The early recanalization of an occluded artery is the primary aim of reperfusion treatment in acute ischemic stroke and is an important predictor of clinical outcome. In the past, the standard treatment of ischemic stroke was intravenous thrombolysis with alteplase within the time window of 4,5 hours from symptom onset. Recent clinical trials have provided evidence for perfusion multimodal imaging-based effective reperfusion therapy within an extended time window and stroke with unknown onset. WAKE-UP trial confirmed the efficacy and safety of intravenous thrombolysis with alteplase in patients with unknown onset stroke based on DWI-FLAIR (diffusion weighted imaging - fluid attenuated inversion recovery) mismatch. EXTEND trial demonstrated the benefit of intravenous alteplase in an extended or unknown time-window in patients with positive CTP or PWI-DWI (perfusion weighted imaging - diffusion weighted imaging) mismatch. This review summarizes the evidence from recent clinical trials and algorithm for selection of imaging methods to guide reperfusion therapy in acute ischemic stroke.

The purpose of the project Health Talk is to provide publicly available information on how people experience various illnesses. This qualitative research offers insights into experiences of parents who have children with epilepsy in the area of specialized health care. The qualitative content analysis is based on 32 in-depth interviews with parents of children with epilepsy of children aged 0 to 18 years using the DIPEx method. The results show that parents evaluate subjectively their experiences with health care based on their experiences with the doctor's and medical staff's attitude (communication, humanity, patience) and based on the amount and type of information provided by the physician, especially at the beginning of the treatment. The participants described the problematic of the accessibility of the health care in terms of capacity and physical distance and related issues as well.

Alemtuzumab is a humanized monoclonal antibody approved in the Czech Republic for the treatment of highly active relapsing-remitting multiple sclerosis (RRMS). The mechanism of action of alemtuzumab consists in its binding to the CD-52 molecule, present particularly on mature T - and B-lymphocytes. This bond induces cell cytolysis with lymphocyte depletion. Subsequent repopulation reduces the autoaggressive potential of the new lymphocyte population. We present two case reports of patients treated with alemtuzumab at our site - one treatment-naive patient with no previous DMD (Disease Modifying Drugs) therapy and one patient with treatment escalation due to insufficient therapeutic response to previous DMD therapy.

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 knowledge and skills is obligatory for appropriate assignment of EP changes and clinical outcome. Aim of this work is general introduction, indications, advantages and limitations of intraoperative neurophysiological techniques, We tried to show optimal IONM usage to gain safety of the surgery and concurrently what practice should be avoided.

Prophylactic treatment is administered in order to reduce the frequency, duration, and severity of migraine attacks. The treatment is typically initiated with antiepileptic drugs or beta blockers; it is further based on the presence of other conditions, for example psychiatric ones, risks of adverse effects, and contraindications, if any. The article uses case reports to discuss the most common errors in choosing a prophylactic agent with respect to comorbidities, the timing and duration of the treatment.

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 costs. Adherence should be constantly promoted in routine clinical practice.

Pain belongs among the most disabling clinical symptoms of multiple sclerosis. Most frequent is chronic central neuropathic type of that. The best treatment option is anticonvulsants therapy by gabanoids or tricyclic antidepressants, but often the second or third line therapy have to been used. One of these next line therapies are the cannabinoids now. Managing of pain treatment needs the multidisciplinary team, including physio and psychotherapeutics. Other type of pain is neuromuscular due to changed movement stereotypes. The primary headaches, like migraine or tension type, occurred frequently.

This paper describes specific problems of headache in seniors. The occurrence of primary headaches (migraine, tension - type headache, cluster headache) decreases with increasing age, the occurrence of secondary headaches (organic or metabolic diseases) increases, certain types of headaches occur almost exclusively in the elderly (giant cell arteritis, hypnic headache). Although treatments for most common primary headaches are available, age-related physiologic changes, comorbidities, contra indications, polypharmacy and increased risk of side effects require appropriate treatment in the elderly. Specific problems of acute and prophylactic treatment in primary headaches in the elderly are mentioned. In the second part of this paper secondary headaches are described, which have increased significance in the elderly. Various imaging and laboratory evaluations are indicated in the presence of any red flag signs and symptoms.

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 drug adherence. In the case of classification of primary headache as comorbidity of MS, specific treatment should be initiated.

Purulent infections of the central nervous system belong to life-threatening diseases. Their incidence is relatively low; however, their importance lies in high case fatality ratio and frequent permanent sequelae. The prognosis depends on a number of factors, most notably the speed of diagnosis and the initiation of correct causal and supportive treatment. Therefore, it is necessary to educate physicians of all disciplines about the importance and approach to these infections. Purulent meningitis is an infection of the soft meninges caused by pyogenic bacteria. Despite declining incidence over the last 20 years and medical progress, due to its high case fatality ratio and permanent sequelae meningitis remains a major challenge for physicians and scientists.

Sporadic Creutzfeldt-Jacob disease (sCJD) is rare, prion and incurable disease. It is characterized by the rapid development of dementia and other focal symptoms. Typical signs of CJD are found in the MR examination of the brain, in the EEG and in the examination of cerebrospinal fluid. The definitive diagnosis is determined by neuropathological examination of brain tissue. We present the case of an elderly man with sudden onset and rapidly progressing dementia and characteristic findings in auxiliary examination methods. Neuropathological changes in the brain eventually demonstrated changes typical of Creutzfeldt-Jakob disease, but also of frontotemporal lobar degeneration with tau positive inclusions.

People with multiple sclerosis (MS) suffer many neurological symptoms including cognitive impairment. The cognitive impairment can have negative effect on employment status, social interactions and quality of life. Because currently there is no symptomatic pharmacological treatment for cognitive impairment, the cognitive rehabilitation plays a key role. This article summaries trends and possibilities in cognitive rehabilitation in MS.

This article deals with the problem of resource allocation in the context of the aging of the human population. First, it focuses on a specific example of the allocation of scarce resources during the covid-19 pandemic and describes the role of patient age during it. Then it moves on to the general theory of resource allocation, which draws on the work of the American ethicist Norman Daniels. Within this theory, age plays an important role, but it cannot be understood as a case of ageism or negative discrimination.

A video case report + review of literature on alien hand phenomenon and RINCH A patient is presented who, shortly after the removal of a parasagitally localized tumour of the right frontal lobe, developed frequent paroxysmally occurring involuntary movements of the right hand fingers. Noninvasive video EEG monitoring confirmed the epileptic origin of these motor manifestations for simultaneously occurring ictal EEG pattern with a maximum at the right frontocentral electrodes. In some aspects (particularly the localization of the causal lesion), our case has a resemblance to the rarely reported ictal alien hand syndrome; however, the rhythmic character of the movements rather corresponds to the RINCH (rhythmic ictal non-clonic hand) motions that, however, have so far been described in temporal lobe epilepsies only, namely in the limb contralateral to the focus.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a chronic dysimmune polyneuropathy. It belongs to rare diseases, as the prevalence is reported between 0.8–8.9/100 000. Progression of signs and symptoms beyond 2 months represents the key diagnostic criterion. Motor signs and symptoms usually prevails to sensory ones. Beside typical form of CIDP representing 2/3 of cases the wide clinical spectrum of CIDP comprises also atypical forms, the most frequent being s.c Lewis-Sumner syndrome (15% of cases) and a sensory form (10% of cases). Diagnostics of CIDP is based, in addition to clinical criteria and course, on electrodiagnostic criteria of multifocal demyelinating neuropathy and some other laboratory findings, especially hyperproteinorrhachia, magnetic resonance finding of thickening and gadolinium enhancement of nerve roots and brachial and lumbar plexuses, and improvement after immunomodulating treatment. Corticosteroids and intravenous humane immunoglobulin are recommended treatment options of first order, followed by therapeutic plasma exchange in case of inefficacy or intolerability of first-order treatment. Immunomodulating drugs (especially cyclosporin, azathioprine, mycophenolate mofetil, cyclophosphamide and methotrexate) are used as additive treatment.

The 2010 revised McDonald criteria reflect the clinical requirement to establish the diagnosis of multiple sclerosis (MS) as early as the initial attack of neurological symptoms, in an early stage – that of clinically isolated syndrome (CIS). CIS is the indication for a diagnostic triad of paraclinical investigations that can support the hypothesis of the initial demyelinating attack of MS and predict the likelihood of conversion to clinically definite MS – CDMS. Early diagnosis is required to meet the need for early MS treatment. Treatment with glatiramer acetate (GA) or other medicinal products for the first-line treatment of MS (interferon-beta or teriflunomide) is of essential importance in reducing the risk of conversion to CDMS and in the therapeutic strategy for influencing MS prognosis. The case report presents treatment of MS with glatiramer acetate following the initial demyelinating attack of MS.

Sleep related breathing disorders (SRBD) are characterized by nocturnal hypoxemia. This hypoxemia induces sympathetic activation and consequently leads to cardiovascular complications. Untreated obstructive sleep apnea syndrome (OSAS) is a risk factor for obesity, hypertension, diabetes, ischemic heart disease, arrhythmias and stroke. SRBD may also arise as a result of stroke. The following article will discuss the epidemiology, pathophysiology, diagnosis and treatment of SRBD in relation to stroke. Raise of awareness about the relationship between SRBDDB and stroke should lead to the improvement of primary and secondary prevention of stroke and in particular to improve the prognosis of patients with stroke. This area is currently a part of the research and we are waiting for the results of large multicenter studies.

Sandifer’s syndrome is a clinical entity characterised by abnormal movements associated with gastroesophageal reflux, with or without hiatal hernia. This syndrome occurrs especially in toddlers and infants but it has been rarely reported also among adult patients and newborns. In the clinical picture various abnormal movements of the body (opisthotonic posturing, head/eye version, torticollis and other dystonic postures) occur in periods several times per day, mainly after feeding. Sandifer’s syndrome is most commonly mistaken for epileptic seizures or some form of dystonia. The syndrome is taken for underrecognized.

More than three quarters of patients with multiple sclerosis (MS) report a history of balance disorders and multiple sclerosis is considered to be the second leading cause of central vertigo. Specific oculomotor syndromes are a typical feature in MS. The knowledge of the individual types of impairments is important for the understanding of the clinical presentation of multiple sclerosis. Some of these impairments are even more specific for diagnosing brain stem lesions than magnetic resonance imaging. The paper presents a review of the most typical vestibular and oculomotor syndromes in patients with demyelinating disease.

Neurodegeneration with brain iron accumulation (NBIA) is a heterogeneous group of genetically-linked neurodegenerative diseases characterized by increased iron accumulation in the basal ganglia. They present with a combination of extrapyramidal symptoms with deterioration of cognitive functions. In most cases, they are diseases with onset in childhood, but adult-onset or late-onset forms are also described. In this paper, we present an overview of recent data on individual types of NBIA with an emphasis on clinical and radiologic findings. In conclusion, we describe a case of a patient with suspected late-onset NBIA.

Multiple sclerosis (MS) represents severe autoimmune disease of the central nervous system, typically afflicting young people in productive age. Disease etiology is not exactly known, however negative impact of low vitamin D serum level on disease onset and progression is undoubted so far. Moreover significant vitamin D deficit is a problem of two thirds of population in our latitude. The article summarizes up-to-date knowledge about vitamin D and its connection with MS including supplementary recommendation.

Parkinson´s disease may be at advanced stage accompanied by behavioral symptoms such as impulse control disorders and dopamine dysregulation syndrome. Both the striationigral denervation induced by neurodegenerative process in substantia nigra and dopaminergic therapy may play a role in the development of these disorders. Dopamin plays an important role in the brain reward system and modulation of behavior. Specifically, disability of reward system induced by neuroadaptation changes and hypersensitization of striatal dopaminergic neurons is considered to be the cause of development of these disorders. The risk factors for development of behavioral complications include younger age at disease onset, higher doses of dopaminergic medication, history of depression, drug or alcohol abuse and certain personality traits. Treatment is difficult and is mainly based on psychosocial intervention. Further the antidepressants, atypical antipsychotics, mood stabilizers or inhibitors of glutamate NMDA receptors may be used; the switch to continuous dopaminergic stimulation may also help. When necessary, the dose reduction or complete withdraval of dopaminergic therapy must be done. syndrome.

Major depression has a relatively high incidence in patients with multiple sclerosis (MS). It needs to be recognized and treatedin a timely manner, as it significantly improves the quality of life and the course of the main disease. From an etiological point ofview, it is not yet clear why major depression in MS occurs so often. Biological, psychological and social factors are involved in itsdevelopment, but it is also influenced by MS treatment itself (corticoids, interferons). Major clinical signs of depression includedisturbances of mood, thinking, perception, and psychomotor impairment. In clinical practice we usually start with structuredinterview along with specialized questionnaire for depression. The basic methods of treatment of depression in MS includepharmacotherapy with antidepressive drugs and psychotherapy. Cognitive behavioral therapy is usually used in MS patients. Thefirst choice of pharmacotherapy is selective serotonine reuptake inhibitors – citalopram, escitalopram, sertraline, that have a verygood safety profile. The therapeutic effect in relation to the main symptoms of depression is usually after 6–8 weeks of treatment.

Fycompa® (perampanel – PER) is an antiepileptic drug for add-on therapy of focal and generalised epilepsy in patient older than 12 years. It has an unique mechanism of action based on decreasing neuronal hyperexcitability by suppressing glutamatergic transmission. Its interactive potential is low allowing combined therapy with other antiepileptic drugs. It is save and its good tolerability is supported by once-daily dosing. It is effective for treatment focal and tonic-clonic seizures (generalized and focal to bilateral tonic-clonic seizures). It is well-tolerated even in long-term treatment. When rightly use (especially slowly titrated), it can be usable add-on therapy in early phase.

Despite the long history and relatively high use in the clinical practice, oral drugs in the therapy of dystonia are associated with considerable limitations. This review summarizes the options in oral therapy of acute drug-induced dystonia and chronic dystonic syndromes with various drug groups as anticholinergics, antidopaminergic agents, baclofen, benzodiazepines and others. It describes the basic posology, adverse effects and risks, emphasizing the need for individualised approach. In addition to the lacking support in relevant randomized clinical trials, the review underlines the mere symptomatic, non-curative character of the effect and the absence of therapies directly targeting the pathogenesis or disease-modifying drugs, with the exception of a few secondary dystonias.

Pain represents one of the most frequent clinical symptoms. According to the recent epidemiological studies, most of one third of neurological patients suffer from pain. Both the neuropathic and/or nociceptive pain may occure in neurological patients and their differentiation is highly important (among others due to their different treatment). The diagnostic process in pain patient consists from several steps. The first one is based on the data from medical history and is focused on history of relevant neurological lesion or disease and presence of pain in neuroanatomically plausile distribution, and also on the pain character and intensity and pain-worsening or relieving factors. Clinical neurological examination confirming the presence of sensory signs in the distribution of pain represents the second step. Finally, the third step is based on the confirmation of the lesion/disease of somatosensory nervous system using imaging, electrophysiological, neuropathological or genetic tests. In neuropathic pain patients, these steps allow the stratification into possible, probable, and definite diagnosis.

Attention deficit/hyperactivity disorder is the most common neurodevelopmental disorder of childhood. The clinical symptoms vary with the age of a child. The diagnosis is established by the presence of core symptoms, ie. attention deficit, hyperactivity and impulsivity. The therapy of the disease is multidisciplinary, using regime adjustment, psychotherapy and pharmacological approaches. Based on ethiopathogenesis, which is complex, the use of new nutritional supplements is being tested, in an effort to reduce clinical symptoms. This trend is probably due to the detection of changes in lipid profiles in the nervous system in patients with Attention deficit/hyperactivity disorder, as well as proven lack of polyunsaturated fatty acids in the diet of these patients. The advantage of nutritional supplements is that they are without the need of prescription by a child psychiatrist. In our work, we present the results of multicenter a multicenter clinical observation in patients with Attention deficit/hyperactivity disorder symptoms on therapy with Concentrix® for six months. The Concentrix® is a new dietary supplement developed to support concentration and congnitive outcome in patients with symptoms of attention deficit and hyperacitivity disorder. Three meetings administered by a psychologist were done during six months. The effectiveness of Concentrix® was evaluated by using psychological tests and obtained data were subsequently statistically processed.