Neurology for Practice, 2021, issue 3

Editorial

Slovo úvodem

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

Neurol. praxi. 2021;22(3):171

Main topic

Novinky ve farmakoterapii vybraných neurologických onemocnění

prof. MUDr. Ivana Štětkářová, CSc., MHA

Neurol. praxi. 2021;22(3):175 | DOI: 10.36290/neu.2021.072

Novel approaches in pharmacological treatment of epilepsy

MUDr. Jana Zárubová, prof. MUDr. Petr Marusič, Ph.D.

Neurol. praxi. 2021;22(3):176-181 | DOI: 10.36290/neu.2021.033

In adults, 70-80 % of patients with epilepsy can be seizure free with pharmacological treatment. Novel approaches have been adopted in treatment strategies, new drugs have been introduced to the market and individualized precision therapy with a use of "orphan drugs" have been successfully used in few well characterized genetically determined epilepsies. In the treatment strategy, a short - and a long-term plan should be established to test systematically for the efficacy of different drugs. Buccal midazolam has been registered as a "rescue medication ". New drugs have been introduced recently for add-on therapy of focal seizures (perampanel, brivaracetam)...

The current state of pharmacotherapy for extrapyramidal diseases

doc. MUDr. Kateřina Menšíková, Ph.D., MUDr. Martin Nevrlý, Ph.D., MUDr. Lenka Hvizdošová, MUDr. Michaela Kaiserová, Ph.D., MUDr. Sandra Kurčová, MUDr. Miroslav Vaštík, Ph.D., MUDr. Jan Bardoň, MUDr. Tereza Bartoníková, MUDr. Zuzana Grambalová, MUDr. Aleš Grambal, Ph.D., MUDr. Pavel Otruba, MBA, prof. MUDr. Petr Kaňovský, CSc., FEAN

Neurol. praxi. 2021;22(3):183-193 | DOI: 10.36290/neu.2021.034

The pharmacotherapy for extrapyramidal diseases experienced a boom during the 1990s, particularly in the second half of the decade, when most clinical trials in neurological indications investigated the effect of various molecules on Parkinson's disease and other extrapyramidal diseases. The following decade witnessed a slow decline in large clinical trials, and an issue of growing importance was the introduction of costly forms of treatment of advanced-stage Parkinson's disease as well as expansion of indications for the treatment with botulinum toxin. The subsequent global economic crisis essentially ended the activities of the pharmaceutical industry...

New insights on the treatment of dementia

Mgr. Radoslava Bajtošová, doc. MUDr. Iva Holmerová, Ph.D., doc. MUDr. Robert Rusina, Ph.D.

Neurol. praxi. 2021;22(3):194-200 | DOI: 10.36290/neu.2021.014

Therapeutic aspects in dementia are focused on complex approaches and are based on four interlinked columns: psychosocial interventions (nonpharmacological interventions and caregiver support), pharmacotherapy (mainly acetylcholinesterase inhibitors and memantine), neuropsychiatry (management of behavioral and psychologic symptoms of dementia) and palliative care (early palliative interventions; complex palliative approach in advanced stages of dementia). Different therapeutic modalities are described in detail and particular impact is attributed to interdisciplinarity and close cooperation with relatives, since the diagnosis is established.

Progress in therapy of autoimmune neuropathies

doc. MUDr. Edvard Ehler, CSc., prof. MUDr. Ivana Štětkářová, CSc., MHA

Neurol. praxi. 2021;22(3):201-205 | DOI: 10.36290/neu.2021.005

Autoimmune neuropathies develope on the gound of immune reaction against own tissue. The tissue can be myelin sheath, proper axon or vascular supply - vasulitis. In only few neuropathies the antibody is known (e.g. GQ1b in Miller-Fisher syndroma) and in other neuropathies the autoantibodies are suspected or some other autoimmune reaction is considered. Corticosteroids are contraindicated. In chronic inflammatory polyneuropathy the treatment begins with induction therapy - intravenous application of immunoglobulins or oral medication with corticosteroids with the target dosis of 1-2 mg pro kilogram of body mass. In rare cases plasma exchange or immune...

Current treatment of brain tumours

MUDr. Jiří Polívka, CSc., Ing. Jiří Polívka, Ph.D., MUDr. Pavel Potužník

Neurol. praxi. 2021;22(3):206-211 | DOI: 10.36290/neu.2021.040

Cancer diseases are the second leading cause of death in the Czech Republic. The incidence of primary malignant brain tumours is approximately 8/100,000 and metastatic CNS involvement is nine times higher. This article deals with new real options and perspectives of their treatment resulting from the application of oncogenesis research. It presents some classic biomarkers that have substantially changed the classification of gliomas - the largest group of primary brain tumours. Examples of essential studies are given which have changed the approach to glioma treatment. References are made to the latest EANO guidelines on the treatment of diffuse gliomas....

Review articles

Neurofilament light chain and disease activity in patients with multiple sclerosis

doc. MUDr. Jarmila Szilasiová, PhD., MUDr. Miriam Fedičová

Neurol. praxi. 2021;22(3):212-216 | DOI: 10.36290/neu.2021.073

The goal of effective treatment of multiple sclerosis with the latest drugs is to prevent the patient's progressive disability. Unmet need for daily practice is the absence of valid laboratory biomarkers, which, in addition to imaging methods such as magnetic resonance imaging of the brain and spinal cord, would show us the current activity of the disease in an individual patient and the effect of treatment. Neurofilament light chain (NfL) is considered to be a non-specific biomarker of neurodegeneration and is easily examined from the blood. In this work, we present an overview of the results of studies evaluating the relationships between blood NfL...

Prophylactic treatment of migraine and the most common mistakes

MUDr. Babeta Hofericová

Neurol. praxi. 2021;22(3):218-224 | DOI: 10.36290/neu.2021.036

Migraine is the most common type of primary headaches encountered in neurological practice. This article provides the overview of current diagnostic criteria for the most common types of migraine, a brief up to date summary of acute treatment, but it is mainly focused on prophylactic treatment of more severe forms of migraine - choosing a suitable prophylactic drug, optimal timing of initiation, termination of treatment and highlighting the most common types of mistakes in treatment.

Long-term management of oral cladribine treatment in multiple sclerosis

MUDr. Radek Ampapa, MUDr. Michal Dufek, Ph.D., MUDr. Pavel Hradílek, Ph.D., MUDr. Ivana Kovářová, prof. MUDr. Jan Mareš, Ph.D., MUDr. Alena Martinková, MUDr. Marek Peterka, doc. MUDr. Pavel Štourač, Ph.D., MUDr. Aleš Tvaroh, Ph.D., MUDr. Marta Vachová, prof. MUDr. Martin Vališ, Ph.D.

Neurol. praxi. 2021;22(3):226-230 | DOI: 10.36290/neu.2021.027

Oral cladribine is a high efficacy disease-modifying drug for treatment of multiple sclerosis. Its mode of action represents a selective immune-reconstitution resulting in simply dosing in two annual curses followed by a sustained period of a potential remission. Our work is aimed to an initiation of oral cladribine treatment, monitoring schedule and types of terapeutic response. Consequent treatment options are suggested based on eventual disease activity after cladribine courses. Furthermore, cladribine is discussed from perspective of pregnancy planning and vaccination.

Treatment persistence to ocrelizumab and local experience

MUDr. Simona Halúsková, prof. MUDr. Martin Vališ, Ph.D., FEAN

Neurol. praxi. 2021;22(3):231-234 | DOI: 10.36290/neu.2021.038

Multiple sclerosis (MS) is a chronic inflammatory autoimmune and neurodegenerative disease of the central nervous system affecting most commonly young adults. There has been tremendous progress in the treatment of MS over recent years. Ocrelizumab is a humanized monoclonal antibody that causes selective depletion of CD20+ B-lymphocytes. The drug has shown its efficacy in treating both relapsing-remitting and primary progressive MS. Medication adherence and persistence play an essential role in the treatment of MS. Adherence to treatment fundamentally contributes to optimal therapeutic outcomes, improved patients' quality of life and reduced healthcare...

From the boundary of neurology

Immunopathogenesis of coronavirus SARS-CoV-2 infection with respect to the multiple sclerosis

prof. RNDr. Jan Krejsek, CSc.

Neurol. praxi. 2021;22(3):236-241 | DOI: 10.36290/neu.2021.028

SARS-CoV-2 virus which is pandemic is entering host cells via interaction between viral spike glycoprotein S with membrane bound ACE2 enzyme. All cells expressing ACE2 are infectable by SARS-CoV-2 virus. The natural course of COVID-19 diseases which is caused by SARS-CoV-2 infection is very individual. It is caused especially by individual immune reactivities. Those infected people who are unable to control and eliminate SARS-CoV-2 infection effectively can progress into severe harm inflammatory response affecting especially respiratory tract. However, SARS-CoV-2 virus could be recognized as neurotropic. Cellular structure of CNS are expressing ACE2...

Case report

Congenital myopathy associated with RYR1 gene mutation (case report)

MUDr. Patrícia Balážová, MUDr. Karin Viestová, MUDr. Miriam Kolníková, PhD.

Neurol. praxi. 2021;22(3):242-247 | DOI: 10.36290/neu.2020.049

Congenital myopathies are a heterogenous group of genetic neuromuscular disorders characterized by variable phenotype and characteristic histopathological picture. The clinical features of patients are muscle weakness and hypotonia, which is often present at birth and in the early months of life (floppy baby syndrome). The clinical course of disease is static or slowly progressive. In the past, diagnose of congenital myopathy was based on muscle biopsy, which has been replaced by methods of genetic testing. In our case report we presented a case of 15 years-old boy with a manifestation of hypotonic syndrome in the neonatal period, followed by difficulty...