Primary insomnia is characterized with difficulty initiating or maintaining sleep, or non-restorative sleep, lasting at least a month in duration. The treatment for short term insomnia with hypnotics is recommended. The use of hypnotics in treating chronic insomnia remains controversial. The non-benzodiazepine hypnotics zolpiden, zopiclone, and zaleplon are replacing benzodiazepines as first-line pharmacotherapy for short-term insomnia. Hypnotics should be considered only after a thorough diagnostic assessment of secondary causes of insomnia, after sleep hygiene has been improved and after behavioral treatments has been attempted. If these approaches are unsuccessful, then hypnotics can be used, starting with very low doses and limiting use to short periods. Some antidepressant, such as sedating tricyclic antidepressants, mirtazapine and trazodone, are also used as sedative-hypnotic agents for the treatment of chronic insomnia. Low nocturnal melatonin production and secretion have been documented in elderly insomniacs, and exogenous melatonin has been shown to be beneficial in treating sleep disturbances of these patients. There are several effective treatment approaches to primary insomnia that do not involve the use of psychopharmacs Education about normal sleep and counseling around habits for promoting good sleep hygiene are a good but not sufficient intervention when used alone. Various relaxation therapies such as progressive muscle relaxation can be helpful. Stimulus control behavior modification focuses on eliminating environmental cues associated with arousal. Sleep restriction therapy is similarly aimed at reducing the amount of wake time spent in bed. Sleep deprivation helps consolidate sleep on subsequent nights, thereby improving sleep efficiency.

The article deals with contemporary conception of PNES, their epidemiology, semiologic manifestations, pathophysiology and treatment.

Chorea could be defined as a state of excessive, spontaneous movements, irregularly timed, randomly distributed and abrupt. Dyskinesias are accentuated by stress, physical and mental effort or voluntary movements and attenuated by mental relaxation and usually disappear in sleep. Choreiform dyskinesias originate in striatal dysfunction. Clinical signs typical for chorea are: tongue protrusion sign (patient can not hold still the protruded tongue, moves the tongue around and back to the mouth), milkmaid grip or grasp sign (during manual grip the patient involuntary relaxes and gripes the hand as if he would „munch” physicians hand) and dance-like gait with rocking hip movements denominated the disorder. Classification of choreatic syndromes is very complex and extensive.

Diagnostic and indication errors are analysed. Differential diagnoses between epileptic and organic non-epileptic seizures comprise syncopes, myoclonus, extrapyramidal disorders, transient global amnesia, metabolic and endocrine breakdown, and parasomnias. Syncopes often present with motor symptoms – myoclonic jerks, tonic limb extension or flection, orofacial movements, and open eyes. Cortical provoked myoclonus is encountered in encephalopaties. Paroxysmal kinesigenic dyskinesias constitute a serious diagnostic problem. Symptoms of transient global amnesia may be caused by non-convulsive epileptic status. Differences between nocturnal frontal lobe seizures and parasomnias are thoroughly discussed. Main indication errors are: late referrals to epilepsy centers, not performing complex re-evaluation in resistant patients after 4–6 years, and belated vagus nerve stimulator indication.

Familial hemiplegic migraine (FHM) is a rare autosomal dominant hereditary disease. It is the first type of migraine with aura in which a genetic defect on chromosome 19 (FHM 1) or, more rarely, on chromosome 1 (FHM 2) and chromosome 2 (FHM 3) has been shown. In addition to migraine headache, a typical presentation includes the presence of motor weakness and an identical impairment in at least one relative. The motor impairment may even be hemiplegic in nature and last for days or even weeks. Triptans are not recommended in the treatment for their potent vasoconstrictive effect; nonspecific antimigraine drugs are preferred. When the course is more severe, prophylaxis similar to that in the treatment of migraine with aura is appropriate. The differential diagnosis must distinguish other types of migraine, strokes, focal epileptic seizures and some rare hereditary diseases such as MELAS and CADASIL. Sporadic hemiplegic migraine has the same clinical presentation except for a negative family history. Also included are two case reports: a family with familial hemiplegic migraine and a case of a woman with sporadic hemiplegic migraine with an emphasis placed on the diagnostic pitfalls of this disease. Even though the prognosis of HM is mostly good with a low frequency and full reversibility of the attacks, some prolonged attacks may be associated with considerable discomfort for the patients. Mutations of the gene affect the release of excitatory amino acids and serotonin neurotransmitters. Knowledge from the field of molecular genetics (e. g. DNA analysis) may, in the future, contribute to introducing a more effective and specific treatment than the one used so far. gene mutation, chromosome.

Corticosteroids are the most widely and frequently used immunomodulatory agents. The immunosuppressive and anti-inflammatory effects of corticosteroids have several components. Corticosteroids induce peripheral blood neutrophilia, whereas T-cells, monocytes, and eosinophils are depleted from blood. Steroids alter functional properties of T-cells and monocytes, act on synthesis and secretion of cytokines and immune mediators, and have effect on microvascular permeability. For autoimmune neuromuscular diseases treatment with corticosteroids can be extended over many years (e.g., myasthenia gravis, polymyositis, dermatomyositis, CIDP, etc), for other diseases corticosteroid treatment is limited to a short period time (e.g., multiple sclerosis). An aggressive approach with high-dose prednisone beginning early in the diseases is recommended. A high dose of at least 1 mg/kg as a single daily morning dose in initial period is prefered. Treatment with corticosteroids can be associated with side reactions. When corticosteroid treatment becomes mandatory, efforts must focus on minimizing corticosteroids side effects while maintaining therapeutic efficacy. The single-dose, alternate-day program minimizes adverse effects while adequately maintaining control of underlying disease.

Abnormal head posture is a frequent but nonspecific symptom in children. In young children, in particular, it may be the first manifestation of a serious condition. The causes may vary significantly and the severity may range from benign to very severe, life-threatening conditions. Aetiology differs from that in adult patients and a number of clinical entities are entirely specific to child age. The paper deals with the differential diagnosis of frequent as well as rare clinical entities occurring in child age in which this may be the presenting symptom; they are divided according to the age at which most commonly manifested.

The author describes a case of 50-year-old woman, with no previous health problems, with three-year secret drinking of alcohol. The patient was admitted as an emergency with signs and symptoms of developed Wernicke encephalopathy, cerebellar degeneration and severe alcoholic polyneuropathy, all as a result of chronic alcoholism. Diagnosis is supported by laboratory, electrophysiological examinations and MRI. Patient is treated by substitution treatment and rehabilitation. The mental changes slowly and partially improved. Self-care and ability of independent living developed. Though long term rehabilitation a severe gait disturbace remained.

Opioid analgesic agents act at receptors within the central nervous system. There are well known three type of receptors and opioid drugs have differing affinities to them. Chronic opioid therapy can be an effective therapy for carefully selected and monitored patiens with chronic pain state. However the opioids are also associated with potentially serious adverse events. Optimally balancing benefits and risks of opioid therapy is depending on regular patient evaluation and structure of individual opioid management plan. Safe and effective opioid therapy requires clinical skills and knowledge.

Information on the indications of video-EEG monitoring (V-EEG), role of interictal and ictal EEG, semeiology, significance and limitations of provocative saline test, role of ECG and standard or modified polysomnography for suspected non-epileptic seizures is presented.

The author presents indications and contraindications of orthopaedic surgery in children and adolescents with cerebral palsy, taking into account the types of cerebral palsy and the level of developmental Vojta stage. Surgical approaches include isolated and combinad procedures on muscles and bones. The ankle, knee and hip should be treated as one functional unit. Surgical approaches in the hip area include isolated and combined surgeries on muscles and bones (adductors and flexors, open reposition, proximal femoral osteotomy, acetabuloplasty). The area of the knee involves a knee flexion deformity and high position of the patela. The main operation in this area is hamstring lengthening. In the area of the foot muscle procedures on triceps surae and operation to stabilize the foot are indicated. There is presents therapeutic principles for procedures in the area of spine and upper extremities in patients with cerebral palsy.

Primary progressive multiple sclerosis (PPMS) accounts for approximately 10–15% of cases of multiple sclerosis. The pathophysiology of the disease has not been elucidated yet; a pathogenetic background different from that in relapsing-remitting MS is assumed, i.e. more neurodegeneration, less inflammation. The current diagnostic criteria for definitive PPMS include clinical progression lasting at least one year, a positive MRI finding and intrathecal synthesis of immunoglobulin G and/or a positive oligoclonal banding in the cerebrospinal fluid. Currently, there are no guidelines on the treatment of PPMS. Because of inconclusive results of clinical trials, no single therapeutic agent has been favoured and therapeutic efforts have so far been limited to interfering with the symptoms of the disease.

The clinical presentation of Parkinson‘s disease (PD) is hallmarked by motor symptoms. In recent years, however, increasing attention has been paid to nonmotor symptoms including sensory, vegetative, or mental symptoms. Since 2000, individual case reports have emerged describing patients with PD who newly developed pathological gambling (PG) that subsided following a decreased dose of dopaminergic medication. The retrospective or cross-sectional epidemiological studies available suggest a higher prevalence of PG (but also of other conduct disorders such as pathological shopping, overeating, hypersexuality, or pathological stereotypy) in PD patients compared to the general population. PG is particularly associated with dopamine agonist therapy (however, no differences have been found among individual drugs of this group; likewise, a drug-dose dependence has not been unequivocally confirmed); additional risk factors mainly include onset of disease at a younger age, personal or family history of alcohol abuse, or tendency to impulsive behaviour. Currently, there are no general guidelines for prevention or therapeutic measures concerning PG in PD patients; it is considered appropriate to make the patients aware of the risk of developing PG and to ask them about their symptoms regularly so that a potential problem could be identified early. In individual cases, lowering the dose and/or changing the dopaminergic agonist may have beneficial effects.

Sexual life is an important aspect of the quality of life. The symptoms and treatment of the PD influence the sexuality of the people with this disease. This topic, however, has been devoted minor scientific attention, and conclusions of the researchers that have been carried out so far are often contradictory. The article therefore sums up the most important researches of the question oriented on bio-psychosocial factors causing a deterioration of the patiens´ sexual functions. The article contains frequently sexual dysfunctions of the men and women with Parkinson´s disease and basic information and recommendation about the treatment of these dysfunctions.

Immunosuppressive drugs have been used in the practice for more than fifty years. In treating neurological autoimmune diseases, their role is irreplaceable. Azathioprine, cyclophosphamide, methotrexate, mycophenolate mofetil, mitoxantrone, cyclosporin A and tacrolimus have been particularly used; clinical trials with cladribine and teriflunomide are under way. The paper deals with the mechanism of action, adverse events and therapeutic regimens of individual agents; also covered are the indications of immunosuppressive drugs in the most common autoimmune diseases. During treatment, it is always necessary to weigh the benefits against risks, monitor the patient carefully and prevent adverse events. polymyositis, myasthenia gravis.

We encounter both acquired and congenital disorders of neuromuscular transmission during childhood. Juvenile myasthenia gravis and transient neonatal myasthenia gravis are classified as acquired and autoimmune disorders. Congenital disorders of neuromuscular transmission are heterogenous genetically determined disorders which are known as congenital myasthenic syndromes. This review is dealing with their pathogenesis, classification, clinical and laboratory characteristics, various difficulties in the area of diagnosis including molecular genetic analysis and their treatment. analysis, prenatal diagnosis.

Dyslexia definitely represents the most frequented diagnostically identified type of specific learning difficulty. Moreover, it is sometimes simply comprehended as a synonym of this heterogeneous group. Despite the fact that various specialists have been addressing the issue of dyslexia for over more than a century, a definite and an exclusive etiological concept that can be implicitly accepted remains undersigned to date. Regarding previous as well as contemporary knowledge of its subtypes, specific reading difficulties can be based on phonological, as well as neurocerebellar, dysfunctions and other deficiency states. Besides dyslexia, there are also other reading difficulties which should be considered within the scope of medical practice, e.g. those related to the concept of non-verbal or pseudoverbal learning difficulties (e.g. hyperlexia) or acquired loss of reading ability (alexia).

Patients with epilepsy have increased mortality and sudden unexpected death (SUDEP) is the most frequent direct epilepsy-related cause of death. In this review the author summarizes risk factor, proposed mechanisms and potential preventive strategies. Universal discussion of SUDEP with all patients remains controversial.