Neurology for Practice, 2019, issue 6

Editorial

Slovo úvodem

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

Neurol. praxi. 2019;20(6):411

Main topic

Vertebrogenné bolestivé syndrómy

MUDr. Robert Rapčan, PhD., MBA, FIPP – editor hlavnej témy

Neurol. praxi. 2019;20(6):415

A multidisciplinary approach in the diagnostics of vertebrogenic diseases from the neurologist’s
and physio-rehabilitation specialist’s perspective

MUDr. Miloslav Dvorák, PhD., MUDr. Ľudovít Želinský, PhD., MUDr. Vlastimil Horný, MUDr. Róbert Rapčan, PhD., MBA, FIPP, prof. MUDr. Jiří Neuwirth, CSc., MUDr. Martin Griger, FIPP, MUDr. Ladislav Kočan, PhD.

Neurol. praxi. 2019;20(6):417-420

Vertebrogenic diseases are one of the segments of population diseases, that are a significant contributing factor to the disability of the modern human population. The strategy of diagnostics and treatment is often ill-conceived. The aim of this paper is to inform about the options of multidisciplinary diagnostics by a neurologist, physiotherapist, pain management specialist and radiologist. This clinical entity is the second most common reason for a doctor’s visit. In the productive age, vertebrogenic diseases are the major reason of sick leave, the fifth most common reason of hospitalisation, and the third most common reason of a surgical interventio...

A multidisciplinary approach in the diagnostics of vertebrogenic diseases from a radiologist’s
and interventional pain management specialist’s perspective

prof. MUDr. Jiří Neuwirth, CSc., MBA, MUDr. Martin Griger, FIPP, MUDr. Róbert Rapčan, PhD., MBA, FIPP, MUDr. Miloslav Dvorák, PhD., MUDr. Ľudovít Želinský, PhD., MUDr. Vlastimil Horný, MUDr. Ladislav Kočan, PhD.

Neurol. praxi. 2019;20(6):423-427

Back pain includes a big variety of diseases and clinical symptoms. They are the most common cause of pain and disability in therecent human population. The strategy of diagnostics and treatment is often ill-conceived. The aim of this paper is to inform aboutthe options of multidisciplinary diagnostics by a neurologist, physiotherapist, pain management specialist and radiologist. Thisclinical entity is the second most common reason for a doctor’s visit. In the productive age, vertebrogenic diseases are the majorcause of sick leave, the fifth most common cause of hospitalisation, and the third most common cause of a surgical...

Percutaneous endoscopic techniques and their position in diagnostic and treatment process focused on
vertebrogenic diseases: epiduroscopy and endoscopic discectomy

MUDr. Juraj Mláka, FIPP, MUDr. Michal Matias, MUDr. Róbert Rapčan, PhD., MBA, FIPP, Simona Rapčanová, MUDr. Ladislav Kočan, PhD.

Neurol. praxi. 2019;20(6):428-432

Percutaneous endoscopic techniques are modern minimally-invasive methods that enable effective treatment of pain and accompanying neurological symptoms in patients with an intervertebral disc herniation and/or other epidural pathologies. Available evidence supports their efficacy and safety therefore, they deserve a stable position in addressing specific types of spinal pathologies. Epiduroscopy is a suitable diagnostic and therapeutic method for chronic conditions associated with back pain in the lower parts of the spine in combination with radicular symptomatology. In this article, we deal with the principles, indication criteria and the performance...

Neuromodulation techniques in the management of vertebrogenic pain syndromes

MUDr. Róbert Rapčan, PhD., MBA, FIPP, doc. MUDr. Igor Martuliak, PhD., MPH, MUDr. Jan Lejčko, MUDr. Róbert Illéš, PhD., MPH, MUDr. Michal Krajčovič, MUDr. Ladislav Kočan, PhD.

Neurol. praxi. 2019;20(6):433-438

Neuromodulation techniques represent a spectrum of therapeutic approaches with various options to influence the pain pathways.It can be either the application of the chosen medication or the action of electrical signals in the vicinity of the peripheral(PNS) or central nervous system (CNS), by which the perception of pain is modulated. The application of medications into theepidural or subdural space is commonly used as a part of catheterisation techniques with a continuous administration of thechosen medication. The second group is made up of modern neurostimulation systems, during which electrical signals at thelevel...

Review articles

Secondary progressive multiple sclerosis: therapeutic nihilism or active approach?

MUDr. Jiří Piťha

Neurol. praxi. 2019;20(6):439-442

In secondary progressive multiple sclerosis (SPRS), such convincing therapeutic successes cannot be achieved as in relapsing disease. However, rapid initiation of effective treatment in the early stages of the disease slows the development of secondary progression. In active SPRS we use the immunosuppressive potential of mitoxantrone, cyclophosphamide eventually high doses of methylprednisolone and intravenous immunoglobulin. Siponimod is the first approved drug in the SPRS indication, which has been shown to slow clinically confirmed progression. At the stage of clinical trials, other drugs are predominantly neuroprotective.

Differential diagnosis of migraine

MUDr. Lukáš Klečka

Neurol. praxi. 2019;20(6):444-450

Migraine is one of the most frequent neurological diseases. The differential diagnosis of migraine is rather extensive comprisingthe whole spectre of primary headaches, i.e. various migraine types, trigeminal autonomic cephalalgias, tension-type headaches,migraine with autonomic displays and other primary headaches including migraine complications. The problems of secondaryheadaches are very comprehensive. However, the essential for diagnosis is to carry out a thorough anamnesis, clinical pictureand neuroimaging methods.

Secondary progressive multiple sclerosis – elevation on diagnostics and treatment options

doc. MUDr. Ema Kantorová, PhD.

Neurol. praxi. 2019;20(6):451-454

Diagnostics and treatment of secondary progressive multiple sclerosis has been problematic. Current options of immunomodulatorytreatment of secondary progressive sclerosis multiplex are limited. Results or clinical studies show promising knowledges,bringing possibilities for more effective treatment even for patients in secondary progressive multiple sclerosis. The work offerscurrent opinions and knowledges of the topic.

Multiple sclerosis and pregnancy – first line treatment and escalation therapy

MUDr. Simona Halúsková, doc. MUDr. Martin Vališ, Ph.D.

Neurol. praxi. 2019;20(6):455-459

Multiple sclerosis (MS) is a chronic autoimmune neurodegenerative disease that affects predominantly young females of childbearing age. Historically, women with MS were discouraged from having children as pregnancy was thought to negatively affect the disease course. However, over the past few decades, studies have shown that the opposite is true. Thanks to scientific research and modern therapeutic approaches many women remain clinically and radiologically stable and they can give birth to healthy babies. Unfortunately, there is limited information regarding the safety of disease-modifying drugs (DMD) during pregnancy. The paper deals with the possible...

From the boundary of neurology

MR monitoring of activity of multiple sclerosis patients: conventional techniques and long-term MR monitoring of ocrelizumab therapy

prof. MUDr. Manuela Vaněčková, Ph.D.

Neurol. praxi. 2019;20(6):460-466

Magnetic resonance imaging (MRI) has been used in multiple sclerosis (MS) imaging since its introduction in practice, and its importance continues to grow. It is the most important biomarker for this disease. It helps in diagnosis, prediction of the most likely development path and in monitoring disease activity. Activity monitoring has recently become increasingly important in view of the expanding portfolio of drugs, as the findings on MRI monitoring help to determine whether a given treatment is effective or not. Conventional MRI monitoring techniques are a part of most clinical trials, most often the number and possibly the volume of T2 lesions,...

Spatiotemporal asymmetry, options of analysis and complex therapy of stance and gait on treadmill in patients with spasticity of the lower limb (after stroke)

Mgr. Barbora Kukolová, prof. MUDr. Petr Kaňovský, CSc.

Neurol. praxi. 2019;20(6):467-474

Patients with post-stroke hemiparesis develop a pathological postural mechanism and pathological gait pattern of residual selective movement control, spasticity and preserved pathological muscle reactions. Hemiparetic stance and gait are characterized by a series of disturbances, including significant spatiotemporal asymmetry. Therefore, one of the most important needs in the neurorehabilitation treatment of patients with hemiparesis after stroke is to improve a postural stability and recover effective, independent and functional gait. Recovering or acquiring new, compensating, motor skills lost after stroke occurs during the motor learning process,...

Case report

The Importance of laboratory screening at paraesthesias

MUDr. Richard Novobilský, MUDr. Jana Horáková, MUDr. Pavel Ressner, Ph.D., doc. MUDr. Michal Bar, Ph.D., FESO, MUDr. Jaromír Gumulec

Neurol. praxi. 2019;20(6):479-481

This case report presents a 53-year-old woman treated at neurological emergency for transient acral paresthesias of the right upper limb and periorally without any other neurological deficit. Following an initial magnesium infusion she was sent home. A week later she was examined again for tingling in both left-sided limbs, objectively there was a central paresis of the left facial nerve, CT brain scan without a pathological finding, in laboratory test there was heavy haemolytic anemia and thrombocytopenia, she was sent to a hemathological ICU with a preliminary diagnosis of Thrombotic thrombocytopenic purpura. In this report I would like to briefly...

Video case reports

Tratable childhood-onset movement disorders: pragmatic approach and case-report of a patient with dopa-responsive dystonia

doc. MUDr. Matej Škorvánek, PhD.

Neurol. praxi. 2019;20(6):482-485

Pediatric movement disorders are a heterogeneous group of mostly rare disorders, which, however, may be treatable in certain percentageof cases. This manuscript discusses the basic differential-diagnostic algorithm in these patients and presents a case report of apatient with dopa-resonsive dystonia due to a tyrosine hydroxylase gene mutation with an excellent therapeutic benefit of levodopa.

Pharmacotherapy

Local therapy with 5 % lidocain medicated plaster (Versatis®)

MUDr. Dana Vondráčková

Neurol. praxi. 2019;20(6):475-478

Postherpetic neuralgia is a very painful complication of shingles (Herpes zoster), which affects a significant percentage of elderlypatients, mostly polymorbid and fragile. It is often difficult to find the appropriate therapy that bring relief pain and can be tolerate.Versatis, 5 % lidocaine medicated patch may be a solution for these patients. This case study proves that the good effectof Versatis has been confirmed by studies where other drugs have failed.