• MeSH
• Brachial Plexus Neuritis * diagnosis   complications   pathology   MeSH
• Dyspnea etiology   MeSH
• Hepatitis E * complications   MeSH
• Middle Aged MeSH
• Humans MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Letter MeSH
• Case Reports MeSH
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: Despite the high prevalence of depression and anxiety in chronic pain conditions, current knowledge concerning emotional distress among painful diabetic polyneuropathy (pDSPN) and other diabetes mellitus (DM) sufferers is limited. METHODS: This observational multicentre cohort study employed the Hospital Anxiety and Depression Scale, the Beck Depression Inventory II and the State-Trait Anxiety Inventory to assess symptoms of depression and anxiety in several groups with diabetes, as well as in a control group. The study cohort included 347 pDSPN patients aged 63.4 years (median), 55.9% males; 311 pain-free diabetic polyneuropathy (nDSPN) patients aged 63.7 years, 57.9% males; 50 diabetes mellitus (DM) patients without polyneuropathy aged 61.5 years, 44.0% males; and 71 healthy controls (HC) aged 63.0 years, 42.3% males. The roles played in emotional distress were explored in terms of the biological, the clinical (diabetes-, neuropathy- and pain-related), the socio-economic and the cognitive factors (catastrophizing). RESULTS: The study disclosed a significantly higher prevalence of the symptoms of depression and anxiety not only in pDSPN (46.7% and 60.7%, respectively), but also in patients with nDSPN (24.4% and 44.4%) and DM without polyneuropathy (22.0% and 30.0%) compared with HCs (7.0% and 14.1%, p < 0.001). Multiple regression analysis demonstrated the severity of pain and neuropathy, catastrophic thinking, type 2 DM, lower age and female sex as independent contributors to depression and anxiety. CONCLUSIONS: In addition to the severity of neuropathic pain and its cognitive processing, the severity of diabetic polyneuropathy and demographic factors are key independent contributors to emotional distress in diabetic individuals. SIGNIFICANCE: In large cohorts of well-defined painless and painful diabetic polyneuropathy patients and diabetic subjects without polyneuropathy, we found a high prevalence of the symptoms of depression and anxiety, mainly in painful individuals. We have confirmed neuropathic pain, its severity and cognitive processing (pain catastrophizing) as dominant risk factors for depression and anxiety. Furthermore, some demographic factors (lower age, female sex), type 2 diabetes mellitus and severity of diabetic polyneuropathy were newly identified as important contributors to emotional distress independent of pain.

• MeSH
• Depression epidemiology   MeSH
• Diabetes Mellitus, Type 2 * complications   epidemiology   MeSH
• Diabetic Neuropathies * MeSH
• Cohort Studies MeSH
• Middle Aged MeSH
• Humans MeSH
• Neuralgia * diagnosis   epidemiology   MeSH
• Cross-Sectional Studies MeSH
• Risk Factors MeSH
• Anxiety epidemiology   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: Quantitative sensory testing (QST) assesses the functional integrity of small and large nerve fibre afferents and central somatosensory pathways; QST was assumed to provide insight into the mechanisms of neuropathy. We analysed QST profiles and phenotypes in patients with diabetes mellitus to study whether these could differentiate patients with and without pain and neuropathy. METHODS: A standardized QST protocol was performed and 'loss and gain of function' abnormalities were analysed in four groups of subjects: diabetic patients with painful (pDSPN; n = 220) and non-painful distal symmetric polyneuropathy (nDSPN; n = 219), diabetic patients without neuropathy (DM; n = 23) and healthy non-diabetic subjects (n = 37). Based on the QST findings, diabetic subjects were further stratified into four predefined prototypic phenotypes: sensory loss (SL), thermal hyperalgesia (TH), mechanical hyperalgesia (MH) and healthy individuals. RESULTS: Patients in the pDSPN group showed the greatest hyposensitivity ('loss of function'), and DM patients showed the lowest, with statistically significant increases in thermal, thermal pain, mechanical and mechanical pain sensory thresholds. Accordingly, the frequency of the SL phenotype was significantly higher in the pDSPN subgroup (41.8%), than expected (p < 0.0042). The proportion of 'gain of function' abnormalities was low in both pDSPN and nDSPN patients without significant differences. CONCLUSIONS: There is a continuum in the sensory profiles of diabetic patients, with a more pronounced sensory loss in pDSPN group probably reflecting somatosensory nerve fibre degeneration. An analysis of 'gain of function' abnormalities (allodynia, hyperalgesia) did not offer a key to understanding the pathophysiology of spontaneous diabetic peripheral neuropathic pain. SIGNIFICANCE: This article, using quantitative sensory testing profiles in large cohorts of diabetic patients with and without polyneuropathy and pain, presents a continuum in the sensory profiles of diabetic patients, with more pronounced 'loss of function' abnormalities in painful polyneuropathy patients. Painful diabetic polyneuropathy probably represents a 'more progressed' type of neuropathy with more pronounced somatosensory nerve fibre degeneration. The proportion of 'gain of function' sensory abnormalities was low, and these offer limited understanding of pathophysiological mechanisms of spontaneous neuropathic pain.

• MeSH
• Diabetes Mellitus * MeSH
• Diabetic Neuropathies * MeSH
• Hyperalgesia etiology   MeSH
• Humans MeSH
• Pain Measurement methods   MeSH
• Neuralgia * MeSH
• Polyneuropathies * MeSH
• Pain Threshold physiology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: Serum antibodies to myelin-oligodendrocyte glycoprotein (MOG) are biomarkers of MOG-IgG-associated disorder (MOGAD), a demyelinating disease distinct from both multiple sclerosis and aquaporin-4-IgG neuromyelitis optica spectrum disorder. The phenotype of MOGAD is broad and includes optic neuritis, transverse myelitis, and acute demyelinating encephalomyelitis. Myelitis is common with MOGAD and typically results in acute and severe disability, although prospects for recovery are often favorable with prompt immunotherapy. CASE PRESENTATION: This contribution presents a unique case report of a young male patient exhibiting relapsing myelitis with normal spinal cord and brain magnetic resonance imaging. Comprehensive diagnostic assessment revealed myelin-oligodendrocyte glycoprotein-IgG-associated disorder. CONCLUSION: MOGAD is one of the conditions which should be considered in MRI-negative myelitis. The diagnosis, however, may prove difficult, especially if the patient is not exhibiting other neurological symptoms of MOGAD. Conus or epiconus involvement is common in MOGAD; the patient reported herein exhibited incomplete rostral epiconus symptoms which, together with somatosensory evoked potential abnormalities, led to the diagnosis.

• MeSH
• Aquaporin 4 MeSH
• Autoantibodies MeSH
• Myelin-Oligodendrocyte Glycoprotein MeSH
• Immunoglobulin G MeSH
• Humans MeSH
• Neoplasm Recurrence, Local MeSH
• Magnetic Resonance Imaging MeSH
• Neuromyelitis Optica * MeSH
• Myelitis, Transverse * diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

Úvod: Neuropatická bolest je častým klinickým projevem řady neurologických onemocnění. Klíčovou součástí jejího diagnostického algoritmu jsou jednoduché dotazníkové nástroje založené na přítomnosti typických popisných charakteristik (tzv. deskriptorů). Cíle: Cílem studie byla validace českých jazykových verzí dvou nejčastěji užívaných jednoduchých screeningových dotazníkových nástrojů zaměřených na neexpertní diagnostiku neuropatické bolesti, tj. dotazníků DN4cz (Douleur Neuropathique en 4 Questions) a PDQcz (painDetect). Soubor a metodika: Po jazykové validaci českých verzí obou dotazníků byly tyto následně administrovány skupině pacientů s periferní neuropatickou bolestí při polyneuropatii diabetické či jiné etiologie (n = 65) a skupině nemocných s nociceptivní bolestí v důsledku pokročilé artrózy kyčelního nebo kolenního kloubu nebo chronických vertebrogenních potíží (n = 74). Výsledky: Oba dotazníky prokázaly vynikající srozumitelnost a snadnou použitelnost. Pacienti s neuropatickou bolestí dosahovali významně vyšších dílčích i celkových skóre obou dotazníků ve srovnání s pacienty s bolestí nociceptivní. ROC analýza potvrdila vynikající diagnostickou validitu obou dotazníků v odlišení neuropatické a nociceptivní bolesti. Dotazník PDQcz však dosahoval významně lepší diagnostické validity při nižším než doporučeném cut-off. Závěr: České verze dotazníků DN4 a PDQ prokázaly vynikající diagnostickou validitu v odlišení neuropatické a nociceptivní bolesti a lze je doporučit pro neexpertní diagnostiku neuropatické bolesti. Diagnostická validita dotazníku PDQ je vyšší při použití nižšího cut-off.

Background: Neuropathic pain is a frequent vlinical manifestation of many neurological disorders. Simple questionnaires mainly based on the presence of so called “neuropathic pain descriptors” represent the most important screening tool in the diagnosis of this condition. Aim: The aim of this study was to validate the Czech language version of two most frequently used questionnaires focused on neuropathic pain diagnosis by non-specialists, i.e., Douleur Neuropathique en 4 Questions (DN4cz) and painDetect (PDQcz). Patients and methods: Initially, the language validation of both questionnaires was performed. In the next step, two groups of patients were examined using these Czech language versions of both questionnaires: a group of patients suffering from peripheral neuropathic pain (in diabetic polyneuropathy or polyneuropathies of other etiology) (N = 65), and a group of individuals with nociceptive pain due to severe coxarthrosis or gonarthrosis or chronic low back pain (N = 74). Results: Both questionnaires proved to be easy-to-use and understandable. The patients with neuropathic pain reached significantly higher both partial and overall scores in both questionnaires compared to nociceptive pain patients. ROC analysis confirmed an excellent diagnostic validity of both questionnaires in the discrimination between neuropathic and nociceptive pain. However, the optimal cut-off with the highest possible diagnostic validity for the PDQcz was found significantly lower than had been recommended. Conclusions: The Czech language versions of both DN4 and PDQ questionnaires proved excellent diagnostic validity in the discrimination of neuropathic and nociceptive pain. Both of them thus can be recommended as easy and useful tools for diagnosis of neuropathic pain by non-specialists. To reach optimal diagnostic validity, the cut-off of the PDQ should be set lower than had been previously recommended.

• MeSH
• Diabetic Neuropathies diagnosis   MeSH
• Humans MeSH
• Pain Measurement * methods   MeSH
• Neuralgia * diagnosis   MeSH
• Nociceptive Pain * diagnosis   MeSH
• Polyneuropathies diagnosis   MeSH
• Surveys and Questionnaires MeSH
• Reproducibility of Results MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

Fabry disease (FD) is a rare X-linked disorder of glycosphingolipid metabolism caused by pathogenic variants within the alpha-galactosidase A (GLA) gene, often leading to neurological manifestations including stroke. Multiple screening programs seeking GLA variants among stroke survivors lacked detailed phenotype description, making the interpretation of the detected variant's pathogenicity difficult. Here, we describe detailed clinical characteristics of GLA variant carriers identified by a nationwide stroke screening program in the Czech Republic. A total of 23 individuals with 8 different GLA variants were included in the study. A comprehensive diagnostic workup was performed by a team of FD specialists. The investigation led to the suggestion of phenotype reclassification for the G325S mutation from late-onset to classical. A novel variant R30K was found and was classified as a variant of unknown significance (VUS). The typical manifestation in our FD patients was a stroke occurring in the posterior circulation with an accompanying pathological finding in the cerebrospinal fluid. Moreover, we confirmed that cornea verticillata is typically associated with classical variants. Our findings underline the importance of detailed phenotype description and data sharing in the correct identification of pathogenicity of gene variants detected by high-risk-population screening programs.

• Publication type
• Journal Article MeSH

Bolesti hlavy v graviditě představují do jisté míry specifickou problematiku: jedná se o poměrně časté obtíže, možnosti jejich farmakoterapeutického ovlivnění jsou však omezené. Navíc je v tomto období zvýšený výskyt některých závažnějších příčin bolestí hlavy a bolest hlavy může být dokonce prvním příznakem závažných systémových komplikací gravidity. Tento článek proto podává přehled o primárních a sekundárních bolestech hlavy, jejich diagnostice a základních možnostech terapie u těhotných žen. Pokud se u těhotné ženy nově objeví bolesti hlavy, je vždy nutné nejdříve vyloučit sekundární příčiny, jako je např. rozvíjející se preeklampsie, trombóza mozkových splavů či intracerebrální krvácení. Tyto jednotky mohou pacientky dokonce ohrozit na životě. Primární bolesti hlavy (zejména migréna bez aury) se během gravidity naopak až u 70 % žen zlepšují, případně dokonce úplně vymizí. U ostatních je pak volba akutní a zejména profylaktické terapie poměrně komplikovaná s ohledem na teratogenní účinky řady preparátů.

The headache during pregnancy represents a specific issue. This complaint is quite common, but the treatment possibilities are limited at that period. In general, the incidence of secondary headaches including serious or life-threatening conditions may increase during pregnancy. Headache may also represent the first symptom of serious systemic complications of pregnancy. This article thus provides an overview of primary and secondary headache disorders, available diagnostic methods and therapeutic options in pregnant women. If the headache occurs for the first time in a pregnant woman, it is necessary to rule out serious secondary types of headache, e.g., pre-eclampsia, cerebral venous sinus thrombosis or intracerebral haemorrhage, which can be life-threatening. In contrast, primary headaches usually improve during pregnancy. About 70% of female patients suffering from primary headache disorders (especially migraine without aura) report improvement or complete remission of migraine attacks during pregnancy. The rest of women requires proper acute or prophylactic therapy, which is rather complicated with regard to teratogenic effect of many drugs.

• MeSH
• Headache * diagnosis   etiology   therapy   MeSH
• Diagnostic Imaging methods   MeSH
• Pregnancy Complications MeSH
• Humans MeSH
• Migraine Disorders diagnosis   etiology   therapy   MeSH
• Pre-Eclampsia diagnosis   therapy   MeSH
• Pregnancy MeSH
• Sinus Thrombosis, Intracranial diagnosis   therapy   MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

Neuropatická bolest je závažným klinickým projevem řady onemocnění periferního i centrálního nervového systému. V řadě případů se podílí také na bolesti vertebrogenní či nádorové. Její terapie se zásadně liší od bolesti nociceptivní, typická je neúčinnost běžných analgetik a nesteroidních antiflogistik. Všechna aktuální zahraniční i česká doporučení se shodují na lécích první volby a částečně i voleb dalších. K lékům první volby patří antiepileptika ze skupiny ligandů α2δ podjednotky kalciových kanálů (gabapentin a pregabalin) a antidepresiva ze skupiny inhibitorů zpětného vychytávání serotoninu a noradrenalinu (duloxetin a venlafaxin) a antidepresiva tricyklická (amitriptylin). K lékům dalších voleb jsou pak řazeny opioidy (především oxykodon), další antiepileptika a některé topicky podávané léky (kapsaicin, lidokain), případně botulotoxin A. Často je nutná kombinace více léků.

Neuropathic pain is a severe clinical symptom of many different conditions affecting peripheral and central nervous system. Cancer-related and spondylogenic pain frequently has neuropathic component. Contrary to nociceptive pain, analgetics such as paracetamole or nonsteroid anti-inflammatory drugs are typically ineffective in neuropathic pain. All current foreign and Czech recommendations agree on the first-line treatment and partially on the other treatment lines. First line treatments include anticonvulsants, in particular α2δ subunit of voltage gated calcium channels ligands (gabapentin, pregabalin), serotonine-norepinephrine reuptake inhibitors (duloxetine, venlafaxine) and tricyclic antidepressants (amitriptyline). Further therapy includes opioids (especially oxycodone), other anticonvulsants and topical agents (capsaicine, lidocain), eventually Botulinum toxine type A. In some cases combined therapy is necessary.

• MeSH
• Antidepressive Agents adverse effects   therapeutic use   MeSH
• Anticonvulsants adverse effects   therapeutic use   MeSH
• Pain * MeSH
• Chronic Pain therapy   MeSH
• Cannabinoids adverse effects   therapeutic use   MeSH
• Humans MeSH
• Central Nervous System Diseases therapy   MeSH
• Trigeminal Neuralgia therapy   MeSH
• Neuralgia * drug therapy   therapy   MeSH
• Check Tag
• Humans MeSH

In this multicenter cross-sectional study, we determined sensory profiles of patients with (NL-1) and without neuropathic pain (NL-0) after nerve lesion and assessed immune-related systemic gene expression. Patients and matched healthy controls filled in questionnaires and underwent neurological examination, neurophysiological studies, quantitative sensory testing, and blood withdrawal. Neuropathic pain was present in 67/95 (71%) patients (NL-1). Tactile hyperalgesia was the most prominent clinical sign in NL-1 patients (P < 0.05). Questionnaires showed an association between neuropathic pain and the presence of depression, anxiety, and catastrophizing (P < 0.05 to P < 0.01). Neuropathic pain was frequently accompanied by other chronic pain (P < 0.05). Quantitative sensory testing showed ipsilateral signs of small and large fiber impairment compared to the respective contralateral side, with elevated thermal and mechanical detection thresholds (P < 0.001 to P < 0.05) and lowered pressure pain threshold (P < 0.05). Also, more loss of function was found in patients with NL-1 compared to NL-0. Pain intensity was associated with mechanical hyperalgesia (P < 0.05 to P < 0.01). However, quantitative sensory testing did not detect or predict neuropathic pain. Gene expression of peptidylglycine α-amidating monooxygenase was higher in NL patients compared with healthy controls (NL-1, P < 0.01; NL-0, P < 0.001). Also, gene expression of tumor necrosis factor-α was higher in NL-1 patients compared with NL-0 (P < 0.05), and interleukin-1ß was higher, but IL-10 was lower in NL-1 patients compared with healthy controls (P < 0.05 each). Our study reveals that nerve lesion presents with small and large nerve fiber dysfunction, which may contribute to the presence and intensity of neuropathic pain and which is associated with a systemic proinflammatory pattern.

• MeSH
• Adult MeSH
• Gene Expression MeSH
• Catastrophization diagnosis   genetics   immunology   MeSH
• Cohort Studies MeSH
• Middle Aged MeSH
• Humans MeSH
• Inflammation Mediators metabolism   MeSH
• Pain Measurement methods   MeSH
• Adolescent MeSH
• Young Adult MeSH
• Nerve Fibers immunology   pathology   MeSH
• Neuralgia diagnosis   genetics   immunology   MeSH
• Cross-Sectional Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH

Chemoterapií indukovaná polyneuropatie (CIPN) je velmi častým nežádoucím účinkem protinádorové léčby, který zásadně ovlivňuje kvalitu života pacientů, a může vést k nutnosti redukce dávkování nebo úpravě schématu protinádorové terapie. U většiny pacientů dochází po čase k regresi či k úplnému vymizení klinických příznaků, u některých jedinců však může klinická symptomatika přetrvávat dlouhodobě. Mezi přípravky s nejvýznamnějším neurotoxickým působením patří deriváty platiny, taxany, vinca alkoloidy, inhibitory proteasomového komplexu (bortezomib) a thalidomid. CIPN postihuje zejména senzitivní nervy, vzácněji se pak setkáváme s autonomními či motorickými příznaky, jako jsou např. posturální hypotenze nebo svalová slabost. Rozvoji CIPN lze předcházet správnou indikací neurotoxické léčby. Zohlednit je vhodné zejména již preexistující neuropatii anebo existenci jejích rizikových faktorů. Současně je nutné stav periferního nervového systému pravidelně monitorovat během léčby a při výskytu klinických příznaků redukovat neurotoxickou terapii či změnit léčebný režim.

Chemotherapy-induced peripheral neuropathy (CIPN) is frequent adverse effect of anticancer treatment. It can severely affect the quality of life of cancer survivors, and lead to dose reduction or discontinuation of the treatment. Clinical symptoms completely or partially resolve after cessation of chemotherapy in most of the patients. However, in subset of them could be irreversible. The most neurotoxic agents are the platinum-based antineoplastic drugs, the vinca alkaloids, the taxanes, the proteasome inhibitors (bortezomib) and thalidomide. CIPN predominantly affects sensory neurons, less frequently autonomic or motor neurons which is manifested for instance by orthostatic hypotension or muscle weakness. Administration of neurotoxic chemotherapy should be carefully considered regarding protentional existence of neuropathy in high-risk patients to prevent CIPN development. If the polyneuropathy occurs during anticancer treatment, dose reduction or change of antineoplastic agent can prevent further worsening of the peripheral nerve impairment.

• MeSH
• Humans MeSH
• Neurons drug effects   MeSH
• Neurotoxicity Syndromes diagnosis   etiology   MeSH
• Drug-Related Side Effects and Adverse Reactions MeSH
• Polyneuropathies * drug therapy   chemically induced   prevention & control   MeSH
• Antineoplastic Agents adverse effects   toxicity   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH