The treatment of multiple sclerosis has undergone great progress in recent years. With the advent of new drugs, our therapeutic possibilities are expanding. The therapeutic goal remains the stability of the disease, which is monitored in clinical practice by controlling the signs of attack or disease progression. This article discusses new data on clinical activity and effects on disease progression in patients treated with ocrelizumab.

The newest generation of antiepileptic drugs (AE), available since 2010, is reviewed: Eslicarbazepine – Zebinix®, Lacosamide – Vimpat®, Perampanel – Fycompa®, Retigabine – Trobalt®. The indication of treatment with retigabin was revised after finding adverse effects, especially of blue pigmentation of retina and nowadays is used only exceptionally. The other AE are beneficial for add-on therapy of partial and secondarily generalized seizures. The drugs are effective with minimal adverse effects. Their interactive potential is low and are suitable for combination with majority of other AE. Their pharmacokinetics is linear, absorption a metabolization fast, there is no need to control their serum levels. Dosing once, maximally twice daily increases not only the comfort for patients but also the compliance. New mechanisms of action are making them suitable for treatment of pharmacoresistant epilepsy.

Multiple sclerosis is an autoimmune-related disease characterized by inflammation and neurodegeneration. Looking at inflammation,
its characteristics, intensity and localization has undergone changes in recent years. Acute and chronic inflammation
is present in all forms of SM. Cortical demyelination is an important pathological substrate for irreversible functional disability,
progression and cognitive impairment. A comprehensive understanding of inflammatory manifestations can help us to set up
individualized therapy for the patient.

In secondary progressive multiple sclerosis (SPRS), such convincing therapeutic successes cannot be achieved as in relapsing disease. However, rapid initiation of effective treatment in the early stages of the disease slows the development of secondary progression. In active SPRS we use the immunosuppressive potential of mitoxantrone, cyclophosphamide eventually high doses of methylprednisolone and intravenous immunoglobulin. Siponimod is the first approved drug in the SPRS indication, which has been shown to slow clinically confirmed progression. At the stage of clinical trials, other drugs are predominantly neuroprotective.

Tremor is the most common abnormal movement, occurring as a single symptom or in combination with other movement disorders. This review article provides an insight into the clinical classification of tremor according to the latest consensus recommendation. The main emphasis is placed on the description of the symptoms and syndromes of tremor and the diagnostic criteria of its principal clinical entities, designated for everyday neurological practice.

Multiple sclerosis (MS) is immunopathological neurodegenerative disease in which the key role was up to recently gained to the abnormaly polarized Th1 and Th17 subsets of T cells. The participation of B cell system has been for long time almost neglected. Recently, it has been evidenced both experimentally and clinically that B cells are an integral part of the immunopathogenesis of MS. Biological therapy targeting the molecule CD20 specifically expressed on mature B cells clearly demonstrated that this previous assumption was wrong as an excellent clinical response is achieved by this therapy with favourite safety profile. Protective components of immunity, such as production of antibodies and renewal of B cells are preserved. Administration of antiCD20 ocrelizumab is followed by significant decrease in the number of peripheral blood B cells. The drop in B cell count in blood serves as a surrogate biomarker of clinical efficacy of ocrelizumab therapy of MS.

Epidemiological studies suggest that one of the most common areas of the human body affected by chronic pain is back. Back pain is one of the most common causes of doctor visits and have an enormous clinical, social and economic impact on our society. Lifestyle changes with a lack of physical activity are a major cause of increasing back pain. In the event of failure conventional therapy, interventional pain management procedures may apply. Interventions should be performed by a physician experienced and trained in invasive pain management - interventional pain specialist. Precise topical diagnosis of pain origin is a precondition for successful treatment. In most cases, the use of navigation techniques is esential - ultrasonography, fluoroscopy. The most frequent interventions are: epidural administradion of steroids, intradiscal intervention, radiofrequency procedures.

Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of diseases affecting striated muscle and several other organs. Significant numbers of patients have autoantibodies in serum that are specific for myositis subtypes and associate with disease course and prognosis. New classification criteria for IIM use weighted assessment of disease related parameters and allow calculation of percentage disease probability. Lately, new criteria for dermatomyositis subtypes have been proposed based largely on the detection of myositis specific autoantibodies. New criteria for clinical response to treatment have been developed in 2017. These criteria are more sensitive and allow better quantification of improvement. Positive effect of Janus kinase inhibitors was recently reported in dermatomyositis.

The history of rare diseases (RDs) dates back to the Middle Ages. At that time, RDs were rather described as "uncommon" phenotypes, somatic or biochemical. "Strange" clinical pictures that were observed repeatedly were thought to have a hereditary component firstly in the 19th century. To date, approximately 6 000 different RDs are known, and although they occur individually in a small number of patients, they affect together 3.5-5.9 % population worldwide. Most of them are genetically determined and the rapid development of molecular diagnostic methods has accelerated the identification of pathogenic, disease-causing variants. Research has also moved towards personalized treatment of RDs. Orphanet is the most comprehensive information portal on RDs for professionals and patients, as well (www.orpha.net). It offers its updated content about RDs for 23 years. Additionally, it is a database of diagnostic and research laboratories, medical expert centers, research projects, patient organizations, registries, biobanks and orphan drugs.

The care of patients with secondary progressive (SP) multiple sclerosis (MS) has made a great step forward in the last year in Czech republic as a result of the approval of siponimod as the first disease modifying drug for the treatment of this form of MS. The introduction of this new treatment however increases the importance of early recognition of transition from relapse remitting to SP form of the disease, and of recognizing the active phenotype in patients where the secondary progressive form has already been identified. Since there is currently no validated biomarker that could be used to distinguish SP MS from relapse remittent form and since the transition to SP form is a gradual process, it is important to know a typical profile of a patient with this form of the disease. Thus, the aim of this article is to familiarize the reader with the widely accepted definition of SP MS and with the known risk factors, typical symptoms, associated biomarkers and prognostic scoring systems. We also give a brief outline of the current treatment options for this diagnosis.

The study aims to present the less widely known pioneering work of Prof. Natalyia Petrovna Bechtereva from the Leningrad Institute of Experimental Medicine utilising electrical stimulation of defined deep brain structures (thalamic nuclei, basal ganglia) by means of long - term externalised intracerebral electrodes for the treatment of some neurological diseases (Parkinson's disease, phantom limb pain, dystonia). Together with the surprisingly long lasting good results some data suggesting the potential abuse of brain stimulation techniques must be noted.

Torticollis in a broader sense is a term for abnormal head posture and is a non-specific symptom of diseases with various etiology. Cause of abnormal head posture may be different in mechanisms of origin as well as localization of primary changes and depends on the patient‘s age category. Case report describes a 4 year old boy with severe fixed torticollis in coincidence with the local inflammation in the middle ear region.

Statins are used to treat primary hypercholesterolemia and dyslipidemia. They significantly reduce cardiovascular risk in primary and secondary prevention. In the Czech Republic, atorvastatin and rosuvastatin are the most used drugs, otherwise simvastatin and fluvastatin are less prescribed. For statin therapy, appropriate HDL cholesterol target values should be established, and special regimen with adjunctive therapy with ezetimibe in selected patients. Drug side effects may occur with statin therapy, such as nausea, fatigue, myalgia, rarely statin myopathy. A number of studies have shown that statins have neuroprotective effects on the brain tissue. They can cross the blood-brain barrier and reduce microglia activation followed by subsequent leaching of proinflammatory mediators. Under pathological conditions, statins induce vasodilation in the brain, inhibit the proliferation of smooth muscle cells in the vessel wall, improve endothelial cell function, and stabilize the atherosclerotic plaque. They have antiplatelet, antioxidant and anti-inflammatory effect.

We have described case of the young man with a rare diagnosis of acquired neuromyotonia with neuromuscular signs and symptoms of autonomic dysfunction. Except specific electromyographic findings, the diagnosis is documented by positive antibodies against voltage- -gated slow potassium channels. Due the assumption of paraneoplastic etiology the patient underwent comprehensive examination with no evidence of malignancy. The patient was treated with immunosuppressive, immunomodulatory therapy and symptomatic medications. Remission was achieved within several months and it is a question wether it was treatment effect or spontaneous remission.

The contemporary care of patients with pharmacologically unmanageable epilepsy increasingly involves the use of neurostimulationmethods. The reason is an entirely legitimate effort to offer a substantially better quality of life even in those in whomresection epilepsy surgery is not suitable for serious reasons. In the case of neurostimulation, palliative interventions are used,i.e. their goal is to at least significantly reduce the number of seizures, particularly those where there is a risk of injury. Althoughcomplete suppression of seizures is relatively rare with their use, standard neurostimulation techniques have been shown to havelong-term efficacy in more than half of the individuals treated. Moreover, their typical feature is that, with increasing durationof stimulation, their efficacy improves progressively. The method of chronic vagus nerve stimulation, whose benefit has beenconfirmed numerous times in both adult and paediatric patients with various types of epilepsy, has been the longest and mostfrequently used method in the practice. More recently, methods of deep brain stimulation (particularly stimulation of the anteriorthalamic nuclei) have been introduced in clinical epileptology. The methods of transcutaneous cranial nerve stimulation (the vagusnerve and the trigeminal nerve) are also currently available for clinical use; however, their true efficacy still remains uncertain.

Ischemic stroke is one of the leading causes of mortality or morbidity in the world. Early therapeutic intervention is important for final clinical outcome and that can be obtained by quick and correct prehospital triage, which is managed by paramedics. The patient with a stroke must by quickly diagnosed and transported to the nearest stroke center, or when a large vessel occlusion is suspected to the comprehensive stroke center to a possible thrombectomy. This decision can be made with different prehospital triage tests. "FAST PLUS" test was introduced in Moravian-Silesian region in year 2016 and it is focused on presence of a severe hemiparesis. The test predicts large vessel occlusion with 92 % sensitivity and 44 % specificity. More studies are needed to improve the specificity of prehospital tests without increasing their difficulty.

Analgesics belong to the most commonly prescribed drugs. Non-opioid analgesics are drugs of various chemical origin that have analgesic, antipyretic and some of them also have anti-inflammatory and antiaggregation effect. They can be divided into analgesics - antipyretics and non-steroidal anti-inflammatory drugs. Inhibition of cyclooxygenase and thus influencing the formation of eicosanoids is a common mechanism of action, especially in nonsteroidal antiphlogistics. Both desirable therapeutic effects and side effects are associated with the influencing of eicosanoid production.

Limb-Girdle Muscular Dystrophies (LGMD) are a clinically and genetically heterogeneous group of diseases. To date, 29 genes associated with LGMD have been identified that divide LGMD into 29 subtypes. About 10 % of LGMD have a dominant type of inheritance, 90 % of LGMD have a recessive type of inheritance. The individual LGMD subtypes do not share a common pathophysiological mechanism of the disease that would distinguish them from other forms of muscular dystrophies. On the contrary, LGMD are associated with genes whose protein products have different functions and cellular localizations. Due to the number of associated genes, molecular genetic diagnosis of LGMD is a relatively complicated process, which is currently based on Next-Generation Sequencing (NGS) techniques both at the panel level of selected genes and at the whole exom level.

Migraine is associated with several comorbidities. The most important comorbidities are mentioned. Basic supposed pathomechanisms are shortly discussed together with specific migraine treatment with regards on present comorbidity.

Introduction: Functional electrical stimulation (FES) of the peroneal nerve is used to improve gait in a large group of patients with central motor neuron disease. The aim of the article is to describe, based on available literature, how FES can be utilized in patients after stroke, brain or spinal cord injuries, or in those with multiple sclerosis (MS). Method: For the purpose of writing this article, specialist literature was searched using the PubMed database. Review articles and meta-analyses as well as articles comparing various groups of neurological patients were selected. Results: According to available literature, FES has a positive effect on increasing gait speed and efficiency, on reducing energy demands, and on symmetry and stability, particularly in patients after stroke, with the effect even being persistent. A positive effect on gait speed and its energy demands has also been described in patients with MS; however, the degree of improvement is more limited, particularly in progressive forms of the disease. In patients with other causes of central motor neuron disease, the evidence of FES effect is not sufficient; however, patients with a nonprogressive neurological diagnosis are generally reported to benefit from FES more significantly. Conclusion: In adult neurological patients with foot drop, FES may be one of the options how to improve both qualitative and quantitative gait parameters. In clinical practice, however, the effect on gait must be assessed individually in every patient, particularly in comparison with the use of ankle-foot orthosis.

Multiple sclerosis (MS), a chronic neurodegenerative disease, is the most common cause of disability in young adults. Regular fitness exercises and rehabilitation therapy can partially aid in preventing or treating the neurological symptoms. Given the heterogeneity and the interindividual variability in the severity of MS symptoms, it is optimal to provide rehabilitation through an interdisciplinary team. The aim of this article is to describe the current possibilities of interdisciplinary rehabilitation therapy.

Brain imaging methods have a major clinical benefit not only for identifying potentially treatable causes or determining the vascular aetiology of dementia, but also for the differential diagnosis of neurodegenerative diseases, especially Alzheimer's disease (AN), frontotemporal dementia (FTD) and dementia with Lewy bodies (DLB) that are characterized by different patterns of brain atrophy. Visual rating scales that allow to quantify the degree of atrophy of individual brain areas have been developed for this purpose. They thus represent a useful tool for the early and differential diagnosis of neurodegenerative diseases in clinical practice. This article summarizes current knowledge about the diagnosis of AN, FTD and DLB using visual rating scales and based on this knowledge offers recommendations for clinical practice.

Syphilis is a chronic systemic disease which is manifested by a wide range of signs and symptoms, particularly in the sex organs, but it also affects the cardiovascular, nervous, integumentary, or musculoskeletal systems. An involvement of the central nervous system may occur at any point of the primary, secondary, or tertiary stages of syphilis. Early forms of neurosyphilis currently prevail, with late parenchymal complications occurring rarely. Meningovascular syphilis typically presents five to seven years after the primary stage, and is among the rare causes of cerebrovascular disease in younger individuals. Imaging of the brain and cerebral arteries as well as a comprehensive cerebrospinal fluid analysis are of crucial importance for the diagnosis. Benzylpenicillin is the principal drug. A case report is presented of a 52-year-old man with neurosyphilis manifested by acute ischaemic stroke in the vertebrobasilar territory in the setting of basilar artery occlusion.

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 that cannot be detected with routine clinical examination. Other parameters observed include magnetic resonance imaging activity and changes in gait speed and upper limb dexterity. Implementation of the above parameters into clinical trials allows for a more detailed comparison of efficacy of individual drugs, leading to a consideration of incorporating the above-mentioned tests into routine clinical practice.

Non-steroidal anti-inflammatory drugs (NSAIDs) are the cornerstone of the treatment of a wide range of painful conditions. Their efficiency and safety are well known. For more than three decades, nimesulide has been a successful representative of a subgroup of preferentially-acting NSAIDs. This text summarizes its basic characteristics, in the context of its obvious benefits and potential risks that define its position among other NSAIDs.

Physiological aging is associated with some loss of cognitive function, which however does not lead to self-insufficiency, but may still have consequences for complex activities of daily living. In the review paper we characterize these changes in cognition, we present the possibilities of differentiating physiological and pathological aging due to Alzheimer's disease and other neurodegenerative diseases, and we summarize the possibilities of prevention of pathological aging and cognitive decline in old age.

CGRP antibodies block the vasodilating effect of CGRP and belong to the most potent antimigraine drugs available. The CGRP receptors are present in many tissues, including the gastrointestinal tract. CGRP is thought to be involved in the regulation of gastrointestinal motility, secretion, resorption and blood flow. Blockade of his action may result in a number of adverse effects. For example, a higher incidence of constipation after erenumab (anti-CGRP) has been reported. Hypothetically, these drugs may also impair gastroduodenal ulcerations healing, course of the inflammatory bowel disease or the gastric emptying rate.

Both T lymphocytes and B lymphocytes are involved in the patogenesis of multiple sclerosis (MS). Ocrelizumab is a monoclonal antibody that targets B lymphocytes. It is indicated for the treatment of relapsing remitting MS (RRMS) as well as for the treatment of primary progressive MS (PPMS). While there are several possibilities for immunomodulatory therapy for the treatment of RRMS, until recently, there was no possibility of influencing the course of PPMS by immunomodulatory treatment. Ocrelizumab is currently the only registered DMD therapy for the treatment of PPRS in the Czech Republic. In general, it is well tolerated with minimal adverse events.

Drivers with untreated obstructive sleep apnoea (OSA) report more frequent excessive daytime sleepiness (EDS) while driving. They have a two- to five-fold higher risk of traffic accidents, with one in six accidents having serious consequences, including fatal ones. Treatment with positive airway pressure (PAP) reduces the risk of traffic accidents while improving EDS. OSA and EDS are important determining factors in road accidents associated with sleep. OSA with EDS is thus among diseases which, unless properly controlled, compromise road safety. A major challenge in the decision-making process is the estimation of EDS severity which has not been defined precisely. In these cases, the decision to issue a driving licence requires careful clinical consideration using subjective scales (the Epworth sleepiness scale – ESS) as well as objective tests (the maintenance of wakefulness test – MWT). Timely screening of patients-drivers (OSA screening questionnaires and/or device-based screening for OSA) is also of importance.