Neurology for Practice, 2011, issue 1

Editorial

Foreword

prof. MUDr. Ivan Rektor, CSc.

Neurol. praxi. 2011;12(1):3

Main topic

Hyperkinetické syndromy

MUDr.Marek Baláž, Ph.D. - editor hlavního tématu

Neurol. praxi. 2011;12(1):7

Tardive dystonia

MUDr.Michal Maršálek, CSc.

Neurol. praxi. 2011;12(1):8-11

Tardive dystonia is chronic symptomatic disorder of extrapyramidal system induced by long-term treatment with antipsychotics. Tardive dyskinesia, acute dystonia and dystonias of another origin must be ruled out in differential diagnosis. Younger age, male gender, and presence of other hyperkinetic extrapyramidal syndromes seem to be the main risk factors. Antipsychotic withdrawal, GABAergic agents, anticholinergics, clozapine, botulinum toxin injection, and brain deep stimulation are recommanded for managing TDt.

Tremor from a clinical neurologist’s perspective

MUDr.Peter Valkovič, PhD., doc.MUDr.Ján Benetin, CSc.

Neurol. praxi. 2011;12(1):12-15

Tremor is characterized by involuntary, rhythmic and sinusoidal movements of one or more body parts. Tremor can affect almost any body part, including the head, chin and soft palate. This paper reviews diagnostic and therapeutic aspects of most common clinical entities and syndromes associated with tremor.

Choreal diskinesias

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

Neurol. praxi. 2011;12(1):16-17

Chorea could be defined as a state of excessive, spontaneous movements, irregularly timed, randomly distributed and abrupt. Dyskinesias are accentuated by stress, physical and mental effort or voluntary movements and attenuated by mental relaxation and usually disappear in sleep. Choreiform dyskinesias originate in striatal dysfunction. Clinical signs typical for chorea are: tongue protrusion sign (patient can not hold still the protruded tongue, moves the tongue around and back to the mouth), milkmaid grip or grasp sign (during manual grip the patient involuntary relaxes and gripes the hand as if he would „munch” physicians hand)...

Tics and Tourette syndrome

MUDr.Ondřej Fiala

Neurol. praxi. 2011;12(1):18-21

Tics are one of the most common movement disorders. They are caused mainly by primary tic disorders in childhood, secondary tics are rare. The most common cause of tics is transient tic disorder, which may affect up to 28% of schoolchildren. The most severe form of tic disorder is Tourette‘s syndrome, which is characterized by multiple motor and vocal tics, and often accompanied by behavioral problems. Education and lifestyle adjustment are the basis for the treatment of tics. Pharmacologic treatment is recommended only for more severe forms of disease.

Myoklonus

MUDr.Marek Baláž, Ph.D., MUDr.Martina Bočková

Neurol. praxi. 2011;12(1):22-25

Myoclonus is a fast, jerky involuntary movement caused by a muscle contraction or inhibition. It is classified according to the clinical characteristics, anatomical origin or its etiology. Myoclonus is either physiological or it can be a symptom of various neurological disorders. Neurophysiological diagnostics is widely used, besides history and meticulous clinical examination. Therapy is empirical, with clonazepam as one of the most often administered drugs. It appears that the combination therapy with several drugs is more successful.

Ballismus

MUDr.Marek Baláž, Ph.D.

Neurol. praxi. 2011;12(1):26-27

Ballismus is considered to be a variant of chorea, with typical clinical appearance of irregular, vigorous limb movements with large amplitude. Most frequently it presents in form of a hemiballism. The diagnostic workup is based on the imaging (preferably MRI) of subthalamic nucleus and neighbouring basal ganglia, because of close causal relationship between structural lesions in this area and ballism. The neuroleptics (dopamine antagonists) are the mainstay of a treatment.

Review articles

Recent advances in treatment of multiple sclerosis with interferon beta in Czech Republic?

MUDr.Michal Dufek

Neurol. praxi. 2011;12(1):28-32

Interferon beta and glatiramer acetate comprise the group of first-choice drugs for the treatment of relapsing-remitting multiple sclerosis. All the drugs have been shown to have an effect on reducing the relapse rate, reducing the disability rate as well as on MRI parameters. In the Czech Republic, patients have been treated with these drugs for about 15 years. The basic indication remains unchanged and the major advances in the past one to two years are: expanding the indication to include clinically isolated syndrome, reducing the age limit for treatment from 18 to 12 years and the possibility to assess neutralizing antibodies against interferon...

New in pharmacotherapy of dementia

MUDr.Martin Vališ, Ph.D., MUDr.Dita Kalnická

Neurol. praxi. 2011;12(1):33-36

There has been only symptomatic treatment focused on amelioration of cognitive and behavioural symptoms. Acetylcholinesterase inhibitors and N-acetyl-M-aspartate antagonist are currently the standard treatment in the most frequent dementia, Alzheimer’s disease. In clinical practice, there is a tendency to broaden the spectrum of indications in present drugs, including the treatment of early dementia stages or the treatment of different types of dementia. Simultaneously, new drug forms are tested. Regarding the research area, multiple of brand new drug molecules reached the clinical phase. In some of them, causal influence on the Alzheimer’s...

Acute myelitis - etiology, diagnosis and treatment

doc.MUDr.Peter Špalek, PhD.

Neurol. praxi. 2011;12(1):37-42

The differential diagnosis of acute myelitis is broad. Therefore, neurologists must be aware of many potential etiologies for acute myelopathy and be able to provide an ordered and efficient diagnostic approach based on patient´s history, clinical examination and magnetic resonance imaging (MRI) findigs. When faced with a patient with an acute myelopathy, excluding an acute compressive cause by MRI is of highest priority. Having excluded a compressive cause and having found an intramedullary spinal cord lesion, the diagnosis of an infectious or inflammatory myelopathy becomes a primary consideration. Detailed history, clinical presentation,...

Contemporary treatment options for Lennox-Gastaut syndrome

MUDr.Michal Ryzí

Neurol. praxi. 2011;12(1):43-47

The Lennox-Gastaut syndrome (LGS) is one of the most severe epileptic encephalopathies of childhood onset. LGS is characterised by occurence of multiple type of epileptic seizures (tonic, atonic, atypical absences), an EEG finding, psychomotor delay and behaviour disorders. The optimum treatment for LGS remains uncertain. This paper summarizes the therapeutical options of LGS including pharmacological therapy, diet and surgery. No study has shown any one drug to be highly efficacious; rufinamide, lamotrigine, topiramate and felbamate may be helpful as add-on therapy. Until further research has been undertaken, clinicians will need to continue...

Sandifer’s syndrome

MUDr.Miroslava Muchová

Neurol. praxi. 2011;12(1):48-51

Sandifer’s syndrome is a clinical entity characterised by abnormal movements associated with gastroesophageal reflux, with or without hiatal hernia. This syndrome occurrs especially in toddlers and infants but it has been rarely reported also among adult patients and newborns. In the clinical picture various abnormal movements of the body (opisthotonic posturing, head/eye version, torticollis and other dystonic postures) occur in periods several times per day, mainly after feeding. Sandifer’s syndrome is most commonly mistaken for epileptic seizures or some form of dystonia. The syndrome is taken for underrecognized.

From the boundary of neurology

Tumors of the central nervous system in children

MUDr.Zdeněk Pavelka, MUDr.Karel Zitterbart

Neurol. praxi. 2011;12(1):52-58

Tumors of central nervous system are the most frequent solid tumors in children and represent an important part of cancer related morbidity and mortality. Prognosis for many high risk tumors remains unsatisfactory. A progress in molecular biology enables to establish biological markers to predict the course of disease. The modern therapeutic approaches should be utilized in conjuction with standard therapy to improve the outcome.

Case report

Complications of percutaneous kyphoplasty

MUDr.Martin Jerie, prof.MUDr.Josef Vymazal, DrSc., MUDr.Radko Kříž, MUDr.Jiří Chrobok, Ph.D., MUDr.Stanislav Černohorský

Neurol. praxi. 2011;12(1):59-62

A 39-year-old female patient was admitted to our department for traumatic compression fracture of the Th9 vertebral body. The clinical finding as well as MRI finding favoured percutaneous kyphoplasty. A rare complication – cement leakage into the soft paravertebral tissues – occurred during this procedure. Because of the declared properties of the implanted material, particularly the biodegradability of bone cement, observation of the patient was carried out. Over the course of days, progressive back pain and difficult breathing occurred. Imaging methods revealed progressive pleuropulmonary changes. A circumscribed inflammatory...

Spontaneous intracranial hypotension

MUDr.Hynek Lachmann

Neurol. praxi. 2011;12(1):63-64

The syndrome of intracranial hypotension is a wellknown complication of lumbar puncture. Its spontaneous variant is not often considered, although well defined clinical diagnostic criteria were established for this entity and the treatment is usually succesful. The case report describes a patient hospitalised with severe headache associated with upright position and accompanied by meningeal symptoms. MRI of the brain was normal, MRI of spine showed ventrolisthesis of L4 vertebra, without extradural collection of CSF. During lumbar puncture low opening pressure CSF was noted. Therefore, CT-perimyelography was performed, which visualized a significant...