Lumbar spinal stenosis (LSS) is considered a slowly progressive disease with long-term clinical stability. However, its natural course remains largely unknown. Two therapeutic options present themselves – conservative treatment or surgical treatment. At the current time, there is no general agreement about approaches to LSS therapy. This article summarizes the pros and cons the two therapeutic methods and presents certain outcome predictors; the authors also draw up recommendations that may assist choice of optimal therapy for patients with LSS.

In some epileptic syndromes, epileptic seizures may be caused by pathological activation of neuronal networks which in normal cicumstances regulate sleep and wake cycle. It applies to perisylvian network in LKS and ESES, thalamo-cortical in IGE, frontal in NFLE, and temporolimbic in TLE. In some epileptic syndromes this may interfere with mechanisms for which sleep is important and cause cognitive defect. Sleep disorders and epilepsy frequently coexist and treatment of one condition may have positive impact on the other.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is characterized by relapsing or progredient course. This is an autoimmune polyradiculoneuropahty with activation of cellular and humoral mechanisms and with primary lesion of myelin sheath in peripheral nerves. Demyelinating and remyelinating changes could be disclosed by nerve biopsy, or their equivalent proved with help of neurophysiological investigation. In clinical finding there is motor nerve disorder in distal and also proximal regions, in typical form in all four extremities, disturbances of sensitive and autonomic nerves are present. Besides the most frequent typical form there are more not so frequent forms. In CIDP therapy corticosteroids are used most frequently, then intravenously administered immunoglobulins and only in restricted indication plasmapheresis. CIDP is a treatable neuropathy, though in substantial proportion of patients leads to invalidity. of immunoglobulins.

Continuous administration of levodopa-carbidopa intestinal gel is a treatment option for motor fluctuations and dyskinesias in advanced Parkinson‘s disease. A suspension of levodopa-carbidopa is delivered in an aqueous gel from a casette reservoir by an infusion pump via percutaneous endoscopic gastrostomy with jejunal extension tube. Continuous administration leads to reduced variability in plasma-levodopa concentrations and subsequently to decreased motor fluctuations and dyskinesias. A case report of 56 year old woman with history of Parkinson‘s disease for 16 years and significant reduction of motor complications due to administration of levodopa-carbidopa intestinal gel for 6 years is presented.

Color duplex sonography, performed according to exact protocol, is a suitable and accurate imaging method of first choice forthe detection and evaluation of vertebral arterial stenoses. In this overview article we offer detailed methodology of examination,detection of direct and indirect signs of the stenosis and classification of hemodynamic parameters, including reference valuesfrom our own research. We also briefly comment clinical importance of findings in vertebral arteries and their position in thediagnostic and therapeutic algorhitm for patients with vertebrobasilar ischemia.

Diagnostic imaging methods play a key role among the diagnostic procedures in patients with hydrocephalus. The most important imaging modality here is the magnetic resonance imaging, which is able to detect and specify possible source of the obstruction within the ventricular system of the brain. Other methods, which can be used in the diagnostics of hydrocephalus, are computed tomography and ultrasonography for the imaging of the brain in fetuses and newborns. In this paper we discuss the features and limitations of the aforementioned imaging techniques and describe their position in the diagnostic algorithm.

Toxic neuropathies play an important part of differential diagnosis in idiopathic neuropathies in adults. Unfortunately, neuropathic symptoms and electromyographic findings resembling other acquires or inherited neuropathies. The careful medical history, including detailed occupational and drug history with relevant data, related to neurotoxic exposure and general physical examination, plays a key role in their diagnostic algorithm. Very important are special laboratory examinations confirmed toxic agents or their metabolites in blood and urine. The cooperation with the experts in industrial neurotoxicology is recommended. The correct considerations regarding interruption toxic treatment or finish exposure to toxic environment with further symptomatic treatment are leading to improvement of peripheral neuropathy. Our knowledges about toxic drugs or industrial toxins constitute a good background for effective prevention of toxic neuropathies.

Introduction: Mechanical thrombectomy is recommended standard treatment of occluded large cerebral artery within first 6hours since stroke onset. Beyond this standard therapeutic time window, thrombectomy may be beneficial in strictly selectedpatients only and upper treatment time limit has been still unknown. The aim was to document a positive clinical effect of thrombectomyperformed after 14 hours since stroke onset.Methods: We describe a case of 73 y/o female, who presented with sudden severe left-sided hemiparesis at home. Shewas admitted to the stroke center after eleven hours after stroke onset with severe and fluctuating hemiparesis. AdmissionCT scan showed partial occlusion of right internal carotid artery (ICA) and occlusion middle cerebral artery (MCA) and relativelylarge ischemic penumbra on CT perfusion scans. Based on clinical symptoms, CT and MRI findings the mechanicalthrombectomy with successful recanalization of ICA and MCA was performed 14 hours after stroke onset with an excellentclinical outcome.Conclusion: Mechanical thrombectomy is recommended a standard treatment of occluded large cerebral artery within first 6hours since stroke onset. Strictly selected patients with ischemic penumbral patterns may have benefit from mechanical thrombectomyeven beyond standard therapeutic time window.

In recent decades, there have been significant advances in the standard therapy of high-grade gliomas. New surgical procedures were introduced; radiotherapy methods were improved. It was also found that the use of chemotherapy in specific tumor types further improves the treatment effects. Diagnostic procedures developed as well. However, treatment results are still not satisfactory. The survival of patients with glioblastoma improved only by a few months in the last several decades. The mainstay of malignant gliomas treatment is always maximal safe tumor resection as feasible without functional consequences. Additional treatment depends on histology but also prognostic and predictive factors. The main traditional prognostic factors include age, performance status and the extent of resection. Novel prognostic factors are cytogenetic and molecular biomarkers, some of which may also predict response to the treatment.

Pain as the most significant clinical symptom of herpes zoster (HZ, shingles) is classified as neuropathic pain. In the acute phase of skin eruption, it is referred to as herpetic neuralgia (HN). Pain, however, can occur as early as the pre-eruptive phase wherein various painful symptoms may be misdiagnosed, depending on the location, as a number of other conditions (e.g., ulcerous disease, renal colic, lumbar ischialgia, myocardial infarction, and others). If acute pain progresses to a chronic stage, it is referred to as post-herpetic neuralgia (PHN) the treatment of which is often very difficult. The case report presents a female patient with an unusually long prodromal phase of the disease as well as evaluates the effect of very early commencement of treatment for neuropathic pain with pregabalin, an adjuvant analgesic, both in terms of the relationship to acute HN and affecting the development of PHN.

Multiple sclerosis (MS) is a chronic inflammatory disease wherein demyelination and axonal loss occur in the central nervous system (CNS). MS is a multifactorial disease in which environmental factors can be responsible for triggering an autoimmune response in genetically susceptible individuals. Environmental factors typically act in combination, while being less selective and having an effect on the pathogenesis of MS. A complex interplay between individual genetic predisposition and environmental factors in MS affects both the incidence of MS and its clinical form. The most significant factors include smoking, reduced vitamin D concentration, reduced UV light exposure, high sodium chloride level, and early Epstein-Barr virus (EBV) infection.

The article presents the results of a pilot study aimed at finding out whether respiratory physiotherapy can affect respiratory and postural function of patients with Parkinson's disease (PD). The study was conducted on a group of PD patients who were selected on the basis of clinical examination and referral by a physician from the unit for extrapyramidal disorders. The individuals enrolled were classified as stage 2–3 on the Hoehn and Yahr scale and were divided into three groups: two experimental ones and one control group. The therapy was based on the assumption that, due to disease symptoms, both postural and respiratory functions are insufficient in PD patients. The therapy was performed as a group exercise and aimed at improving the baseline postural conditions for respiration, strengthening of the respiratory muscles, and activating the muscles providing an interplay of postural and respiratory functions while using selected respiratory physiotherapy procedures. Respiratory physiotherapy resulted in improvement of most respiratory as well as postural parameters in the study group; however, these changes were not statistically significant.

Natalizumab belongs to monoclonal antibodies. This is a high- efficacy drug, which substantially reduces the activity and leads to long-term stabilization of multiple sclerosis. However, the therapy is associated with a risk of developing progressive multifocal leukoencephalopathy (PML) in patients infected with the John Cunningham Virus. Standardized high-quality monitoring procedures, clinical assessments, magnetic resonance imaging monitoring and use of biomarkers enable risk stratification. Early detection of disease in asymptomatic stage substantially improves survival and reduce the functional outcomes.

Multiple sclerosis is a chronic autoimmune disease affecting the central nervous system. T and B lymphocytes play an important rolein the pathophysiology of the disease. The majority of anti-inflammatory drugs used in the treatment of multiple sclerosis affect theactivation of T lymphocytes in particular. Ocrelizumab is a novel monoclonal antibody that causes selective depletion of CD20 B lymphocytes.The drug has shown its efficacy in treating multiple sclerosis in both relapsing-remitting and progressive forms. In terms ofserious adverse effect rates, no statistically significant differences were found among ocrelizumab, interferon beta-1a, and placebo.

Cladribine represents a novel possibility of multiple sclerosis treatment. Mechanism of action is derived from observation of adenosindeaminase deficiency in severe combined immunodeficit. Cladribin exerts incomplete depletion of both activated and restingT- and B- lymphocytes, with repopulation which induces long-term shift in immune system function including change in cytokineproduction. When this effect is compared with alemtuzumab we observe difference in repopulation of B lymphocytes which donot jump above baseline values in patients treated with cladribine. This may explain no occurence of secondary autoimmunities.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterised by progressive impairment of upper and lower motor neurons. The typical sign of ALS is focal onset. The differential diagnosis of ALS, especially in the early stage of the disease when clinical and electrophysiological abnormalities are not fully developed, is wide. We present a case report that describes mistaking diagnosis of ALS in early stage for lumbar spinal stenosis that resulted in not indicated surgery. This case report emphasises the necessity of careful evaluation of degenerative impairment of spine as the main cause of neurological problems.

Multiple sclerosis (MS) is a chronic disease of the central nervous system leading primarily to motor and sensitive disability. Cognitivedeficit is present in almost 70 % of patients with MS and is detectable even at the earliest stage of MS – in patients with clinicallyisolated syndrome (CIS). Because cognitive deficit has an important impact on a patients‘ quality of life, it is important to focus ontheir potential cognitive deficit in routine clinical practice. The aim of this review is to summarize new findings about cognitivedeficit and neuropsychiatric symptoms in patients with MS and to describe how to manage cognitive deficit in patients with MS.

Brain metastases are ten times more common than primary brain tumors. Patients with brain metastases represent a large group indicated to radiation treatment. This article summarizes the most commonly used radiotherapy techniques, as well as side effects and the ways of their treatment.

Multiple sclerosis is a chronic inflammatory demyelinating disease which affect central nervous system with neurodegenerative changes of brain. This autoimmune disease manifests itself with various symptoms. Treatment options in multiple sclerosis have expanded considerably in the recent years. This review explore current treatment options for multiple sclerosis. We report one casee from our own patients base through we demonstrate possible use of fingolimod for treatment escalation.

Fycompa® (perampanel – PER) is new antiepileptic drug with a specific mechanism of action, different from other drugs. It is well tolerated and its safety profile is favourable with minimum of adverse effects, which are mild to moderate intensity even in high doses. Its interactive potential is low and allow combined therapy with other antiepileptic drugs. Great advantage are perampanel pharmacokinetic characteristics, offering the convenience of once- daily administration. It is effective add-on therapy of focal epilepsy and primary generalized tonic-clonic seizures in idiopathic generalised epilepsy. Many open label extension studies proved its efficacy even on generalized seizures (primary or secondary). Its pharmacological characteristics, good tolerability and high efficacy in focal and generalized epilepsies make perampanel promising drug in seizure freedom reaching and so reduce the risks associated with seizures.

Cladribine tablets has been registered recently for treatment of relapsing multiple sclerosis. The article presents results of thepivotal clinical trial CLARITY and its extension – efficacy of cladribine tablets on clinical and radiological outcomes, and safetyand tolerability data.

Pediatric hydrocephalus is a pathophysiology condition which can negatively influence the development of the child permanently. It is most commonly caused by congenital defects and by intraventricular haemorrhage at premature infants. Diagnostics and treatment vary from adult patients in some areas. That is caused by physical parameters of the child in the time of treatment and subsequent growth and development. We always try to avoid diagnostic methods which use ionizing radiation due to its negative impact on developing brain. For surgical solution we use neuroendoscopy for obstructive hydrocephalus and shunt surgery for communicating hydrocephalus. For complex hydrocephalus we use combination of both methods. In case of well-timed and adequate treatment the child suffering from hydrocephalus can develop normally.

The role of B lymphocytes in the pathogenesis of multiple sclerosis is undoubted any more. The research of last years has beenrecently corroborated by three successful phase III clinical trials with ocrelizumab, a humanized monoclonal antibody againstCD20 molecule which is a marker of B lymphocytes. The spectrum of most effective drugs for remitting phase of multiple sclerosisis broadened by a drug with novel mechanism of action. The proof of the effect of this drug in primary progressive multiplesclerosis where no treatment existed up to now represents an important progress.

Chronic migraine (CM) is a neurological disease that remains underdiagnosed and difficult to treat. In the comparison with episodic migraine, patients with CM show a higher degree conditional functional limitation, reduced work productivity and quality of life. This personal and socioeconomic burden emphasizes the urgent need for adequate treatment. Although we commonly use a wide range of oral preventatives in the clinical practice, currently the only the Food and Drug Administration (FDA) approved treatment for CM prevention is onabotulinumtoxin A. In this review, we discuss history and present perspectives of this therapy.