Skleróza multiplex – imunodeplécia a imunorekonštrukčná liečba

prof. MUDr. Jarmila Szilasiová, PhD. – editorka hlavnej témy

Neurol. praxi. 2025;26(3):179

Continuous immunomodulation and immunosuppression versus reconstitution therapy in multiple sclerosis

doc. MUDr. Ema Kantorová, PhD.

Neurol. praxi. 2025;26(3):185-191 | DOI: 10.36290/neu.2025.018

Multiple sclerosis (MS) is a common immune-mediated demyelinating and degenerative disease of the central nervous system (CNS), which can lead to serious disability early in its course. The expanding portfolio of therapeutic agents against MS reflects progress in our understanding of MS pathogenesis and the mechanisms of CNS injury. Early initiation of treatment is recommended. Moderate-efficacy or high-efficacy immunotherapeutics can be used. The escalation strategy involves gradually increasing the intensity of treatment, while the induction strategy supports initiating treatment with highly effective therapeutics. Both continuous immunomodulation/immunosuppression...

Evaluating the efficacy of treatment for multiple sclerosis in the practice; development of the NEDA concept

prof. MUDr. Eva Kubala Havrdová, DrSc.

Neurol. praxi. 2025;26(3):192-196 | DOI: 10.36290/neu.2025.007

With the advent of highly effective treatment for multiple sclerosis, it is currently possible to consider even long-term remission. The NEDA (no evidence of disease activity) concept was introduced following the evaluation of a clinical trial with natalizumab. Since then, it has been used to evaluate the effect in studies with novel drugs, allowing their comparison. It involves the assessment of relapse rates, progression, and MRI findings. It would certainly be possible to add many more items; however, even in this simple form, it is very difficult to achieve in the long term in the majority of patients.

IAT + AHSCT: role of high-dose immunoablative therapy with autologous haematopoietic stem cell transplantation in patients with multiple sclerosis

doc. MUDr. Pavel Hradílek, Ph.D.

Neurol. praxi. 2025;26(3):197-201 | DOI: 10.36290/neu.2025.010

High-dose immunoablative therapy with autologous haematopoietic stem cell transplantation (IAT + AHSCT) is currently the most effective method of interfering with the natural course of multiple sclerosis. Its effect has been shown to be superior to the vast majority of the currently used specific medicinal products. Despite the continuous development of novel drugs with different mechanisms of action, there still remains a certain group of patients with a rapidly developing aggressive course of MS that does not respond to specific disease-modifying therapy. It is in these patients that IAT + AHSCT may be indicated. IAT + AHSCT has a history of nearly...

Changes in the pathophysiology of multiple sclerosis are age-dependent: DMT methods in patients over 55 years

MUDr. Viera Hančinová

Neurol. praxi. 2025;26(3):202-205 | DOI: 10.36290/neu.2025.015

With a rapidly aging global population and the advent of highly effective disease-modi­fying treatments (DMT) for multiple sclerosis (MS), the epidemiology of MS has changed. Currently, the largest group are patients aged 55-65. Changes in the pathophysiology of MS are age-dependent. After 50 years of life, reparative processes in the CNS fail, the level of oxidative stress increases, the phenotype of the immune system changes to a pro-inflammatory one. All these changes contribute to an accelerated increase in neurological disability. Due to the modification of the immune system due to aging, the effectiveness of DMT may decrease, while the risk of...

The impact of immunosupressive therapy on the immune system of a patient with multiple sclerosis

prof. MUDr. Mgr. Miloš Jeseňák, PhD., MBA, MHA, Dott.Ric., FAAAAI, prof. MUDr. Jarmila Szilasiová, PhD.

Neurol. praxi. 2025;26(3):206-210 | DOI: 10.36290/neu.2025.026

Highly effective innovative immunotherapies for multiple sclerosis (MS) significantly improve the long-term prognosis of patients with MS. This immunointerventional treatment - DMT (Disease modifying therapy) affects various levels of immune proces­ses and can induce secondary immunodeficiency, mainly lymphopenia, by changing lymphocyte transport, their depletion and disruption of their replication. Immunosuppressive treatment of the disease can also lead to hypogammaglobulinemia and an increased risk of occurrence and worsening of the course of infections, to reactivation of latent pathogens and to worsening of asymptomatic chronic infections. In...

Current options for prophylactic treatment of migrain

MUDr. Jolana Mračková, Ph.D.

Neurol. praxi. 2025;26(3):212-216 | DOI: 10.36290/neu.2025.019

Migraine is a very common disease in the general population. It is associated with considerable disability and thus with a high socio-economic burden. Fortunately, recent years have brought fundamental new possibilities in both acute treatment of migraine attacks and prophylactic treatment, which aims to reduce the frequency and intensity of migraine attacks as much as possible. Another benefit of prophylactic treatment should optimally be the improvement of the response to acute treatment. Last but not least, prophylactic treatment should prevent the transformation of migraine from episodic to chronic form, and also eliminate the risk of developing...

Amyotrophic lateral sclerosis: new guidelines on diagnostics and management

doc. MUDr. Eva Vlčková, Ph.D., MUDr. Adam Betík

Neurol. praxi. 2025;26(3):217-224 | DOI: 10.36290/neu.2024.069

Amyotrophic lateral sclerosis (ALS) is a fatal, rapidly progressive neurodegenerative disease that primarily affects motor neurons in the brain and/or spinal cord. In recent years, a number of new recommendations have been published regarding the diagnosis of ALS, including the approach to genetic testing of these patients, as well as the therapy or general comprehensive management of this disease and its complications and comorbidities. The aim of this article is to summarize these recommendations and the most important current knowledge about this very serious disease.

Sleep disorders in neurological diseases

doc. MUDr. Jitka Bušková, Ph.D.

Neurol. praxi. 2025;26(3):225-229 | DOI: 10.36290/neu.2024.050

Sleep plays a significant role in neurology. There is a very close relationship between sleep quality or duration and individual neurological diseases. Poor quality sleep adversely affects the course of a number of neurological diseases, such as cerebrovascular, autoimmune, and neuromuscular ones, and may increase the rates of epileptic or migrainous attacks. Sleep apnoea is also an independent risk factor for the development of stroke. Sleep disorders may precede Alzheimer's disease or represent a prodromal stage of other neurodegenerative diseases. Interventions to improve the quality of sleep and treatment of specific sleep disorders can play an...

Posttraumatic headache

doc. MUDr. Zbyšek Pavelek, Ph.D.

Neurol. praxi. 2025;26(3):230-232 | DOI: 10.36290/neu.2024.072

Posttraumatic headache (PTH), a headache that develops within 7 days of a causative injury, is one of the most common secondary headaches. PTH are mostly attributed to mild traumatic brain injury. The risk of PTH is the transition to chronic and possibly debilitating conditions.

Nutrition in acute neurological conditions

MUDr. Michal Šenkyřík

Neurol. praxi. 2025;26(3):234-238 | DOI: 10.36290/neu.2024.083

Acute illness in neurological intensive care represent a heterogeneous group of patients with increased nutritional risk or malnutrition with a combination of underlying neurological disease and complications resulting from the acute illness. Correctly applied enteral and parenteral nutrition mitigates the development and consequences of stress malnutrition in an acute state. The importance of nutritional support and physiotherapy in the recovery stage is emphasized. The consequences of the experienced critically ill can persist for months to years after the primary stroke, independently of the actual neurological disease.

Anxiety disorders in epilepsy

MUDr. Dominika Jarčušková, PhD., MUDr. Aneta Bednářová, PhD.

Neurol. praxi. 2025;26(3):240-243 | DOI: 10.36290/neu.2024.061

Psychiatric comorbidities of epilepsy, including anxiety disorders, have a high prevalence and massive impact on the daily lives of patients. These disorders manifest through emotional and physical changes and can influence patients' cognitive skills. They have a bidirectional relationship with epilepsy, caused by similar neurobiological correlates of both disorders. Their treatment is based on combining changes in patients' daily life, pharmacotherapy, and psychotherapy. This paper aims to review anxiety disorders in patients with epilepsy, discussing their prevalence, neurobiological correlates, their influence on the quality of life in patients,...

Can I drive a truck? - very late-onset Friedreich's ataxia

MUDr. Kristýna Janotová, MUDr. Zdeněk Kunáš, doc. MUDr. Svatopluk Ostrý, Ph.D.

Neurol. praxi. 2025;26(3):244-248 | DOI: 10.36290/neu.2025.048

Friedreich's Ataxia (FA) is a rare, genetically inherited multisystem disorder that ranks among the most common hereditary ataxias. The initial symptoms typically manifest during adolescence, and within approximately ten years, the disease often leads to fatal disability. However, this case report discusses a rare atypical form with late onset in adulthood. Diagnosing late-onset forms is particularly challenging due to their more variable phenotypic presentation and slower progression compared to the classic form. Accurate diagnosis of FA in patients with chronic ataxic symptoms has gained renewed importance, especially in light of the first approved...

How the patient and her neurologists managet to win the fight against the chronic form of cluster headache - a case report

MUDr. Evgeni Kavrakov

Neurol. praxi. 2025;26(3):249-252 | DOI: 10.36290/neu.2025.008

This case report describes a rare disease - the chronic form of cluster headache. Here a female patient with this severe neurological disorder is discussed. The difficulties in understanding the pathogenesis of cluster headache in general are noted. Our patient tried different types of "classical" treatment but none of those led to a sufficient effect and her quality of life was very low for a long period of time. Lithium therapy also did not help. Later, galcanezumab was prescribed in our outpatient clinic, which led to a significant decrease in headache frequency and headache intensity. Our patient also suffered from symptoms of depression, which...

Even extraordinary things could be ordinary: a case report of atypical neurodegeneration due to vascular and malnutrition components

MUDr. Matyáš Sýkora, RNDr. Eva Parobková, Ph.D., prof. MUDr. Robert Rusina, Ph.D., prof. MUDr. Radoslav Matěj, Ph.D.

Neurol. praxi. 2025;26(3):253-257 | DOI: 10.36290/neu.2025.020

Establishing the correct clinical diagnosis of neurodegenerative diseases can be a real challenge, particularly in rare forms with a complex clinical presentation. In such cases, neuropathological examination may reveal unexpected findings. In our case study, we observed a patient in the preterminal stage of a neurodegenerative disease that initially mimicked acute brainstem stroke, followed by hypoactive delirium, and finally frontotemporal lobar degeneration (FTLD). Neuropathological and immunohistochemical examination after autopsy revealed combined toxic-metabolic and vascular damage (chronic Wernicke's encephalopathy and angiosclerotic encephalopathy)...

Léčba hypomagnezemie jako možné příčiny některých symptomů neurologických poruch

MUDr. Jiří Havel, MSc.

Neurol. praxi. 2025;26(3):258-262