Neuropathic pain is defined as a pain arising as a direct consequence of a lesion or disease affecting the somatosensory system. A convenient classification of neuropathic pain is anatomical, according to the site of initiating nervous system pathology, with an etiological sub-classification. Where possible it should be divided into peripheral or central neuropathic pain based on the location of the lesion in the nervous system. In certain disorders pain could be of mixed type with both nociceptive and neuropathic components. Neuropathic pain is a very common problem in many neurological diseases. It may arise from a heterogeneous group of disorders that affect the peripheral and central nervous system. The present paper reviews common neuropathic pain syndromes. central poststroke pain.

Pyridoxine dependent epilepsy is a rare autosomal recessive hereditary disorder causing a severe intractable epileptic seizures presenting typically in prenatal and neonatal period, rarely in early infancy (age up to 3 years). Pyridoxine dependent epilepsy, caused by metabolic disturbance of pyridoxine, is associated with mutations in ALDH7A1 or ALDH4A1 gene. Similar condition, pyridoxal-phosphate dependent epilepsy (also called neonatal epileptic encephalopathy), is caused by mutations in PNPO gene. Pyridoxine dependent epilepsy is successfully treatable using high doses of pyridoxine. Neonatal epileptic encephalopathy is refractory to pyridoxine administration, however responses to treatment with pyridoxal-phosphate. The diagnosis of both pyridoxine dependent epilepsy and neonatal epileptic encephalopathy is based on biochemical and genetic examinations.

Patients with low grade glioma and symptomatic focal epilepsy represent a complicated clinical problem. A case report of now 37 years old female successfully treated with temozolomid is presented here. She had her first secondarily generalized epileptic seizure in postpartum period. MRI discovered low grade glioma in the right parietal region. Her epilepsy soon proved refractory to treatment. Because of epilepsy farmacoresistancy and tumor growth on MRI neurosurgery was indicated. Only partial resection was done due to risk of permanent motor deficit. Histopathology exam diagnosed fibrilary astrocytoma WHO II. Further growth of the tumor was noted on MRI three years later. The choise of temozolomid as most suitable treatment was based on thorough interdisciplinary discussion including assesing the risks of alternative treatments, neurosurgery and radiotherapy. After 12 month of treatment with temozolomid the tumor ceased to grow and remains unchanged in size for four years. Epilepsy is reasonably controled without change in medication. Treatment with temozolomid is not a standard option in treatment of low grade gliomas. An overview of data on this issue available in the literature is presented here for discussion.

The therapeutic guidelines for Parkinson’s disease have been developed for more than 15 years. Due to improved recognition of the symptoms of the disease and extended therapeutic options, the original short and brief guidelines have been replaced by multipart guidelines that separately deal with motor and non-motor symptoms of Parkinson’s disease. Currently, there are both European and American variants of therapeutic guidelines which serve as guidance, but not an obligatory one; their application has to be creative and respect individual features of the disease in a particular patient.

In acute period after the first seizure – loss of consciousness with convulsions with suspicion on GTCS – it is emphasized to distinguish epileptic and nonepileptic origin (mostly convulsive syncope) and identify an acute disorder, which can cause provoked seizure. Later on it is highly desirable to disclose appearance of inconspicuous seizures of other type, e.g. myoclonia, absences, focal seizures, in patient history as it can prove diagnosis of epilepsy. CT scan is always recommended as soon as possible, MRI can be delayed. Except for abnormal neurological findings, EEG abnormality – both nonspecific slowing and specific epileptiform changes – increases risk for seizure recurrence. Initiation of antiepileptic therapy after first unprovoked seizure is reasonable when there is a high risk of recurrence or complications of seizure.

Spinal cord injury is often accompanied by pain. Prior to treatment it is always necessary to establish a correct diagnosis. In his classification, Siddall distinguishes between nociceptive and neuropathic pain. Nociceptive pain can be further divided into musculoskeletal and visceral subtypes. The pain originates most commonly from overloaded muscles and joints or from dysfunctional inner organs. If the cause is correctly diagnosed, treatment is usually successful. Neuropathic pain originates directly from the spinal cord or its roots above, at or below the lesion. It is often intractable and long-lasting and may in some cases lead to psychic derangement. Therapy is long-term and results are often unsatisfactory. In the following text we present an outline of the above mentioned types of pain, including their characteristics and treatment.

A successful therapy of dementia should positively influence cognitive functions as well as the quality of life and behavioral and psychological symptoms. This goal can be achieved by combination of pharmacological and non-pharmacological approaches. Diseases manifesting with dementia are a heavy burden not only for the patients but also for caregivers caring for their relatives at home. The article reviews current therapeutic approaches to dementia with the focus on non-pharmacological interventions that informal carers might try or access in the home background.

The paper deals with secondary headaches. Secondary headaches are symptoms of a certain structural lesion or organic disorder intraor extracranially or they may be the manifestation of a metabolic disorder, application or removal of a certain substance. The paper focuses on serious life or health – threatening secondary headaches and their characteristic features. They are divided in several groups: headaches associated with vascular disorders, posttraumatic headaches, headaches associated with space – occupying lesions, with infection, and disorders of eye, nose and paranasal sinuses. The paper is completed with 9 case reprorts. mass, meningitis, HIV infection.

In the Czech Republic, children with cerebral palsy (CP) should be evaluated by paediatric ophthalmologists. Ophthalmological examination in children of preverbal age or in verbally non-communicating patients with multiple disability must, in addition to describing squint and the findings at the anterior segment of the eye and eye fundus, invariably include an evaluation of the quality of visual acuity, size of refraction, ability of accommodation, visual field defects and the quality of contrast sensitivity. Based on these data, it is possible to propose a therapeutic and vision rehabilitation plan for developing visual function, sometimes long before the definitive ophthalmological diagnosis is established. The critical stages of vision development make us insist on providing maximum available treatment always at the right age of the child. Early referral of the child to an eye specialist is essential for the success of possible treatment.

Start of the therapy: L-dopa; DA-agonists; selegiline; amantadine; rasagiline; in patients older than 70 years L-dopa. When therapy insufficient: add on/increase the standard or controlled-released L-dopa, COMT inhibitor; DA-agonists orally or in patch; rasagiline. Severe motor complication: partial „drug holiday” with amantadine i. v.; apomorphine/lisuride s. c.; intraduodenal L dopa; surgery (DBS). Psychiatric complications: graduall discontinuation of DA agonists, amantadine, MAO inhibitors, anticholinergics; to continue with the minimal effective dose of L-dopa; atypical antipsychotics. Dementia: acetylcholinesterase inhibitors.

Autism is a complex pervasive developmental disorder with early childhood onset characterized by social deficits, impaired communication and stereotyped behaviour. The disorder has increasing prevalence, enormous variability of symptoms and unknown etiology. Generally the disorder is diagnosed four times more often in boys than in girls and this provokes theories relating autism to testosterone effect. The theory of hypermale brain considers disturbed neurodevelopment with consequent structural brain anomalies and atypical development of brain hemispheres leading to autistic phenotype.

Although Parkinson´s disease is neurodegenerative disorder where causal treatment is still non-existing, there is always necessity to make correct diagnosis, to differentiate secondary parkinsonian syndromes or other entities mimicking or presenting with parkinsonian syndrome. The introduction of correct treatment in correct time is the key. The absence of systematic history taking, complete neuro-exam with corresponding laboratory and other examinations, the delay of the introduction of symptomatic drugs, the continuation of obsolete treatment, inadequadate dose of dopaminergic drugs, confusion of side-effects for inefficacy and lack of time for our patients are most commonly seen pittfalls and mistakes.

Establishment of a proper diagnosis and therapy of vestibular patology requires interdisciplinar approach. There are some diseases such as Méniére´s disease or BPPV, which have defined diagnostic crietria and guidelines for treatment.It is necessary to know, that the most of patients who are visiting specialists has atypical symptoms not easy to interpret. We present a current situation of a treatment of vestibulat disorders in Czech republic ad we try to compare recommended guidelines with analysis of situation of vestibular therapy in Czech republic, which is based on survey of effectiveness of treatment dizzy patient over 6 months.

A 26-year-old patient, currently on hormonal contraceptive medication, with a prior medical history of common migraine and a mild head injury was admitted in our department for typical presentation of a migrenous headache. No significant neurological findings during her medical examination. Due to the prolonged course of a headache, risk factors and changes in presentation of a headache a CT scan was requested. Due to the suspission of venous thrombosis MRI of the brain was also requested. Thrombosis of the sigmoid and transverse sinuses were proven. It is a tendency or common practise, not to pay so much attention as to include secondary cause of a headache, in the differential diagnosis of patients already suffering from the primary headaches. Therefore it is necessary to consider morphological examination of a brain, especially when there is an atypical presentation headache combined with other major risk factors. The objective of the case study is to highlight the problems associated with the diagnosis of cerebral venous thrombosis, in a patient suffering primary headaches.

Tardive dystonia is chronic symptomatic disorder of extrapyramidal system induced by long-term treatment with antipsychotics. Tardive dyskinesia, acute dystonia and dystonias of another origin must be ruled out in differential diagnosis. Younger age, male gender, and presence of other hyperkinetic extrapyramidal syndromes seem to be the main risk factors. Antipsychotic withdrawal, GABAergic agents, anticholinergics, clozapine, botulinum toxin injection, and brain deep stimulation are recommanded for managing TDt.

Temporal arteritis (TA) is an inflammatory vasculopathy of old people. Neurologic manifestations include headaches, memory disturbances, and dementia; from the ophthalmologic point of view, it is sudden and irreversible decrease or loss of visual functions. The systemic manifestations include fatigue, scalp tenderness, night swelling, loosing the weight, intermittent claudication during mastication or walking, and pain of the muscles. The early diagnosis is mandatory for the beginning of the treatment; its delay may be also the cause of blindness. Clinically, the diagnosis is based on high, and otherwise without other reasons, ESR, or CRP as well. Definitely, the diagnosis is confirmed by histopathological examination of the superficial temporal artery biopsy specimen. The cornerstone of the treatment is the corticosteroid therapy. The activity of the disease is monitored by means of the ESR values. It is necessary to follow-up the patients until the end of their life and the chronic corticotherapy is very often lifelong necessity. Ill-considered withdrawn from steroids, may have fatal consequences for the patient.

Epilepsy treatment went through a substantial evolution in the last years, which obviously improved prognosis of the patients, but simultaneously strongly increased demands on disease management from the viewpoint of the medical professionals. Contemporary management of epilepsy patients requires highly complex and rational approach. The treatment always has to be „tailored“ to the need of individual patient. Regarding the pharmacological treatment choice we should prefer maximal effectivity and tolerability of the antiepileptic drugs before economic factors. In patients resistant to the pharmacotherapy an early assessment of epilepsy surgery is strongly recommended. Systematic psychosocial support represents a significant part of the modern care of intractable epilepsy patients.

The question whether a woman with epilepsy can become pregnant and give birth to a healthy child is still one of the most important for women in the childbearing age with this chronic neurological disease. The majority of women with epilepsy can have an uncomplicated pregnancy and give birth to a healthy child (Tomson, Battino 2009). There are risks related to the disease itself and/or to treatment with antiepileptic drugs (AEDs). These risks can be minimized by appropriate individual approach and counselling. For a woman with epilepsy and the developing fetus, it is particularly important during pregnancy to control generalized convulsive seizures, monitor the levels of AEDs and individually adjust the doses of AEDs administered. Some published data clarify how to optimally care for women in the childbearing age when planning a pregnancy as well as during the pregnancy, puerperium and lactation. Gathering information in national and international registries as well as reviews of publications leads to guidelines and evidence-based conclusions. There still remain a number of questions to which there are no unequivocal, scientifically-proven answers. Given the diversity of individual epileptic syndromes and the variety of AEDs administered, the situation of each woman with epilepsy needs to be assessed with respect to these facts.

This review summarizes the principles of normal neuromuscular transmission. Depolarization of the nerve terminal produces an influx of calcium through voltage-gated calcium channels and acetylcholine vesicles then fuse with the presynaptic membrane. After release, acetylcholine (ACh) interacts with the acetylcholine receptor (AChR); this opens the AChR channel, resulting in an influx of sodium. When a sufficient quantity of ACh binds to the receptors, sodium channels in muscle membrane open, leading to depolarization of the muscle and contraction. Electrodiagnostic studies can demonstrate a defect of neuromuscular transmission in two ways. The first is by repetitive nerve stimulation at slow rates 2–3 Hz and detection of decrement. The second is by performing single fiber electromyography and evaluating jitter or neuromuscular block.

According to various sources in the literature, dementia is caused by Alzheimer’s dementia in approximately 50–60 %, vascular dementia in 10 % and dementia with Lewy bodies in 15–20 %. In addition to these untreatable or difficult-to-treat conditions, there are causes of dementias which are reversible and these account for about 10 % of dementias. Cognitive disorder is the main symptom in all aetiologies of dementias; however, the risk of patient institutionalization is rather dependent on the severity of noncognitive disorders in dementia syndromes, i. e. behavioural and psychological symptoms in dementia (BPSD). BPSD represent a major burden for caregivers and inadequate BPSD treatment increases the likelihood of failure of the caregiver and of the entire background of the patient. The article presents an overview of BPSD, the methods of examining noncognitive disorders and the treatment options. It aims to be a practical guide for the physician caring for patients with dementia and outlines the topics and aspects that should be remembered when caring for these patients.

Brain metastases are the most common intracranial neoplasms. The incidence of brain metastases is rising due to earlier detection, more effective imaging modalities and more effective treatment of systemic disease. The median survival of these patients is without treatment one month, corticosteroids can extend median survival to 2 months and radiotherapy to 3–6 months. The gold standard was WBI, but in the last 20 years are most often used stereotactic radiosurgery and stereotactic radiotherapy and neurosurgery for solitar lesions with improving median survival to 16 months. The goal of my work is to review important treatment modalities in patients with brain metastases with multidisciplinary approach.