Magnetic resonance imaging has a very important role in the diagnosis of opportunistic infections of multiple sclerosis patients. Most often it is possible occurrence of progressive multifocal leukoencephalopathy in connection with the treatment of the monoclonal antibody natalizumab. There is currently no causal treatment, the only thing that positively affects the prognosis of the patient is the earliest possible diagnosis of the disease, followed by a rapid change in clinical management of the patient. That can be achieved only by regular, frequent MRI monitory. This article summarizes the typical early symptoms of the disease, highlights the differences in the findings on MRI, which help to distinguish progressive multifocal disease relapse of multiple sclerosis. There are presented other diseases too, which come into consideration in the differential diagnosis.

Migraine is common in adult as well as pediatric population. In our countries a neurologist is often called to the emergency roomfor differential diagnosis of headache and its therapy management in contrast with western countries, where acute managementof migraine is the premise of the emergency specialist. Local standard treatment protocols rarely exist. The current article reviewsdata on treatment of acute headache patients in the acute care setting.

Multiple sclerosis is a chronic inflammatory demyelinating disease which affect central nervous system. Treatment options in multiple
sclerosis have expanded considerably in the recent years. This article deals with new data about clinical activity, influencing
of disease progresion among patients treated with ocrelizumab.

Noninvasive brain stimulation brings alternative insight into rehabilitation and treatment of neurological diseases. The researchmoved forward in recent years. Based on clinical controlled studies there seems to be clinically meaningful effect in differentgroups of neurological patients with no serious side effects. Methods were so far clinically approved only for treatment of medicallyresistant depression, but studies indicate potential future use also in a therapy of depressive symptoms caused by otherdiseases, rehabilitation of aphasia or cognitive symptoms in early stages of neurodegenerative diseases. In the current review,the reader is briefly introduced to the NIMS methods and results of published research studies.

Vertebrogenic diseases are one of the segments of population diseases, that are a significant contributing factor to the disability of the modern human population. The strategy of diagnostics and treatment is often ill-conceived. The aim of this paper is to inform about the options of multidisciplinary diagnostics by a neurologist, physiotherapist, pain management specialist and radiologist. This clinical entity is the second most common reason for a doctor’s visit. In the productive age, vertebrogenic diseases are the major reason of sick leave, the fifth most common reason of hospitalisation, and the third most common reason of a surgical intervention.

Epilepsy surgery is the most effective way to achieve long-term seizure freedom in patients with drug-resistant focal epilepsy.Advances in neuroimaging investigations and development of methods for data postprocessing have increased the possibilityof accurately localizing the epileptogenic zone, particularly in patients with normal MRI. The need for invasive brain recordingsremains unchanged, with increasing proportion of stereo-EEG to target deep foci. Multi-modal co-registration may yield improvedguidance of resection. Surgeries performed in recent period were more likely to yield a favorable outcome, and improvementwas more marked in extratemporal and non-lesional temporal lobe epilepsy.

Dimethyl-fumarate (DMF) is a drug indicated for relapsing-remitting forms of multiple sclerosis. Treatment leads to reduction ofrelapses, delays invalidity and supresses manifestations of disease shown on MRI. Treatment by DMF has also side effects, includinggastrointestinal side effects and increase of liver enzymes activity. Clinical trials DEFINE and CONFIRM shown elevation of ALTin 6 % cases and discontinuation of treatment leaded do normalisation of liver tests. DMF is an effective and safe drug, possibleincreasing of liver tests does not mean serious risk, for which the treatment should by discontinued.

The most of neurologists deal with the peripheral nerve injury of the upper limbs (especially closed) in everyday practice. EMG
examination remains a gold standard for more accurate determination of the level of injury, importance of imaging methods also
has been increased. The decision whether conservative or surgical treatment should be indicated depends on the mechanism and
level of injury, results and dynamics of EMG results. No reliable procedure has been found to accelerate the axonal regeneration
of the peripheral nerve.

Interferon beta and glatiramer acetate comprise the group of first-choice drugs for the treatment of relapsing-remitting multiple sclerosis. All the drugs have been shown to have an effect on reducing the relapse rate, reducing the disability rate as well as on MRI parameters. In the Czech Republic, patients have been treated with these drugs for about 15 years. The basic indication remains unchanged and the major advances in the past one to two years are: expanding the indication to include clinically isolated syndrome, reducing the age limit for treatment from 18 to 12 years and the possibility to assess neutralizing antibodies against interferon beta.

Prion diseases are the group of rare neurodegenerative diseases affecting both humans and animals, characterized by a longincubation period, rapidly progressing symptoms and infaust prognosis without the possibility of influencing the course of diseaseby therapy. The basic pathophysiological process is accumulation of "infectious" protein – prion in the brain tissue with itsirreversible spongiform damage. The most common human prion disease is Creutzfeldt-Jakob disease. It should be considered indifferential diagnostic process especially in cases of rapidly progressive dementia in combination with other neurological symptoms.The aim of this article is to really point out the issue of prion diseases and to briefly describe it in following case-reports ofsporadic Creutzfeldt-Jakob disease which was diagnosed at our department in years 2015 and 2016.

Current progress in genetic technologies increases the detection rate of genetic causes of epilepsies, especially of early infantileonset epilepsies associated with comorbidities. Cooperation of neurologists with clinical geneticists and molecular biologist isessential for correct interpretation of the results.

Headache is a common accompanying symptom in cerebrovascular diseases. Recognition of the features and identification ofheadaches in these conditions can aid diagnostic accuracy, therapeutic selections, and improve clinical care.

This case report presents a 53-year-old woman treated at neurological emergency for transient acral paresthesias of the right upper limb and periorally without any other neurological deficit. Following an initial magnesium infusion she was sent home. A week later she was examined again for tingling in both left-sided limbs, objectively there was a central paresis of the left facial nerve, CT brain scan without a pathological finding, in laboratory test there was heavy haemolytic anemia and thrombocytopenia, she was sent to a hemathological ICU with a preliminary diagnosis of Thrombotic thrombocytopenic purpura. In this report I would like to briefly introduce this rare syndrome, of which wide range of symptoms are reflected into many of medical disciplines.

Sleep-related movement disorders are simple, non-purposeful and usually stereotyped movements that occur at sleep onset orduring sleep. In some cases they represent transient or insignificant symptom without any health consequences. But they can alsocause insomnia, worsening of sleep quality or lead to injury. Bruxism and sleep-related leg cramps are very frequent. Sleep-relatedrhythmic movement disorder, propriospinal myoclonus at sleep onset and benign sleep myoclonus of infancy are less common.The definition of these disorders, clinical picture, diagnostics and therapy are summarized in the article.

Isolated sleep paralysis occurs in up to 7,6 % of general population, which makes it to be a common sleep disorder. Recurrent isolated sleep paralysis (RISP) means REM (rapid eye movement) related parasomnia, which occurs recurrently during the transition between sleep and wake that means during falling asleep or awakening. It is a transient loss of speech and voluntary movement that affects limbs and trunk muscles, which is especially at the beginning of the accompanied by an intensive fear. This burdensome experience can be elevated by accompanying fearful dreamy delusions, so called hypnagogic/hypnopompic hallucinations. Pathophysiological background of sleep paralysis is the continuing muscle atonia of REM sleep that persists until the full awakening. Current sleep medicine offers psychoterapeutic as well as farmacological treatment options.

Duchenne/Becker muscular dystrophy, caused by mutations in dystrophin gene,is one of the most frequent muscular dystrophies. First
symptoms of DMD include delayed motor milestones, difficult running or climbing stairs. Boys with DMD use the Gower´s maneuver to
arise from floor. Cardiomyopathy and respiratory failure most often occur in the third decade. Diagnostical process is based on clinical
picture, blood tests results (esp. elevated CK) and confirmation on molecular genetic base. Treatment aims to control symptoms. New drugs
in clinical practice as well as in clinical trials together with better multidisciplinary care can prolong patients life and improve its quality.

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.

Multiple sclerosis is a chronic inflammatory autoimmune disease which affect central nervous system. Treatment initiation ofearly multiple sclerosis may postpone thie development of disease progression and disablement. Goal of MS treatment is statewithout cninical and sublinical markers of diseasety aktivity, state known as NEDA (No Evidence of Disease Activity). This work isconcerned with treatment of MS, monitoring and predictors of treatment.

Ocrelizumab (Ocrevus) is a humanized monoclonal antibody that was approved by the US Food and Drug Administration (FDA)on 28th March 2017 for the treatment of relapsing remitting multiple sclerosis (RRMS) and primarily progressive multiple sclerosis(PPMS) approved immunomodulatory treatment. European Medicines Agency (EMA) has recommended 10th November 2017OCR for the treatment of adult RRMS patients and early primary progressive MS patients in the European Union (EU) countries.In the Czech Republic, OCR was registered on 8th January 2017. The treatment is focused on mature B lymphocytes, immune cellsexpressing the protein CD20 molecule on their surface. It is believed that these CD20-positive B-lymphocytes are directed againstthe axons and myelin of healthy neurons, initiating a cascade of immune responses that lead to their damage and consequentlyto the disability in MS patients. This new view on MS pathogenesis was supported by evidence from a phase III, OPERA I, OPERAII and ORATORIO clinical trial.

Iatrogenic cause of disease is defined as a harmful response to medicamentous or surgical therapy. Iatrogenic peripheral nerve
lesions can be brought about with a surgical instrument in an operational field, but also with compression, traction, catching the
nerve by splint, damage of nerve by bleeding or radiation. In the paper there is given an overview of the most frequently injured
peripheral nerves and situations, in which a iatrogenic lesion developes.

The Lennox-Gastaut syndrome (LGS) is one of the most severe epileptic encephalopathies of childhood onset. LGS is characterised by occurence of multiple type of epileptic seizures (tonic, atonic, atypical absences), an EEG finding, psychomotor delay and behaviour disorders. The optimum treatment for LGS remains uncertain. This paper summarizes the therapeutical options of LGS including pharmacological therapy, diet and surgery. No study has shown any one drug to be highly efficacious; rufinamide, lamotrigine, topiramate and felbamate may be helpful as add-on therapy. Until further research has been undertaken, clinicians will need to continue to consider each patient individually, taking into account the potential benefit of each therapy weighed against the risk of adverse effects.

The aim of therapeutic plasma exchange (TPE) is to remove pathological (autoantibodies, monoclonal proteins, toxins bound to plasma proteins) or increased physiological plasma components (cytokins, kinins). Among neurological diseases, TPE is the accepted first-line therapy (according to American Society for Apheresis [ASFA] – category I) in PANDAS („Pediatric Autoimmune Neuropsychiatric Disorders Associated with streptoccal infections and Sydenham’s chorea“), and the second-line therapy (category II) in acute disseminated encephalomyelitis, multiple sclerosis, Devic disease and some paraneoplastic neurological syndromes with autoantibodies. Autoimmune neuromuscular disorders, however, are the most frequent indications for TPE in neurology: myasthenia gravis (MG), Guillain- Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP) and paraproteinaemic polyneuropathy IgG/IgA are classified as category I (acc. to ASFA), and Lambert-Eaton myastenic syndrome (LEMS) and acquired neuromyotonia as category II. Guidelines of the European Federation of Neurology, the American Academy of Neurology and the Czech Neurological Society, however, consider TPE as the first-line therapy in GBS and MG only (as the alternative method to intravenous humane immunoglobulin [IVIG] that has more favourable safety profile), while TPF is recommended as the second-line therapy in CIDP, and the evidence of the TPE effect in paraproteinaemic polyneuropathies and LEMS is lacking.