Slovo úvodem

prof. MUDr. Ivan Rektor, CSc.

Neurol. praxi. 2009;10(6):335  

Léčba onemocnění extrapyramidového systému

prof.MUDr.Ivan Rektor, CSc. - editor hlavního tématu

Neurol. praxi. 2009;10(6):339  

Treatment of Parkinson’s disease

prof.MUDr.Ivan Rektor, CSc.

Neurol. praxi. 2009;10(6):340-346  

Start of the therapy: L-dopa; DA-agonists; selegiline; amantadine; rasagiline; in patients older than 70 years L-dopa. When therapy insufficient: add on/increase the standard or controlled-released L-dopa, COMT inhibitor; DA-agonists orally or in patch; rasagiline. Severe motor complication: partial „drug holiday” with amantadine i. v.; apomorphine/lisuride s. c.; intraduodenal L dopa; surgery (DBS). Psychiatric complications: graduall discontinuation of DA agonists, amantadine, MAO inhibitors, anticholinergics; to continue with the minimal effective dose of L-dopa; atypical antipsychotics. Dementia: acetylcholinesterase inhibitors.

Surgical treatment of extrapyramidal disease

MUDr.Marek Baláž, prof.MUDr.Ivan Rektor, CSc.

Neurol. praxi. 2009;10(6):348-352  

The number of indications for the surgical intervention in movement disorders grows in recent years. Most frequent indications comprise the Parkinson‘s disease, essential tremor and dystonia. Currently the deep brain stimulation is the most frequently used method.

Treatment of choreatic dyskinesias

doc.MUDr.Jan Roth, CSc., MUDr.Jiří Klempíř, Ph.D.

Neurol. praxi. 2009;10(6):353-355  

Choreatic dyskinesias are caused by the hetegenous dysfunctions of basal ganglia system. For clinical settings we have several options: antipsychotics (i. e. risperidone, tiapride), presynaptic dopamine depletors (tetrabenazine), GABAergics (clonazepam), antiglutamatergics (i. e. amantadine). Their intensity could be pharmacologically controlled, at least partially, however their causal curability is only seldom available.

Treatment of dystonias

prof.MUDr.Martin Bareš, Ph.D.

Neurol. praxi. 2009;10(6):356-359  

Dystonia is characterized by sustained muscle contractions frequently causing repetitive twisting movements or abnormal postures. Based on the distribution of the symptoms, we classify the dystonias as focal, segmental, multifocal and generalized. Majority of dystonic syndromes is idiopathic, differential diagnosis of the secondary forms of dystonias is always needed. There is increasing knowledge about the genetics of dystonias lately. Treatment of dystonias was regarded as complicated and limited. The various drugs were used (antiepileptic, cholinergic, dopaminergic as well as antidopaminergic drugs) were introduced in the treatment with...

Acute conditions with extrapyramidal symptoms

doc.MUDr.Irena Rektorová, Ph.D.

Neurol. praxi. 2009;10(6):360-362  

A movement disorder emergency (MDE) is an acute or subacute state, in which failure to accurately diagnose and manage the patient may result in significant morbidity or even mortality. The syndromes are most frequently caused by certain drugs administration, or conversely their withdrawal, but the etiology may also include infections, toxins, focal brain lesions, metabolic disturbances, or autoimmune disorders. MDEs are frequent in patients with Parkinson’s disease. With respect to differential diagnosis, psychogenic movement disorder or psychiatric etiology of an acute state should be considered. Further in the text, serotonine syndrome,...

Postural instability in patients with Parkinson’s disease and its treatment

MUDr.Peter Valkovič, PhD.

Neurol. praxi. 2009;10(6):363-368  

Postural instability (PI) is a cardinal sign of Parkinson’s disease (PD). Its importance increases along with the disease progression. Most serious consequences of PI are recurrent falls, which extremely worsen quality of patients´ life, and complications of which increase healthcare expenditures. Most of falls happens in patients’ home environment and in state of good mobility. Targeted history taking and specified clinical neurological assessment is needed to detect and follow-up PI. Pharmacotherapy has only limited effect. Drugs working predominantly through the noradrenergic neurotransmitter system seem to be promising. Long-term...

Prophylactic treatment of migraine

MUDr.Ingrid Niedermayerová

Neurol. praxi. 2009;10(6):369-371  

Prophylactic drug treatment is foregrounded in attempt to reduce frequency, duration or severity of migraine attacks, further after inefficiency or contraindications of acute therapy. Drugs of the first choice are initially administrated, i. e. valproate, topiramate, metoprolol, flunarizine. If these drugs are not effective, are contraindicated or in case of comorbidity, we use drugs of the second choice (amitriptylin) or another prophylactic drugs. Monotherapy is preferred at first, prophylactic drugs may be combined. Duration of prophylaxis is usually 6–9–12 months. During menstrual migraine, nonsteroidal anti-inflammatory drugs...

Mistakes and errors in treating epilepsy

doc.MUDr.Vladimír Donáth, CSc.

Neurol. praxi. 2009;10(6):372-377  

The number of antiepileptic drugs has been increasing. An increased number of drugs brings with it certain pitfalls as well as the possibility of an ill-judged indication, mistakes and errors. The most common errors include: 1. failure to administer the maximum tolerated dose in uncontrolled epilepsy, 2. addition of another drug before the previous one failed to have an effect, 3. delayed patient referral to a higher specialized centre, 4. mistaking frontal lobe seizures for nonepileptic psychogenic seizures, 5. errors in diagnosing epileptic syndromes, 6. suboptimal use of new generation antiepileptics, 7. unnecessarily high dosage of antiepileptics,...

Diabetic Neuropathy - Neurologist Perspective

MUDr.Radim Mazanec, Ph.D., doc.MUDr.Martin Bojar, CSc., MUDr.Tomáš Nedělka

Neurol. praxi. 2009;10(6):378-383  

Diabetic neuropathy, a common complication of diabetes mellitus type 1 and type 2, represents clinically heterogeneous syndrome with various involvement of peripheral, cranial and autonomic nerves. The progression is usually slow and patients may stay for a long time asymptomatic. Prevalence of diabetic neuropathy is estimated between 13 and 54 % according to the duration of the disease. Two main clinical types of diabetic neuropathy – generalized and focal – can be distinguished by clinical examination. The basic diagnostic tool is electromyography. The symptomatic treatment is focused on neuropathic pain. As the effective treatment...

Treating Alzheimer’s disease and related neurodegenerative dementias

doc.MUDr.Roman Jirák, CSc.

Neurol. praxi. 2009;10(6):384-389  

Dementias of neurodegenerative origin represents big therapeutical problem for its frequency (Alzheimer´s disease is most common dementia), health and social unadvisability (diseases devastating the quality of life and in most cases with letal end), for its financial expensiveness and for its difficult currability. In most cases of these diseases is not known its ethiology and pathogenesis completely at present time, and thus our contemporary treatment results from the affection of known pathogenetic mechanisms. Therapy of neurodegenerative dementias includes pharmacotherapy of cognitive functions, pharmacotherapy of non-cognitive functions,...

Lumbar spinal stenosis in the elderly

prof.MUDr.Vladimír Smrčka, CSc., prof.MUDr.Martin Smrčka, Ph.D., MBA, MUDr.Karel Máca

Neurol. praxi. 2009;10(6):390-393  

Introduction: Lumbar spinal stenosis is a relatively common disorder in patients of higher age groups. Opinions on treatment options vary. Material and methods: Sixty-seven patients were operated on for central spinal stenosis at L2–L5 at our department between 2004 and 2008. All were over 60 years of age and 75 % of them had one-level stenosis mostly at L4–L5 or L3–L4. The length of the stenotic segment was 4–9 mm at the site of maximal involvement. The major symptoms included claudications, nocturnal pain, and/or complete chronic cauda equina syndrome. All patients underwent MRI and functional imaging of the lumbar...

A rare lysosomal disease - Niemann-Pick disease type C

MUDr. Miriam Kolníková, doc. MUDr. Pavol Sýkora Ph.D, RNDr. Ivan Chalupa, PhD

Neurol. praxi. 2009;10(6):394-395  

Niemann-Pick disease type C (NPC) is a rare autosomal recessive neurovisceral disease from the group of lysosomal disorders caused by a defect in lipid metabolism. The most common forms are late-infantile and juvenile NPC. The diagnosis is based on the assessment of build-up of free cholesterol in lysosomes and the reduction in cholesterol esterification in fibroblasts (Filipin test). The disease is caused by mutations in the NPC1 (95 %) and NPC2 (4 %) genes. The treatment employs miglustat aimed at reducing the pathological substrate in order to stop the progression of the disease.

37. Šerclovy dny

MUDr.Radomír Taláb, Ph.D.

Neurol. praxi. 2009;10(6):401-406  

Neurologové se ptají...

MUDr. David Doležil, Ph.D.

Neurol. praxi. 2009;10(6):396  

V. levočské pracovné dni neuropsychiatrie, 24.-26. 9. 2009

MUDr.Miloslav Dvorák, PhD.

Neurol. praxi. 2009;10(6):397  

Rozlúčili sme sa s primárom

MUDr.Ladislavom Bevilaquom prof.MUDr.Michal Drobný, DrSc.

Neurol. praxi. 2009;10(6):398-399  

Jubileum profesora MUDr. Daniela Bartka, DrSc.

prof.MUDr.Michal Drobný, DrSc.

Neurol. praxi. 2009;10(6):399-400