Slovo úvodem

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

Neurol. praxi. 2020;21(2):87  

Paliativní péče a neurologie

doc. MUDr. Robert Rusina, Ph.D.

Neurol. praxi. 2020;21(2):93 | DOI: 10.36290/neu.2020.053  

Neuropalliative care

Claire J. Creutzfeldt, MD

Neurol. praxi. 2020;21(2):94-96 | DOI: 10.36290/neu.2020.054  

Fifty years ago started the hospice movement having revolutionized end-of-life care by easing symptom burden, by improving the quality of life, and by not 'giving up' on dying patients. Palliative care is a philosophy of care for patients that was born with the hospice movement but is not limited to patients nearing the end of life: Instead, palliative care is appropriate at any age, stage of illness, or prognosis and focuses on improving communication about goals of care and maximizing comfort and quality of life. In neurologic diseases palliative care accompanies patients on a journey that can sometimes last years and even decades, with often-increasing...

Nutrition dilemma: gastrostomy in a patient with Parkinson's disease. Collaboration of a palliative care specialist and a neurologist

MUDr. Denisa Mlčochová, MUDr. Pavel Dušek, MUDr. Hana Brožová, Ph.D., MUDr. MgA. Kateřina Rusinová, Ph.D.

Neurol. praxi. 2020;21(2):97-99 | DOI: 10.36290/neu.2020.055  

Advanced Parkinson's disease (PD) is characterized by many complications: motor fluctuations and dyskinesias, but also non-motor symptoms. From the palliative point of view the concept of advanced PD refers to a situation when non-motor symptoms surpass motor symptoms in severity and movement disability does not respond any more to therapeutic interventions. We present an illustrative case report demonstrating the utility and benefit of interdisciplinary collaboration of neurologists and palliative care specialists in a chronic disease with irreversible progression. The palliative care specialist's opinion is helpful in current medical decision making...

Aspects of palliative care in advanced dementia

doc. MUDr. Robert Rusina, Ph.D., JUDr. Šárka Špeciánová

Neurol. praxi. 2020;21(2):100-102 | DOI: 10.36290/neu.2020.056  

Dementia is characterized by overall progression over time and in most cases, causal therapy is not available. Patients in advanced stages of dementia have severe cognitive deterioration and depend on nursing support, and during terminal stages there is irreversible loss of autonomy and need of continual nursing. Dementia should be considered as a serious life limiting condition with predictable and irreversible progression to terminal stages of the underlying disease. Physicians should early open discussion about prognostic aspects, anticipate the predictable worsening and together with the patient and his family search for therapeutic options that...

Ocrelizumab and novel therapeutic goals in multiple sclerosis

MUDr. Radek Ampapa

Neurol. praxi. 2020;21(2):104-108 | DOI: 10.36290/neu.2019.061  

The group of drugs intended for the treatment of multiple sclerosis has continuously expanded to include new agents in the recent years. The first drug intended not only for the treatment of relapsing-remitting, but also primary-progressive multiple sclerosis is the monoclonal antibody ocrelizumab. The increasing number of effective drugs simultaneously expands treatment algorithm options. Disease stability remains the therapeutic goal; however, its definition has shifted from a mere monitoring of clinical signs and symptoms of disease relapse or progression to more complex composite parameters encompassing activity or progression of multiple sclerosis...

Therapeutic uses of Magnesium in Neurology

MUDr. Milan Grofik, PhD., MUDr. Michal Cibulka, doc. PharmDr. Daniela Mináriková, PhD., MSc., doc. RNDr. Martin Kolísek, Dr. Rer. Nat., prof. MUDr. Egon Kurča, PhD., FESO

Neurol. praxi. 2020;21(2):109-113 | DOI: 10.36290/neu.2020.057  

Magnesium takes part in the main life processes of all human cells. Deficit of magnesium is connected to an increase risk of civilization, neurodegenerative and psychiatric diseases. In neurology, magnesium is used for its calming effects on the irritability of the central and peripheral nervous system and neuromuscular transmission. It is basically the essence for the treatment of tetanic syndrome, tension headache, cramps, epilepsy and migraine. Vasoactive and metabolic effects of magnesium are used in the prevention and treatment of the cerebrovascular diseases.

Management of respiratory muscleweakness in advanced stages of Duchenne muscular dystrophy

doc. MUDr. David Kemlink, Ph.D.

Neurol. praxi. 2020;21(2):114-119 | DOI: 10.36290/neu.2020.058  

Duchenne muscular dystrophy is a progressive neuromuscular disorder inevitably leading to respiratory muscle weakness with subsequent impaired airway clearance and hypercapnic respiratory failure. These complications were the main cause of death in this patient population. The main intervention is early and regular assessments of respiratory muscle strength and adequate compensation of the impartment. Thanks to modern technical devices it is possible to prolong the survival of the patients with preserved quality of life relative to the state before respiratory failure. The main methods are airway clearance techniques including regular use of mechanical...

The new trends in multiple sclerosis treatment

prof. MUDr. Ľubomír Lisý, DrSc.

Neurol. praxi. 2020;21(2):120-124 | DOI: 10.36290/neu.2020.059  

During several last years, important progress in medicamentous treatment of multiple sclerosis has been achieved. Every year new molecules with higher degree of efficiency are approved. Medication with continuous application is replaced by pulse therapy that improves adherence of patients to the therapy. Used medication beside anti-inflammatory effect has also immunosuppressive effect. The treated patients are under increased risk of infectious complications. Identification of heterogenous pathomechanisms of the disease in the future could help to find better approach to the treatment of inflammation and accompanying neurodegeneration.

Psychological aspects of adherence to prophylactic medication in migraine patients: tools for the practice

Mgr. Jana Černá Tomanová, Ph.D., PhDr. Pavla Banýrová

Neurol. praxi. 2020;21(2):125-129 | DOI: 10.36290/neu.2020.060  

When adherence is not good, therapeutic outcomes are not good either. This is a key finding in the case of complaints that are very often accompanied by psychosocial burden and/or comorbidities even from among psychiatric diagnoses. Metastudies have shown that adherence to prophylactic migraine treatment, particularly in the long term, is low, such as that in the case of daily routine measures for the purpose of lifestyle changes. There are tools and techniques that healthcare professionals, and physicians in particular, have at hand which, when adopted, practised, and applied practically, can positively affect adherence. They include, for instance,...

Coffee, tea, and tobacco, interactions and other risks in patients at a neurological outpatient department

PharmDr. MVDr. Vilma Vranová, Ph.D., MUDr. Pavel Ressner, Ph.D., prof. MUDr. David Školoudík, Ph.D., FESO, FEAN

Neurol. praxi. 2020;21(2):130-134 | DOI: 10.36290/neu.2020.061  

At both outpatient and inpatient departments, one may encounter conditions that can be associated with coffee, tea, and tobacco consumption, e.g. nicotine poisoning, particularly with an e-cigarette filling liquid typically presented by emergency ambulance crews as unclear disturbances of consciousness, coma, etc., or sudden anxiety states with psychotic manifestations in the case of acute caffeine poisoning. These substance can also interfere with the effect of pharmacotherapy of patients through both pharmacokinetic and pharmacodynamic interactions. The risk of these intoxications has been increasing, particularly due to easy access to the above...

Sexual dysfunctions in patients with epilepsy

MUDr. Taťána Šrámková, CSc.

Neurol. praxi. 2020;21(2):135-140 | DOI: 10.36290/neu.2019.036  

Sexual dysfunctions are common complications of epilepsy. With respect to the quality of life of epileptics, they need to be concerned about their sexuality It is important to initiate communication on the topic of sexuality between doctor and patient. The recommendation of epileptics to a specialist, sexologist-adnrologist or gynecologist is indicated. Mostly epileptic patients experience erectile dysfunction that responds favorably to oral phosphodiesterase type 5 inhibitors. In women with epileptics the etiology of sexual dysfunction is multifactorial, treatment is symptomatic. Both men and women with epilepsy require medical intervention when planning...

The pitfalls of treating rapidly evolving multiple sclerosis

MUDr. Pavel Hok, prof. MUDr. Vojtěch Thon, Ph.D., prof. MUDr. Jan Mareš, Ph.D., MBA

Neurol. praxi. 2020;21(2):142-145 | DOI: 10.36290/neu.2020.033  

In this case report of a young female patient with multiple sclerosis, we demonstrate three pitfalls of current treatment in patients with this condition: the issue of accurate diagnosis in ambiguous cases; the choice of appropriate immunomodulatory therapy in a previously untreated patient; and the safety of treatment and related prophylactic measures. The paper discusses selected sections of the current guidelines and demonstrates the advantages of interdisciplinary cooperation which, in this particular case, resulted in a personalized vaccination scheme for active immunization against the varicella-zoster virus.

Charcot-Marie-Toothdisease as the most common inherited neuropathy: a case report from our department

MUDr. Alžbeta Hlucháňová, MUDr. Michal Kozmon, doc. MUDr. Pavol Kučera, PhD., MUDr. Mário Lazar

Neurol. praxi. 2020;21(2):146-150 | DOI: 10.36290/neu.2020.062  

Hereditary peripheral neuropathies represent a large group of genetic neurological diseases presenting with a heterogeneous clinical picture. We mainly think about these disorders at positive family history, presentation of chronic and progressive muscle weakness, atrophy of the limbs and by the presence of typical foot deformities appears. This article closely focuses on the most common hereditary neuropathy - Charcot-Marie-Tooth (CMT) disease and the accelerated progression of this disease in combination with chronic alcohol abuse in our patient's case report.

Clinical experiences in multiple sclerosis patients treated with alemtuzumab

MUDr. Mária Ďurišová, MUDr. Eva Recmanová

Neurol. praxi. 2020;21(2):153-158 | DOI: 10.36290/neu.2020.035  

Alemtuzumab is a humanized monoclonal antibody approved in the Czech Republic for the treatment of highly active relapsing-remitting multiple sclerosis (RRMS). The mechanism of action of alemtuzumab consists in its binding to the CD-52 molecule, present particularly on mature T - and B-lymphocytes. This bond induces cell cytolysis with lymphocyte depletion. Subsequent repopulation reduces the autoaggressive potential of the new lymphocyte population. We present two case reports of patients treated with alemtuzumab at our site - one treatment-naive patient with no previous DMD (Disease Modifying Drugs) therapy and one patient with treatment escalation...

Treating Holmes tremor with deep brain stimulation

MUDr. Martin Nevrlý, Ph.D., doc. MUDr. David Krahulík, Ph.D., MBA, MUDr. Pavel Otruba, MBA, MUDr. Jan Bardoň, prof. MUDr. Petr Kaňovský, CSc., FEAN

Neurol. praxi. 2020;21(2):159-161 | DOI: 10.36290/neu.2019.071  

Rubral tremor, also known as Holmes tremor (HT), is a relatively rare type of tremor defined as a coarse tremor, accentuated in a static position or during movement. It is usually unilateral, with bilateral involvement occurring only rarely. It occurs due to a lesion of cerebello-rubral pathways. Pharmacological therapy is difficult and, largely, ineffective. Deep brain stimulation (DBS) of the ventral intermediate (VIM) nucleus of the thalamus is a treatment option that, in some cases, can have a very good effect. A case is reported of a 38-year-old woman who, at the age of 37 years old, suffered a left cerebellar hemisphere haemorrhage with subsequent...

Dlouhodobá účinnost a bezpečnost kladribinu v léčbě roztroušené sklerózy

MUDr. Zuzana Zafarová

Neurol. praxi. 2020;21(2):162-164 | DOI: 10.36290/neu.2020.063  

Za jakých podmínek je možné žádat zdravotní pojišťovnu o mimořádnou úhradu zdravotních služeb?

JUDr. Šárka Špeciánová

Neurol. praxi. 2020;21(2):166