Slovo úvodem

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

Neurol. praxi. 2023;24(1):3  

Spinální stenóza

prof. MUDr. Blanka Adamová, Ph.D. 

Neurol. praxi. 2023;24(1):7  

From degenerative compression of the cervical spinal cord towards degenerative cervical myelopathy

prof. MUDr. Josef Bednařík, CSc.

Neurol. praxi. 2023;24(1):8-11 | DOI: 10.36290/neu.2022.044  

Degenerative cervical myelopathy (DCM) is a consequence of a degenerative disease of the cervical spine leading to stenosis of the cervical canal and eventually to compression of the cervical spinal cord. DCM involves about 2% of the population and despite all accessible therapeutic options it could lead to a significant disability. Signs of cervical spinal cord compression detected with magnetic resonance imaging (MRI), however, end up in clinically symptomatic myelopathy in a smaller part of individuals with compression, while the rest remains without clinical symptoms and signs of cervical myelopathy - so called non-myelopathic degenerative cervical...

Degenerative cervical myelopathy - clinical manifestation, diagnosis and practical management

MUDr. Zdeněk Kadaňka, Ph.D., prof. MUDr. Josef Bednařík, CSc.

Neurol. praxi. 2023;24(1):12-16 | DOI: 10.36290/neu.2022.061  

Degenerative cervical myelopathy (DCM) is a chronic progressive disease of the cervical spinal cord. Osteoarthritic degeneration (spondylosis, facet hypertrophy, and degenerative disc disease), ligament changes (ossification of the posterior longitudinal ligament, hypertrophy of the ligamentum flavum) may lead to the spinal cord compression and result in neurological deficits. It is manifested as clumsy hands syndrome, gait impairment, and bladder problems. The latest clinical guidelines recommend surgery for patients with moderate and severe DCM. For patients with mild DCM (or non-myelopathic patients with radiculopathy), the guidelines suggest that...

Lumbar spinal stenosis - clinical manifestation, diagnosis and therapeutic strategy

prof. MUDr. Blanka Adamová, Ph.D., MUDr. Peter Krkoška

Neurol. praxi. 2023;24(1):19-25 | DOI: 10.36290/neu.2022.040  

Lumbar spinal stenosis (LSS) is a clinical-radiological syndrome, a recent definition covers both the clinical manifestation and the anatomic abnormalities (narrowing of the spinal canal). The symptoms and signs usually begin in the 6th decade. The LSS contributes to impaired mobility in older age, but it is often underdiagnosed. Clinical manifestation includes neurogenic claudication, radicular syndrome, cauda equina syndrome, and low back pain is often present. Diagnosis and therapy of patients with LSS are multidisciplinary issues. This review focuses on updating knowledge of LSS clinical manifestation, diagnosis, and therapeutic strategy.

Surgical treatment of the secondary lumbar spinal stenosis (a narrative review)

MUDr. Pavel Barsa, Ph.D.

Neurol. praxi. 2023;24(1):26-30 | DOI: 10.36290/neu.2022.053  

Patients with lumbar spinal stenosis may experience symptoms such as back pain, nerve root irritation and neurogenic claudication. Although studies have shown that differences between non-surgical and surgical treatments are not significant, positive effects such as early pain relief, associated functional improvement and higher quality of life, may be expected after surgery in patients with severe lumbar stenosis. Surgical treatment consists of decompression of nerve structures. Additional stabilization is considered depending on the degree of decompression and accompanying instability. Recently introduced techniques of minimally invasive surgery...

Current options for surgical treatment of cervical spondylotic myelopathy

MUDr. Luděk Ryba, Ph.D., doc. MUDr. Richard Chaloupka, CSc., MUDr. Dušan Matějíčka

Neurol. praxi. 2023;24(1):32-38 | DOI: 10.36290/neu.2022.058  

The principle of the surgical treatment of cervical spondylotic myelopathy is to eliminate the compression of nerve structures or increase the diameter of the spinal canal. Surgery options are divided into anterior, posterior, and combined approaches. Through the anterior approach, the intervertebral discs are removed, and if necessary also vertebral body. In addition to the previously used bone graft, mostly an autologous graft from the pelvis, there has been significant progress in the possibility of using various materials, metal, titanium, PEEK, Trabecular Metal, filled with artificial bone with the aim of rapid growth into neighboring vertebral...

High efficacy treatment since the first attack - an important step in the treatment of multiple sclerosis?

MUDr. Dominika Šťastná, MUDr. Ingrid Menkyová, doc. MUDr. Dana Horáková, Ph.D.

Neurol. praxi. 2023;24(1):40-44 | DOI: 10.36290/neu.2022.068  

Multiple sclerosis (MS) is a serious chronic disease of the central nervous system, in whose pathogenesis both autoimmune inflammation and neurodegeneration play a role from the beginning. Therapeutic options for MS have expanded significantly in recent years. Early initiation of high efficacy treatment after the first attack is now at the forefront of interest, as reimbursement criteria now allow it for monoclonal antibodies targeting the CD20 molecule in the Czech Republic. Ofatumumab can also be administered at home, subcutaneously once a month. However, even in light of these favourable prospects, we must not forget the need for a comprehensive...

The use of anti-CGRP monoclonal antibodies amongst wide variety of patients

MUDr. Markéta Škodová

Neurol. praxi. 2023;24(1):46-49 | DOI: 10.36290/neu.2023.003  

Monoclonal CGRP antibodies represent a specific type of migraine profylaction. A high effectivity on both episodic and chronic migraine including concomitant medication overuse headache was proven in scientific studies as well as in clinical practice. Once-monthly or once-quarterly dosing improving the therapy adherence proved to be the main advantage of the treatment. The therapy is well tolerated by patients. Monoclonal CGRP antibodies do not affect the immune system and do not have drug interactions.

Molecular and cellular biology of amyotrophic lateral sclerosis

RNDr. Kateřina Klíčová, prof. MUDr. Jan Mareš, Ph.D., MBA

Neurol. praxi. 2023;24(1):50-53 | DOI: 10.36290/neu.2022.012  

Amyotrophic lateral sclerosis (ALS) is a severe progressive disease characterized by changes in upper and lower motor neurons. Due to degeneration and extinction of motoneurons, muscle weakness and atrophy gradually occur. ALS is increasingly considered a multisystem disease. Understanding the pathogenesis of ALS is important for the development of effective therapeutic approaches. The aim of this article is to identify and summarize selected molecular and cellular mechanisms involved in the pathogenesis of ALS - mitochondrial dysfunction, aberrant RNA metabolism, oxidative stress, as well as molecular approaches to treatment.

Poisoning with poisonous plants in neurology: misidentification with edible or medicinal plants

PharmDr. MVDr. Vilma Vranová, Ph.D., MUDr. Pavel Ressner, Ph.D., MUDr. Petra Bártová, Ph.D., prof. MUDr. Milan Brázdil, Ph.D.

Neurol. praxi. 2023;24(1):54-58 | DOI: 10.36290/neu.2022.052  

The severity of plant poisonings is documented by annual reports on deaths caused by mistaking colchicum leaves for wild garlic, and this is not the only problem that can be brought about by unwise use of natural plant products. We present an overview of poisonings caused by confusion with edible plants, while considering the possible presence of neurological symptoms. These conditions are infrequent, but can be encountered during acute neurological evaluations. Since it is necessary to identify and know how to manage them, possible methods of treatment are briefly outlined. Our paper deals with plants of Central European biotopes, which, although...

Autoimmune disease with positivity of anti­‑CASPR2 antibodies - a case report

MUDr. Lubomír Jurák, Ph.D., MUDr. Zuzana Eichlová, MUDr. Eva Řeháčková, MUDr. Martin Jíra, MUDr. David Krýsl, Ph.D., MUDr. Martin Elišák, Ph.D., prof. MUDr. Petr Suchomel, Ph.D.

Neurol. praxi. 2023;24(1):60-64 | DOI: 10.36290/neu.2023.012  

Autoimmune disease associated with anti-CASPR2 antibodies is a relatively rare neurological illness characterized by the presence of anti-CASPR2 antibodies in serum and/or CSF. It manifests with a variety of symptoms - from the central nervous system (cognitive impairment, epilepsy and cerebellar symptoms), from the peripheral nervous system (peripheral nerve hyperexcitability and neuropathic pain), and from the autonomic nervous system (autonomic dysfunction, insomnia and weight loss). Case report: The 61-year-old patient was admitted to the intensive care unit of our neurological department with myoclonic abdominal muscle twitching with intermittent...

Spinal muscular atrophy affecting the lower limbs, dominantly inherited (SMALED), an example of a non-5q form of the disease

MUDr. Pavlína Hemerková, MUDr. Hana Matulová, MUDr. Pavel Kunc, Ph.D., MUDr. Lenka Pospíšlová, MUDr. Jiří Jandura, Ph.D.

Neurol. praxi. 2023;24(1):65-69 | DOI: 10.36290/neu.2022.051  

Spinal muscular atrophy (SMA) is a degenerative disease of the motoneurons of the anterior horns of the spinal cord, which in approximately 95% of cases is caused by a mutation in the SMN1 gene on chromosome 5q13. Progress in genetic testing, particularly next-generation sequencing, has led to the discovery of additional causative genes underlying non-5q forms of SMA. These are very rare and genetically and phenotypically very heterogeneous. One of these subtypes is caused by a mutation in the cytoplasmic heavy chain gene dynein, gene DYNH1C1. It is a form of SMA with dominant involvement of the lower autosomal dominantly inherited and thus...

Subacute cerebellar degeneration, or Antibodies as an enemy

MUDr. Karolína Javornická, MUDr. Tereza Jirmusová, MUDr. Štěpánka Brušáková, MBA, MUDr. Ing. David Černík, Ph.D., MBA

Neurol. praxi. 2023;24(1):70-72 | DOI: 10.36290/neu.2022.003  

Introduction and aim: Subacute cerebellar degeneration is one of the paraneoplastic neurological syndromes that occur in cancer diseases in which tumour cells express neuronal proteins, causing an immune response not only against the tumour, but also against the nervous system. Patient-produced onconeural antibodies attack and damage various parts of the nervous system, resulting in the development of a broad spectrum of neurological symptoms.  Methods: We report the case of a 62-year-old woman with a history of cancer and advanced neurological cerebellar signs. Accordingly, after the exclusion of the most common causes of cerebellar syndrome (stroke,...

How to assess aphasia in clinical practice

doc. MUDr. Robert Rusina, Ph.D., prof. PaedDr. Zsolt Cséfalvay, Ph.D.

Neurol. praxi. 2023;24(1):73-78 | DOI: 10.36290/neu.2022.071  

Despite the large variability of language symptoms, it is possible to cluster most patients with stroke induced aphasia into basic clinical syndromes of aphasia. The core dichotomy of aphasias is based on the localization of brain lesions (in anterior lesions, non-fluent aphasia occurs, while fluent aphasias develop in posterior lesions of the cerebral cortex). The degree of aphasia mostly corresponds to the extent of the lesion. Since anomia occurs in every type of aphasia, the clinical assessment consequently focuses on three language processes: speech comprehension, spontaneous speech, and repetition. We propose a simple roadmap for bedside examination,...