Bilateral vestibulopathyMain topic

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,...

Acute dizziness and balance disorders: an imaging perspectiveMain topic

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....

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

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.

Závratě a poruchy rovnováhyEditorial

doc. MUDr. Jaroslav Jeřábek, CSc.

Neurol. praxi. 2025;26(4):267  

Skleróza multiplex – imunodeplécia a imunorekonštrukčná liečbaEditorial

prof. MUDr. Jarmila Szilasiová, PhD.

Neurol. praxi. 2025;26(3):179  

Léčba hypomagnezemie jako možné příčiny některých symptomů neurologických poruchCompany information

MUDr. Jiří Havel, MSc.

Neurol. praxi. 2025;26(3):258-262  

Even extraordinary things could be ordinary: a case report of atypical neurodegeneration due to vascular and malnutrition componentsCase report

MUDr. Matyáš Sýkora, RNDr. Eva Parobková, Ph.D., prof. MUDr. Robert Rusina, Ph.D., prof. MUDr. Radoslav Matěj, Ph.D.

Neurol. praxi. 2025;26(3):253-257 | DOI: 10.36290/neu.2025.020  

Establishing the correct clinical diagnosis of neurodegenerative diseases can be a real challenge, particularly in rare forms with a complex clinical presentation. In such cases, neuropathological examination may reveal unexpected findings. In our case study, we observed a patient in the preterminal stage of a neurodegenerative disease that initially mimicked acute brainstem stroke, followed by hypoactive delirium, and finally frontotemporal lobar degeneration (FTLD). Neuropathological and immunohistochemical examination after autopsy revealed combined toxic-metabolic and vascular damage (chronic Wernicke's encephalopathy and angiosclerotic encephalopathy)...

How the patient and her neurologists managet to win the fight against the chronic form of cluster headache - a case reportTrends in neuropharmacotherapy

MUDr. Evgeni Kavrakov

Neurol. praxi. 2025;26(3):249-252 | DOI: 10.36290/neu.2025.008  

This case report describes a rare disease - the chronic form of cluster headache. Here a female patient with this severe neurological disorder is discussed. The difficulties in understanding the pathogenesis of cluster headache in general are noted. Our patient tried different types of "classical" treatment but none of those led to a sufficient effect and her quality of life was very low for a long period of time. Lithium therapy also did not help. Later, galcanezumab was prescribed in our outpatient clinic, which led to a significant decrease in headache frequency and headache intensity. Our patient also suffered from symptoms of depression, which...

Can I drive a truck? - very late-onset Friedreich's ataxiaTrends in neuropharmacotherapy

MUDr. Kristýna Janotová, MUDr. Zdeněk Kunáš, doc. MUDr. Svatopluk Ostrý, Ph.D.

Neurol. praxi. 2025;26(3):244-248 | DOI: 10.36290/neu.2025.048  

Friedreich's Ataxia (FA) is a rare, genetically inherited multisystem disorder that ranks among the most common hereditary ataxias. The initial symptoms typically manifest during adolescence, and within approximately ten years, the disease often leads to fatal disability. However, this case report discusses a rare atypical form with late onset in adulthood. Diagnosing late-onset forms is particularly challenging due to their more variable phenotypic presentation and slower progression compared to the classic form. Accurate diagnosis of FA in patients with chronic ataxic symptoms has gained renewed importance, especially in light of the first approved...

Anxiety disorders in epilepsyFrom the boundary of neurology

MUDr. Dominika Jarčušková, PhD., MUDr. Aneta Bednářová, PhD.

Neurol. praxi. 2025;26(3):240-243 | DOI: 10.36290/neu.2024.061  

Psychiatric comorbidities of epilepsy, including anxiety disorders, have a high prevalence and massive impact on the daily lives of patients. These disorders manifest through emotional and physical changes and can influence patients' cognitive skills. They have a bidirectional relationship with epilepsy, caused by similar neurobiological correlates of both disorders. Their treatment is based on combining changes in patients' daily life, pharmacotherapy, and psychotherapy. This paper aims to review anxiety disorders in patients with epilepsy, discussing their prevalence, neurobiological correlates, their influence on the quality of life in patients,...

Nutrition in acute neurological conditionsFrom the boundary of neurology

MUDr. Michal Šenkyřík

Neurol. praxi. 2025;26(3):234-238 | DOI: 10.36290/neu.2024.083  

Acute illness in neurological intensive care represent a heterogeneous group of patients with increased nutritional risk or malnutrition with a combination of underlying neurological disease and complications resulting from the acute illness. Correctly applied enteral and parenteral nutrition mitigates the development and consequences of stress malnutrition in an acute state. The importance of nutritional support and physiotherapy in the recovery stage is emphasized. The consequences of the experienced critically ill can persist for months to years after the primary stroke, independently of the actual neurological disease.

Posttraumatic headacheReview articles

doc. MUDr. Zbyšek Pavelek, Ph.D.

Neurol. praxi. 2025;26(3):230-232 | DOI: 10.36290/neu.2024.072  

Posttraumatic headache (PTH), a headache that develops within 7 days of a causative injury, is one of the most common secondary headaches. PTH are mostly attributed to mild traumatic brain injury. The risk of PTH is the transition to chronic and possibly debilitating conditions.

Sleep disorders in neurological diseasesReview articles

doc. MUDr. Jitka Bušková, Ph.D.

Neurol. praxi. 2025;26(3):225-229 | DOI: 10.36290/neu.2024.050  

Sleep plays a significant role in neurology. There is a very close relationship between sleep quality or duration and individual neurological diseases. Poor quality sleep adversely affects the course of a number of neurological diseases, such as cerebrovascular, autoimmune, and neuromuscular ones, and may increase the rates of epileptic or migrainous attacks. Sleep apnoea is also an independent risk factor for the development of stroke. Sleep disorders may precede Alzheimer's disease or represent a prodromal stage of other neurodegenerative diseases. Interventions to improve the quality of sleep and treatment of specific sleep disorders can play an...

Amyotrophic lateral sclerosis: new guidelines on diagnostics and managementReview articles

doc. MUDr. Eva Vlčková, Ph.D., MUDr. Adam Betík

Neurol. praxi. 2025;26(3):217-224 | DOI: 10.36290/neu.2024.069  

Amyotrophic lateral sclerosis (ALS) is a fatal, rapidly progressive neurodegenerative disease that primarily affects motor neurons in the brain and/or spinal cord. In recent years, a number of new recommendations have been published regarding the diagnosis of ALS, including the approach to genetic testing of these patients, as well as the therapy or general comprehensive management of this disease and its complications and comorbidities. The aim of this article is to summarize these recommendations and the most important current knowledge about this very serious disease.

Current options for prophylactic treatment of migrainReview articles

MUDr. Jolana Mračková, Ph.D.

Neurol. praxi. 2025;26(3):212-216 | DOI: 10.36290/neu.2025.019  

Migraine is a very common disease in the general population. It is associated with considerable disability and thus with a high socio-economic burden. Fortunately, recent years have brought fundamental new possibilities in both acute treatment of migraine attacks and prophylactic treatment, which aims to reduce the frequency and intensity of migraine attacks as much as possible. Another benefit of prophylactic treatment should optimally be the improvement of the response to acute treatment. Last but not least, prophylactic treatment should prevent the transformation of migraine from episodic to chronic form, and also eliminate the risk of developing...

The impact of immunosupressive therapy on the immune system of a patient with multiple sclerosisMain topic

prof. MUDr. Mgr. Miloš Jeseňák, PhD., MBA, MHA, Dott.Ric., FAAAAI, prof. MUDr. Jarmila Szilasiová, PhD.

Neurol. praxi. 2025;26(3):206-210 | DOI: 10.36290/neu.2025.026  

Highly effective innovative immunotherapies for multiple sclerosis (MS) significantly improve the long-term prognosis of patients with MS. This immunointerventional treatment - DMT (Disease modifying therapy) affects various levels of immune proces­ses and can induce secondary immunodeficiency, mainly lymphopenia, by changing lymphocyte transport, their depletion and disruption of their replication. Immunosuppressive treatment of the disease can also lead to hypogammaglobulinemia and an increased risk of occurrence and worsening of the course of infections, to reactivation of latent pathogens and to worsening of asymptomatic chronic infections. In...

Changes in the pathophysiology of multiple sclerosis are age-dependent: DMT methods in patients over 55 yearsMain topic

MUDr. Viera Hančinová

Neurol. praxi. 2025;26(3):202-205 | DOI: 10.36290/neu.2025.015  

With a rapidly aging global population and the advent of highly effective disease-modi­fying treatments (DMT) for multiple sclerosis (MS), the epidemiology of MS has changed. Currently, the largest group are patients aged 55-65. Changes in the pathophysiology of MS are age-dependent. After 50 years of life, reparative processes in the CNS fail, the level of oxidative stress increases, the phenotype of the immune system changes to a pro-inflammatory one. All these changes contribute to an accelerated increase in neurological disability. Due to the modification of the immune system due to aging, the effectiveness of DMT may decrease, while the risk of...

IAT + AHSCT: role of high-dose immunoablative therapy with autologous haematopoietic stem cell transplantation in patients with multiple sclerosisMain topic

doc. MUDr. Pavel Hradílek, Ph.D.

Neurol. praxi. 2025;26(3):197-201 | DOI: 10.36290/neu.2025.010  

High-dose immunoablative therapy with autologous haematopoietic stem cell transplantation (IAT + AHSCT) is currently the most effective method of interfering with the natural course of multiple sclerosis. Its effect has been shown to be superior to the vast majority of the currently used specific medicinal products. Despite the continuous development of novel drugs with different mechanisms of action, there still remains a certain group of patients with a rapidly developing aggressive course of MS that does not respond to specific disease-modifying therapy. It is in these patients that IAT + AHSCT may be indicated. IAT + AHSCT has a history of nearly...

Evaluating the efficacy of treatment for multiple sclerosis in the practice; development of the NEDA conceptMain topic

prof. MUDr. Eva Kubala Havrdová, DrSc.

Neurol. praxi. 2025;26(3):192-196 | DOI: 10.36290/neu.2025.007  

With the advent of highly effective treatment for multiple sclerosis, it is currently possible to consider even long-term remission. The NEDA (no evidence of disease activity) concept was introduced following the evaluation of a clinical trial with natalizumab. Since then, it has been used to evaluate the effect in studies with novel drugs, allowing their comparison. It involves the assessment of relapse rates, progression, and MRI findings. It would certainly be possible to add many more items; however, even in this simple form, it is very difficult to achieve in the long term in the majority of patients.

Continuous immunomodulation and immunosuppression versus reconstitution therapy in multiple sclerosisMain topic

doc. MUDr. Ema Kantorová, PhD.

Neurol. praxi. 2025;26(3):185-191 | DOI: 10.36290/neu.2025.018  

Multiple sclerosis (MS) is a common immune-mediated demyelinating and degenerative disease of the central nervous system (CNS), which can lead to serious disability early in its course. The expanding portfolio of therapeutic agents against MS reflects progress in our understanding of MS pathogenesis and the mechanisms of CNS injury. Early initiation of treatment is recommended. Moderate-efficacy or high-efficacy immunotherapeutics can be used. The escalation strategy involves gradually increasing the intensity of treatment, while the induction strategy supports initiating treatment with highly effective therapeutics. Both continuous immunomodulation/immunosuppression...

Smrt mozkuEditorial

doc. MUDr. Svatopluk Ostrý, Ph.D., prof. MUDr. Štefan Sivák, PhD.

Neurol. praxi. 2025;26(2):95  

Spinal muscular atrophy and its differential diagnosis. A patient's case report and his journey to diagnosisCase report

MUDr. Olesja Parmová, Ph.D.

Neurol. praxi. 2025;26(2):169-174 | DOI: 10.36290/neu.2025.023  

Spinal muscular atrophy (SMA) is a hereditary neuromuscular disease characterized by degeneration of motor neurons, leading to muscle weakness and atrophy. Differential diagnosis of SMA can be challenging due to the same or similar symptoms with other neuromuscular diseases, leading to misinterpretation of disease symptoms and delayed diagnosis. We present a case report of a patient with spinal muscular atrophy who had been waiting for a correct diagnosis for 43 years.

Modifiable risk factors for dementiaFrom the boundary of neurology

RNDr. Mgr. Kateřina Veverová, Ph.D., MUDr. Julie Martínková Nováková, MUDr. Juraj Sečník, Ph.D., MUDr. Jakub Šteiner, MUDr. Simona Karamazovová, Mgr. Zuzana Chmátalová, Ph.D., MUDr. Ondřej Lerch, Ph.D.

Neurol. praxi. 2025;26(2):163-168 | DOI: 10.36290/neu.2025.040  

The number of dementia cases is increasing globally. Currently, more than 55 million people worldwide are living with dementia, and according to the World Health Organization, this number is expected to more than double in the next 30 years. Dementia thus represents a significant global health challenge. The 2024 Lancet Commission report identified 14 modifiable risk factors, the elimination of which could potentially prevent up to 45 % of dementia cases. These key risk factors include low education, hearing loss, high LDL cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, hypertension, obesity, excessive alcohol...

The potential of artificial intelligence in the diagnosis and treatment of neurological diseasesReview articles

prof. MUDr. David Školoudík, Ph.D.

Neurol. praxi. 2025;26(2):154-162 | DOI: 10.36290/neu.2024.065  

Although the idea of artificial intelligence (AI) can be found as early as the ancient philosophers, it is only the development of computing technology in recent decades that has enabled the practical development of AI. In recent decades, AI has begun to make a significant impact in many fields, including medicine, not least neurology. AI is currently being tested in diagnosis and treatment planning for many neurological diseases. In particular, the use of AI in evaluating neuroimaging findings seems promising. AI is being tested in the diagnosis and treatment of neurodegenerative diseases, especially Alzheimer's dementia, diagnosis and treatment of...

Biting the bullet: Errors in electroencephalography (EEG)Review articles

doc. MUDr. Zdeněk Vojtěch, Ph.D.

Neurol. praxi. 2025;26(2):147-153 | DOI: 10.36290/neu.2024.056  

In this article, we want to highlight the causes of the most frequent mistakes in indications and descriptions of EEG findings, both generally and specifically in seizure disorders and encephalopathies. We refer to the mistakes in descriptions and interpretations we most frequently see in our practice. We want to open the discussion about how to minimalize these mistakes in Czech environment.

Relationship between headaches and sleepReview articles

MUDr. Petra Migaľová

Neurol. praxi. 2025;26(2):142-146 | DOI: 10.36290/neu.2024.079  

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.

Prodromal Parkinson's disease - making the diagnosis in the premotor stageReview articles

doc. MUDr. Petr Dušek, Ph.D.

Neurol. praxi. 2025;26(2):135-141 | DOI: 10.36290/neu.2025.002  

Prodromal Parkinson's disease (PD) manifests with a wide range of clinical symptoms and biological markers, including autonomic nervous system dysfunction, neuropsychiatric symptoms, sleep disorders, hypomimia, and dysarthria. Ultrasound and scintigraphic examinations, genetic variants (e.g., GBA1, LRRK2), and detection of pathological α-synuclein provide valuable diagnostic tools for early identification of at-risk individuals. Despite advancements in diagnostics, effective treatment for the prodromal stage is unavailable, raising ethical questions regarding prognosis communication and patient support. Future research is expected to focus on...

A new perspective on the generalized myasthenia gravis (gMG) treatmentReview articles

MUDr. Ivan Martinka, PhD.

Neurol. praxi. 2025;26(2):129-134 | DOI: 10.36290/neu.2024.077  

Generalized myasthenia gravis (gMG) is a severe disease leading to risk of immediate life threatening and/or quality of life reduction in case of missing treatment. Even with an excellent therapeutic effect of conventional treatment, the treatment itself can lead to patient's quality of life worsening through unpleasant and/or serious adverse effects (AEs). Currently, in the latest recommendations for the gMG treatment, there is a very striking effort to identify patients with highly active gMG in whom early treatment escalation is needed in order to induce rapid gMG symptoms control and quality of life improvement, preferably with as little frequency...

Brain death diagnosis and the role of diagnostic imagingMain topic

MUDr. Martin Vorčák, Ph.D., MUDr. Hubert Poláček, PhD., MUDr. Zuzana Gešvandtner Trabalková, MPH, MUDr. Daniel Evin, PhD., MUDr. Martin Števík, PhD., doc. MUDr. Kamil Zeleňák, PhD., FCIRSE

Neurol. praxi. 2025;26(2):122-128 | DOI: 10.36290/neu.2025.005  

Brain death remains a clinical diagnosis, based mainly on clinical criteria. Ancillary tests, including diagnostic imaging, are used to confirm the absence of cerebral perfusion when clinical findings are inconclusive. Imaging methods like DSA, perfusion scintigraphy and transcranial Doppler can provide critical, legally required data to support the diagnosis. Despite ongoing efforts, there is no global consensus on the optimal ancillary test, with practices varying by the region. Modern techniques like CT angiography (CTA), MR imaging, CT perfusion and time-invariant CTA, offer increasingly accurate outcomes. However, further validation is needed,...

Clinical determination of brain death - methodology of neurological examination and apnea testMain topic

MUDr. Petr Hollý, MUDr. Zdeněk Kunáš, doc. MUDr. Eva Pokorná, CSc., prof. MUDr. Štefan Sivák, PhD., MUDr. Denisa Osinová, doc. MUDr. Juraj Miklušica, PhD., doc. MUDr. Svatopluk Ostrý, Ph.D.

Neurol. praxi. 2025;26(2):109-116 | DOI: 10.36290/neu.2024.078  

We define brain death as a condition following catastrophic brain injury with permanent irreversible loss of all functions of the entire brain, including the brain stem. Diagnosis is based on clinical examination, where are completely unacceptable false negative individual tests that support irreversible brainstem involvement from the mesencephalon (photoreaction) to the pons Varoli (corneal, oculocephalic reflex and facial alginic irritation) to the medulla oblongata (gag and cough reflex). At present, the methodology for performing each exa­mination is not clearly established. This article discusses the basic clinical examination in the determination...