Creutzfeldt-Jakob disease (CJD) is an irreversibly fatal disease caused by a pathologically conformed prion protein. Although it can also occur at a younger age, it is found in a surprisingly high percentage in all age groups in comorbidity with other neuropathological entities. In many cases, the comorbidities can change the typical clinical symptomatology of patients and thus significantly complicate clinical diagnosis. We present the case report of a 75-year-old female patient, in whom definitive neuropathological examination revealed a combination of sporadic Creutzfeldt-Jakob disease, fully developed dementia with Lewy bodies, fully developed Alzheimer's disease, frontotemporal lobar degeneration with predominance of features of age-related astrogliopathy, and relatively advanced vascular dementia. Although comorbidities of other neurodegenerative diseases are common in CJD, in this case it was a very unusual combination of multiple developed neurodegenerations.

A fixed combination of paracetamol and tramadol per tablet enhances analgesic efficacy and reduces side effects of the individual components. This expands the portfolio of analgesics to treat acute and chronic pain, especially in elderly and at-risk patients. The article concludes by describing the practical use of analgesics in the treatment of back pain.

Pharmacological treatment of epilepsy is more and more complex, requiring comprehensive knowledge and clinical experience. Up to one-quarter of people with epilepsy take more than one antiseizure medication, and they have frequent comorbidities, as well as acute or chronic intercurrent diseases requiring the administration of other drugs. Pharmacokinetic and pharmacodynamic drug interactions are usually well described and information about them is easy to find. We know less about drugs' active influx/efflux transport both during their absorption from the gastrointestinal tract and their transfer across the blood-brain barrier. When choosing a combination(s) of antiseizure medication and/or drugs for other indications, the neurologist needs to know whether a clinically significant interaction can occur between them, what its mechanism and manifestations are, how high the probability of its occurrence and how severe it will be.

Myasthenia gravis is a chronic autoimmune disorder affecting neuromuscular transmission, leading to increased muscle fatigability and weakness. In recent years, treatment options have expanded significantly, increasing the need for standardized patient monitoring. The range of available objective assessments and patient-reported outcome measures is quite wide. However, in clinical practice and research, the following four basic ones are recommended: MGFA classification, QMG score, and subjective tools such as MG-ADL and MG-QoL-15r. The key is the assessment of the treatment response by the patient himself, which is why the PASS is considered as the fifth tool. The combination of subjective and objective methods allows for effective disease monitoring and optimization of therapy.

Autoimmune encephalitides (AIE) are autoimmune diseases of the central nervous system with predominant involvement of the cerebral cortex. The prevalence of AIE is comparable to that of encephalitis of infectious etiology. They can occur as paraneoplastic syndromes (in which the abnormal immune response is triggered by the presence of a peripheral tumor) or as non-paraneoplastic syndromes (where a combination of a viral trigger and an innate disposition seems to play a role). The most common AIEs include encephalitis with antibodies to glutamate N-methyl-D-aspartate receptors (NMDAR encephalitis), limbic encephalitis with antibodies to leucine-rich glioma inactivated protein 1 (LGI1 encephalitis) and syndromes formerly referred to as "classic paraneoplastic" - in today's terminology "high-risk phenotypes". These include limbic encephalitis with anti-Hu and anti-CV2 positivity, rapidly progressive cerebellar syndrome (usually associated with anti-Yo antibodies) and stiff-person syndrome (including its variants). In recent years, several new phenotypes have been described that deserve attention, such as anti-GFAP syndrome, anti-GABAA receptor encephalitis (relevant in the context of new-onset refractory status epilepticus - NORSE) and syndrome with anti-IgLON5 antibodies. This article provides a basic overview of current information regarding AIE.

Serotonin syndrome is a potentially life-threatening drug-induced toxidrome associated with increased serotonergic activity in both the peripheral and central nervous systems. It is characterized by a broad spectrum of clinical findings, which include mental state changes, autonomic instability, and hyperexcitability of CNS with neuromuscular abnormalities. Serotonin syndrome can arise usually by simultaneous administrations of 2 or more serotoninergic drugs, the combination including monoamine oxidase inhibitors is especially dangerous, but occurrence in monotherapy is also possible. This review describes pathophysiology and clinical manifestation of this syndrome and the drugs at risk, with a particular focus on drugs used in the treatment of chronic pain.

In the following review article, we introduce fenfluramine - an "old-new" drug, used in the past for the treatment of obesity and now relatively newly registered in the European Union, the USA and the UK as an orphan drug for the therapy of epileptic seizures associated with Dravet and Lennox-Gastaut syndrome, i.e. with severe and generally ultrarefractory epileptic encephalopathies. The mechanism of action of fenfluramine is based on interaction with serotoninergic and sigma-1 receptors, which, in addition to reducing seizure activity, promises to patients cognitive, emotional, and behavioral benefits. Efficacy and a safety profile have been proved in four randomized phase III trials and subsequently confirmed in two follow-up open-label studies.

Brain tuberculomas and tuberculous abscesses are rare focal manifestations of central nervous system tuberculosis. Their clinical and morphological presentation may mimic brain tumors or bacterial abscesses, and therefore be a source of diagnostic ambiguity. The goal of our presentation is to demonstrate two case reports of patients with a solitary lesion of tuberculous origin, and related diagnostic pitfalls. Despite the decrease in tuberculosis incidence in the Czech Republic, it is obvious that physicians may continue to encounter patients with immunosuppressive therapy and migrants from endemic regions. Regarding their relatively favorable therapeutic outcome, focal tuberculous lesions should be considered in the differential diagnosis of intracerebral expansions.

Sleep is a basic human need, almost half of the human population suffers from its disorder. Headache is one of the most common health problems. According to the WHO, 50-75 % of adults suffer from it. Both of these phenomena have the character of a global health burden. The relationship between headache and sleep disorder is multifaceted and complex, the comorbidity of these two syndromes leads to the chronification of both diseases, increases the burden and leads to the worsening of both disorders, a decrease in the quality of life, an increase in the frequency of complications and a decrease in the effectiveness of treatment.

The association of headaches and multiple sclerosis (MS) has been found in the last years in more studies. Most of them are of migrainous type. The prevalence of migraine in MS patients is significantly higher (46%) than in general population (10-15%). This association is considered in clinical practice usually as a comorbidity of two independent diseases. Some facts however indicate, that headaches, especially of migrainous type, could be also the symptom of MS. Then they would belong to the secondary headaches. The headache occurs with increased frequency especially in the initial stage of MS. A prospective multicenter study has revealed the occurrence of headache in 78% of patients with clinically isolated syndrome (CIS) or early MS. Most often patients suffered from throbbing and pulsating headaches of migrainous type. The headache is also in half of cases the cause of brain MRI (magnetic resonance imaging) performance in radiologically isolated syndrome(RIS). This high frequency raises the question, whether it is really a comorbidity of two independent diseases or whether the headache could be also a primary syndrome of MS. Clinically and therapeutically this is very important, as presence of headache alone would allow the classification as CIS instead of RIS and to treat the patients accordingly with immunomodulatory therapy. In addition nowadays the question is being discussed, whether to treat already in the stage of RIS.

Multiple sclerosis is the most common acquired chronic inflammatory demyelinating disease of the central nervous system. The diffferential diagnosis of multiple sclerosis includes acute disseminated encephalomyelitis, which is a monophasic autoimmune demyelinating disease. Clinically, acute disseminated encephalomyelitis is manifested by encephalopathy and multifocal involvement. In addition to clinical findings, magnetic resonance imaging and cerebrospinal fluid examination can hepl us to differentiate these two entities. This case report describes a rare variant of tumefactive multiple sclerosis, which was initially presented with epileptic seizure and encephalopathy.

Ravulizumab is a humanized monoclonal antibody targeting the complement C5 protein. This drug has been approved by different regulatory agencies worldwide for the treatment of AQP-4 seropositive NMOSD based on the results of the CHAMPION-NMOSD trial. Similar to eculizumab, ravulizumab offers highly effective prevention of NMOSD relapses. Both molecules demonstrated more than 90% reduction in relapse risk compared to the placebo group. Ravulizumab has a longer half-life allowing extending interval dosing from two to eight weeks compared to eculizumab. Patients taking C5 complement inhibitors have an increased risk of serious meningococcal infections, therefore vaccination is mandatory before treatment initiation.

Laboratory biomarkers play a crucial role in the diagnosis, prediction, and monitoring of treatment efficacy in patients with multiple sclerosis (MS). Their use enables better individualization of therapy, increasing the chances of slowing disease progression and improving patients' quality of life. The most important diagnostic laboratory biomarkers in MS are oligoclonal IgG bands and free kappa light chains, while neurofilament light chains are essential for disease prediction and monitoring treatment efficacy. Research in this area is continuously evolving with the aim of discovering new indicators that further improve diagnostic accuracy and enable more detailed monitoring of disease progression.

From a speech therapist's perspective, multiple sclerosis causes speech (dysarthria), voice (dysphonia), and language difficulties. Currently, automated analysis is increasingly used to assess voice, speech, and language deficits, as it is much more accurate than perceptual assessment or standard tests. Acoustic analysis can be used to detect features that might be potential biomarkers for the early detection of multiple sclerosis or indicators of the severity of the disease. The aim of this paper is to present speech and language deficits in people with multiple sclerosis, outline the possibilities for their assessment using available tools with automated speech analysis, and present digital biomarkers at the voice, speech, and language level.

Rare diseases represent a broad and heterogeneous group of disorders that are predominantly genetically determined. Currently, more than six thousand clinical entities have been identified, which collectively affect approximately 68% of the global population and pose a significant healthcare and socioeconomic burden. Major advances in molecular genetics, particularly the introduction of whole-exome and whole-genome sequencing, have markedly shortened the time to diagnosis and enabled the discovery of new genetic causes of disease. Nevertheless, approximately half of all patients remain without a causal diagnosis. At present, targeted causal therapy is available for only a small proportion of these disorders, highlighting the need for continued research and innovation in the field of precision medicine. This article focuses on an overview of current diagnostic and therapeutic approaches and on the perspectives offered by emerging genomic technologies and targeted treatment strategies.

This review summarizes current options for both disease-modifying and symptomatic treatment of degenerative cerebellar ataxias, with a particular focus on two conditions that are significantly reshaping everyday neurological practice: Friedreich's ataxia (FA), with the recent availability of the targeted therapy omaveloxolone, and spinocerebellar ataxia type 27B (SCA27B), for which accumulating evidence supports the efficacy of 4-aminopyridine (4-AP).

The article introduces the options of rehabilitation interventions that can be used to restore function and fitness after Covid-19 disease in patients with a chronic neurological disease - multiple sclerosis. Two individual case reports of patients are included to discuss the use of respiratory physiotherapy as well as the issue of restoring mobility and increasing fitness in post-Covid-19 patients.

Coincidence of ischemic stroke and acute myocardial infarction is not common, but neither it is rare. We present two case reports of patients admitted to hospital for ischemic stroke who have developed acute myocardial infarction with different final outcomes. A 66-year-old woman was admitted to the hospital for symptoms of stroke in the form of severe monoparesis of left upper limb, central left facial nerve paresis, and dysarthria. There was a gradual improvement in the patient's condition after intravenous thrombolysis was administered. The next day, the patient developed stenocardia, sweating, hypotension, and bradycardia and was diagnosed with an acute anterior wall myocardial infarction. Following percutaneous coronary intervention, the patient's symptoms completely regressed. After a total seven-day hospitalization, the patient was released with a mild residual paresis of two fingers of left upper limb without any heart problems. A 69-year-old man was admitted to hospital for symptoms of stroke in the form of somnolence, left-sided hemiplegia and hemihypesthesia, central paresis of the left facial nerve, paresis of the gaze left, neglect of the left-sided syndrome and severe dysarthria. Following intravenous thrombolysis and mechanical thrombectomy, the patient gradually improved. The next day, the patient developed epigastric pain and was diagnosed with acute myocardial infarction of the lower wall. After percutaneous coronary intervention, the patient's problems were partially regressed. Two days after the cardiac intervention, the patient went into sudden cardiac arrest with unsuccessful cardiopulmonary resuscitation. Acute myocardial infarction complicating ischemic stroke causes increase in patients` morbidity and mortality despite adequate and timely diagnosis and therapy.

Congenital and developmental disorders of the spine and spinal cord in the lumbosacral region in childhood are affections divided into two main groups - spina bifida aperta and spina bifida occulta. These dysrapisms in many cases significantly affect the motor and sensitive functions of the lower limbs, deterioration of urine and faeces. We present the most frequent clinical units, their diagnosis and treatment.