Slovo úvodem

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

Neurol. praxi. 2022;23(3):183  

Poruchy spánku a neurologická onemocnění

prof. MUDr. Karel Šonka, DrSc.

Neurol. praxi. 2022;23(3):187 | DOI: 10.36290/neu.2021.079  

Sleep apnea in patients with ischemic stroke

doc. MUDr. Pavel Šiarnik, PhD., prof. MUDr. Branislav Kollár, PhD.

Neurol. praxi. 2022;23(3):188-191 | DOI: 10.36290/neu.2022.006  

Sleep-disordered breathing is a significant risk factor for cerebrovascular diseases. Sleep apnea syndrome is common among patients with stroke and negatively influences outcomes of patients. However, most cases of sleep apnea in patients with stroke remain undiagnosed and patients are losing potential benefits of positive airway pressure therapy. In this article, we focus in detail on the specific aspects of epidemiology, etiopathogenesis, diagnostic process, and therapy of sleep apnea syndrome in stroke patients. We also deal with the relationships and connections between these two separate nosological units.

Daytime sleepiness in a neurologist's office

doc. MUDr. Eva Feketeová, PhD.

Neurol. praxi. 2022;23(3):192-197 | DOI: 10.36290/neu.2022.010  

Daytime sleepiness (DS) poses a serious risk to the affected individual in the form of difficult employment and reduced quality of life and, depending on its cause, also metabolic and cardiovascular consequences. The work analyzes the nature of sleepiness depending on its cause, diagnostic procedures and therapeutic options. On the example of five case reports points out the differences in clinical manifestation of sleepiness in narcolepsy type 1, Klein-Levin syndrome, epilepsy, multiple sclerosis and osmotic demyelinating syndrome, it demonstrates the application of diagnostic and therapeutic options in clinical practice.

Continuous positive airway pressure (CPAP) - 40 years of effective conservative obstructive sleep apnea treatment

prof. MUDr. Karel Šonka, DrSc., MUDr. Simona Dostálová, Ph.D., MUDr. Jana Vyskočilová

Neurol. praxi. 2022;23(3):198-202 | DOI: 10.36290/neu.2022.005  

Continuous positive airway pressure (CPAP) is an effective treatment for moderate and severe obstructive sleep apnea (OSA) that improves OSA symptoms, reduces the health consequences of OSA, and improves the patient's quality of life. Sufficient compliance and proper CPAP settings are required to achieve the therapeutic effect of CPAP. This treatment should be supplemented with other methods of OSA treatment, especially weight reduction. The principle of CPAP was described by Colin Sullivan in 1981, and many technical improvements have subsequently been made to facilitate its application and improve compliance. The discovery of CPAP is one of the milestones...

Paroxysmal sleep-related events

MUDr. Petr Bušek, Ph.D., MUDr. Jitka Bušková, Ph.D.

Neurol. praxi. 2022;23(3):203-210 | DOI: 10.36290/neu.2022.007  

There is a wide range of different paroxysmal motor events with various aetiology during sleep. The most important issue in their evaluation is to distinguish epileptic seizures from other sleep disorders. Sleep-related epileptic seizures are relatively frequent and they may occur predominantly or exclusively during sleep in approximately 12 %. The most frequent seizure type during sleep is a focal hyperkinetic seizure in the frame of the sleep-related hypermotor epilepsy (SHE), previously known as nocturnal frontal lobe epilepsy, which is a heterogeneous group in terms of aetiology and localization of epileptic focus. The differentiation of SHE from...

Sleep related breathing disorder in neuromuscular diseases

doc. MUDr. David Kemlink, Ph.D.

Neurol. praxi. 2022;23(3):211-216 | DOI: 10.36290/neu.2022.038  

Numerous conditions from the group of neuromuscular diseases lead at some point to weakness of respiratory or upper airway musculature, which is most prominent in supine position. These conditions most frequently result in obstructive sleep apnea or sleep related hypoventilation, central sleep apnea is diagnosed less often. Most typical daytime symptoms are excessive daytime sleepiness, cognitive problems, or body weight changes, whereas nighttime symptoms are dominated by periodic snoring, sleep fragmentations and morning headache. The precise identification of the disorder frequently requires polysomnographic investigation. Most frequent therapeutic...

Breastfeeding and multiple sclerosis

MUDr. Eva Meluzínová

Neurol. praxi. 2022;23(3):217-220 | DOI: 10.36290/neu.2022.033  

Multiple sclerosis (MS) is a chronic autoimmune and neurodegenerative disease affecting the brain and spinal cord. Most often the disease begins between the ages of 20-30 and occurs three times as often in women. Treatment is initiated early, preferably after the first symptom of the disease. In patients of childbearing age, it is advisable to choose a drug that is safe after conception. The period of pregnancy has a favourable effect on the course of the disease, with a decrease in activity in most cases. In stable patients, therapy is discontinued. If patients have unplanned pregnancy and the disease is not stable, therapy with certain drugs can...

Cognitive dysfunction in secondary progressive multiple sclerosis

MUDr. Radek Ampapa

Neurol. praxi. 2022;23(3):221-226 | DOI: 10.36290/neu.2021.094  

Cognitive dysfunction is among the less frequently investigated and diagnosed signs in multiple sclerosis (MS). Standard diagnostic processes used in routine neurological practice fail to sufficiently consider cognitive impairment. Cognitive dysfunction is more common in progressive MS variants and can have a significant impact on the patient's quality of life. Secondary progressive MS is a difficult-to-treat condition. Siponimod is the first drug which, in patients with secondary progressive MS, has been shown to reduce the progression of disability while having a positive effect on cognitive functions. Cognitive monitoring can prospectively be a...

Elimination half‑life is not just a pharmacological profile

MUDr. Ondřej Strýček, Ph.D., MUDr. Jitka Kočvarová

Neurol. praxi. 2022;23(3):227-230 | DOI: 10.36290/neu.2022.031  

When choosing the optimal drug, we focus on several key characteristics of the drug. The drug pharmacokinetic profile is usually a less significant factor in this choice. The aim of the following article is to clearly explain why we should pay particular attention to the elimination half-life as an important pharmacokinetic parameter. We also want to point out its role in anti-seizure medication, for which the stability of plasma drug levels is essential.

Ocrelizumab - long-term efficacy and safety in real-world clinical practice in patients with relapsing-remitting multiple sclerosis

MUDr. Martin Elišák, Ph.D.

Neurol. praxi. 2022;23(3):233-237 | DOI: 10.36290/neu.2022.029  

Ocrelizumab is a humanized monoclonal antibody against CD20+ lymphocytes, which is expressed mainly, although not exclusively, on B lymphocytes. The binding of ocrelizumab leads to rapid and efficient depletion of these cells. It has demonstrated its high efficacy in patients with relapsing-remitting multiple sclerosis in the OPERA clinical trials published in 2017, which led to its approval in the Czech Republic as an escalation therapy in 2018. Current trends recommending early initiation of highly effective treatment, especially in patients with an unfavorable prognosis, reflect new indication restrictions from 2022, allowing for the initiation...

Improving gait in patients with multiple sclerosis

Mgr. Klára Novotná, Ph.D., MUDr. Jana Lízrová Preiningerová

Neurol. praxi. 2022;23(3):239-244 | DOI: 10.36290/neu.2022.032  

Gait impairment is among the most limiting symptoms in multiple sclerosis. The goal of specific treatment with immunomodulatory drugs (disease-modifying drugs, DMD) is to halt or at least suppress disease activity as much as possible. Despite this, gait impairment may occur in some patients. In such a case, it is possible to offer symptomatic pharmacological treatment or rehabilitation therapy. Symptomatic drugs intended to treat gait impairment particularly include the medicinal product fampridine (Fampyra®) which has been available in the Czech Republic since 2011. In April 2022, it became possible to receive reimbursement by health insurance...

Symphysitis pubis purulenta - a rare cause of back pain

MUDr. Dalibor Zimek, MUDr. Blanka Rychlíková

Neurol. praxi. 2022;23(3):245-248 | DOI: 10.36290/neu.2022.039  

Symphysitis pubis purulenta is a rare infectious disease caused mostly by Staphylococus aureus. This infection affects mainly immunocompromised elderly patients. Symphysitis can spread hematogenously from a distant site of infection or directly through damaged skin cover. Antimicrobial treatment regimens are similar to the treatment of spondylodiscitis. We present a case of a young male with this diagnosis, who was not in the expected risk group.

Autoimmune encephalitis associated with anti-Caspr2 antibodies

MUDr. Martin Sabela, doc. MUDr. Ondřej Volný, Ph.D., doc. MUDr. Michal Bar, Ph.D.

Neurol. praxi. 2022;23(3):249-251 | DOI: 10.36290/neu.2021.037  

We present a case report of a 61-year-old man with an acute onset of epileptic seizures, encephalopathy, delirium, peripheral nerve hyperexcitability syndrome and dysautonomy with indentified anti-Caspr2 antibodies whose clinical status has promptly improved after a high dose of corticosteroids. Subsequently a short review of anti-Caspr2 pathophysiology, spectrum of clinical manifestation with emphasis put on a typical Morvan syndrome, diagnostics and treatment of these conditions is presented.

Coincidence of ischemic stroke and acute myocardial infarction - two case reports

MUDr. Lubomír Jurák, Ph.D., doc. MUDr. Vladimír Beneš, Ph.D. III, MUDr. Jan Dienelt, prof. MUDr. Petr Suchomel, Ph.D.

Neurol. praxi. 2022;23(3):252-256 | DOI: 10.36290/neu.2020.045  

Coincidence of ischemic stroke and acute myocardial infarction is not common, but neither it is rare. We present two case reports of patients admitted to hospital for ischemic stroke who have developed acute myocardial infarction with different final outcomes. A 66-year-old woman was admitted to the hospital for symptoms of stroke in the form of severe monoparesis of left upper limb, central left facial nerve paresis, and dysarthria. There was a gradual improvement in the patient's condition after intravenous thrombolysis was administered. The next day, the patient developed stenocardia, sweating, hypotension, and bradycardia and was diagnosed with...

EEG in non-convulsive status epilepticus

MUDr. Hana Krijtová, MUDr. David Krýsl, Ph.D., prof. MUDr Petr Marusič, Ph.D.

Neurol. praxi. 2022;23(3):E1-E11 | DOI: 10.36290/neu.2022.017  

EEG is essential for diagnosis of non-convulsive status epilepticus (NCSE). Two compatible diagnostic systems have been developed for this purpose during last 15 years. The Salzburg Consensus Criteria for Nonconvulsive Status Epilepticus define unequivocal EEG patterns that confirm NCSE but also patterns that may or may not represent NCSE (i. e. "possible NCSE"). The Salzburg Criteria adopt the rigorous definitions of the American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology (ACNS-SCCET), which, in turn, became the main tool for description of EEG in all patients suspected to suffer from NCSE. Its latest 2021 version...

Vzpomínka na MUDr. Evu Meluzínovou

Petr Marusič

Neurol. praxi. 2022;23(3):258