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Olomouc, Czech Republic

Kotas R.,Neurologicka Klinika
Bolest | Year: 2010

The survey deals with all important aspects of migraine. At the beginning the epidemiology, impact of the disease on the individual and the whole society and clinical picture are mentioned. In the next part the pathophysiology of migraine is described including cortical spreading depression, trigeminal vascular system, vasoactive neuropeptides, especially calcitonin gene-related peptide, vasodilatation and sterile neurogenic inflammation, transmission of the pain along the trigeminal pathway, mechanisms of peripheral and central sensitization, significance of brainstem generator, serotonin and nitric oxide. Genetics of migraine and provoking factors are described. Menstrual migraine is specially mentioned. Then the pharmacotherapy of migraine follows, which is divided into the acute and prophylactic treatment. From the acute therapy except other medications especially triptans are described in detail. From the prophylactic treatment all drug groups used in migraine are listed. The paper continues with the treatment of menstrual migraine, migraine in pregnancy and pediatric migraine. The last part is dedicated to the future therapy which includes receptor antagonists of calcitonin gene-related peptide, glutamate receptor antagonists, especially memantine, then tonabersat, some anti-epileptic drugs and inhibitors of nitric oxide synthase. Source

Anticoagulant therapy plays an important role in thromboembolic disorders, in primary and secondary prevention as well as treatment, and especially in the prevention of brain systemic embolism in patients with non-valvular atrial fibrillation and other sources of cardioembolic strokes. Unless contraindicated, warfarin is recommended for the treatment of these patients. Warfarin significantly reduces the risks of stroke and death, but increases that of haemorrhage. Life-threatening intracerebral haemorrhage is the most serious complication of oral anticoagulant therapy, with a mortality that can exceed 50%. The need for frequent laboratory monitoring, a narrow therapeutic window, and a plethora of interactions with food and drugs are also reasons to seek new, safe, effective anticoagulant agents that are convenient to use. New oral direct thrombin inhibitors and factor Xa inhibitors present promising alternatives to warfarin. Unfractionated heparin or low-molecular-weight heparins are not recommended for the prevention of early stroke recurrence in patients with acute ischemic stroke of cardioembolic origin. Low-dose unfractionated subcutaneous heparin or low-molecular-weight heparins should be considered for patients with acute ischemic stroke at high risk of deep venous thrombosis or pulmonary embolism. Source

Kadanka Jr. Z.,Neurologicka Klinika
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2013

Even though EMG of the pelvic floor has predominantly been used in research it is also often indicated in routine clinical practice. The article describes electrophysiological tests used to diagnose pelvic floor lesions and emphasises their beneficial effect and diagnostic value. Source

Stetkarova I.,Neurologicka Klinika
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2013

Spasticity is one of the complex motor system disorders and is a sign of central motor neuron disorder caused by trauma, ischemia or haemorrhage, inflammation, degenerative process or tumour. Spasticity is a symptom associated with a lesion within the central motor neuron. In addition to increased muscle activity, muscle contraction and paresis also occurs. Voluntary movement is associated with co-contractions and synkinesis, adversely affecting dexterity and muscle strength. Flexor and extensor spasms also have a negative effect. There are two types of spasticity: cerebral and spinal. Cerebral lesions occur either above the level of brainstem or at the level of brainstem. Due to these lesions, cerebral cortex looses its control over the inhibitory structures of the brainstem. Spinal lesions lead to severe spastic dystonia with predominant involvement of flexors. An objective examination is required to assess the type and degree of spasticity. An objective examination should be performed at the start of treatment and it is the main parameter determining further management. Routine clinical practice mainly relies on clinical evaluation scales. Neurophysiological, physical and biochemical methods are used less frequently and mainly at specialised centres. Rather than complete amelioration of spasticity, the aim of treatment is to alleviate its negative effects on activities that limit the patient. Achievable aims should be set by the patient and the physician at the initiation of treatment. Rehabilitation has a crucial role in the treatment of patients with spasticity. Pharmacotherapy is used, also due to uncomplicated application. Owing to its high efficacy and low incidence of adverse effects, botulinum toxin has an exclusive place in the treatment of focal spasticity. Administration of baclofen via intrathecal pump systems has been proven as highly effective in patients with severe generalized spasticity. New technologies and new treatment modalities, including advanced use of robots, are being developed. Source

Vohanka S.,Neurologicka Klinika
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2014

Pompe disease (glycogen storage disease type 2, acid maltase deficiency) is inherited auto-somal recessive metabolic disorder caused by deficiency of acid alpha-glucosidase and resulting in lysosomal glycogen storage in various tissues, mainly heart and skeletal muscle. Continuous spectrum of phenotypes from the rapidly progressive infantile form to the slowly progressive late onset form of the disease can be observed. Classical infantile form of the disease manifests soon after birth due to absent or nearly absent activity of the key enzyme. Typical manifestations include failure to thrive, muscle weakness, cardiomegaly, and respiratory failure. Before the era of substitution therapy, the majority of children died within the fjrst year of life. Partial enzyme deficiency (severe mutation on one allele and milder on the second) leads to the less severe phenotype with manifestation in child- or adulthood Time span is from the first to the sixth decade of life, leading symptoms include slowly progressing limb girdle and trunk muscle weakness with significant involvement of respiratory muscles. There is no cardiomegaly. Suspicion of Pompe disease is confirmed in three steps. The first involves screening with the Dried Blood Spot test. Testing of the activity of aKa glucosidase in leukocytes is used to confirm the disease. Mutation analysis is important to assess the correlation between genotype and phenotype and to identify familial carriers. Source

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