Slovo úvodem

prof. MUDr. Ivan Rektor, CSc.

Neurol. praxi. 2010;11(1):3  

Paliativní léčba a péče u nemocných s neurologickými chorobami

MUDr. Jan Hromada - editor hlavního tématu

Neurol. praxi. 2010;11(1):7  

Palliative treatment in brain and spinal cord tumours

prof.MUDr.Zdeněk Kadaňka, CSc.

Neurol. praxi. 2010;11(1):8-10  

First, the author deals with the etymology of the word palliative for a better understanding of its meaning and defines its use in medicine. Next, he presents a list of the major symptoms accompanying brain tumours that make the lives of patients harder and focuses on their palliative management. He emphasizes the need for a multidisciplinary approach which should result in a most bearable quality of life of patients in their last months or years of life, which is not only about relieving the symptoms of disease. A similar approach is described also for malignant spinal cord tumours including terminal care.

Palliative treatment in stroke

MUDr.Jan Hromada

Neurol. praxi. 2010;11(1):11-12  

Recent years have seen considerable advances in acute stroke treatment. Patiens who survive the acute phase following stroke often retain severe limitations of motor and cognitive functions and communicative problems. This article describes basic questions of paliative care and treatment for stroke patiens.

Palliative care in patients with Parkinson's disease

prof.MUDr.Martin Bareš, Ph.D.

Neurol. praxi. 2010;11(1):13-15  

Parkinson‘s disease is a chronic, progressive neurological disease with prevalence of 1 % in the population over 65 years. The modern success of pharmacology and deep-brain % of the populatstimulation surgery to treat the motor symptoms of tremor, rigidity, and bradykinesia provide PD patients with longer lives and increased motor functioning. However, in the moderate and advanced stages of disease, the therapeutic benefits of pharmacology diminish and motor symptoms are more complicated to treat. The nonmotor symptoms of Parkinson´s disease receive little attention in clinical settings, although they can lead to disability and caregiver...

Management of advanced dementia - palliative approach

MUDr.Robert Rusina, MUDr.MgA.Kateřina Rusinová, doc.MUDr.Iva Holmerová, Ph.D., doc.MUDr.Jiří Šimek, CSc.

Neurol. praxi. 2010;11(1):16-19  

End-stage of dementia can be defined as a period when the disease reaches irreversible and severely reduced autonomy in basic activities of daily living with a need of persistent nursing care. Treatment options, mainly acetylcholinesterase inhibitors and memantin, decision making capacity and principles of autonomy in these patients are discussed. Indication of intensive care, the role of palliative approaches and management of complications are described. Finally, the importance of communication with the patient and the caregiver and aspects of institutionalization are mentioned more in detail.

Palliative care in patients in vegetative state

MUDr.David Doležil, Ph.D.

Neurol. praxi. 2010;11(1):20-22  

The term vegetative state has been first used by Jennett and Plum in their 1972 paper. The vegetative state is defined as a clinical condition of complete unawareness of the self and the environment accompanied by sleep-wake cycles with either complete or partial preservation of hypothalamic and brain-stem autonomic functions. Palliative care in the vegetative state includes medical, nursing, rehabilitation, social, psychological, and spiritual care and all patients are entitled to receive this care. Discontinuation of palliative treatment, including the discontinuation of fluid and food intake, is a point of controversial discussion from ethical,...

Palliative care in terminal states of motor neuron diseases (amyotrophic lateral sclerosis, progressive bulbar palsy,

MUDr.Petr Ridzoň, MUDr.Radim Mazanec, Ph.D.

Neurol. praxi. 2010;11(1):23-26  

and progressive muscular atrophy) Motor neuron disease (MND), most commonly presenting as amyotrophic lateral sclerosis (ALS) or progressive bulbar palsy (PBP) and progressive muscular atrophy (PMA), is a typical disease managed predominantly with palliative care. Over months to years, the condition progresses to a state of total dependence of the patient on both nursing care and artificial feeding or even mechanical ventilation. Thus, over time, the disease becomes extremely demanding for both the family and the attending physician. Therefore, treatment of a patient with MND requires knowledge of the practice of palliative medicine and palliative...

Palliative care in advanced muscular dystrophies

MUDr.Jan Hromada

Neurol. praxi. 2010;11(1):27-28  

Muscular dystrophies are diseases characterized by progressive loss of muscle strenght, loss of respiratory muscle strenght and in DMD death from respiratory insufficiency. The majority of patients develop cardiomyopathy. An effective care plan for patients involve interdiciplinary approach: regular assessment of medical status, education for the patiens and family, nutritional counseling, physical therapy and rehabilitation, psychosocial services and end-of-life planning.

Palliative Care and Treatment in Multiple Sclerosis Patients

MUDr.Hedviga Jakubíková, doc.MUDr.Eleonóra Klímová, CSc.

Neurol. praxi. 2010;11(1):29-31  

Multiple sclerosis is inflammatory and degenerative disease of the central nervous system with autoimmune origin. In progressive types of multiple sclerosis and after disease modifying treatment failure attention focuses primarily to the symptom treatment and the need for palliative care. The most common symptoms are movement disorders, spasticity, pain, visual disturbances, fatigue, tremor, bulbar symptoms, sphincter disturbances, cognitive failure and depression. Patients often die of respiratory and renal complications. Maintaining quality of life and dignity of the patient should be the main aim of palliative treatment of this progressive...

Palliative care in paediatric neurology

MUDr.Josef Kraus, CSc.

Neurol. praxi. 2010;11(1):32-35  

The goal of palliative care is to provide relief or alleviate symptoms and support the best possible quality of life regardless of the disease status. In paediatric care, it includes the following components: biological, psychosocial, spiritual, treatment plan and practical solutions. The most important part is a mutual communication about the disease as well as options. In addition to the psychosocial aspect, an individual approach is of major importance. The term palliative care has different meanings for the child, parents or carers. Sometimes it means management of pain and symptoms; at other times it is a spiritual aspect, for instance....

Neuromyelitis optica (Devic's disease) - first demyelinating aquaporin channelopathy?

MUDr.Petra Nytrová, MUDr.Dana Horáková, RNDr.Vlastimil Král, CSc., doc.MUDr.Manuela Vaněčková, Ph.D., prof.MUDr.Zdeněk Seidl, CSc., doc.MUDr.Eva Havrdová, CSc.

Neurol. praxi. 2010;11(1):36-40  

Neuromyelitis optica (NMO) (also known as Devic‘s disease or Devic‘s syndrome) is an idiopathic inflammatory disorder of the central nervous system (CNS), usually with a relapsing-remittent course. This disease is characterised by recurrent uni- or bilateral optic neuritis (ON), or presents concurrently with transverse myelitis- typically a longitudinally extensive form (LETM). In patients with a full clinical manifestation, establishment of diagnosis is no major issue. At the beginning of the disease, an isolated manifestation of either recurrent optic neuritis or myelitis can lead to incorrect diagnosis of multiple sclerosis (MS)....

Diagnosing and differential diagnosis of diabetic polyneuropathy

MUDr.Helena Vondrová, CSc.

Neurol. praxi. 2010;11(1):41-44  

Diabetes mellitus is one of the most common causes of polyneuropathy (PNP). Diagnostics of diabetic polyneuropathy is based on a neurological examination and auxilliary examination methods. It is crucial to diagnose PNP as soon as possible in order to prevent complications, such as the diabetic neuropathic foot. The diagnosis of diabetic PNP is a diagnosis „per exclusionem“, so even in diabetic patients it is necessary to exclude other possible causes of PNP, in particular when the clinical image and disease course show atypical symptoms.

Extra-intracranial bypass in arteria carotis interna occlusion

MUDr.Jan Šroubek, MUDr.Martin Kovář, MUDr.Aleš Tomek, MUDr.Richard Plný, prof.MUDr.Josef Vymazal, DrSc.

Neurol. praxi. 2010;11(1):45-49  

The use of extra-intracranial bypass (EC-IC) for secondary prevention of ischemic stroke dropped markedly after results of randomized multicenter EC-IC bypass trial in the mid 80th. Patients after ischemic stroke with proved ACI occlusion did not benefit from the surgery treatment. In the 90th a vast progression appeared in the area of functional examination of cerebrovascular compromise with the abilitiy to identify cerebrovascular reserve capacity. Upon small trials of patients with hemodynamic compromise there is clear positive effect of EC-IC bypass; though the new sufficient randomized trial proving the efficacy is missing. The paper is...

Opioid treatment strategies

MUDr.Boris Leštianský, MUDr.Marek Hakl, Ph.D.

Neurol. praxi. 2010;11(1):50-54  

Opioid analgesic agents act at receptors within the central nervous system. There are well known three type of receptors and opioid drugs have differing affinities to them. Chronic opioid therapy can be an effective therapy for carefully selected and monitored patiens with chronic pain state. However the opioids are also associated with potentially serious adverse events. Optimally balancing benefits and risks of opioid therapy is depending on regular patient evaluation and structure of individual opioid management plan. Safe and effective opioid therapy requires clinical skills and knowledge.

Stroke in diabetic patients

doc.MUDr.Jaromír Chlumský, Ph.D., prof.MUDr.Jindra Perušičová, DrSc., prof.MUDr.Milan Kvapil, CSc.

Neurol. praxi. 2010;11(1):56-58  

It is estimated that the risk of stroke is increased by 1.5–3 fold for patients with diabetes. Diabetes also doubles the risk of stroke recurrence, and stroke outcomes are significantly worse among patients with diabetes with increased mortality, more residual neurological deficit and longer hospital stays. Diabetes increases the risk of ischaemic stroke more than haemorrhagic stroke. Despite the higher prevalence of stroke in patients with diabetes, they have been shown to be less likely to develop transient ischaemic attack. Tight glycaemic control is recommended to prevent microvascular complications, but its benefits on macrovascular...

A case of motor and sensory neuropathy and cerebrospinal multiple sclerosis in one patient

MUDr.Martin Nevrlý, MUDr.Vladimíra Sládková, MUDr.Pavel Otruba, doc.MUDr.Stanislav Buřval, Ph.D., prof.MUDr.Zdeněk Lukáš, CSc., prof.MUDr.Petr Kaňovský, CSc.

Neurol. praxi. 2010;11(1):59-62  

Patients with Charcot-Marie-Tooth (CMT) disease may have demyelinating involvement also within the central nervous system. An MRI scan of the brain then shows a finding similar to that in patients with cerebrospinal multiple sclerosis (MS). Similarly, MS patients may develop peripheral nerve injury analogous to that in CMT. However, immunohistochemical examination of the peripheral nerve can distinguish between these two types of injury. We recorded a case of a 38-year-old man presenting with upper limb amyotrophy, flexed posture of the fingers and wrist with a bilateral restriction in movement, hypotrophy of the lower limb periphery, flexed...

Paroxysmal alien hand syndrome or RINCH in frontal lobe epilepsy?

MUDr.Věra Zelená, prof.MUDr.Milan Brázdil, Ph.D., doc.MUDr.Robert Kuba, Ph.D.

Neurol. praxi. 2010;11(1):64-68  

A video case report + review of literature on alien hand phenomenon and RINCH A patient is presented who, shortly after the removal of a parasagitally localized tumour of the right frontal lobe, developed frequent paroxysmally occurring involuntary movements of the right hand fingers. Noninvasive video EEG monitoring confirmed the epileptic origin of these motor manifestations for simultaneously occurring ictal EEG pattern with a maximum at the right frontocentral electrodes. In some aspects (particularly the localization of the causal lesion), our case has a resemblance to the rarely reported ictal alien hand syndrome; however, the rhythmic...

Publikujeme v zahraničí

-

Neurol. praxi. 2010;11(1):69  

Neurologové se ptají...

MUDr. Juraj Vyletelka

Neurol. praxi. 2010;11(1):70