Slovo úvodem

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

Neurol. praxi. 2020;21(4):255  

Elektromyografie a evokované potenciály v neurologii - úvodník

MUDr. Svatopluk Ostrý, Ph.D.

Neurol. praxi. 2020;21(4):259  

Needle electromyography

doc. MUDr. Edvard Ehler, CSc.

Neurol. praxi. 2020;21(4):261-263 | DOI: 10.36290/neu.2020.014  

During the investigation of muscle with EMG electrode the spontaneous activity is evaluated at first - fibrillations, positive sharp waves, fasciculations, myotonic discharges etc. This pathological activity at rest may be characteristic for certain types of disorders. The investigation of voluntary activity with evaluation of motor unit action potentials (MUP) follows. There is necessary to assess not only a form of MUP (amplitude, duration, number of phases), but also their stability, recruitment, firing rate, interferential curve. A needle EMG owns a potential to respond to many logical questions of a clinician, but it has also its restricions,...

Electromyography, nerve conduction studies, repetitive nerve stimulation

MUDr. Petr Ridzoň

Neurol. praxi. 2020;21(4):264-267 | DOI: 10.36290/neu.2020.048  

Nerve conduction studies are basic electrophysiologic technique for evaluation of damage of peripheral nerves (neuropathies). Motor and thick myelinated sensory fibers are examined, and the method allows to determine the degree and type of the damage (motor, sensory as well as axonal or demyelinating). Indications for the examination of nerve conduction are as follows: polyneuropathies of all kind of aetiology (metabolic, malnutrition, toxic, hereditary, inflammatory, paraneoplastic), mononeuropathies (compressive, traumatic, inflammatory), further unclear findings, as well as combined central and peripheral lesions where it is necessary to assess...

Evoked potentials

prof. MUDr. Ivana Štětkářová, CSc., MHA

Neurol. praxi. 2020;21(4):268-274 | DOI: 10.36290/neu.2020.037  

Evoked potentials (EPs) are electrical responses arising in the nervous system. EPs are evoked by different stimuli of the specific modality. According to the stimulated part of the nervous system, we divide them into visual (VEP, Visual Evoked Potentials), auditory (BAEP, Brainstem Auditory Evoked Potentials), somatosensory (SEP, Somatosensory Evoked Potentials) and motor (MEP, Motor Evoked Potentials) evoked potentials. Absence of the response is the most significant abnormal finding of EPs. Other important parameters are decrease of the amplitude and prolongation of the latency. When indicating the examination of EPs, the correct question asked...

Intraoperative neurophysiological monitoring - Evoked potentials and Electromyography

MUDr. Svatopluk Ostrý, Ph.D.

Neurol. praxi. 2020;21(4):277-282 | DOI: 10.36290/neu.2020.093  

Intraoperative neurophysiological monitoring (IONM) is aimed at reducing risk of poostoperative neurological deficit in particular group of surgical procedures. There is much similar with evoked potentials (EP) examination routinely performed in labs. There are two main differences between EPs in lab and IONM, invasive versus noninvasive stimulation and/or registration and evaluation changes of responses in time during surgery instead of comparison to normative values. Pure EP parameters has to be compared not only with the baseline values but also with clinical picture, actual situation at the operation room and in the operation field. Thorough neurophysiological...

Migraine and multiple sclerosis - symptom or comorbidity

doc. MUDr. Radomír Taláb, CSc., MUDr. Marika Talábová

Neurol. praxi. 2020;21(4):283-286 | DOI: 10.36290/neu.2020.082  

The increased incidence of headache in MS patients compared to a healthy population is generally known. Prevalence in individual studies, in their meta-analyses and in individual published MS patient populations has a large dispersion of 4-64 %. It turns out that there is an increased incidence of headache in the early stage of MS and during relapse and are likely equivalent to an inflammatory reaction on meninges in MS patients. In this sense, headaches, migraine or a tension type of headache (TTH) can be understood as a symptom of MS. Several drugs used in the treatment of MS can cause headaches or decompensate migraine, worsen quality of life and...

Interferons-β treatment during pregnancy and breast-feeding

MUDr. Eva Meluzínová, MUDr. Jana Libertínová

Neurol. praxi. 2020;21(4):289-290 | DOI: 10.36290/neu.2020.085  

Multiple sclerosis is autoimmune and neurodegenerative disease of central nervous system. The onset is usually between 20^th and 30^th year of life and females are affected three times more often than males. Thus, a large proportion of patients consists of women with childbearing potential and the choice of the treatment should reflect potential pregnancy planning very early in the course of the disease. In 2019 interferons-β have been assigned as the first line treatment options along with glatiramer acetate. The advantage of the treatment is a favourable safety profile not only in pregnancy but during lactation as well. Pregnancy...

Longterm safety of Ocrelizumab in Multiple Sclerosis treatment

MUDr. Marek Peterka, MUDr. Pavel Potužník

Neurol. praxi. 2020;21(4):291-293  

A huge shift has been made in the field of Multiple Sclerosis treatment in the last decades. New modern medicaments have brought us the ability to suppress the disease activity and thereby save the patients from becoming invalid in the future. Therefore, the main feature of these drugs must be not only their efficiency, but also long-term safety. And so, we collect long-term data about the efficiency and safety of these new medicaments. This article focuses on the data of ocrelizumab. A remedy that is used today to treat not only relapse remittent form of MS but also is the first remedy in history used to treat primary progressive form of MS.

Diagnostic options in retrobullar neuritis

MUDr. Tereza Svrčinová

Neurol. praxi. 2020;21(4):296-299 | DOI: 10.36290/neu.2020.094  

Acute optic neuritis is the most common optic neuropathy. In its typical form, optic neuritis presents as an inflammatory demyelinating disorder of the optic nerve affecting majority of patients with multiple sclerosis (MS). Atypical forms of optic neuritis may occur, either in association with other inflammatory disorders or in isolation. Differentiation from other optic neuropathies is vital for treatment choice and further patient management to prevent visual loss. Diagnostic investigations include MRI, visual evoked potentials, and CSF examination. Over the past decade, a number of new imaging, laboratory and electrophysiological techniques have...

Immunosuppressive treatment of multiple sclerosis and risk (of reactivation) of viral hepatitides

MUDr. Václav Hejda, MUDr. Aleš Tvaroh, Ph.D.

Neurol. praxi. 2020;21(4):301-306 | DOI: 10.36290/neu.2020.084  

The article presents a current perspective on the risk of reactivation of viral hepatitides in association with the administration of drugs with an immunosuppressive effect to treat multiple sclerosis. The aim of the article is to provide a practical approach for testing viral hepatitides prior to initiation of immunosuppressive treatment, taking into account recommendations resulting from the summaries of individual products.

Cryptogenic Neuropathy - a retrospective analysis - Transthyretin-related familial amyloid polyneuropathy - differential diagnostic pathway

MUDr. Jana Junkerová, MUDr. Eva Kovalová

Neurol. praxi. 2020;21(4):307-312 | DOI: 10.36290/neu.2020.089  

We retrospectively evaluated 2 years of our diagnostic efforts. The subjects of interest were 25 patients with acutely or subacutely progressing polyneuropathy, with the etiology remaining unclear in 22of cases even after the use of all available diagnostic methods. Transthyretin familial amyloid polyneuropathy, TTR-FAP, certainly belongs to the considerations of etiopathogenesis with a rare occurrence. Although we have not yet detected this diagnosis, we present a brief outline of the disease, reflections on the occurrence of this unit in our region and the possibilities of its diagnosis. We offer comparisons in the success of revealing the complex/unclear...

Opsoclonus-myoclonus syndrome - case report

MUDr. Adéla Škvorová, MUDr. Kateřina Matějová

Neurol. praxi. 2020;21(4):313-315 | DOI: 10.36290/neu.2019.079  

Opsoclonus-myoclonus syndrome is a rare and heterogeneous disorder of children and adults. Main clinical features, as the name of the syndrome suggests, are opsoclonus and myoclonus of trunk and limbs. Next features are ataxia, dysarthria, behavioral and sleep disturbance. In this case report we will look into OMS in adults, his diagnostics, finding out an etiology a his treatment. The treatment is imunomodulating, sympthomatic, in case of paraneoplastic etiology of course the treatment of primary neoplasia. Physiotherapy, logopedia, ergotherapy and psychotherapy play an important part in the treatment too.

Atypical Charles Bonnet syndrome and psychosis in Parkinson´s disease: two players in one patient

MUDr. Ján Necpál, MUDr. Miroslav Borsek, MUDr. Marcel Árvai, MUDr. Suren Karapetian

Neurol. praxi. 2020;21(4):316-318 | DOI: 10.36290/neu.2020.095  

Psychosis in Parkinson´s disease manifests most often with visual hallucinations and delusions in people with Parkinson´s disease. Prevalence of other forms of hallucinations is much lower and may suggest an alternative diagnosis. Rarely bimodal hallucinations can occur. We report a case of a patient with Parkinson´s disease with visual hallucinations along with coexisting auditory hallucinations which are caused by rare atypical Charles Bonnet syndrome arising from longstanding and profound deafness.

Eye of tiger sign in patient with extrapyramidal syndrome - unique case report

MUDr. Martin Daniš, MUDr. Juraj Cisár, MUDr. Georgi Krastev, PhD.

Neurol. praxi. 2020;21(4):319-321 | DOI: 10.36290/neu.2020.036  

In this paper we present a case of a 39-year-old patient, who presented with a 4-year history of gradually worsening symptoms of uncontrolled movements of the right limbs, walking difficulties and unsteadiness pulling her to the right. During clinical examination we observed choreoathetoid movements and dystonic posture of the head and the limbs on the right side of the body, rigidity of the right limbs, postural and resting tremor of the hands, positive Romberg's and Babinski sign on the right. On brain MRI we could see pathological hypodensity zones symmetrically in the region of globus pallidus bilaterally - typical for the eye of the tiger sign...

Sir William Richard Gowers (1845-1915) and the first neurology textbook

prof. MUDr. Petr Kaňovský, CSc.

Neurol. praxi. 2020;21(4):327-333 | DOI: 10.36290/neu.2020.097  

William Richard Gowers was born into a shoemaker family in London on 20 March 1845. When he was eleven years old, his father and three of his siblings have died, probably due to typhoid fever, and his mother decided to return to live in Doncaster, but he started to attend Christ Church Cathedral School in Oxford. When he left the college, he tried farming for a short time, but then, thanks to his family connections, he became a medical apprentice with a local doctor in Coggeshall, Essex. Three years later, he passed the exams and was accepted to study medicine at the University College of London, graduating in 1870. After graduation, he was appointed...

Motto for epilepsy treatment: "Never give up."

MUDr. Irena Novotná, MUDr. Dana Vyskočilová

Neurol. praxi. 2020;21(4):322-324 | DOI: 10.36290/neu.2020.096  

This article presents case reports of two young female patients with epilepsy. The case reports depict several clinical attempts with the aim to modify patients' therapy. In addition, the first patient also suffered stigma for several years. Rational polytherapy let not only to the clinical benefit but also to the overall quality of life improvement. Herein, we would like to demonstrate how important it is for the patients with the life-long disorder like epilepsy to unceasingly communicate, propose new solutions, administer novel antiepileptics and not to give up reassessing the overall health status.

Jak postupovat, pokud je hospitalizovaný pacient na tzv. akutním lůžku a rodina odmítá podepsat překlad pacienta do zařízení, které poskytuje následnou péči?

JUDr. Šárka Špeciánová

Neurol. praxi. 2020;21(4):334