Excessive daytime sleepiness (EDS) is defined as the inability to stay awake and alert during the usual awake period of the day with unintended episodes of drowsiness and/or sleep. EDS increases the risk of accidents and errors and may also be a symptom of serious underlying disease. Diagnosis is based on patient history and paraclinical examinations, particularly polysomnography. If possible, the treatment of EDS consists in removing the cause. When causal treatment is not possible or sufficiently effective, it is advisable to use psychostimulants. Most psychostimulants enhance the activity of the adrenergic system in the CNS.

Among the psychiatric comorbidities in epilepsy, anxiety and anxiety disorders are ones of the most frequent. Mainly upon the epilepsy features these conditions occur in 10–50 % of patients. However in the shadow of epileptic seizures these problems have been mostly disregarded in the past. They were not properly diagnosed and treated. Withal they have a profound influence on the quality of life of epilepsy patients. This review focuses on occurrence of anxiety disorders, their early diagnostic and treatment recommendation for the epileptological practice.

Inflammatory myopathies represent a heterogennic group of acquired myopathies, which have an inflammatory cause. Idiopathic inflammatory myopathies have the most frequent occurrence and they are differentiated by a course, occurrence of associated diseases, by treatment effect and by findings in muscle biopsy. Myopathies in systemic diseases, vasculitides, viral, bacterial, fungal and parasitary infectious diseases have an inflammatory cause too. In the following paper we present overview of basic inflammatory myopathies with emphasis on the clinical characteristics and muscle biopsy findings.

Patients with Charcot-Marie-Tooth (CMT) disease may have demyelinating involvement also within the central nervous system. An MRI scan of the brain then shows a finding similar to that in patients with cerebrospinal multiple sclerosis (MS). Similarly, MS patients may develop peripheral nerve injury analogous to that in CMT. However, immunohistochemical examination of the peripheral nerve can distinguish between these two types of injury. We recorded a case of a 38-year-old man presenting with upper limb amyotrophy, flexed posture of the fingers and wrist with a bilateral restriction in movement, hypotrophy of the lower limb periphery, flexed leg position, and muscle wasting. Electromyographic as well as histological tests indicated motor and sensory axonal-demyelinating polyneuropathy corresponding to a hereditary type of polyneuropathy. In addition, he had a history of recurrent retrobulbar neuritis and paraesthesia attacks at various sites with a good effect following a therapy with corticoids. The MRI finding of the brain and cervical spinal cord, VEP as well as CSF examination are clearly indicative of MS. A novel, or uncommon, gene mutation is considered in this patient, and what is more, in a rare coincidence with MS.

In this article, we will focus on our own experience with children headache drawing, which is based on Staftrom et al.´s (2002) low structured administration and analysis of headache symptoms and behavioral changes. Apart from the presentation of this method, we will briefly mention the broader context of the topic (the developement of drawing and the ability to perceive pain depending on cognitive maturity in childhood) and the real pictures we have obtained. It can be seen as an instruction and an ecouragement to distribute this inexpensive method, whith is popular wiht children.

Neuromyelitis optica (NMO) (also known as Devic‘s disease or Devic‘s syndrome) is an idiopathic inflammatory disorder of the central nervous system (CNS), usually with a relapsing-remittent course. This disease is characterised by recurrent uni- or bilateral optic neuritis (ON), or presents concurrently with transverse myelitis- typically a longitudinally extensive form (LETM). In patients with a full clinical manifestation, establishment of diagnosis is no major issue. At the beginning of the disease, an isolated manifestation of either recurrent optic neuritis or myelitis can lead to incorrect diagnosis of multiple sclerosis (MS). Currently, we are able to assess the serum antibodies against aquaporin 4 (NMO-IgG, also known as AQP4-IgG), which are highly sensitive (75–91 %) and specific (91–100 %) for NMO. These antibodies can significantly facilitate correct diagnosis already in the time of first symptoms, and, in case of isolated ON or LETM, they can predict the risk of relapse or full manifestation of NMO. NMO IgG positivity is one of the supportive criteria within the revised Wingerchuk‘ s criteria for diagnosis of NMO from 2006.

Parkinsonian syndromes are a large and heterogeneous group of diseases. The classification of these diseases has been making a rapid progress and, due to advances in the field of molecular genetics in particular, it may be possible to distinguish new nosological entities in the future. Atypical parkinsonian syndromes can be divided into synucleinopathies and tauopathies, and other heredodegenerative diseases. Parkinsonian syndromes are most characteristically represented by multiple system atrophy (MSA) and progressive supranuclear palsy (PSP), with PSP being a type of tauopathy and MSA that of synucleinopathy. The present article provides general information on MSA and PSP.

Diabetic neuropathy may be associated with neuropathic pain. Type, intensity and localization of pain differ according to the type of neuropathy or the pathophysiology of neuropathic pain. In treatment of diabetic neuropathy and following neuropathic pain there is necessary to compensate diabetes and associated metabolic abnormalities. On the basis of many randomized clinical trials there was proved effectivity on neuropathic pain in diabetic neuropathy for tricyclic antidepressants, gabapentin/pregabalin, serotonin-noradrenalin- reuptake inhibitors and opioids. Monotherapy is successful in 30–40 % of patients, but the most patients should be treated by combined therapy.

Anxiety disorders commonly occur in neurologic conditions, and the relationships they have with such conditions are of particular interest, pointing in some instances to the involvement of certain brain regions or circuits. Neurological illnesses in comorbidity with anxiety disorders are associated with greater functional impairment, increased utilization of health services, and less favorable outcome. The manifestations and comorbidities of various neurological illnesses routinely involve psychiatric diagnosis and management.

Some types of primary headaches in the elderly age occur less often (migraine, cluster headache), others are typical for this period (hypnic headache). The occurence of secondary headaches increases. Red flags help in differential diagnostic of serious secondary headaches. The most important kinds of primary and secondary headaches in senior age are described in the text. Lower doses of medication are used more frequently. Some drugs (triptans, amitriptylin) are inappropriate in elderly age. It is necessary to pay attention to the combinations of drugs with regard to the occurence of sides effects (warfarin).

Persistent aura without infarction (PAWI) is among rare complications of migraine. The diagnostic criteria include: a history of attacks of migraine with aura; an aura persisting for more than one week; and a neuroradiological examination failing to demonstrate migrainous infarction. The most common symptoms of aura are visual and may persist for months or years. The differential diagnostic process involves ruling out complications of migraine (migrainous infarction, status migrainous) as well as some eye diseases (such as vitreous opacities), visual hallucinations in psychiatric diseases, hallucinogen persisting perception disorders and some other rarer causes. An effective treatment for PAWI is not known; acetazolamide, valproic acid and topiramate are recommended. The author reports two interesting cases of migraineurs with chronic visual aura. A 29-year-old woman has had migraine with aura since puberty. In July 2010, she developed a persistent visual disturbance characterized by visual snow – speckling, combined with flashing and colour effects. A 22-year-old man with occasional migraine with aura (visual, sensory and dysphasic) has suffered since early childhood from a persistent visual disturbance characterized by speckling, when "the outside world is seen as if behind this veil". The condition is accompanied by symptoms of depersonalization and derealization. Both patients were evaluated thoroughly. Ophthalmological examination, CT, MRI, EEG, CSF and laboratory tests, psychological and psychiatric examinations were mostly negative. Permanent visual problems significantly complicate the life in both our patients. Repetitive transcranial magnetic stimulation appears to be a promising method for affecting persistent visual aura caused by visual cortex hyperexcitability.

In this review article the new diagnostic guidelines for Alzheimer’s disease are reported. The recommended biomarkers that confirm the AD pathophysiological process are listed, however the use of these biomarker tests has not yet been advocated for routine diagnostic purposes at present time.

of epileptic paroxysms occurs in childhood and adolescence In children these are especially somatic non-epileptic seizures while psychogenic conditioned non-epileptic seizures appear gradually and may also prevail in preadolescence and adolescence. The report has summed up the most important entities in infant and young children emphasizing thein clinical picture and usual age incidence. The author has not dealt intentionally with the problems of syncopes and paroxysmal extrapyramidal conditions. Out of the paroxysmal sleep disorders imitating epileptic seizures only those occurring in children have been mentioned. The goal is to improve the knowledge of neurologists who meet in their practice these problems most frequently.

Diabetes mellitus and the treatment of associated complications is a great problem oll over the world. Modern medicine offeres a wide range of therapeutical possibilities. There are some new drugs in clinical praxis, some are not registrated in Czech republic or their indication is out off label. Non- pharmaceutical methods can be used as alternative treatment of diabetic neuropathy.

Parkinson‘s disease is a chronic, progressive neurological disease with prevalence of 1 % in the population over 65 years. The modern success of pharmacology and deep-brain % of the populatstimulation surgery to treat the motor symptoms of tremor, rigidity, and bradykinesia provide PD patients with longer lives and increased motor functioning. However, in the moderate and advanced stages of disease, the therapeutic benefits of pharmacology diminish and motor symptoms are more complicated to treat. The nonmotor symptoms of Parkinson´s disease receive little attention in clinical settings, although they can lead to disability and caregiver burden. The concept of paliative care accepts the actual clinical disability of the patient and his needs for everyday life.

Patients with ischemic cerebrovascular accident (CVA) can develop complications. About 30 % of patients experience progression of focal or global brain changes. In this case, the CVA is progressive, which is a neurological complication. As a general rule, complications affecting organ systems other than just the brain are called medical complications. They occur both in the acute stage of ischemic CVA, due to pathological changes existing already before a CVA occurs (e. g., hypertension, diabetes mellitus, and ischemic heart disease), and in association with the type and severity of a CVA (impairment of consciousness, edema). In the first week, complications of the acute phase of a CVA can develop (such as confusion, negativism, dysphagia, phlebothrombosis, and pressure sores). After the resolution of the acute stage, there is a rising incidence of other complications (depression, spasticity, undernutrition, and falls). It is necessary to know the complications, their risk factors, and their timing in relation to stroke, and based on this knowledge, to implement preventive measures and sensible therapy.

Idiosyncratic adverse effects account for only a small portion of all adverse effects of antiepileptic drugs. They are of significance particularly because some of them may be life-threatening for the patient. The review article provides basic information on the most common idiosyncratic adverse effects of antiepileptic drugs.

Hyperkinetic disorder (HKD) or Attention Deficit Hyperactivity Disorder (ADHD) is considered to be a neurodevelopmental disease and also in its diagnostic criteria the onset is postulated before the age of seven. In 40–50 % of patients the symptoms persist into the adulthood. In the case the disease is not diagnosed and tretaed properly in time, the patient is exposed to the sustained stress and pressure and secondary somatic complaints and comorbidities may occur.

Guidelines for diagnosis and therapy of Alzheimer´s disease provides an evidence based review of the literature. Scientific papers are assessed according to levels of evidence, where I means the most convincing and IV means the weakest evidence. There was provided a recommendation of level A – efficient, B – probably efficient and C – possibly efficient, based on the levels of evidence. Presented guidelines revise previous recommendations published in 2007. New biomarkers of Alzheimer´s disease are discussed, especially examination of cerebrospinal fluid, magnetic resonance and other imaging methods, as well as new neuropsychological instruments. In the pharmacological section, there are critically evaluated many substances lacking sufficient evidence of its efficacy, but still used in the Czech Republic.

Prion diseases are caused by proteinous infectious particles, which are very resistant to usual sterilization procedures. The most current is Creutzfeldt-Jakob disease. Its diagnosis is based on clinical findings (rapidly progressive dementia, pyramidal or extrapyramidal involvement, myoclonus, visuo-spatial impairment and akinetic mutism) and positive 14–3–3 protein in CSF and/or periodic activity on EEG. MRI hyperintensities in FLAIR and diffusion weighted images in subcortical structures (putamen and caudate) and in some cortical areas, are currently being added to new WHO diagnostic criteria. Early recognition of a prion disease is crucial for the patient and his family, mainly in case of genetic forms of diseases. Since causal therapy is inexistent, many futile investigations including invasive procedures can be avoided and adequate palliative care can be introduced.

Authors review the topic of idiopatic intracranial hypertension or pseudotumor cerebri from an ophthalmologist‘s point of view. Thus the article can not serve as a complete rewiew of the disease. The suspicion is often made by an ophthalmologist according to typical signs, especially papilledema. Neurological examination finds no patology, normal findings of imaging techniques are also typical. Etiology and pathogenesis still remains unclear. Therapy, if started early enough, can in most cases effectively prevent a visual loss. Authors add brief case reports.

The goal of this article is to inform readers about the treatment options for severe spasticity and dystonia in children with cerebral palsy by intrathecal baclofen (ITB). Cerebral palsy plays serious role in life of spastic child and his/her family. ITB is in position of trusted method, which improves quality of life of spastic child with or without dystonia and so quality of life of his/her parents. Reduction of spasticity leads to marked reduction of pain. This article presents basic indication criteria for ITB as well as basic information about baclofen test, implantation method, refill procedure and summarizes complications of ITB therapy.

Delirium is an acute, life-threatening condition requiring a timely diagnosis, a timely differential diagnosis to distinguish it from similar life-threatening conditions and a timely treatment. Delirium tremens is among the leading causes of death among those with a psychiatric diagnosis; however, the risk of delirium complications is still underestimated. The treatment of milder, uncomplicated deliria is feasible in conventional detoxification centres or at psychiatric wards through collaboration between a psychiatrist and an internist. The treatment of severe deliria and deliria in patients with serious somatic complications comes within the competence of an intensive care unit where continuous monitoring and artificial ventilation are possible and auxiliary diagnostic methods are available.

Neuropathy of the ulnar nerve at the elbow is only second to carpal tunnel syndrome as the most common cause of upper extremity mononeuropathies encountered by an outpatient neurologist and an electromyographer in their practice. In clinical electromyography, a number of motor and sensory conduction studies and needle electromyography are used to diagnose this mononeuropathy. Segment study of motor conduction across the elbow (inching) is a less-commonly used technique due to the demands for execution and interpretation. However, this examination is essential because of accurate localization of the injury and may be beneficial in the case of a negative result of conventional neurography in clinically highly suspected neuropathy. The result of an examination using this method is useful for a neurologist, physiotherapist and surgeon. The aim of the article is to provide an overview of this neurographic technique for electromyographic practice.

Huntington´s disease (HD) is a well-defined autosomal dominant neurodegenerative disease. It is caused by CAG repeat expansions in huntingtin gene. There are a significant number of HD cases where this mutation was not found and such cases are named HD-like phenotype (HDL) or HD phenocopies. The aim of our work is to review these HDL. We studied existing resources and further we describe these syndromes, including HDL1, HDL2, and HDL4 (SCA17), and also (because of phenotypic overlap) dentatorubral-pallidoluysian atrophy, Friedreich‘s ataxia, neuroferritinopathy and neuroacanthocytosis.We also bring our proposal for diagnostic process, to diagnose the most frequent syndromes. However, current worldwide research shows, that major number of patients with HDL phenotype remain without final diagnosis. This suggests that other genes or gene modifiers may exist, where the mutation can cause the syndrome with clinical features similar to HD.

Learning disabilities condue to a failure of acquirement of such abilities as reading, writing, and computing. They are usually revealed during childhood at the age when we start attending school, because pupils at this age much more experience requirements during this developmental stage that discloses this disabilities. Some of the traits are evident in preschool age and lead us to thinking about the risk of persisting to adolescence. In case of insufficient school support the disabilities last till adulthood and usually are the reason for achieving lower level of education and professional status than could be expected due to intellect capacity (Law et al., 2009). Many and frequent failures in this field can secondary lead to conduct, and affective disorder, and even to social maladaptation. In this article we will focus on particular functional deficits, which are prerequisites of learning disabilities manifestation and some of the used neuropsychological models.

Chronic low back pain (CBBP) is a common symptom affecting around 10 % of adult population in Western societies. Neuropathic component is common, affecting around 1/3 of CBBP patients. It consists of local neuropathic pain within the degenerated intervertebral disc and surrounding soft tissues as well as radicular pain which is caused by local nerve root compression, swelling or inflamation. Clinical manifestation of neuropathic low back pain depends on affected nerve structures. Compression of nerve root or ventral rami of spinal nerve usually causes sciatica. Symptoms of local neuropathic pain vary from latent trigger points or segmental tenderness (myofascial pain syndrome) to abnormal skin sensations within the low back area. Presence of neuropathic pain has important impact upon analgetic treatment, first line non-steroid antiflogistics (NSA) are effective in nociceptive pain only and does not have significant effect on neuropathic component. Adjunct of tricyclic antidepressants, 3rd generation anticonvulsants such as pregabaline or gabapentine or local anesthetic/steroid blocks can be beneficial in patients who do not respond to NSA in monotherapy. Non-pharmacotherapeutical procedures – manipulation techniques, back school, physical therapy, accupuncture or psychotherapy are no less effective therapeutic approaches, that can be used for complex treatment of chronic low back pain.

Paragangliomas are benign neuroepithelial tumours typically localized in glomus caroticum and jugulare. Their spinal localization is very rare, entirely in the area of cauda equina and filum terminale. We present a case report of 33-year old woman. Her initial symptom was low back pain irradiating into lower limbs without neurological deficit. Magnetic resonance showed tumour expansion filling the whole spinal canal in the range from L4 to S1. Peroperatively we found a well circumscribed intramural tumour which clearly originated from filum terminale interconnected by a vascular pedicle. The tumour was radically resected. The histopathological and imunohistochemical exam classified the tumour as paraganglioma. Six months after the surgery the magnetic resonance is without any evidence of the tumour recurence. The general analysis of the available literature concerning paraganglioma of cauda equina and filum terminale is present in the discussion.