Závratě a poruchy rovnováhy

doc. MUDr. Jaroslav Jeřábek, CSc.

Neurol. praxi. 2025;26(4):267

The evolution of the sense of balance throughout the animal kingdom - from protozoans to humans

MUDr. Rudolf Černý, CSc.

Neurol. praxi. 2025;26(4):276-279 | DOI: 10.36290/neu.2025.039

This paper provides a brief overview of the phylogenetic evolution of the vestibular labyrinth in multicellular animals. The presence of a sense of balance in the evolutionary lineage from the simplest animals to humans underscores the biological importance of the vestibular system for organismal survival. During evolution, several parallel solutions to the sense of balance have emerged that use the same physical principles. Article focuses on the picture of the evolutionary relationships between the prehistoric ancestors of modern humans.

Acute dizziness and balance disorders: an imaging perspective

MUDr. Lukáš Martinkovič

Neurol. praxi. 2025;26(4):280-284 | DOI: 10.36290/neu.2025.035

Vertigo and balance disorders are among the common patients complaints in emergency rooms. Up to 15 % of them are potentially life-threatening, especially based on cardio/cerebro-vascular events. The use of imaging methods is widely used, but their yield in the acute phase is still low. Noncontrast brain CT in patients with symptoms from posterior fossa shows acute ischemia in only a few percent of cases, more accurate MRI is in the first 48 hours falsely negative in up to 20 % of cases. Careful history taking and performing a basic vestibular examination (HINTS+, STANDING protocol) leads to a reliable distinction between central and peripheral etiology....

Bilateral vestibulopathy

MUDr. Michaela Kuzmiak, Ph.D.

Neurol. praxi. 2025;26(4):286-291 | DOI: 10.36290/neu.2025.028

Bilateral vestibulopathy is defined as a dysfunction of both vestibular labyrinths or vestibular nerves simultaneously. It is mainly manifested by stance and gait instabi­lity, typically worse in the dark or on uneven surfaces, and blurring of vision when moving. Patients do not have difficulties under static conditions. A clinically essential examination is the head impulse test. Quantification of bilateral impairment of vestibular function using calorization, sinusoidal stimulation, or video Head Impulse testing is required to confirm the diagnosis. The most common causes include the use of vestibulotoxic drugs, bilateral Menière's disease,...

Benign paroxysmal positional vertigo in the elderly

doc. PhDr. Ondřej Čakrt, Ph.D., Mgr. Klára Kučerová, Ph.D.

Neurol. praxi. 2025;26(4):293-296 | DOI: 10.36290/neu.2025.033

Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder and its incidence increases significantly with age. In the elderly, BPPV often manifests differently than in younger patients - rather than the typical positional vertigo, a feeling of uncertainty and postural instability dominates, often leading to misdiagnosis and delayed treatment. The basis of treatment is repositioning manoeuvres, which have a success rate of up to 80 % when performed correctly, but in the elderly it is often necessary to modify them due to associated limitations and to take into account the occurrence of residual instability. In practice, the main...

Cervical vertigo

doc. MUDr. Jaroslav Jeřábek, CSc.

Neurol. praxi. 2025;26(4):297-301 | DOI: 10.36290/neu.2025.037

Cervical vertigo is an overused diagnosis. We do not have a clearly defined clinical test on which to base positive diagnostic criteria. It is always a diagnosis of exclusion, after ruling out peripheral or central vestibular pathology in other diseases. Cervical vertigo can be considered if the following are present: "Neck stiffness and pain that worsens with neck movement. Transient instability, presyncopal states, illusions of movement induced by cervical spine movement. Cervical spine therapy relieves symptoms. The absence of neck pain excludes this diagnosis, as do spontaneously occurring vertigo symptoms."

Gene thepapy of (selected) neurological diseases

doc. MUDr. Jana Haberlová, Ph.D., prof. MUDr. Tomáš Honzík, Ph.D., prof. MUDr. Přemysl Jiruška, Ph.D.

Neurol. praxi. 2025;26(4):302-309 | DOI: 10.36290/neu.2025.004

According to the definition of the European Medicines Agency, gene therapy is a treatment based on the insertion of a recombinant gene into a patient's body for therapeutic, prophylactic, or diagnostic purposes. In recent years, there has been a growing number of clinical studies as well as an increasing number of approved gene therapies, particularly for rare monogenic diseases. The first examples in the field of neurology include gene therapy for spinal muscular atrophy, gene therapy for primary disorders of biogenic amine synthesis (aromatic L-amino acid decarboxylase [AADC] deficiency), and gene therapy for metachromatic leukodystrophy. In the...

The role of gut dysbiosis in the pathogenesis of neurodegenerative diseases

Petr Roudenský, MSc., MSc.

Neurol. praxi. 2025;26(4):312-317 | DOI: 10.36290/neu.2025.036

The gut microbiome plays a crucial role in the regulation of the central nervous system through the gut-brain axis, and especially in the last decade, new findings have emerged suggesting a key role of its imbalance - dysbiosis - in the pathogenesis of a number of neurodegenerative diseases, particularly Alzheimer's disease, Parkinson's disease and amyotrophic lateral sclerosis. Underlying mechanisms include increased intestinal permeability, neuroinflammation, microbiota metabolites and disruption of neurotransmitter signalling. Experimental studies suggest that modulation of the gut microbiome, for example through fecal microbial transplantation,...

Patients with myasthenia gravis as seen by a urologist

MUDr. Eva Burešová, Ph.D.

Neurol. praxi. 2025;26(4):320-323 | DOI: 10.36290/neu.2025.003

Myasthenia gravis is a neurological autoimmune disease characterized by muscle fatigue. There are two clinical forms: ocular and generalized. The disease should be both diagnosed and treated in myasthenia centres. Myasthenia patients tend to have urinary tract symptoms; therefore, for a urologist, it is important to recognize the symptoms of myasthenia gravis that has not yet been diagnosed. In the treatment of urological diseases in these patients, avoid medication that is contraindicated and/or could lead to worsening of myasthenia symptoms.

Therapy of tremor

prof. MUDr. Evžen Růžička, DrSc.

Neurol. praxi. 2025;26(4):324-330 | DOI: 10.36290/neu.2025.057

Tremor is the most common type of movement disorder, and its precise syndromological classification is essential for effective therapy. This review summarizes current treatment options for the major clinical tremor syndromes, particularly essential tremor, Parkinsonian tremor, dystonic tremor, and functional tremor, as well as less frequent causes including Wilson's disease and multiple sclerosis. Special attention is given to symptomatic pharmacotherapy, with propranolol and primidone remaining the mainstays of treatment for essential tremor, including considerations of dosage, efficacy, and potential risks. The article also discusses alternative...

Tailored MS care: ocrelizumab among the pioneers of exposure-based treatment?

MUDr. Dominika Šťastná, Ph.D.

Neurol. praxi. 2025;26(4):332-336 | DOI: 10.36290/neu.2025.059

Multiple sclerosis treatment has advanced rapidly in recent years. One of the emerging trends is the individualisation of exposure to disease-modifying therapies. Available evidence indicates that patients with higher ocrelizumab exposure have a lower risk of confirmed disability progression compared to those with lower exposure. At the same time, it has been observed that in clinically stable patients, individually extended dosing intervals may help reduce the risk of adverse events and overall treatment burden. Personalised dosing thus appears to be a promising strategy for improving long-term outcomes. However, this approach requires careful monitoring...

What options do anti-seizure medications provide us today?

MUDr. Dana Vyskočilová

Neurol. praxi. 2025;26(4):338-341 | DOI: 10.36290/neu.2025.061

Cenobamate (CNB) is a third generation anti-seizure medication with a dual mechanism of action indicated for the adjunctive treatment of focal-onset seizures in adult patients with epilepsyinadequately controlled despite prior treatment with at least two anti-seizure drugs. In therapeutic doses, it most likely acts through positive allosteric modulation of γ-aminobutyric acid type A (GABAA) receptors at the non-benzodiazepine binding site, as well as preferential inhibition of persistent sodium currents and enhancement of the deactivated state of voltagegated sodium channels. Numerous clinical experiences with cenobamate testify to its high e...

Komentář k článku Richarda B. Liptona: Situational prevention: Pharmacotherapy during periods of increased risk for migraine attacks

MUDr. Rudolf Kotas, Ph.D.

Neurol. praxi. 2025;26(4):342-344

Hereditary spastic paraplegia type 6 (SPG6) with phenotypic conversion to ALS

MUDr. Pavlína Malá, MUDr. Hana Matulová, MUDr. Olga Hübschová, prof. MUDr. Robert Rusina, Ph.D., MUDr. Pavel Kunc, Ph.D., MUDr. David Matyáš

Neurol. praxi. 2025;26(4):345-349 | DOI: 10.36290/neu.2025.047

Hereditary spastic paraplegias (HSP) are a group of genetic disorders causing central motor neuron degeneration, while amyotrophic lateral sclerosis (ALS) affects both central and peripheral motor neurons, progressing more rapidly with a poorer prognosis. In this study, we present a case of spastic paraplegia type 6 (SPG6), a rare form of HSP caused by mutations in the NIPA1 gene, that progressed to ALS. Similar phenotypic conversions have also been reported in other HSP types, such as SPG5 and SPG18. This case suggests that there may be a pathophysiological link between these two disorders, but its mechanisms remain unclear and warrant further...

Hypomagnezemie jako nejčastější nediagnostikovaná iontová nerovnováha v klinické praxi a jak ji řešit

MUDr. Jiří Havel, MSc.

Neurol. praxi. 2025;26(4):350-354