Slovo úvodem

prof. MUDr. Ivan Rektor, CSc., FCMA, FANA, FEAN

Neurol. praxi. 2021;22(4):255  

Neuroinfekce

doc. MUDr. Ondřej Beran, Ph.D.

Neurol. praxi. 2021;22(4):259 | DOI: 10.36290/neu.2021.097  

Community-acquired bacterial meningitis

doc. MUDr. Olga Džupová, Ph.D.

Neurol. praxi. 2021;22(4):260-263 | DOI: 10.36290/neu.2021.004  

Purulent infections of the central nervous system belong to life-threatening diseases. Their incidence is relatively low; however, their importance lies in high case fatality ratio and frequent permanent sequelae. The prognosis depends on a number of factors, most notably the speed of diagnosis and the initiation of correct causal and supportive treatment. Therefore, it is necessary to educate physicians of all disciplines about the importance and approach to these infections. Purulent meningitis is an infection of the soft meninges caused by pyogenic bacteria. Despite declining incidence over the last 20 years and medical progress, due to its high...

Brain abscess

doc. MUDr. Olga Džupová, Ph.D.

Neurol. praxi. 2021;22(4):264-266 | DOI: 10.36290/neu.2021.010  

Brain abscess is a focal pyogenic infection in the brain parenchyma caused most often by pyogenic bacteria. Advances in diagnosis and treatment in the last few decades have led to a significant improvement in the prognosis of this disease. Nevertheless, the case fatality ratio and frequency of permanent sequelae are relatively high. Rapid and correct diagnosis and early initiation of treatment increase the chances of a better outcome.

Aseptic infections of central nervous system

MUDr. Michal Skurák, MUDr. Aleš Chrdle

Neurol. praxi. 2021;22(4):267-273 | DOI: 10.36290/neu.2021.018  

Aseptic infections of the central nervous system are common in Czechia, as the two of them, tick-borne encephalits and Lyme disease, both tramsitted by infected ticks, are endemic there. They are characterized by a non-purulent inflammation in the cerebrospinal fluid and by presence of so-called encephalitic or meningeal symptoms. They are caused mainly by viruses for which causal treatment is available only for few, and by bacteria for which antimicrobial treatment is available. In recent years, West Nile Fever (WNF), which used to be an imported disease, is becoming endemic in the Czech Republic. Aseptic neuroinfections may cause various long-term...

Lyme neuroborreliosis

doc. MUDr. Lenka Krbková, CSc.

Neurol. praxi. 2021;22(4):274-277 | DOI: 10.36290/neu.2021.012  

Lyme borreliosis is multisystemic disease, caused by a Lyme borrelia from a serocomplex of Borrelia burgdorferi sensu lato. The main vector of borreliae in Europe is Ixodes ricinus. All stages of a tick (larvae, nymphae and adults) play a role in the transmission of the disease. Two borrelial species seem to be the most neurotropic: B. garinii and B. bavariensis. Lyme neuroborreliosis (LNB) is an acute involvement of central and peripheral nervous system which develops usually within a few weeks after a tick-bite. The disease presents as painful meningoradiculoneuritis in adults or as meningoneuritis in children. Cranial neuritis...

Opportunistic infections of the central nervous system in human immunodeficiency virus-(HIV-) infected individuals

doc. MUDr. Hanuš Rozsypal, CSc.

Neurol. praxi. 2021;22(4):278-282 | DOI: 10.36290/neu.2021.025  

Impairment of the nervous system may occur practically anytime during of human immunodeficiency virus (HIV)-infection. Diseases may be either primary - caused directly by HIV - or secondary - infections caused by various microorganisms or neoplasms. With worsening of cellular immunodeficiency, conditions for opportunistic infections arise. The opportunistic infections include particularly three typical diagnoses: toxoplasmic encephalitis, cryptococcus meningitis, and progressive multifocal leukoencephalopathy (PML). Antiretroviral therapy (ART) has changed significantly incidence of CNS complications, opportunistic infections occur less frequently,...

Should we treat patients with chronic alcohol dependency by antiepileptics?

MUDr. Jana Zárubová

Neurol. praxi. 2021;22(4):284-288 | DOI: 10.36290/neu.2021.013  

Alcohol dependency syndrome is common in the Czech population. Neurologists encounter these patients during inpatient and outpatient care. One of the frequent health problems is the occurrence of epileptic seizures. People addicted to alcohol may have some type of epilepsy as well. The aim of the review article is to specify whether these are acute symptomatic seizures or clinical manifestation of epilepsy as a chronic disease and how to approach them in treatment. The therapy of withdrawal and addiction syndrome is briefly mentioned. Chronic administration of antiepileptic drugs is indicated in alcoholics in the case of diagnosed epilepsy and in the...

MS and NMOSD during the pandemic COVID-19 - what have we already learnt?

MUDr. Dominika Šťastná, MUDr. Ingrid Menkyová, doc. MUDr. Dana Horáková, Ph.D.

Neurol. praxi. 2021;22(4):289-294 | DOI: 10.36290/neu.2021.039  

When COVID-19 started to spread in 2019, concerns about its course among patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) arose. It seems that the course of this infection in MS patients is similar to the general population as well as the basic risk factors. However, anti-CD20 therapy and recent glucocorticoid administration are associated with a more severe COVID-19 course. Contrarily, it seems that NMOSD patients are at higher risk of worse COVID-19 course and death, even though the COVID-19 reports are scarce. These findings have been already reflected in the preferential vaccination and administration of...

Role of subcutaneous interferon beta-1a in treating relapsing-remitting multiple sclerosis

MUDr. Radek Ampapa

Neurol. praxi. 2021;22(4):295-299 | DOI: 10.36290/neu.2021.061  

In relapsing-remitting multiple sclerosis, the treatment with subcutaneous interferon β-1a (IFN β-1a) reduces the risk of clinical and radiological progression. Efficacy has been shown even in the stage of clinically isolated syndrome. Long-term data on the safety of IFN β-1a have been promising, including the treatment options during pregnancy and breast-feeding. Patient adherence to treatment with IFN β-1a is increased by the use of an electronic autoinjector. The ReMuS Registry has been collecting data on multiple sclerosis patients in the Czech Republic since 2013. An analysis of available data allows for a detailed characterization...

Shorter infusion of ocrelizumab in the treatment of multiple sclerosis

MUDr. Marek Peterka, MUDr. Pavel Potužník

Neurol. praxi. 2021;22(4):300-302 | DOI: 10.36290/neu.2021.048  

Patients with multiple sclerosis can nowadays be treated with the humanized monoclonal antibody ocrelizumab. This drug has so far been administered parenterally intravenously at an interval of 3,5 hours. As we know from other fields of medicine, reducing the infusion time can minimise the burden of treatment on patients and reduce the length of stay in the infusion room without compromising patient safety, which is especially important in the light of the current COVID-19 pandemic. The ENSEMBLE PLUS study investigated the safety of ocrelizumab administration when the infusion time was reduced to 2 hours. This article reports the results of this study.

Drug-induced depression

doc. MUDr. Dana Končelíková, Ph.D.

Neurol. praxi. 2021;22(4):303-307 | DOI: 10.36290/neu.2021.043  

Drug treatment plays a key role in modern medicine. Each use is associated with a number of benefits, but the fact that the patient may be harmed by the treatment cannot be overlooked. The spectrum of effects is as wide as the indication. Among the possible pitfalls of pharmacology include the risk of inducing mental difficulties, eg. a mood disorder. Depressive symptoms or depression itself are described, for example, with the administration of corticoids, antiparkinsonians, antivirals but also commonly used drugs such as beta-blockers, statins or opioid analgesics. It should be added that the development of depressive symptoms is not one of the various...

Neurological manifestations of hypothyroidism

doc. MUDr. Jan Jiskra, Ph.D.

Neurol. praxi. 2021;22(4):308-314 | DOI: 10.36290/neu.2021.046  

Hypothyroidism is a common disease, affecting up to 5% of the population. Neurological symptoms are frequent in hypothyroidism, involving both the central and peripheral nervous systems. In some cases, hypothyroidism is a direct cause of a manifestation or deterioration of neurological symptoms; at other times, it is an association on the basis of a common pathogenic (autoimmune) background; however, there are also cases when a causal link is controversial, being burdened with methodological selection bias of published studies. In manifest hypothyroidism, replacement therapy with levothyroxine leads, in most cases, to partial or total regression of...

CGRP inhibitors and gastrointestinal tract

MUDr. Vladimír Kojecký, Ph.D.

Neurol. praxi. 2021;22(4):315-319 | DOI: 10.36290/neu.2021.052  

CGRP antibodies block the vasodilating effect of CGRP and belong to the most potent antimigraine drugs available. The CGRP receptors are present in many tissues, including the gastrointestinal tract. CGRP is thought to be involved in the regulation of gastrointestinal motility, secretion, resorption and blood flow. Blockade of his action may result in a number of adverse effects. For example, a higher incidence of constipation after erenumab (anti-CGRP) has been reported. Hypothetically, these drugs may also impair gastroduodenal ulcerations healing, course of the inflammatory bowel disease or the gastric emptying rate.

Siponimod: the first drug in secondary progressive multiple sclerosis in clinical practice

MUDr. Pavel Potužník, MUDr. Marek Peterka

Neurol. praxi. 2021;22(4):320-324 | DOI: 10.36290/neu.2021.047  

Siponimod is the first disease-modifying drug in the treatment of secondary progressive multiple sclerosis (SPRS). Its efficacy was demonstrated in the EXPAND trial. It is an oral selective sphingosine 1-phosphate receptor modulator, specifically of the 1 and 5 subtypes (S1P1, S1P5). Siponimod binds to the S1P1 receptors on lymphocytes, preventing their egress from lymph nodes, thus inhibiting their recirculation to the central nervous system (CNS). By crossing the blood-brain barrier, it affects the inflammatory and neurodegenerative processes occurring in the CNS during SPRS. A case report is used to show what treatment options for SPRS have been...

The late-onset form of Pompe disease

MUDr. Radka Mišurová, MUDr. Věra Malinová

Neurol. praxi. 2021;22(4):325-330 | DOI: 10.36290/neu.2021.053  

A case report is presented of a female patient with adult-onset Pompe disease (GSD II). The patient was diagnosed when 21 years old and is now being successfully treated with replacement therapy. The author provides an overview of the current knowledge on the aetiopathogenesis, classification, diagnostic procedures, and treatment options of this congenital disease. Pompe disease (glycogen storage disease type 2, deficiency of alpha-glucosidase enzyme) is a hereditary autosomal recessive metabolic disorder caused by the deficiency of the lysosomal acid alpha-glucosidase enzyme leading to the accumulation/storing of lysosome glycogen in cells and tissues...

Praktický pohled na využití infuzního léčivého přípravku infuzní fixní kombinace Neodolpasse (diklofenak/orfenadrin) v neurochirurgické perioperační péči

MUDr. Jiřina Habalová, Ph.D.

Neurol. praxi. 2021;22(4):332-336 | DOI: 10.36290/neu.2021.098  

Fycompa in children - posibilities of use and practical experience

MUDr. Michal Ryzí, Ph.D., MUDr. Pavlína Danhofer, Ph.D., MUDr. Michaela Habalová, doc. MUDr. Hana Ošlejšková, Ph.D.

Neurol. praxi. 2021;22(4):338-342 | DOI: 10.36290/neu.2021.055  

Approved options of antiepileptic treatment in children are limited in comparison with adults and the process of introduction of new antiepileptic drug is often longer. The aim of this review is to present comprehensive information concerning perampanel, its new indications and practical experience. Fycompa® (perampanel - PER) is antiepileptic drug with a specific mechanism of action low interactive potential, safe and well tolerated, with satisfactory long term tolerability profile. When rightly use it can be usable add-on therapy in early phase of treatment.