Epilepsia parcial motora (vascular + contexto parkinsonismo prováve)

"Uma doente esteve internada na medicina e teve alta com um diagnóstico secundário de epilepsia parcial motora (vascular + contexto parkinsonismo provável) – como codificar? G40.009?"

(Responde Fernando Lopes)
 
 
Como não existe uma entrada no índice alfabético para a epilepsia parcial motora temos de percorrer a lista tabular à procura do código mais adequado.
 
Os códigos possíveis para a epilepsia parcial, na ICD-10-CM são G40.1- e G40.2-
O primeiro refere-se a epilepsia com crises parciais simples e o segundo a crises parciais complexas.

"Simple partial seizures (SPS) are defined as those that are not associated with any alteration of consciousness. Although the ability to respond may be preserved, motor manifestations or anxiety relating to the seizure symptoms may prevent a patient from responding appropriately." (Medscape: Simple Partial Seizures).

"A seizure that starts in one area of the brain and the person remains alert and able to interact is called a focal onset aware seizure.
This term replaces simple partial seizure.
These seizures are brief, lasting seconds to less than 2 minutes.
Many treatment options are available, including medications, dietary therapy, surgery, and devices. (Epilepsy Foundation)
 
"A complex partial seizure, now known as a focal impaired awareness seizure according to the updated classification system from the International League Against Epilepsy (ILAE), starts focally within the brain and causes impairment of consciousness. In most patients, focal impaired awareness seizures represent underlying temporal lobe epilepsy" (Medscape: Cpmplex Partial Seizures).
 
"Impairment of consciousness may be severe, moderate, mild or inconspicuous. This is often associated with motor manifestations, automatisms and autonomic disturbances. Clonic, tonic and atonic components alone or in combination are motor symptoms; myoclonia, mainly of facial muscles, is the most common". (Typical Absence Seizures and Related Epileptic Syndromes).
 
Assim, se as manifestações motoras estão associadas às alterações da consciência, e estas existem nas convulsões complexas, então a epilepsia parcial motora enquadra-se nas convulsões parciais complexas e, por isso, em G40.2-. E dentro desta subcategoria, não existindo menção de epilepsia intratável, o código a selecionar será:
 
G40.209 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromeswith complex partial seizures, not intractable, without status epilepticus
Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes withcomplex partial seizures NOS
 
As entradas para chegar a este código são as seguintes:
 
Epilepsy, epileptic, epilepsia (attack) (cerebral) (convulsion) (fit) (seizure)
- localization-related (focal) (partial)
- - symptomatic
- - - with complex partial seizures G40.209
 
 
Fernando Lope