Neuromuscular transmission may be negatively influenced by many drugs and agents. Some of them are targeted to this purpose – most important are the following: depolarizing and non-depolarizing neuromuscular blocking agents (used to produce muscular paralysis in anesthetized patients), botulinum toxin (effectively weakening appropriate muscles for treatment of spasticity and dystonic syndromes) and cholinesterase inhibitors (used to reduce clinical symptoms in myasthenia gravis). Furthermore, several drugs may negatively influence the neuromuscular transmission as an undesirable side effect, particularly in case of pre-existed impaired function of neuromuscular junction (mainly in patients with myasthenia gravis). Among others, D-penicillamine, interferon alfa, magnesium, some antibiotics, quinidine, procainamide, statins, and calcium channel blockers may present with such an influence. Furthermore, transient worsening of myasthenia gravis may be evoked by corticosteroids.

Immune-mediated necrotizing myopathy is considered to be one of the idiopathic inflammatory myopathies. It is characterised byan acute onset of limb girdle weakness with widespread necrosis and regeneration of the myofibrils with minimal inflammatoryinfiltrates. Some patients have myositis-specific antibodies. Combined immunosupression is used for treatment but the responseis often poor with relapses.

Magnetic resonance imaging is an important tool in establishing the diagnosis of multiple sclerosis as well as in subsequentlymonitoring the success of immunomodulatory therapy in patients already diagnosed with the disease. Clinical signs are presentonly in a proportion of inflammatory lesions of the brain and spinal cord, and it is magnetic resonance imaging that helps to monitorthe clinically silent phase of the disease. Early treatment initiation is important for prognosis of the disease since irreversibleneurodegeneration occurs already at the onset of the disease. Subcutaneous interferon ß-1a was shown to have significant efficacyin reducing MRI activity also in patients with a higher disease activity at treatment initiation in the IMPROVE trial. Moreover, inthe EVIDENCE trial, it was confirmed to have a higher efficacy in reducing the observed MRI parameters when directly comparedwith interferon ß-1a administered intramuscularly once a week.

The issue of the keeping and handling of medical records is faced by physicians on everyday basis. The article presents the legislationin force for keeping medical records. Attention is paid to practical aspects such as when and under what conditions healthcare professionals are obliged to breach the broadly-defined confidentiality. This area is governed by various legal provisionswhich define the obligation to provide information from medical records.

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.

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.

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.

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.

Myasthenia gravis is an autoimmune disorder of neuromuscular transmission. There are many drugs frequently used in anesthesiologywhich interfere significantly with this disease. The most important are peripheral blocking agents and potent inhaledanesthetic agents. Patients suffering from myasthenia reveal modified sensitivity to these drugs, esp. to the peripheral blockingagents. Regional methods of the anesthesia or combination of both are preferred. Postoperative management is based on thecareful monitoration of patients until full recovery is reached. In patient with myasthenia gravis there is no risk of malignanthyperthermia.

Pain in diabetic polyneuropathy is a pharmacologically difficult-to-manage condition that tends to be resistant to treatment with both non-steroidal anti-inflammatory drugs and common analgesics. Antidepressants and antiepileptics are the first-choice drugs. Pregabalin is an antiepileptic drug derived from gabapentin that has been shown to reduce the intensity of neuropathic pain (Richter et al., 2005). It is a structural lipophilic GABA analogue, which readily crosses the blood-brain barrier. The mechanism of action likely involves an ability to bind to the α2 δ-subunit of a voltage-gated presynaptic calcium channel, by which pregabalin reduces the release of excitatory calcium into the cell. It is usually administered twice or three times daily at a total daily dose of 150–600 mg. It is generally well tolerated, with the most common adverse effects being vertigo, somnolence, and peripheral oedema.

Statins are competitive inhibitors of enzyme 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR) lowering cholesterol and low-density lipoprotein levels. Due to their effectiveness they became the most frequently used group of drugs worldwide taken by more than 100 millions of patients. Statin myopathy is the most frequent and serious adverse event of statin use. Its clinical spectrum is very broad fluctuating from asymptomatic hyper-CK-aemia, myalgia, crampi, muscle weakness to most serious rhabdomyolysis with 10 % mortality. Randomized controlled and cohort studies report statin myopathy incidence of 1–5 % and the incidence of rhabdomyolysis of 1.6–4.4 cases/per 100 thousands of cases/per year. The real incidence in the clinical setting with respect to the results of observational studies is estimated to be 10–15 %. Statin myopathy usually manifests within 6 months of statin use and myopathic symptoms are completely or partially reversible. Newly described statin induced necrotizing autoimmune myopathy associated with autoantibodies against HMGCR displayed different course and clinical pattern, manifesting usually after years of statin use and requiring immunomodulatory treatment. The review offers overview of current knowledge upon pathophysiology of statin myopathy and recommendations concerning its practical management.

Chronic subjective dizziness (CSD) is defined as a state of non-rotating dizziness, uncertainty, or oversensitivity to one’s own movements or comprehensive motor stimuli. It typically develops after vestibular pathology has resolved. The patient makes the impression of not being able to readapt following the resolution of the acute phase of the disease and their motion patterns remain identical to those in the acute phase of the disease. This condition is often accompanied by profound anxiety that can gradually gain prominence in the clinical presentation.

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.