs as a result of endogenous (independent of external conditions) disorders of the brain, while the secondary form develops after any severe pathologies suffered.

Prevention

Parkinson's disease does not develop as often as people think. Many live to a very old age and die from completely different causes, maintaining clarity of mind and musculoskeletal functions until the end of their days.

But the risk of such a pathology always remains, and following preventive recommendations will help minimize it:

1. There should always be time in life for physical activity. This could be doing “light” sports: running, gymnastics, swimming. Dancing and yoga are useful in this regard. It is enough to visit the training room or swimming pool 1-2 times a week or go for short morning runs - and illness in old age can most likely be avoided.

All head injuries and infectious diseases should not be ignored, as they are predisposing factors to the development of parkinsonism. Often the disease develops due to a lack of dopamine in nerve cells. According to research, caffeine stimulates the production of this substance, so it is recommended to drink a cup of coffee a day (but no more). Women need to undergo periodic examinations for hormonal balance, especially after childbirth and gynecological operations. Hormonal imbalance can lead to parkinsonism at an early age.

Parkinson's disease, once thought to be a disease of only old people, can develop in anyone.

Treatment of pathology is a long process and not always effective, and the quality of life, even with slowly progressing parkinsonism, is significantly reduced.

Classic symptoms of Parkinson's disease

As mentioned earlier, the main symptoms of Parkinson's disease appear when most of the brain cells responsible for the production of dopamine have been destroyed. It is with its deficiency that the appearance of typical parkinsonisms is associated. Even people far from medicine know them well. The complex of symptoms includes:

1. Sustained increase in muscle tone.
2. Tremor of the limbs.
3. Insufficient physical activity.
4. Postural instability.

The problems listed above are the clinical core of Parkinson's, but at the same time they are characteristic of some other diseases, often called secondary and atypical parkinsonism.

Muscle stiffness

Increased muscle tone, leading to constant stiffness, is one of the first to appear. At first it brings only minor discomfort due to stiffness of the muscles of the head, neck and back. Over time, this sensation spreads to the arms and legs, and rather painful spasms appear. Muscle tension increases in stressful situations, during emotional outbursts. The patient makes fewer and fewer movements to limit discomfort.

To treat muscle rigidity, physiotherapeutic procedures, massages, and a course of exercise therapy are prescribed. If the symptoms and treatment of Parkinson's disease are advanced, doctors often resort to immobilization in order to minimize the load on tired muscles and at least slightly normalize their tone. Traditional medicine often comes to the rescue with solving this problem, namely medicinal baths, rubdowns and other procedures.

Tremor of limbs

Parkinson's symptoms develop gradually and tremor is no exception. It first appears on one arm at rest, but over time it spreads to the rest of the limbs and even the entire torso. The degree of trembling depends on the emotional state of the patient and what movements he makes. When using one hand, the symptom may disappear, but as soon as you use the second hand or add walking, the tremor seriously intensifies, involving the whole body.

Treatment for tremors involves taking medications, but it is impossible to get rid of it forever. The maximum result that can be achieved is getting rid of resting tremor, while during movements it continues to bother, although it becomes less pronounced. A greater effect can be achieved only by surgical intervention, which involves stimulation of individual areas of the brain.

Hypokinesia

Insufficient motor activity, also called hypokinesia, occurs as a consequence of other Parkinson's symptoms. It affects all movements made by a person, so the signs of the disease include:

1. Speech that is too quiet due to the use of insufficient muscular effort of the speech apparatus during a conversation.
2. Poor facial expressions due to impaired functioning of the facial muscles.
3. Rare flashing.
4. Shorter steps.
5. Difficulty in changing posture, rising from a sitting position, and so on.

Often, hypokinesia is also manifested by voluntary movements, and in the later stages the patient can take static poses, somewhat resembling a mannequin. Such symptoms of Parkinson's disease are treated with drugs that eliminate dopamine deficiency. They are usually used in combination and are selected individually for each patient.

Postural instability

This symptom appears in the terminal stage. The problem is manifested by a shift in the center of gravity of the body, due to which a person is forced to constantly lean forward or to the sides. It becomes unimaginably difficult to move and even just stand still. If the patient picks up the pace, it is difficult for him to stop his movements in time, which is why falls often occur.

Gradually, the ability to sit and move disappears completely, disability sets in, due to which the ability to independently care for oneself disappears. Treatment of this symptom is no longer possible. Medications used in combination can improve health somewhat, but the patient will in any case need constant help and support. The earlier the first symptoms, signs and treatment of Parkinson's disease are detected, the greater the chance of delaying the onset of postural instability.

Diagnosis and treatment

First of all, during the diagnosis, the doctor collects a life history and anamnesis of the disease.

The doctor asks questions about the patient’s living conditions, his financial condition, bad habits, injuries and head injuries, previous or existing diseases, etc.

It is determined whether the patient's relatives suffer from parkinsonism. At the next stage, it is important to evaluate the patient’s appearance, his facial expression, resting position, and gait.

Often, when diagnosing a disease, a so-called pharmacological test is performed, the essence of which is to prescribe dopamine-based drugs to the patient.

If, after starting to take these drugs, the symptoms of parkinsonism decrease or disappear altogether, then we can talk about making a diagnosis.

It would also be useful to consult a psychologist to assess your emotional state. This is done with the help of questionnaires, questionnaires, and tests.

The diagnosis is finally confirmed using magnetic resonance imaging (MRI), in which the damaged areas of the brain responsible for coordinating movements and maintaining muscle tone appear to be highlighted.

An MRI will also help rule out other diagnoses, including a tumor.

Treatment of this disease is carried out both surgically and with medication.

Surgery involves intervention in the brain and destruction of its areas responsible for sensitivity.

This is done to restore the ability to move normally.

Drug treatment consists of prescribing special medications, which include:

• drugs containing dopamine or its precursors;
• medications that slow down the breakdown of dopamine;
• so-called neuroprotectors that protect neurons from destruction;
• antidepressants that help normalize the patient’s emotional state;
• physiotherapy;
• deep brain stimulation, in which electrodes are inserted into the brain to stimulate a particular area, which can also help stabilize the patient’s condition.

Read about the treatment of parkinsonism with folk remedies and unconventional methods in this article.

Diagnostics

Diagnosis of Parkinson's disease consists of 3 stages:

Stage 1

Identifying symptoms indicating the presence of parkinsonism. This stage includes a physical examination of the patient at the time of contacting the doctor. It allows you to identify the main signs of Parkinson's disease: constant muscle tremors, muscle stiffness, difficulty maintaining balance or performing directed movements.

Stage 2

It is important for the doctor to exclude all possible diseases with similar symptoms. These can be oculogyric crises, repeated strokes, secondary traumatic brain injuries, brain tumors, poisoning, etc.

Stage 3 - confirmation of the presence of Parkinson's disease

The final stage of diagnosis is based on the presence of at least three signs. This:

• the duration of the disease is more than 10 years,
• disease progression,
• asymmetry of symptoms with a predominance on the side of the body where the disease debuted, the presence of rest tremor, unilateral manifestations of the disease at the initial stage of its development.

In addition to these three diagnostic stages of a neurological examination, a person may be referred for an EEG, CT scan or MRI of the brain. Rheoencephalography is also used.

Symptoms

Precursors of PD may appear long before characteristic movement disorders.
Typical symptoms of Parkinson's manifestation include disturbances in the sense of smell and sleep inversion, in which the rapid phase of sleep is affected.

At this time, patients experience pathological mobility, they laugh, wave their arms or cry.

Another characteristic manifestation of the onset of PD is a change in handwriting - it becomes small and uneven.

Problems with alternating movements prevent patients from brushing their teeth, stirring tea, or pressing keyboard keys. Often such clumsiness catches the eye of others and the patient’s relatives before he notices it himself.

The basis of the clinical manifestations of PD in the advanced stage is akinetic-rigid syndrome, containing a triad of specific symptoms of the disease:

• tremor;
• bradykinesia (oligokinesia);
• muscle rigidity.

The complex of typical motor symptoms is usually unilateral and involves the upper extremities. A specific feature is also a gradual decrease in the amplitude of arm swings when walking.

Patients with PD are characterized by a specific flexion posture (camptocormia) - half-bent legs, head and body tilted forward, half-bent arms brought to the body. The speech of patients in the advanced stage of PD seems quiet and monotonous, without pronounced accents and modulations. The spoken phrases have little emotion, are not accompanied by gestures, and fade away towards the end of each sentence. Parkinson's is characterized by very poor facial expressions, up to complete facial expressions.

As the disease progresses, gross disturbances in voluntary movements are observed: slowdown, even to complete immobility, in the speed of voluntary movements, absence of hand movements that are conducive to walking. The gait of PD is characterized by shuffling and small steps, with episodes of propulsive running (involuntary impulsive forward movement). The inability to maintain their center of gravity (postural instability) is especially pronounced when moving: they seem to “catch up” with the center of gravity of their body, retreating forward, backward or to the side if they are pushed.

Movement disorders of a person suffering from Parkinson's disease

An optional but characteristic symptom of PD is tremor, which involves the muscles of the face, head, tongue, lower jaw and limbs and is aggravated at rest and disappears during sleep. Often, peculiar finger movements appear - “counting coins” or “rolling pills”.

An obligatory component of PD, in addition to motor disorders, is autonomic dysfunction. Most often these are constipation, dysfunction of the sebaceous and sweat glands and diuresis disorders. Increased salivation manifests itself in the need to constantly have a napkin or handkerchief with you. Patients with PD are characterized by constant hypotension.

In the later stages of PD, the psyche of patients is deformed - they become inactive, lose initiative, lose interest in what is happening and the ability to respond emotionally.

Cognitive and thought processes are also inhibited, which results in difficulty switching from one thought to another. Patients in this period are characterized by clinginess and manifestations of egocentrism. Manifestations of depression and dementia are typical for terminal PD.

What happens in the body

The main pathogenetic mechanism is the degeneration and death of neurons, first of the substantia nigra, and then of other parts of the brain. The process is irreversible and steadily progressing. A special protein substance, synuclein alpha, is subject to the greatest destruction.

The destructive process develops due to disruption of intracellular respiration. Apoptosis is activated - cell self-destruction.

The main manifestation of Parkinson's disease is movement disorders. According to the mechanism of their occurrence, they are divided into four groups:

• tremor, or shaking syndrome;
• muscle stiffness;
• motor impairment, or hypokinesia;
• postural disturbances.

There is usually a sequence in which these symptoms occur.

Trembling syndrome can manifest itself differently in different patients. Rest tremor is often observed - trembling of the limbs appears without making any movements.

Postural tremor is less common. It occurs after making any movement. Rarely, intention tremor is observed - trembling when trying to make a purposeful movement.

Muscle stiffness is a characteristic symptom of Parkinson's disease. It consists of changes in muscle tone and disruption of their plasticity. As a result, the limbs become as if stiff.

The symptom does not appear immediately; in the initial stages it is practically invisible. A pathognomonic sign for the disease is the asymmetry of tone in different limbs.

Hypokinetic manifestations consist of slow movements and a small number of them. This symptom is constant for Parkinson's disease. Initially, it can be detected during everyday movements. Then facial expressions and gestures begin to become poorer.

Postural disorders appear early, but in the initial stages they do not cause inconvenience to the patient. They begin to disrupt the usual rhythm of life in the third or fourth stage. Manifest in the form of asymmetry of movements.

The disease has several stages of development - Parkinson's classification according to Hoehn-Yahr, created back in 1967 and still relevant today.

1. Stage zero is the absence of movement disorders.
2. The first stage is characterized by symptoms on only one side of the body.
3. The second stage is characterized by bilateral symptoms without postural manifestations.
4. In the third stage, postural symptoms are present, but the patient is capable of self-care.
5. The fourth stage is characterized by severe motor impairment - the patient is able to stand independently and move slowly.
6. At the fifth stage, the patient is completely helpless and there is no possibility of self-care.

This is an international version of the classification, which is used in all countries. In addition to stages, there are different rates of progression of Parkinson's disease:

• slow progression - more than five years pass between stages;
• moderate progression - changes in stages occur every 3-4 years;
• rapid progression - changing stages every two years.

Description

ICD-10 code: G20
Parkinson's disease is a condition caused by a deficiency of the neurotransmitter dopamine. Dopamine synthesis is disrupted when neurons in the substantia nigra (lat. Substantia nigra) die. This anatomical structure is located in the midbrain and is the boundary between the cerebral peduncles and the midbrain tegmentum. The substantia nigra got its name because of its highly pigmented cells. The black color gives a high iron content.

The striatum is a structure that includes the caudate and lenticular basal ganglia. Between the substantia nigra and the striatum there is a functionally important dopaminergic connection, which ensures the normal functioning of the entire striopallidal system.

Lack of dopamine affects the aforementioned striopallidal system. It consists of the striatum (corpus striatum) and the globus pallidus (globus pallidus). The striatum receives information from the medial nuclei of the thalamus, which, in turn, receive impulses from all subcortical centers of general and special sensitivity. One of the nuclei of the thalamus (dorsal medial nucleus) is the subcortical sensory center of the extrapyramidal motor system. This system is responsible for:

1. Implementation of complex stereotypical movements (playing a musical instrument, running)
2. Maintaining and distributing muscle tone when moving
3. Activity of facial muscles
4. Forming an incentive to initiate action, etc.

The reasons contributing to the development of Parkinson's disease have not yet been established. Experts suggest that this may be the participation of genetic factors, environmental influences, aging of the human body and brain, and inferiority of the reparative system. In some families, there is a tendency to inherit parkinsonism (up to 10% of cases). However, in most cases, Parkinson's disease is a multifactorial disease.

Parkinson's disease affects all peoples of the world. According to statistics, men are more susceptible to this disease. The typical age for the first clinical manifestations is 45-50 years. Due to the increase in life expectancy in developed countries, the disease in question is somewhat more common. Thus, among people over seventy years of age, per 100,000 people there are 55 patients with parkinsonism. In the group of people over eighty years of age, this figure is higher: 220 people with Parkinson's disease per 100,000 people.

Causes

Scientists have not yet been able to identify the exact causes of Parkinson's disease, but there is a certain group of factors that can trigger the development of this disease.

The causes of Parkinson's disease can be identified as follows:

• aging of the body, in which the number of neurons naturally decreases, which leads to a decrease in the production of dopamine;
• hereditary predisposition;
• permanent residence near highways, industrial enterprises or railways;
• lack of vitamin D, which is formed when exposed to ultraviolet rays in the body and protects brain cellular formations from the destructive effects of free radicals and various toxins;
• poisoning with certain chemical compounds;
• the appearance of defective mitochondria due to mutation, which often leads to neuronal degeneration;
• neuroinfections (tick-borne encephalitis);
• tumor processes occurring in the brain or its trauma.

Parkinson's disease can also develop, according to some statements, against the background of drug intoxication associated with long-term use of phenothiazine medications by patients, as well as with certain narcotic drugs.

The causes of the disease also depend on the type:

• Primary parkinsonism is caused by a genetic predisposition in 80% of cases.
• Secondary parkinsonism occurs against the background of various pathologies and existing diseases.

Risk groups include people 60-65 years old, most often the male population. It also occurs in young people. In this case, it proceeds more slowly than in people of the older age group.

Disease code in neurology according to ICD-10

Parkinsonism in neurology refers to a condition of the body in which the patient experiences constant muscle strain, involuntary tremors in the arms and legs, stiffness in movements, and the inability to do any actions requiring fine motor skills independently.

As a rule, this disease is based on organic disorders of the brain.

Today this disease is divided into:

1. Primary parkinsonism. In this case we are talking about Parkinson's disease. The ICD-10 code is G20.
2. Secondary parkinsonism. It is caused by a number of reasons and accompanies any other pathologies of the nervous and other body systems.

In the International Classification of Diseases (ICD-10), the code for Parkinson's syndrome is G21. Since this disease is very common and has several variations, the encoding of the syndrome may be different.

According to the latest data, there are the following types of secondary parkinsonism and their corresponding encodings:

• G21.0 – neuroleptic malignant syndrome, is relatively rare and life-threatening. Associated with complications that arose while taking antipsychotic drugs (neuroleptics);
• G21.1 – this code denotes any other types of secondary parkinsonism associated with taking any medications;
• G21.2 – a secondary form of the disease, which developed as a result of the patient’s exposure to external factors (any other than taking medications);
• G21.3 – postencephalic (atypical) parkinsonism. Most often it is a consequence of epidemic encephalitis that has spread to the upper part of the patient’s brainstem. A characteristic symptom that screams about this disease are various types of oculomotor disorders (for example, the patient may involuntarily roll his eyes while looking up). Other symptoms include drowsiness;
• G21.4 – vascular parkinsonism. Parkinson's disease is much less common. It develops mainly in cerebral circulatory disorders and can accompany strokes and hypertensive crises. Differs from Parkinson's disease in the absence of tremor under resting conditions;
• G21.8 – other forms of secondary parkinsonism. This includes toxic parkinsonism, which occurs as a result of poisoning with salts of heavy metals, alcohol, carbon monoxide, etc. This code also denotes post-traumatic parkinsonism, which develops after any serious injuries to the brain and spinal cord with damage to the extrapyramidal system. Other types of this disease are known under this code, such as tumor (develops as a result of brain tumors), infectious (as a result of severe infections such as syphilis, influenza, etc.);
• G21.9 – secondary parkinsonism (idiopathic) of unspecified etiology. It is not known for certain what exactly causes diseases of this species.

Necessary treatment

The most important differences between the two conditions described are the different approaches to treatment. So, for example, with parkinsonism syndrome, the doctor’s task is to eliminate the immediate cause of the disruption of the extrapyramidal system. If this develops while taking medications, you should stop using them. This approach allows you to restore the function of the subcortical nuclei and get rid of existing clinical manifestations. If malignant tumors are detected in the central nervous system, they can be removed by a neurosurgeon.

In case of primary damage to cerebral vessels by atherosclerosis, a good effect can be obtained with proper therapy with the use of statins and changes in lifestyle and nutrition

It is important to note that atherosclerotic plaques do not disappear, and therefore the patient may continue to have some neurological deficits

Statins are used to treat arteriosclerotic parkinsonism

The use of medications, such as Levodopa, is not as effective as for Parkinson's disease. These medications reduce the severity of symptoms, but are not able to eliminate them. Therefore, they are not prescribed to all patients, but only to those who have a pronounced response to dopamine receptor agonists.

In the treatment of Parkinson's disease, medications are of utmost importance. First of all, these are Levodopa and its analogues. When taking such medications, the severity of clinical manifestations quickly decreases, and in some cases, their complete disappearance during therapy is possible

It is important to note that the course of taking Levodopa lasts for years, and most often for life.

In addition to the use of medications, neurosurgical methods are very popular among doctors. These operations involve installing special electrodes in the area of ​​the substantia nigra, which constantly stimulate neurons and replace them with their activity.

It is important for doctors and patients to distinguish parkinsonism syndrome from Parkinson's disease, since both of these conditions differ significantly in treatment tactics and prognosis for a person. In this regard, each patient must undergo a proper medical examination and consultation with a neurologist who is able to correctly interpret the results obtained

Causes of Parkinson's syndrome

The main cause of the disease is the degradation and death of neurons in the brain and spinal cord responsible for coordination of movements, muscle tone, and maintaining a stable position of the body in space.

Scientists note a lack of the neurotransmitter dopamine at sites of massive neuronal death in these areas.

Dopamine is responsible for the coordination of movements and their correct contractions.

Risk factors include alcohol abuse, smoking, old age (over 65 years), diabetes mellitus, the presence of this disease in relatives, the development of schizophrenia at an early age, etc.

The exact cause of the development of the disease can be established only after undergoing an examination and consultation with a neurologist.

Methods for diagnosing diseases in neurology

In addition to a visual examination to detect tremor and tests for cognitive abilities, the diagnosis of parkinsonism involves the following instrumental procedures:

• electromyography (study of bioelectrical activity processes in muscles);
• electroencephalography (examination of the brain for electrical activity);
• MRI and CT.

The formulation of the diagnosis is regulated by ICD-10. If parkinsonism is detected in the patient's medical history, either “Diseases of the nervous system” is recorded, or a more detailed transcript is given, which indicates the form, the involvement of the left or right extremities is noted, and the rate of progression of the disease and the degree of severity are indicated.

The neurological status of Parkinson's Disease is also described, which notes whether the patient has a clear consciousness and how well he orients himself in space and time, and whether he requires outside help for normal functioning.

Manifestations of Parkinson's disease according to ICD-10

In addition to the most striking symptoms - “parkinsonism”, the disease also manifests itself in other neurological problems. Outwardly, they look very specific, so the late stage can be noticed even by an unprofessional eye. The patient shows little facial expression, rarely blinks, and speaks quietly and monotonously. Movements become slow, even inhibited. At first, it becomes difficult for the patient to walk and turn around, then fine motor skills of the hands suffer.

The whole posture of a person becomes more “senile” - the back is hunched, the legs shuffle when walking, and the hands cease to help in maintaining balance. Tremors gradually appear - first in the hands, and then in the head. It disappears only in a situation when a person completely relaxes, which means in a dream. Ultimately, the patient becomes disabled, and in addition to physical defects, mental defects also appear. According to ICD-10, Parkinson’s disease is almost always accompanied by dementia, so leaving a patient in the later stages unattended becomes dangerous.

Stages of Parkinson's disease according to ICD-10

Most doctors use the classification of Margaret Hoehn and Melvin Yahr.
It includes 5 main stages and two intermediate ones. They are presented in the table. Classification of Parkinson's disease

Treatment of Parkinson's disease according to ICD-10

To eliminate the symptoms of the disease, strong medications are required, and they often themselves lead to unwanted severe side effects. The list of essential drugs in ICD-10 includes:

1. Azilect – prevents the destruction of dopamine. Used in the first stages of the disease.
2. Mendylex is an anticholinergic drug that can somewhat reduce parkinsonism.
3. Midantan or PC-merz - increase the release of dopamine.
4. Mirapex – stimulates the release of dopamine.
5. Nakom or Tremonorm - relieve parkinsonism for a long time, compared to other substances.
6. Pantogam or pantocalcim - stimulate mental activity.
7. Parkon - stimulates the activity of certain brain structures.

All of these drugs require medical prescription and supervision. They can be dangerous even for a healthy person.

Parkinson's disease is defined in ICD 10 as a severe disorder, and without medical help, degeneration occurs quite quickly, which means a person risks becoming disabled in a matter of months. On the other hand, proper care and timely medical assistance make it possible to live normally for many years, although it will not be possible to completely stop the development of the disease.

Parkinson's disease according to ICD-10 and its features

In the classifier, the ICD code for Parkinson's disease is designated as Class VI G20. This class is assigned to all diseases of the nervous system, that is, the disease is based on neurological problems. To be more precise, the disorder manifests itself due to the primary damage to a group of neurons whose main function is the production of dopamine.

It is generally accepted that this hormone is responsible for the formation of feelings of love, affection, and other positive emotions, but in fact it also plays an extremely important role in human cognitive activity, and it is this aspect that suffers the most in Parkinson’s disease. A person becomes inert, his mental processes slow down significantly, and perseverations appear in consciousness and speech.

The letter G in ICD-10 is assigned to extrapyramidal and other movement disorders. Parkinson's disease according to ICD-10 causes motor disorders specifically in the extrapyramidal structures of the brain. Its main symptoms are:

1. Muscle rigidity - they become as if “hard”, difficult to control.
2. Limitation of movements - the little activity that remains in the patient has a very slow pace.
3. Involuntary movements in the form of hand tremors.
4. Unstable position of the body, and we are talking not only about the limbs, the patient’s head is also positioned incorrectly in relation to them.

Important: All of the above symptoms do not appear all at once, but gradually, constantly worsening the patient’s life. That is why the disease in ICD-10 is classified as degenerative.

Parkinson's disease code according to ICD 10 also contains a digital designation - 20. This makes it possible to distinguish this disorder from many others with similar symptoms and causes, but still having its own characteristics.

Other codes in the ICD-10 classification

The symptoms of Parkinson's disease are so specific that over time they have a single definition - “parkinsonism”.
Although most often a complex of problems indicates the development of Parkinson's disease, there are also other neurological diseases that are characterized by the manifestation of the same group of symptoms. They are divided into separate groups in the structure of ICD-10. Pathology similar to Parkinson's disease

Important: Parkinson's disease is several times more common than any of the disorders presented above, so it is the first thing to rule out when symptoms appear.

ICD code for Parkinson's syndrome

Parkinson's disease in ICD-10 is often confused with other complex disorders that have a similar name, but are fundamentally different in etiology, symptoms and treatment methods. One of these errors is Parkinson's syndrome ICD 10.

It should be remembered that a neurological degenerative disease manifested by parkinsonism is never called a syndrome by medical professionals. At their core, all syndromes are only a collection of symptoms with a common basis, while diseases are a general condition of the body that interferes with normal life and activity.

Wolff Parkinson White syndrome ICD 10 is a congenital cardiac anomaly manifested mainly by arrhythmia and tachyarrhythmia. In the structure of the classifier, it is included in another class and group. The ICD 10 code for Parkinson's syndrome is Class IX I45.6. This means that the disorder is included in the class of circulatory diseases. Its official name in the ICD-10 system is preexcitation syndrome. It is characteristic of several severe heart diseases, including:

1. Ebstein's anomalies.
2. Some types of cardiomyopathies.
3. Mitral valve prolapse and others.

Naturally, the treatment of such a lesion requires a different approach, special medications that have nothing to do with relieving the symptoms of Parkinson’s disease.

Treatment for men, women and children

The only relatively effective treatment for Parkinson's disease today remains conservative drug therapy.

Dopamine receptor agonist drugs are used. These are medications based on rotigotine, ropinirole, pramipexole or piribedil.

Rasagiline-based MAO inhibitors are also used. These drugs are effective in the early stages of pathology development. Starting from the third stage, drugs with levodopa are more effective, but such drugs still remain more symptomatic than therapeutic.

An addition to conservative therapy can be traditional medicine, the action of which is aimed at stabilizing brain and muscle activity. These are various herbal decoctions and infusions in different combinations.

Experts are neutral about such drugs: such methods do not have harmful effects, but are ineffective as a symptomatic treatment, although in some cases they can stop the signs of parkinsonism.

Parkinson's disease

Treatment options for Parkinson's disease differ significantly in the early and late stages of the disease, so they should be considered separately.

Treatment of Parkinson's disease in the early stages.

An early diagnosis of Parkinson's disease does not always mean immediate initiation of any drug therapy. To determine the timing of the start of drug treatment, it is necessary to take into account the severity of the disease, the duration of the disease, the rate of its progression, any concomitant diseases, as well as “personal factors” (professional, social and family status of the patient, mental state, personality characteristics, etc.). The goal of such therapy is restoration (sufficient regression) of impaired functions using the lowest possible doses.

Drug therapy in the early stages of Parkinson's disease involves the use of drugs that increase the synthesis of dopamine in the brain, stimulate its release and block its reuptake, inhibit the breakdown of dopamine, stimulate dopamine receptors and prevent the death of neurons. Such drugs include amantadine, selective MAO-B inhibitors (selegiline, etc.), dopamine receptor agonists (piribedil, pramipexole, etc.). The above drugs can be used both as monotherapy (more often) and in various combinations.

The above drugs are significantly inferior in effectiveness to levodopa drugs, but they are quite suitable for the treatment of Parkinson's disease in the early stages. Theoretically, in the early stages of Parkinson's disease, dopamine receptor agonists can delay the initiation of levodopa, and in later stages, reduce its dose. However, a large number of side effects (gastric ulcer, orthostatic hypotension, mental disorders, erythromelalgia, retroperitoneal fibrosis, etc.) and the ability to reduce the sensitivity of postsynaptic dopamine receptors do not speak in their favor.

There are no clear criteria determining the optimal time to start treatment with levodopa. However, one should take into account the patient’s age (if possible after 60-70 years), avoid early prescription of levodopa, and when selecting a dose, focus on the patient’s “responsiveness” to the drug, improvements in his professional and social activities.

Treatment of Parkinson's disease in advanced stages.

Regardless of the nature of the course of Parkinson's disease, a gradual transformation of the clinical picture of the disease necessarily occurs. Over time, existing disorders progress and new ones appear, most of which are difficult to treat, thereby exerting a strong stressor effect on the patient. In addition, the usual effect of levodopa changes - the effectiveness of the drug decreases, drug-induced dyskinesias increase (as a result of hypersensitivity of dopamine receptors).

A decrease in the effectiveness of therapy is manifested by a decrease in the duration of the therapeutic effect of each levodopa vine. An “on-off” phenomenon is formed, the only way to combat which is to gradually increase the dose of levodopa, and this in turn starts a vicious circle that gives rise to new problems, which become increasingly difficult to combat. Real help in this case can be provided in two ways: by prescribing an additional dose of levodopa in order to reduce the intervals between doses; adding a COMT inhibitor to the treatment regimen and transferring the patient to therapy with a combination drug of levodopa and entacapone.

Side effects of levodopa therapy. One of the manifestations of a decrease in the threshold of sensitivity to certain side effects is the tendency to the appearance of oral (or other) hyperkinesis against the background of symptoms of hyperkinesia. Thus, the clinical picture of Parkinson's disease paradoxically combines symptoms of dopamine excess (oral hyperkinesis) and its deficiency (hypokinesia). Reducing the dose of levodopa in such a situation provides only a temporary elimination of hyperkinesis; after a while it appears again. Orthostatic hypotension in Parkinson's disease is usually manifested by a relatively sharp decrease in blood pressure shortly after taking levodopa. Both levodopa and dopamine receptor agonists have this side effect, so after determining the cause of the side effect, it is necessary to reduce the dose of the appropriate drug.

Mental disorders in Parkinson's disease can manifest themselves in the form of depression, anxiety, apathy, visual hallucinations, and agitation. In addition, the appearance of memorable, vivid dreams is typical. Over time, all of the above disorders progress and sooner or later appear in the waking state. Treatment of such mental disorders must be carried out together with a psychiatrist. Sometimes it is enough to relieve the patient of anxiety and fear, since it is they that provoke more severe mental disorders. Most drug-induced dyskinesias occur at the peak of the drug's effect. The most reliable way to eliminate them is to reduce the single dose of levodopa while maintaining the daily dose of the drug. Therefore, split doses of levodopa are the best way to prevent this type of dyskinesia.

In end-stage Parkinson's disease, the main difficulties are associated with cachexia, loss of the ability to stand, walk and self-care. At this time, it is necessary to carry out a whole range of rehabilitation measures aimed at providing optimal conditions for the patient’s daily activities. It should be remembered that in the later stages, Parkinson's disease becomes a heavy burden not only for the patient himself, but also for his family, whose members may require not only therapeutic, but sometimes specialized help.

Surgical treatment of Parkinson's disease involves stereotactic destruction of the ventrolateral nucleus of the thalamus and subthalamic nucleus, as well as deep brain stimulation. In cases of severe akinetic-rigid syndrome, pallidotomy is recommended, as well as deep electrical stimulation of the globus pallidus and subthalamic nucleus.