Slovo úvodem

prof. MUDr. Ivan Rektor, CSc., FCMA, FANA

Neurol. praxi. 2015;16(3)  

Introdukcia

prof. MUDr. Peter Kukumberg, PhD. – editor hlavního tématu

Neurol. praxi. 2015;16(3):128  

Ethics of crisis states (not only) in neurology – versus "Ad usum Delphini"

prof. MUDr. Peter Kukumberg, PhD.

Neurol. praxi. 2015;16(3):129-132  

Deontology and ethics cover the professional responsibilities and moral aspects of human activity. They have an eminent significance and impact in the physician's theoretical (scientific research) and practical (clinical) work. The explosive growth of medical technology has, paradoxically, resulted in new ethical issues. They are dealt with in general terms with an emphasis on neuroscience. Also highlighted is the risk of slipping into a routine, non-committal approach and, in particular, into an unacceptable "Ad usum Delphini" method, i.e. an improper censorship of reasoning and acting in medicine as a supremely noble and responsible "ars".

Neurological disturbances in critically ill patients: why to diagnose them?

prof. MUDr. Josef Bednařík, CSc.

Neurol. praxi. 2015;16(3):133-136  

Management of critically ill patients brings about several ethical problems. One of them is to balance the extend of diagnostic procedures aimed at diagnosis of newly disclosed brain and neuromuscular disturbances as sequelae of critical illness to optimize care of these patients, and not to traumatize them and waste medical care sources. Both neuromuscular disturbances – critical illness polyneuropathy and myopathy, and critical illness encephalopathy worsen prognosis of critically ill patients. Effective treatment or prevention of these disturbance is, however, limited, and it is necessary to consider performance of invasive (muscle biopsy)...

Legal and ethical issues of autopsies and research with tissues obtained post-mortem

prof. MUDr. Jan Roth, CSc.

Neurol. praxi. 2015;16(3):137-139  

The New Civil Code, effective in the Czech Republic from 1st January 2014, has considerably changed the rules for performing autopsies. Enshrined in this law is the human right to give a living consent that their body or its part can serve after death for the purposes of medical science, research, or teaching, or that the body can be autopsied. An autopsy cannot be performed without this consent. As a result of the above, problems occur with "elective" autopsies and, consequently, a lot of hospitals do not want to accept the risk of a possible lawsuit. Therefore, much fewer autopsies are currently performed in the Czech Republic (approximately one-tenth...

Brain death – medical aspects, legislative standards in Slovak republic

MUDr. Jana Martinková, PhD., MUDr. Martin Chrastina, PhD., MUDr. Miriam Cingelová, doc. MUDr. Peter Valkovič, PhD.

Neurol. praxi. 2015;16(3):140-143  

The death of an individual was considered after cardiac and respiratory arrest till the middle of last century. The concept of death has changed after development of resuscitation, extracorporeal circulation and with progression of organ transplantation. The organism is considered as dead even with the cessation of all brain functions, including the brainstem, irrespective of persistent cardiovascular and other organ functions. The declaration of brain death is not uniform worldwide, but varies between developed countries. Slovak republic enacted the algorithm of brain death declaration in the late seventies and is still valid until today. The determination...

Errors and mistakes in diagnosing multiple sclerosis

MUDr. Jiří Piťha

Neurol. praxi. 2015;16(3):144-148  

The late establishment of the diagnosis of multiple sclerosis results in delay in treatment initiation, affecting the course of the disease, and thus in poorer prognosis. In the case of a false positive diagnosis, in addition to funds being expended inappropriately, the patient is exposed to the risk of adverse drug effects. Particular attention has to be paid to patient history data analysis, proper assessment of clinical evaluation, and realistic interpretation of auxiliary examinations.

Indication of the palliative hospital care for stroke survivors

doc. MUDr. Miroslav Kala, CSc., Mgr. Zlatica Dorková, Ph.D.

Neurol. praxi. 2015;16(3):149-151  

Life prognosis of some stroke patients is quite similar as in advanced cancer patients. Dismal clinical status and life limiting terminal prognosis can be indication for palliative hospice care. Palliative therapeutic approach enables spend last period of life peacefully and with dignity.

Katogenic diet: its efficacy and practical use

MUDr. Ivana Tyrlíková, Pavel Klein, M.B.B.Chir.

Neurol. praxi. 2015;16(3):152-154  

Ketogenic diet (KD) is a high fat, low protein, low carbohydrate diet that is an effective treatment of refractory epilepsy in children. The “classic” diet consists of long chain saturated triglycerides with a 3:1 or 4:1 [fat]: [protein + carbohydrate] ratio by weight, with 87–90% of calories derived from fat. In children, the diet may lead to disease modification, with permanent seizure freedom or improvement. In spite of the success of KD treatment of children, KD has been little studied in adults. The anticonvulsant effect occurs quickly within days to a couple of weeks. The efficacy of KD compares favorably with efficacy of new...

Pregabalin in treatment of neuropathic pain

MUDr. Petr Sperling

Neurol. praxi. 2015;16(3):155-158  

Neuropathic pain is defined as a pain arising as a direct consequence of a lesion or disease affecting the somatosensory system (Treede, 2008). According to the anatomical localization neuropathic pain can be sorted into central and peripheral and then by etiology. In some cases there can occur both nociceptive and neuropathic component. Neuropathic pain has its specific symptoms and in contrast to nociceptive pain does not require the stimulation of pain receptors, though stimulation of nociceptive receptors can cause or emphasize the neuropathic pain. For patients, it is a symptom that persists and can significantly limit daily life. Therapy of neuropatic...

Cerebral amyloid angiopathy

MUDr. Pavel Šiarnik, MUDr. Zuzana Čarnická, MUDr. Lucia Krížová, MUDr. Stanislav Šutovský, PhD., MUDr. Veronika Vestenická, PhD., doc. MUDr. Branislav Kollár, PhD.

Neurol. praxi. 2015;16(3):159-162  

Cerebral amyloid angiopathy is characterized by amyloid deposition in the walls of cortical and leptomeningeal arteries and arterioles. Disorder occurs most frequently as a sporadic form in the elderly. Incidence of sporadic form increases with advancing age. Hereditary forms are earlier in onset. The most important clinical consequence of the disease are recurrent lobar intracerebral hemorrhages. Progressive cognitive impairment and dementia can also be present. In a case report of 76-year-old patient with recurrent intracerebral hemorrhage and dementia authors present current options of diagnostics, prevention and treatment of cerebral amyloid angiopathy.

Clinical and genetic heterogenity of dopa-responsive dystonia

MUDr. Ján Necpál

Neurol. praxi. 2015;16(3):163-166  

Dopa-responsive dystonia, one of the dystonia-plus syndromes, is a rare neurometabolic disorder caused by alteration of dopamine biosynthesis, mainly by mutation in GTP-cyclohydrolase I. gene. It is characterised by early onset dystonic gait with frequent generalisation, parkinsonism, diurnal fluctuation of the symptoms and excellent long-term levodopa-responsiveness without chronic motor complications of levodopa therapy. The disorder is genetically heterogeneous and therefore clinically often atypical. As an example it is presented a case report of the patient and her daughter detected with a new mutation in GTP-cyclohydrolase I. gene.

Fycompa® (perampanel): a novel drug for treating epilepsy

prof. MUDr. Ivan Rektor, CSc.

Neurol. praxi. 2015;16(3):167-170  

Fycompa® (perampanel) is a new drug for difficult to treat focal epilepsy. It is a selective non-competitive antagonist of the AMPA receptor, indicated for the adjunctive treatment of partial-onset seizures with or without secondarily generalisations in patients with epilepsy aged 12 years and older. Perampanel has demonstrated efficacy in a broad spectrum of preclinical models of seizures. Clinical trials Phase I and II showed a favourable safety profile and a good tolerability. Three Phase III studies and the follow-up study (up to 4 years) showed that the adjunctive treatment with perampanel at the dose of 4–12 mg/day has significantly...

Vortioxetine - the antidepressant with multimodal activity

doc. MUDr. Ján Pečeňák, CSc.

Neurol. praxi. 2015;16(3):171-173  

Depressive disorder is one of the most serious health problems and is in two-way relationship with various physical diseases. Depression could be one of the primary goals of treatment in coincidence with neurological disorders.The treatment follows the general recommendations including a substantial role of treatment with antidepressants. The new antidepressant with multimodal activity – vortioxetín – has influence by multiple ways on the serotonin system and secondary influence on different signaling systems and neuronal circuits. The positive effect on cognitive functions and safety use in elderly patients has been demonstrated. The aim...