This systematic review summarizes the clinical manifestations and the existing knowledge about the treatment of the most frequentprimary headaches – migraine, tension type headache and cluster headache. The acute treatment of migraine attacks consists inthe use of simple analgesics, non-steroidal anti-inflammatory drugs, ergotamines and triptans. Patients with frequent or long lastingattacks require the prophylactic treatment. So far beta-blockers, antiepileptic drugs, calcium channel blockers and antidepressantsare used. Injections of onabotulinumtoxin A reduce the frequency of attacks in chronic migraine. The most promising new approachin the prophylactic treatment are monoclonal antibodies able to block either CGRP or its receptor, such as erenumab, fremanezumab,galcanezumab, and eptinezumab. Tension type headache is the most frequent type of headache. The treatment of acute attacks andprophylactic treatment in frequent episodic and chronic forms are described. Cluster headache (CH) is a primary headache from theTACs group. The clinical manifestation and the existing knowledge about the acute, bridging and prophylactic treatment are described.

Multiple sclerosis is a chronic inflammatory autoimmune disease which affect central nervous system. Treatment initiation ofearly multiple sclerosis may postpone the development of disease progression and clinical activity, including magnetic resonancefindings and disablement. The aims of this paper is to describe options for treating multiple sclerosis and risks.

Prophylactic treatment of frequent episodic and chronic migraine is often unsuccessful. In recent years, the therapeutic procedures
have focused on the particular segments of the pathophysiological chain of migraine. Calcitonin Gene-Related Peptide (CGRP) is
a key peripheral and central agent. Data emerging from trials with monoclonal antibodies (mAb) suggest that this specific blockade
of the CGRP pathway may provide an effective and safe novel preventive therapeutical approach in migraine.

Nowadays we should suppose that epileptology come in the period of DNA and the genetics has become one of main trend of research in epileptology over the world. Epilepsies in which genetic background is predicted are called “idiopathic”. In recent years genetic discoveries have shown the central role of ion channels in the pathophysiology of idiopathic epilepsies. Ion channels are divided to voltage-gated and ligand-gated ion channels. For voltage-gated ion channels, mutation of Na+, K+ and Cl- channels are associated with forms of generalized epilepsy and infantile seizures syndromes. Mutations in ligand-gated ion channels, such as nicotinic acetylcholine receptors and GABA receptors, are associated with specific syndromes of frontal and generalized epilepsies, respectively. Mutations in few genes that do not encode ion channels have been identified in the idiopathic human epilepsies. In children and young adults are idiopathic epilepsies often, that´ s way identification of the genetic-biological ethiopatogenesy can perspectively lead to individualization and selection of farmacotherapy in clinical practice. The article suggests the summary of up-todate discoveries in the field of genetic epilepsy research.

Autoimmune involvement of CNS can accompany systemic or organ specific autoimmune diseases or is a primary CNS affection. Clinically, autoimmune CNS disorders present with a variety of symptoms and there are distinctive neurological syndromes where autoimmune etiology should be suspected like limbic and NMDAR encephalitis, opsoclonus-myoclonus or stiff person syndrome. In other CNS disorders (myelitis, cerebellar ataxia, acute/subacute encephalopathy, status epilepticus and some types of epilepsy), autoimmune etiology should be considered if no other cause has been identified. Autoimmune etiology can be suggested by results of some investigations – autoantibodies, cerebrospinal fluid pleocytosis, specific brain or spinal cord MR findings, which should by always interpreted within the clinical context of an individual patient.

Spontaneous intracranial hypotension is a remarkable but often misdiagnosed cause of new daily persistent headaches. The syndrome is characterised by headache that occurs shortly after assuming an upright position, low cerebrospinal fluid pressure, and magnetic resonance imaging findings diffuse pachymeningeal enhancement after gadolinium administration. We describe a 39-year-old man, with history of an operation of lumbar spine for radiculopathy, who presented 6-weeks after the operation orthostatic headache with photophobia, osmophobia and tinnitus. He was primary diagnose as aseptic meningitis syndrome. Soon after the patient´s history was carefully reviewed, he was treated successfully with epidural autologous blood patch.

The hereditary motor neuropathies (HMN), sometimes called distal spinal muscular atrophies (dSMA), are characterized by selective involvement of peripheral motor nervous system. They affect about 10% of all patients suffering from hereditary neuropathies. The typical clinical features are symmetric atrophies and weakness of distal muscles of all extremities in lenght dependent pattern. They are clinically and genetically heterogeneous group of motor neuropathies with great diversity of phenotype and genotype. This group was subdivided into different types according to age of onset, muscle weakness distribution at upper or lower limbs, minor sensory impairment, neuromyotonia or vocal cord paralysis. Recently, more than 12 genes were discovered and are considered as a cause of different type of HMN. The diagnostic algorithm include clinical symptoms, electrophysiology and molecular genetic testing. The differential diagnosis is very important and similar conditions are considered, g.e. Charcot-Marie-Tooth disease, motor neuron diseases, including juvenile forms of amyotrophic lateral sclerosis or acquired multifocal motor neuropathy. The causative treatment is not available. The physiotherapy, orthotics and orthopedic surgery are important. The genetic counselling, prenatal or preimplant genetics testing are very important in the case of known causative mutation.

Teriflunomide is medicine used for treatment of relapsing- remitting multiple sclerosis. It is administered as oral tablet once daily.Its safety profile and effectiveness were verified in four clinical trials and is supported with 13 years of clinical experience. Medicineis well tolerated by patients, adverse effects are mostly mild to moderate. This article shows on important data for clinical practiceespecially focused on treatment of young women, that are necessary to consider before and during treatment with teriflunomide.

Spinal cord lesions represent a complicated clinical problem connected with serious consequences both for the patient andthe society. Regenerative potential of spinal cord is extremely limited. From this point of view, fast diagnostics followed by anappropriate treatment based on the etiology of the lesion is fundamental. Etiology of spinal cord lesions can be traumatic andnon-traumatic. Traumatic spinal cord lesions are most often connected with spine injuries. Tumors, degenerative diseases andvarious hemorrhages are the most common cause of non-traumatic spinal cord lesions. Early decompression along with anadequate conservative treatment currently represents the only therapy with prospect of clinical improvement. In prolongedcomplete spinal cord lesions, the patient prognosis is, in spite of significant efforts in experimental research, still unfavourableand the improvement of a serious neurological deficit is rather exceptional.

Brain computed tomography (CT) is the most widely used and widespread imaging method in acute (vascular) neurology. Non-contrastbrain CT, CT angiography, and CT perfusion represent important imaging tools, complementary to clinical examination andpatients history, helping in diagnosis and decision-making on subsequent therapy. The main aim of this article is to summarizeCT imaging modalities, which are used in routine clinical practise.

Intraparenchymal hemorrhage (ICH) accounts for 10–20 % of all strokes, its mortality is much higher compared to ischemic strokes. 55 % of hematomas are localised deeply in brain hemisphere, 30 % in lobes and 15 % in the brain stem. The most frequent causes of ICH are hypertensive vasculopathy, amyloid angiopathy, vessel malformation or tumors. ICH patients should be admited to an ICU, the goal of therapy is blood pressure normalisation using intravenous drugs, coagulopathy treatment in patients on anticoagulation therapy and cerebral edema treatment. Prophylactic antiseizure medication is not recommended. Surgical treatment is effective in cerebellar or superficial hemorrhages. Anticoagulation after ICH is possible in carefully selected patients, an alternative approach in atrial fibrilation patients is left appendage closure.

The treatment of the inherited metabolic disorders with primary biochemical defects in the CNS has undergone a considerableprogress, recently. Our work brings a brief summary of currently available therapeutic possibilities including intrathecal applicationof enzyme replacement therapy, small molecules treatment, hematopoietic stem cells transplantation and the gene therapy. Theearly diagnosis and introduction to the therapy are crucial for the therapeutic success.

Pelvic fl oor dysfunctions occur in up to 80 % of patients with multiple sclerosis (MS). Symptomsinclude overactive bladder, urgency, urge urinary/fecal incontinence, pollakiuria, nocturia, andsexual dysfunction. Despite their common occurrence, pelvic fl oor dysfunctions are often a taboosubject for patients and are frequently overlooked by clinicians during assessment, particularly in theearly stages of the disease. Notwithstanding the development of modern investigative instrumentsin the clinical assessment process, the author believes that comprehensive assessment of pelvicfl oor dysfunction must include a range of manual examinations, including are patient’s perception,refl exes, and the PERFECT scheme. A thorough and inclusive assessment is essential for targetedtherapy that reduces symptoms and leads to improved quality of life for MS patients.

Pregnancy has a profound effect on a woman´s body including musculoskeletal system, specifically the axial skeleton. The developmentof low back pain and/or pelvic girdle pain (lumbopelvic pain) is a frequent consequence. Lumbopelvic pain has impacton the quality of life for women and is the frequent cause of sick leave. The prevalence of pelvic girdle pain ranges from 20% to65%, the prevalence of low back pain during pregnancy is about 50%. Lumbopelvic pain can be divided into three categories:low back pain, pelvic girdle pain, combined low back pain and pelvic girdle pain. The aim of this article is to summarize the recentdata about clinical manifestation, diagnostics and management of lumbopelvic pain in pregnancy.

Multiple Sclerosis is a serious neurological illness affecting approximately 20,000 patients in the Czech Republic. Without treatment,the majority of patients develop a severe disability. Although there is still no cure for the disease, we can at least slowdown its progress thanks to modern, but costly therapy. The modern drugs are undoubtfully more effective; however, they alsopose a higher risk of developing various adverse events that must be carefully monitored. The basics of proper patient treatmentmanagement primarily rely on the data from the registration studies as well as the data regarding the treatment effectivity andsafety obtained from real clinical practice. The latter data can be collected via high-quality registries. In the Czech Republic, theregistry ReMuS founded and run by a non-governmental organization the Endowment Fund IMPULS together with the scientificcommunity has been collecting the data since 2013. Over the five years of its existence, the number of patients monitored by ReMuShas increased more than ninefold; the registry contained data of more than 13 thousand patients in all phases of the disease asof June 30, 2018. The registry regularly provides important cross-sectional data on the demographics, the severity of the disease,the type of treatment, and the ability to work, and has also started to provide first longitudinal analysis. More information can beobtained at www.multiplesclerosis.cz.

A movement disorder emergency (MDE) is an acute or subacute state, in which failure to accurately diagnose and manage the patient may result in significant morbidity or even mortality. The syndromes are most frequently caused by certain drugs administration, or conversely their withdrawal, but the etiology may also include infections, toxins, focal brain lesions, metabolic disturbances, or autoimmune disorders. MDEs are frequent in patients with Parkinson’s disease. With respect to differential diagnosis, psychogenic movement disorder or psychiatric etiology of an acute state should be considered. Further in the text, serotonine syndrome, neuroleptic malignant syndrome, parkinsonism-hyperpyrexia syndrome, status dystonicus, and acute hemichorea-hemibalism with be described in more details. syndrome, status dystonicus, acute hemichorea-hemibalism.

Alemtuzumab (ALM) is a humanized monoclonal antibody intended for the treatment of patients with active relapsing-remitting multiple sclerosis. Treatment with this agent may be accompanied by some serious complications. Following this treatment, another autoimmune disease can develop and infectious complications of varying severity can also occur. The present case report describes the development of listeria meningitis in a female patient following a course of ALM for multiple sclerosis. Listeria meningitis is a bacterial infection whose source usually is contaminated food. Patients who have had treatment with ALM may be more vulnerable to this infection due to changes in the immune system; thus, increased clinical alertness is essential in order for the condition to be correctly diagnosed as well as managed.

Myasthenia gravis is an autoimmune disease with formation of antibodies against the postsynaptic part of the neuromuscularjunction. When the presence of anti-acetylcholine receptor antibodies is demonstrated, the condition is referred to as seropositivemyasthenia gravis; when these antibodies are absent, it is seronegative myasthenia gravis. The anti-muscle-specific tyrosine kinase(MuSK) antibody was demonstrated in 35% (0–49%) of the seronegative forms. Anti-MuSK myasthenia gravis exhibits the followingfeatures: a predominance in women, earlier onset, characteristic clinical finding, and worse and inconstant response to treatmentwith cholinesterase inhibitors. With regard to neurophysiological tests, it is of importance to use repetitive stimulation to examinethe proximal muscles (trapezius muscle, deltoid muscle) as well as the mimic muscles (nasalis muscle, orbicularis oculi muscle).With SF EMG (single-fibre EMG), there is a substantially higher positivity in examining the frontalis muscle or the orbicularis oculimuscle. Thymectomy is not indicated. Immunotherapy is effective – the administration of immunoglobulins, plasmapheresis, andcorticosteroids in combination with other immunosuppressants. Myasthenia gravis with anti-MuSK antibodies is characterizedby an unstable course, a higher frequency of myasthenic crises, and greater therapeutic complexity.

Chronical alcohol abuse may affect among the others also peripheral nervous system. Although high prevalence among alcoholicsthis group of diseases remains often neglected. Alcohol abuse affects all types of nerve fibers including thin unmyelinated onesmediating pain. The range of damage rise from mono – to polyneuropathies and the disease course may fluctuate from acute tochronic one. Alcohol neuropathy is caused by two dominant pathophysiological mechanisms: 1) direct toxicity of ethanol and itsmetabolite of acetaldehyde, 2) alcohol interaction with thiamine metabolism resulting in nutritional neuropathy. Axonal damageis the dominant hallmark of neuropathy detectable on EMG. The treatment is substitutional by thiamin administration, dietaryand also behavioral (by abstinence often requiring the care of psychiatrist).

The paper presents a review of current options for objective evaluation of the function of the vestibular labyrinth, oculomotor function, and postural stability. Particular attention is paid to newly introduced methods of quantitative assessment using the head impulse test and testing of the otolithic apparatus by means of vestibular evoked myogenic potential.

Following the discussion at all levels, ILAE Commission for Classification and Terminology has published in 2017 two position papers onclassification of the epileptic seizures and on classification of the epilepsies. In the text we present translation of some parts of the originalposition papers and the Czech version of the terminology and classification that is recommended by the Czech League against Epilepsy.

Ginkgo Biloba extract EGb761 constitutes the mixture of many active substances with different pharmacological activities. Finaleffect is synergistic. Main effects are nootropic, neuroprotective, scavenging of free radicals, hemorrheologic. The outcomes ofmany clinical studies in dementia are ambiguous, but most of them demonstrate mild to medium improvement of cognition andnon-cognitive symptoms of dementia. That is why EGb761 is establisched for the treatment of mild cognitive impairment andmild dementias of Alzheimer´s type, for the treatment of vascular dementias and mixed dementias, also as an add-on therapy toacetylcholinesterase inhibitors and memantine. Effectiveness of EGb761 on the improvement of functional sexual disorders andprobace anxiolytik effect are investigated.

The article provides an overview of diagnostic options and basic differential diagnostic approaches for extrapyramidal diseasesusing magnetic resonance imaging. It aims at distinguishing between Parkinson’s disease and atypical parkinsonian syndromesas well as describes the characteristic presentation of Huntington’s disease and Wilson’s disease on magnetic resonance imaging.Moreover, chronic subdural haematoma and normal pressure hydrocephalus are discussed as part of a broader differential diagnosis.