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.

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.

Myasthenia gravis is an autoimmune disease affecting the postsynaptic part of neuromuscular junction. The disease can manifest in early or late age, weakening of muscles is generalized, or only affects the extraocular muscles. Pathological changes in the thymus consist card follicular hyperplasia or atrophy. Paraneoplastic form is associated with thymoma. The 80% can be demonstrated antibodies against acetylcholine receptor or muscle specific tyrosine kinase. Although in its course highly variable disease, we can, according to its course, particularly in the initial stages and to predict the prognosis of the disease in a particular patient is trying to establish an individualized treatment, which would lead to the achievement of clinical remission and the best possible quality of life. Bad prognostic factors include the detection of antibodies to muscle-specific tyrosine kinase, higher age manifestations, associated comorbidities, association with thymoma, fulminant development myasthenic crisis during the first year of the disease and delayed assesment of diagnosis.

epilepticus (SE) is an urgent neurological condition with high morbidity and mortality regardless intensive health care. Early identification of SE with the rapid initiation of its treatment can influence the outcome. The proposed concept of SE according to International League Against Epilepsy (ILAE) includes an assessment of clinical diagnosis with its timeline and adequate therapeutic approach. Despite aggressive therapy the refractory SE with necessity to use general anesthesia and artificial ventilation is developed in one third of patients. While clinical recognition of convulsive status is not difficult, the diagnosis of nonconvulsive status is not straightforward, especially in comatose patients. The article gives an overview of the status epilepticus with emphasis on therapy.

Idiopathic orbital inflammatory disease (IOID) is a relatively common disease – on average, 10 new patients a year are detected in our neuro-ophtalmologic departement alone. IOID is a non-infectious inflammation in the orbit, which behaves like a tumour clinically, but only signs of a chronic inflammation can be found histologicaly. The etiology of this disease is unknown. IOID can infiltrate any soft tissue in the orbit. It presents itself with various clinical symptoms, some of them can resemble any CNS disease. One should think of the diagnosis of IOID when eyelid oedema or ptosis and eye motility disorder is present. IOID is diagnosed according to the clinical features, CT or MR imaging and histology, if it is possible to conduct biopsy. The corticosteroid treatment quickly relieves the pain and diplopia and other clinical symptoms disappear.

Vascular dementia and vascular cognitive impairment include a heterogeneous group of ischemic or hemorrhagic insult (s) of the brain resulting in cognitive impairment. Based on localization and an extent of vascular patology, manifestation can be either subcortical (namely dysexecutive syndrome and decreased psychomotor speed) or cortical (instrumental functions). Vascular etiology is supported by case history, certain neurological findings and results of brain CT or MR imaging. Treatment efforts should be focused on modification of vascular risk factors. Clinical studies showed an effect of acetylcholinesterase inhibitors even in VD. diagnosis, treatment.

Huntington's disease (HD) is an autosomal dominant hereditary neurodegenerative disease with an incidence of approximately 1:10-15000. The mutation involves an expansion of CAG triplets in the first exon. An individual develops HD when the number of triplets is 40 or more. A typical age of onset of initial symptoms in classic, adult-onset HD is between 35 and 50 years of age. Much more rarely (approximately 5% of all cases), HD develops in child or adolescent age (juvenile form of HD /JHD/, arbitrarily defined as a disease with the onset of clinical manifestations by 20 years of age). This form of disease usually occurs when the number of CAG triplet repeats exceeds 60. Intellectual impairment often occurs first. A typical initial manifestation of JHD is failure to cope with academic demands, particularly due to a combination of cognitive disorder with motor slowing, discoordination of movement and voluntary movement disorder. Also typical are conduct disorders: most commonly temper tantrums, aggressiveness, antisocial behaviour and obsessive-compulsive features. JHD is most typically characterized by hypokinesis, rigidity, and dystonia, accompanied by rapidly progressive stability and gait disturbances. Chorea is usually absent. A relatively early occurrence is dysarthria, which may progress to mutism in the later stages, and dysphagia. JHD is sometimes referred to as primary Westphal variant HD. Another relatively common manifestation in JHD is epileptic seizures. Cachexia constantly occurs as early as the middle stages of the disease. To date, there have been no standards or uniform recommendations for therapeutic management in JHD. There are no pharmacological studies investigating symptomatic effects of drugs that would meet the requirements of evidence-based medicine; everything is off-label treatment. The article describes the therapeutic options used in individual manifestations of JHD.

Idiopathic generalized epilepsies (IGEs) constitute one-third of all epilepsies. They are genetically determinate in some epileptic syndromes the molecular-genetic etiopatogenesis is known. Clinical status is performed by age of onset of disorder, type of seizures (typical absences, myoclonic jerks, generalized tonic clonic seizures alone or in varying combinations) and characteristic EEG features. The article provides review of individual epileptic syndromes, their clinical status, diagnostic, therapy and prognosis with information about actually known molecular-genetic base of IGEs. Dividing of epileptic syndromes result from Proposal ILAE Task Force 2001. seizures, myoclonic absences, childhood absences, juvenile absences, juvenile myoclonic epilepsy.