Low back pain (LBP) is one of the most common disabling conditions among adults 60+ years old. The severity and chronicity ofthis clinical syndrome clearly increase with age. The annual prevalence of LBP in the elderly population ranges between 13–50%.Pain is usually caused by functional and non-specific degenerative changes of the spine, but in the elderly population the differenttypes of pathology such as osteoporotic fractures, spinal tumors, or infections, may play a role. Diagnostic procedure should befocused on detection of symptoms of serious spinal pathology, called "red flags". Insufficient pain treatment may lead to sleepdisturbances, mental disorders, malnutrition, multiple falls, rapid deterioration in self-care, and social isolation. The aim of thiswork is to highlight the specifics related to the causes, diagnosis and conservative treatment of LBP in elderly patients.

Visualization of the brachial plexus (BP) and lumbosacral plexus (LSP) by magnetic resonance imaging (MRI) allows us to obtain detailed information useful in diagnosing and treatment of disorders affecting these complex nerve structures. MR techniques helpful in visualising BP and LSP include conventional methods, MR neurography (MRN), diffuse tensor imaging (DTI) and MR tractography (MRT). MRN provides detailed analysis of anatomical structure, DTI and MRT inform us on the functional integrity of the nerve fibers. With continuing development and improvement of these advanced MR techniques, we can assume their gradual introduction into standard MR protocols.

Muscular dystrophies are a heterogeneous group of inherited rare disorders that is characterized by progressive muscular weakness and a dystrophic pattern in muscular biopsy. As these disorders are inherited, the first symptoms typically appear during childhood. In the last few years, mainly due to the new genetic possibilities, this area is changing. There is an increase of diagnostic clarity (in our Centre it is more than 90 %) and an improvement in symptomatic care; and due to this, an increase of life expectancy and quality of life. Now, there are the first possibilities of causal therapy. In the article there is a description of the most common type of muscular dystrophies in childhood, diagnostic tools and therapy.

When adherence is not good, therapeutic outcomes are not good either. This is a key finding in the case of complaints that are very often accompanied by psychosocial burden and/or comorbidities even from among psychiatric diagnoses. Metastudies have shown that adherence to prophylactic migraine treatment, particularly in the long term, is low, such as that in the case of daily routine measures for the purpose of lifestyle changes. There are tools and techniques that healthcare professionals, and physicians in particular, have at hand which, when adopted, practised, and applied practically, can positively affect adherence. They include, for instance, emotional mirroring, open-ended questions, checking for understanding, and, in general, building a trust-based relationship with the patient.

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.

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.

Alzheimer's disease (AD) is the most common cause of dementia in elderly. Only a small proportion of cases is caused by pathogenic
variants in one of the AD associated genes – monogenic forms (autosomal dominant forms of AD). Most cases of late-onset
AD are considered to have multifactorial ethiology with a high contribution of hereditary component (up to 74 %). The paper
summarizes current knowledge about the genetic basis of AD, including recommendations for clinical practice.

The author presents a brief guide and a decision tree to be used by the clinical neurologist in routine outpatient practice, e.g. during emergency hours. Emphasis is placed on symptoms that can be identified and tests that can be performed in any outpatient setting, without the need for special devices or examination tools. The aim is to more precisely determine the clinical outcome, create a rational indication for auxiliary and/or specialized examinations, to better formulate the question the referring clinician requests to be answered, and to make a responsible decision on the urgency of the condition or potential danger in delay.

Acute optic neuritis is the most common optic neuropathy. In its typical form, optic neuritis presents as an inflammatory demyelinating disorder of the optic nerve affecting majority of patients with multiple sclerosis (MS). Atypical forms of optic neuritis may occur, either in association with other inflammatory disorders or in isolation. Differentiation from other optic neuropathies is vital for treatment choice and further patient management to prevent visual loss. Diagnostic investigations include MRI, visual evoked potentials, and CSF examination. Over the past decade, a number of new imaging, laboratory and electrophysiological techniques have entered the clinical arena.

Teriflunomide is a disease modyfing drug for treatment in multiple sclerosis as one of the options for first-line therapy. It has teratogenic and embyotoxic potential according to animal studies. The data on pregnancy use in women are limited and its use in pregnancy is contraindicated. However, there are cases where women have taken teriflunomide during conception and pregnancy.

At both outpatient and inpatient departments, one may encounter conditions that can be associated with coffee, tea, and tobacco consumption, e.g. nicotine poisoning, particularly with an e-cigarette filling liquid typically presented by emergency ambulance crews as unclear disturbances of consciousness, coma, etc., or sudden anxiety states with psychotic manifestations in the case of acute caffeine poisoning. These substance can also interfere with the effect of pharmacotherapy of patients through both pharmacokinetic and pharmacodynamic interactions. The risk of these intoxications has been increasing, particularly due to easy access to the above substances, including pure ones, on the internet.

Multiple sclerosis is a chronic inflammatory autoimmune disease which affect central nervous system. Treatment initiation of early multiple sclerosis may postpone the development of disease progression and disablement. Adherence to treatment fundamentally contributes to achieving optimal results of therapy, improving the quality of life of patients and reducing healthcare costs.

Entrapment syndromes are a very common cause of mononeuropathies of the upper extremity nerves. While the carpal or cubital tunnel syndromes are relatively frequent, entrapment syndrome of the suprascapular nerve is very rare. The authors present a case report of a 13-year-old patient with injury to the suprascapular nerve in the spinoglenoid notch region that was manifested only by atrophy of the infraspinatus muscle. The patient's condition improved gradually with conservative therapy.

Multiple sclerosis is a chronic inflammatory demyelinating disease which affect central nervous system. This autoimmune disease manifests itself with various symptoms. Glatiramer acetate (Copaxone) is a drug of the the first line treatment for relaps/remitent type of multiple sclerosis or clinically isolated syndrome. This review explore the mechanism of action of glatiramer acetate in treatment of multiple sclerosis, its indication for treatment, use and possible side effects too. We report three cases from our own patients base through we demonstrate possible use of glatiramer acetate.

Worster-Drought syndrome (WDS) is a mild form of cerebral palsy. Although the symptoms can be seen from the first year of life, the WDS is usually diagnosed in a much later age even the syndrome is not rare in the population and even the diagnosis is not difficult to be determined. An interdisciplinary group has been set to bring this issue to our experts and to our general public.

Back pain is probably the most prevalent clinical syndrome at all – lifetime prevalence is thought to be approximately >70% and currently about 30% of the population have this condition. Presently, chronic lumbar radicular pain is the most common neuropathic pain syndrome at all. Neuropathic component is present in at least 1/5 patients suffering from back pain. The pathophysiology of back pain is complex. Nociceptive – and neuropathic pain–generating mechanisms are thought to be involved, which established the term mixed pain syndrome. Radicular syndromes serve as typical examples of neuropathic pain. Neuropathic component, however, is also present in pseudoradicular and local types of back pain. Practical diagnostics of neuropathic back pain is based on the same diagnostic tools and principles as diagnosis of neuropathic pain in general. Current knowledge on the optimum therapy of neuropathic back pain is not sufficient to formulate unequivocal recommendations. Combined therapy utilising drugs focused to both nociceptive and neuropathic pain represents probably the best choice with respect to presumed pathophysiology of back pain in most patients.

Toxic epidermal necrolysis (TEN) is a critical exfoliation syndrome that, due to its local nature, mimics superficial burns. It is a drug-induced reaction that is manifested not only on the skin, but also on the mucosae. The induction of an apoptotic process in the dermo-epidermal junction zone is the underlying cause of the disease. Antiepileptics currently represent one of the most important drug groups with respect to developing TEN. The case report presents a young woman who developed toxic epidermal necrolysis following lamotrigine treatment.

Unique case report of prostate cancer metastasis to the membranes of the chronic subdural haematoma The study aims to present the case of prostate cancer patient with generalised metastatic skeletal involvement with sudden deterioration into comatose status and gradual development of bilateral mydriasis caused by bilateral non homogenous chronic subdural haematoma. After emergency bilateral frontal trephinations another surgery for residual subdural haematoma in parietal region was performed. Histological study of the resected outer membrane of the chronic subdural haematoma showed prostate cancer infiltration. Metastatic disease affecting the outer membrane of the chronic subdural haematoma is an exceptional finding described in only two literature reports so far. This exceptional finding together with literature data about non traumatic chronic subdural haematomas in patients with tumorous involvement of dura mater support the benefit of histological evaluation of the resected membranes of the chronic subdural haematoma in patients without the history of trauma and the necessity of such investigation in patients with cancer history because of tumorous etiology of chronic subdural haematoma.

Multiple sclerosis a serious disease of the central nervous system in which an autoimmune inflammatory process is directed against the myelin sheaths of nerve fibres. In addition to inflammatory mechanisms, neurodegenerative processes are also involved. The treatment options for multiple sclerosis have been expanding considerably in the recent years and more novel drugs are expected to be available for use in the clinical practice within the next two years. This progress results not only in higher treatment efficacy, but also a wider spectrum of adverse effects. For this reason, careful monitoring of adverse effects, collaboration with other medical specialities, and benefit-risk ratio assessment of treatment in a particular patient are all necessary. The situation is even more complex in that not all drugs have comparable long-term data on safety. It is therefore essential to consider treatment in every patient strictly individually and have the patient participate in the discussion on choosing an optimal treatment strategy.

How did we improve the diagnosis since 1984 and why we don’t have a causal therapy yet? In 2011, new guidelines for the diagnosis of Alzheimer’s disease (AD) based on biomarker assessment were published. They define AD as a neuropathological continuum independently of the clinical symptoms of the patient. They describe three clinical stages – preclinical with AD pathology only, prodromal with AD pathology and mild cognitive impairment and dementia stage. We evaluate the benefits and pitfalls of particular biomarker examinations, their availability and benefits for clinical practice and the ethical impact of early diagnosis in the light of so far unavailable causal therapy. We present recommendations for clinical practice emanating from the international harmonized guidelines from 2014.

The reason for introduction of novel therapies in epilepsy surgery is invasiveness and adverse effects of existing therapies. Inclinical epileptology, radiosurgical, radiofrequency, laser, and ultrasound ablations have been used. The article summarizescontemporary literary data and, in case of radiosurgery and radiofrequency ablations, personal experience with these methods.

Progress in developing new monoclonal antibodies allows us to affect pathological immune processes on many different levels.For treating MS, we now have available monoclonal antibodies capable of influencing the lymphocytes migration or inducingtheir depletion. Also, the development of new humanized and human antibodies caused significant improvement of their safetyprofile. Currently there are four types of monoclonal antibodies available in Europe for treating MS: natalizumab, alemtuzumab,daclizumab and ocrelizumab. The last one has also shown effectivity on suppressing progression of primary progressive form of MS.