Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disorder of the central nervous systeme. It is characterizedby the loss of the homeostatic regulations of the immune systeme comprising both innate and specific T cell mediatedimmunity resulting in the abnormal functional polarisation of T cells into Th17 and Th1 subsets together with the participation ofabnormal B cells. Drugs used in clinical practice are targeting different steps of the inflammatory immunopathological process.The effect of this treatment could be enhanced by the optimal life style of MS patients. The inflammation in MS patients couldbe simply targeted by optimal nutrition. The special emphasize should be paid to the optimalisation of the gut microbiota. Thenutrition should be enriched for all components modulating inflammation in MS patients. These comprise vitamine D, vitamineB, vitamine C, polyunsaturated fatty acids, prebiotics, probiotics and the substances of herbal origin, especially polyphenols.

diseases associated with disorders of iron metabolism Iron plays a significant role in the human body. Neurodegeneration with brain iron accumulation (NBIA) characterizes a heterogeneous group of neurodegenerative diseases associated with iron accumulation in the central areas of the brain. The most common disease of this group is pantothenate kinase-associated neurodegeneration (PKAN), an autosomal recessive disease characterized by a mutation in the PANK2 gene and impaired metabolism of coenzyme A. Also included here are phospholipase A2-associated neurodegeneration caused by a mutation in the PLA2G6 gene and conditions, such as neuroferritinopathy, aceruloplasminaemia, and others, that currently belong to the NBIA group. Iron metabolism is also linked to other systemic conditions, e.g. haemochromatosis. The paper presents the characteristic features, clinical manifestations as well as the options for diagnosis and differential diagnosis of these conditions. aceruloplasminaemia, haemochromatosis.

Vestibular rehabilitation is a set of exercises that accelerate the process of vestibular compensation and allowing adaptation to existing vestibular pathology. These techniques utilize CNS neuroplasticity, leading to a recalibration of the sensory system. In order for rehabilitation to be successful, an individual rehabilitation plan has to be devised with respect to the test results of examinations, symptoms and patient´s present complaints.

Vaccination is a topic which is being more and more discussed in recent years. As with every effective medicament, the use of vaccines can also lead to side effects which are more or less reversible, affecting mainly children vaccinated during infancy due to their vulnerability. Serious adverse events such as neurological complications are fortunately rare. The following article presents a listing of complications and focuses on vaccines available in Czech Republic at the time.

Another drug for relapsing-remitting multiple sclerosis (MS) has been introduced into the market in recent months. It is the socalled“PEGylated” interferon beta-1a. It is the original interferon beta-1a molecule, which has been known in the treatment of MSfor two decades, but has newly been bound to a molecule of polyethylene glycol (PEG), which provides it with some propertiesimproving the overall profile of the original interferon molecule. The article summarizes the profile of efficacy on clinical andradiological parameters and the safety profile of the drug established by the pivotal clinical trial ADVANCE as well as by its extensionstudy, called ATTAIN. PEGylated interferon beta-1a has now expanded the portfolio of first-line disease-modifying drugs(DMDs) used in the treatment of clinically isolated syndrome or relapsing-remitting MS.

The role of B cells in the inflammatory response is much wider as previously thought. B cells are not only antibodies producingcells but are the rich source of various proinflammatory cytokines and chemokines. B cells can identify various signals of dangeror damage. These danger molecules are processed and presented in the form of antigenic peptides in the context of HLA moleculesto T cells. Suprisingly, biological therapy with ocrelizumab targeting CD20 molecule expressed on B cells was evidencedas highly effective therapy of multiple sclerosis in large clinical trials. There are the substantial differencies in the structure andposttranslational modification comparing different antiCD20 monoclonal antibodies. These differences are responsible for bothimmediate and longterm adverse effects of this type of biological therapy in the treatment of multiple sclerosis.

Aim: To highlight the need for early diagnosis of inflammatory rheumatic causes of back pain that, due to their rare occurrence,tend to be overlooked easily in patients with back pain.Summary: The group of inflammatory rheumatic diseases of the back (spondyloarthritides /SpA/) include autoimmune inflammatorydiseases wherein the inflammation affects the axial skeleton, root joints, and peripheral joints, predominantly in the lowerlimbs. The most common disease of the SpA group is ankylosing spondylitis (Bechterew’s disease). The diagnosis of ankylosingspondylitis has been based on the 1984 modified New York criteria which require radiographic confirmation of injury to thesacroiliac joints. The author aims to highlight in the article that the use of novel diagnostic methods has fundamentally changedthe approach to this disease, and presents an overview of the current classification criteria that allow for detection of the diseaseprior to developing permanent structural changes.Conclusion: Early diagnosis allows for a rapid commencement of adequate treatment that can significantly affect the furthercourse of the disease.

Surgical treatment of epilepsy represents an important therapeutic option in patients with drug-resistant epilepsy. At Departmentof Paediatric Neurology, Motol Epilepsy Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospitalpaediatric epilepsy surgery has been practiced since 2000. Up to 1st November 2017 263 surgeries in 232 patients have beenperformed. This article aims to summarize essential principles both epilepsy surgery and preoperative diagnostic work-up as wellas results of our paediatric epilepsy surgery programme including recent trends. 80,7 % children in our series are seizure-free at 2year follow-up. Candidates undergoing early surgery have better chance gaining both seizure and AED freedom and (in children)their cognitive potential is more likely to be preserved.

Benign focal epilepsies (BFE) are one of the most frequent epilepsies in childhood. They are usually described as an epileptic spectrum, whose nosologic units have the same pathogenetic base, may show blurry boundaries among them and may convert during the time. Besides well-known epilepsy with centro-temporal spikes or Panayiotopoulos syndrome, there are new recently defined syndromes, completing the spectrum. Nowadays, the molecular genetic background of BFE is the largest area of interest as well as the research of psychologic-psychiatric comorbidities, which acquire searching for answer the question: Are the benign focal epilepsies really benign? encephalopaties.

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.

Within last 15 years the treatment approach to multiple sclerosis (MS) has been substantially changed in accordance with the recent knowledge about its etiopatogenesis. Intravenous administration of high-dose methylprednisolone still remains the first choice in the treatment of MS relapses. Between relapses immune system modifying therapy should be started early in the course of the disease as the major axonal loss appears in this period and early treatment can protect patients from subsequent disability. Since 2009, some of interferon-beta products are indicated even in cases of clinically isolated syndrome when the risk of MS development is deemed to be high. When the disease activity is not effectively suppressed by interferon-beta the treatment should be switched to either monoclonal antibody natalizumab, or to pulse-therapy with immune suppressive and cytostatic agents. When these approaches fail immune ablative autologous haemopoetic stem cell transplant is an option in some well selected cases. Symptomatic treatment and continuing physiotherapy are still an important and inevitable part of comprehensive approach. mitoxantrone.

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.

In neurological diagnostics, Single Photon Emission Computed Tomography (SPECT) is used only in a limited number of indications, mainly: 1) in presurgical assessment of refractory epilepsy patients, 2) in differential diagnostics of parkinsonian syndrome, 3) to assess functional cerebrovascular reserve in patients with internal carotic or intracerebral artery stenosis.

Treatment options in multiple sclerosis have expanded considerably in the recent years. In 2013, several new effective drugs were registered and more will be introduced in therapeutic practice in the coming years. However, the availability of drugs is limited due to restrictions of health care payers. Reimbursement regulations are often in conflict with evidence-based medicine. This article deals with both the good prospects in treating multiple sclerosis including an overview of new drugs and the current situation in the Czech Republic. The article presents specific cases of discrepancy between therapeutic options and the clinical reality.

Neuropathic pain is defined as a pain arising as a direct consequence of a lesion or disease affecting the somatosensory system (Treede, 2008). According to the anatomical localization neuropathic pain can be sorted into central and peripheral and then by etiology. In some cases there can occur both nociceptive and neuropathic component. Neuropathic pain has its specific symptoms and in contrast to nociceptive pain does not require the stimulation of pain receptors, though stimulation of nociceptive receptors can cause or emphasize the neuropathic pain. For patients, it is a symptom that persists and can significantly limit daily life. Therapy of neuropatic pain is complicated and should always be carefully and individually chosen. In terms of pharmacotherapy, antidepressants (SNRI serotonin–norepinephrine reuptake inhibitors and TCA tricyclic antidepressants) and antiepileptics (modulators of α2δ subunit of voltage-gated calcium channels) are recommended as first line therapy and opioids as second line therapy. The two case reports represent patients with neuropathic pain of diabetic origin in the first case and of spinal origin in the second case. These are the ones of the most common types of peripheral neuropathic pain. In both cases pregabalin was chosen as a therapy, in various schemes. Both patients rated the treatment positively, reported a significant improvement of their conditions. However, the treatment was always complete, it was necessary to carefully and gradually titrate the dose or choose a combination of drugs. In the second case, it was included interventional treatment solution.

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.

The Aim: The aim of this work is to evaluate the effect of constraint induced movement therapy on patients with hemiparesis. Material and method: 34 patients that underwent the combinet therapy (standard rehabilitation + constraint induced movement therapy) and 14 patients that underwent standard rehabilitation after a stroke in chronic stage of disease got involved in our pilot study. With patients admitted to the constraint induced movement therapy and to a control group we observed the quality with MAL (QOM) – motor activity log (quality of movement) test and quantity of using the weaker upper limb with MAL (AOU) – motor activity log (amount of use) test. We also observed the free activity of upper limbs with an action research arm test (ARAT). Results: All monitored parameters of patients that underwent the therapy of constraint induced movement therapy improved after the therapy. The quality and quantity of using the weaker limbs has significantly enhanced fine and gross motor skills (p<0.001). The control group has not proved any statistically significant improvement in the chosen tests. Conclusion: The results of our study suggest that the method of constraint induced movement therapy with patients with hemiparesis has a positive effect on the improvement of fine and rough locomotion and on the quality and quantity of using the weaker limb regardless the age, gender and the time that has elapsed since the disease.

Diagnosing endocrine disorders as the underlying cause of cognitive symptoms has essential importance since adequate treatment of hormonal dysfunction may improve neurological manifestations. Hypothyroidism may cause decrease in cognition very similar to depression, with a very good effect of substitution therapy. Therefore thyroid hormone level dosage is useful in dementia screening. A rare but treatable cause of rapid progressive dementia is Hashimoto´s encephalopathy. Hyperparathyroidism is often associated with psychiatric features and encephalopathy. Postmenopausal estrogen deficiency is related to increased risk of Alzheimer’s disease, the benefit of preventive hormonal substation therapy, however, remains controversial. Cognitive symptoms in chronic renal disease include mainly uremic encephalopathy and it is important to differentiate manifestation of kidney disease itself and complications due to dialysis.

Friedrich Heinrich Lewy (1885–1950), the man, who discovered Lewy bodies, pathological hallmark of neurodegenerative synucleinopathies, live dout an adveturous life. After serving in the German Army in the First World War, he became a professor of neurology and psychiatry. He had build a modern neuroscience institute in Berlin; after that has been forced to escape his country for Nazi repressions. He put down root in USA, served in the US Army and became a professor of neuroanatomy and neuropathology. The role of bodies, which bear his name, in the pathophysiology of parkinsonian neurodegeneration has been elucidated nearly half a century after his death.

Disorders of consciousness accompany a wide range of diseases, involving almost all branches of medicine. Despite different etiology, in the first contact with the patient we should follow a standardized diagnostic approach in order to distinguish the acutest cases. In less serious cases we have more time for diagnostics – detailed medical history and further investigations help us to discover the cause of the problem. The border between the urgent medicine procedures and observation are defined by the stability of the patient. The aim of this article is not to give a review of anatomy, physiology and neurological examination. It should rather inform the clinician that even though the differential diagnosis can be initially wide, the first steps of diagnostic and therapeutic process determine the patient's survival.

Epilepsy is a chronic brain disorder characterized by spontaneous or reflex, uncontrolled epileptic seizures (Kršek, 2006). Approximately between three and four hundred children in the Czech Republic are born to women diagnosed with epilepsy before pregnancy (Zárubová, 2010). For this reason, nursing care provided by midwives to epileptic women plays a significant role during pregnancy, childbirth and the postpartum period. Such care has its own characteristics with which midwives should be conversant. Therefore, one of the aims of the conducted qualitative research was to survey their knowledge in this area. The results have showed that addressed midwives are well-informed about epilepsy in terms of pregnancy, childbirth and nursing care of the newborn in the postpartum period. Another aim was to explore the effect of epilepsy on pregnancy, childbirth and nursing care for the newborn in the postpartum period from the perspective of epileptic mothers. The results of this survey are not the subject of this report.

Alemtuzumab (Lemtrada) is a humanized monoclonal antibody targeting the surface molecule CD 52 on immune cells. The bond between alemtuzumab and lymphocyte leads to cytolysis resulting to development of new lymphocyte generation potencially without autoaggressive signes of original population. Nowadays, alemtuzumab is in Czech Republic (CR) approved for treatment of highly active relaps–remitting multiple sclerosis (RR MS). In this paper we describe 2 cases of patients on alemtuzumab treatment in our department. We demonstrate both high efficacy confirmed in clinical trials together with potential risk of side effects following from mechanism of action.

Review article sumarises recent imaging possibilities of spinal cord and its diseases. The stress is put on the magnetic resonanceimaging (MRI) as the only method for spinal cord leasion visualisation. Both basic and advanced MRI techniques and sequenciesare explained, possible drawbacks included. The short differential of common spinal cord leasions in MRI is discussed at the end.