Edvard Ehler

Pardubická krajská nemocnice · Department of Neurology

Up to 50% of diabetic patients with neuropathy suffer from chronic pain, namely painful diabetic neuropathy (PDN), an unmet medical need with significant impact on quality of life. Gabapentin is widely used for PDN, albeit with frequent dose-limiting effects. Trazodone, an antidepressant with multi-modal action, has shown promising results when giv...

Background and objectives: ASPEN-1 was a phase 3, randomized, double-blind, placebo-controlled study to evaluate the efficacy, duration of response, and safety of 2 doses of DaxibotulinumtoxinA for Injection (DAXI), a novel botulinum toxin type A formulation in participants with cervical dystonia (CD). Methods: Adults (aged 18-80 years) with mod...

Objectives Elevated blood glucose and CRP (C-reactive protein) are usually related to a worsened clinical outcome in neurological diseases. This association in Guillain-Barré syndrome (GBS) has been studied rarely. We tried to analyse if hyperglycaemia and CRP at admission may influence the outcome of GBS, including mechanically ventilated (MV) pat...

A number of neurological complications have been reported after the administration of flu vaccine, including Guillain-Barré syndrome (GBS), especially after vaccination against swine flu. Only facial nerve neuropathy has thus far been reported after vaccination against COVID-19. More recently, there was a case of an elderly woman with GBS. In our r...

Aim of the study: Spontaneous spinal epidural haematomas (SSEH) are rare nosological units wherein acute collections of blood develop in the spinal canal. SSEH are usually manifested by sudden severe back pain accompanied by the development of neurological symptoms. In this study, we retrospectively describe management and the main risk factors of...

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 multi-centre cohort study employed the Hospital Anxiety and Depression Scale, th...

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease characterized by gradual loss of upper and lower motor neurons and their pathways, usually without affecting the extraocular and sphincter muscles. The cause of the disease is not yet known. It is a chain of subsequent events, ending in programmed cell death in selective...

Background: Painful diabetic neuropathy is an important therapeutic challenge as the efficacy of analgesic drugs in this setting is still unsatisfactory. Monotherapy with available treatments is often not sufficient and a combination of drugs is necessary. Trazodone (TRZ) is a compound with a multi-modal mechanism of action, being a serotonin-2 an...

Acute compartment syndrome occurs most frequently in connection with injuries, terminal or chemical damage of tissues, ischemia, the activity of toxins or in patients with tissue ischemia or muscle necrosis. Clinical findings have found pronounced pain, followed by paresthesias, pallor, and paresis. Decreased pulsation of arteries has also been a f...

PURPOSE OF THE STUDY The prevalence of nerve structure injuries accompanying pelvic and acetabular fractures is stated to be 5-25 %, with most frequent injuries to motor nerve structures associated with fractures of the posterior wall of the acetabulum. Prognostically worse outcomes of regeneration are documented mainly in iatrogenic, intraoperativ...

Aim: For uniform assessment of occupational ulnar nerve entrapment at elbow (UNE) assessment methods using electrophysiological criteria were introduced in 2011. The study aimed at determining changes in selected EMG parameters in UNE recognized as occupational disease using the methods in 2012–2016. Patients and methods: In 55 participants (49 mal...

Antibodies against myelin oligodendrocyte glycoprotein cause inflammatory lesions of central myelin – in optic nerves, of the brainstem, and spinal cord. There are characteristic changes of CNS white matter, protein-cytological association in cerebrospinal fluid, MOG IgG antibodies, a very important differential diagnosis and a relatively mild cour...

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease of increased prevalence with age. The main findings are loss of peripheral and central motoneurons and their pathways with extraocular and sphincter muscle sparing. These are classical forms of ALS with loss of central and peripheral motoneurons, as well as progressive b...

Chronic inflam matory demyelinating polyradiculoneuropathy (CIDP) is a chronic demyelinating polyneuropathy with a relapsing or progres sive course. This is a dysim mune polyneuropathy with activation of humoral and cel lular mechanisms with a primary lesion of myelin sheath in the peripheral nerves. Most frequent is a typical sym metrical polyneur...

Background Although viral poliomyelitis has been eradicated in the Czech Republic for over 50 years, lesions of peripheral mononeurons with acute onset, frequently accompanied by fever, have still been known to occur. Despite the fact that there are no sensory distrubances, and the paresis tend to have typical distribution, they are often accompani...

Objective: Martin-Gruber anastomosis (MGA) is a median-to-ulnar nerve communication i. The forearm; three types of MGA occur. Typically, motor fibres course throug. The median nerve i. The upper arm and elbow, however, they suppl. The ulnar-innervated muscles. The hand: abductor digiti minimi (ADM) -MGA-I; first dorsal interosseous (FDI) -MGA-II; o...

Introduction: The Guillain-Barré syndrome is an acute inflammatory autoimmune polyradiculoneuropathy and belongs among rare neurologic diseases. Since poliomyelitis has been almost completely eliminated, it is currentl. The most frequent cause of acute flaccid paralysis worldwide. The registry was formed i. The Czech Republic in 2012 and is an impo...

Background: Patients with minor acute ischemic stroke or transient ischemic attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute St...

Ulnar nerve, together with mediannerve, innervates the volar group of forearmmuscles, hand and fingers. Ulnar nerve is more important for innervation of muscles and weakness, clumsiness of fingers and hand occure in case of the nerve lesion; ulnar claw hand developes in advanced cases. According to the length of the nerve and to the exposed course...

Aim: The first aim was to determine the performance of three self-report pain scales, the combined Visual Analogue Scale / Numerical Rating Scale (VAS/NRS), NRS, and Faces Pain Scale – Revised (FPS-R), in a study on pain in Czech patients with stroke. The second aim was to compare the patients’ overall pain scale preference rankings and preference...

The Heidenhain form of Creutzfeldt-Jakob disease (CJD) is a rare CJD variant with predominantly visual symptoms in the early stages. Clinical manifestations of metamorphopsia, hemianopia and Balint's syndrome correlate with the involvement of the posterior cortical regions. A 71-year old healthy and very active man was admitted because of impaired...

Background: Approved botulinum toxin A products require reconstitution. AbobotulinumtoxinA solution for injection is a ready-to-use liquid formulation of abobotulinumtoxinA. Objectives: The objective of this study was to demonstrate the superior efficacy of abobotulinumtoxinA solution for injection to placebo and to test the noninferior efficacy...

Aim: The aim of the study was to investigate the inter-rater agreement (IRA) of the 8-item Brief Bedside Dysphagia Screening Test-Revised (BBDST-R). Design: An observational IRA study was conducted. Methods: Forty-six patients with stroke were independently assessed by two nurse raters using the BBDST-R. Rater agreement was described and analysed u...

Introduction Lumbosacral plexus consists of ventral branches of roots L1-S4 and is divided in two relatively separate portions. The lumbar plexus originates in L1, L2, L3 and part of L4 and frequently receives contribution from Th12. The sacral plexus consists of lower branch L4 and ventral branches L5-S4. EMG examination of lumbal and sacral plexo...

Aim: The aim of the study was to develop a computational module for the prediction of compressive force on the L4/L5 disc suitable for use in field settings. Method: The value of compressive force is intended to be used as a proxy measure of the mechanical burden of low-back when performing work activities. The compressive force predicted by the mo...

Background: Miller Fisher syndrome is a well-known disorder that belongs to a group of conditions with a high level of antibodies against ganglioside GQ1b. It is characterized by acute onset of ataxia, areflexia, and ophthalmoplegia. In cases of acute-onset ophthalmoplegia without ataxia, the diagnosis is more difficult; therefore, it is frequently...

Pozadi: Diagnosticka kriteria kriteria chronicke zanětlive demyelinizacni polyradikuloneuropatie (CIADP) jsou založena na klinických nalezech a pomocných vysetřenich, z nich největsi význam maji neurofyziologicka vysetřeni. Od te doby co se do neurofyziologických EFNS/PNS kriterii CIADP zabudovalo trvani distalniho složeneho svaloveho akcniho poten...

Introduction: The splenium of the corpus callosum has a specific structure of blood supply with a tendency towards blood-brain barrier breakdown, intramyelinic edema, and damage due to hypoxia or toxins. Signs and symptoms of reversible syndrome of the splenium of the corpus callosum typically include disorientation, confusion, impaired consciousn...

Aim: Low-back pain diseases (LBPD) belong to the most frequent diagnoses determined by general practitioners, and constitute one of the most common reasons for sick leave and permanent disability pension in the Czech Republic and other European countries. Epidemiological studies have shown a statistically significant association between LBPD and ce...

Aim: The purpose of this study was to develop a revised version of the Brief Bedside Dysphagia Screening Test for determining penetration/aspiration risk in patients prone to dysphagia. The priority was to achieve high sensitivity and negative predictive value. Methods: The study screeners conducted bedside assessment of the swallowing function...

According to some studies, peripheral nerve injury healing is prolonged in elderly patients. Compressive ulnar neuropathy in the elbow (UNE) is the second most common compressive mononeuropathy. To our knowledge, no study has investigated the effect of age on the postoperative ulnar nerve injury repair rate. Our aim was to evaluate age-related diff...

Peripheral nerve hyperexcitability disorders are characterized by constant muscle fiber activity. Acquired neuromyotonia manifests clinically in cramps, fasciculations, and stiffness. In Morvan's syndrome the signs of peripheral nerve hyperexcitability are accompanied by autonomic symptoms, sensory abnormalities, and brain disorders. A 70-year-old...

Patients frequently suffer from lumbosacral plexus disorder. When conducting a neurological examination, it is essential to assess the extent of muscle paresis, sensory disorder distribution, pain occurrence, and blocked spine. An electromyography (EMG) can confirm axonal lesions and their severity and extent, root affliction (including dorsal bran...

Introduction Miller Fisher syndrome (MFS) is a variant of Guillain–Barré syndrome (GBS). MFS is clinically defined by trias – ophthalmoplegia, ataxia, areflexia. Antibodies against ganglioside GQ1b are bound on the nodal and paranodal sections of oculomotor nerves, sensory nerves (including spinal ganglia) and cerebellum. Ophthalmoparesis is usuall...

Parkinson’s disease (PD) is characterized by motor and nonmotor symptoms. Nonmotor symptoms include primarily visual hallucinations (VH). The aim of our study was to establish whether patients with PD and visual hallucinations (PDH+) have structural changes of retina detected by an optical coherence tomography (OCT) in comparison with PD patients w...

The authors present two clinical cases of young women with pseudotumor cerebri, which manifested with a tension headache and transient visual disturbance. Normal findings on the neurological examination and the unspecified imaging findings were found in both cases. Optic disc edemas were found in both patients and subsequent lumbar puncture reveale...

Aim: The aim was to study criterion validity of the Czech version of the Eating Assessment Tool (EAT-10) by comparing it with the Nursing Dysphagia Screening Tool (NDST). Moreover, the aim was to compare three items of the EAT-10 that focused on swallowing liquids (EAT3) and solids (EAT4) and on cough while eating (EAT9) with one item of the NDST,...

Miller Fisher syndrome is defined by a triad of symptoms, namely areflexia, ataxia, and ophthalmoparesis. The ophthalmoparesis is mostly severe, undulating weakness of eye movements with ptosis and increased fatigability resembling a neuromuscular transmission disorder. We present a 52-year-old man with severe Miller Fisher syndrome with a high lev...

Peripheral neuropathic pain (PNP) poses a significant clinical challenge. The long-term efficacy of delta-9-tetrahydrocannabinol (THC)/cannabidiol (CBD) oromucosal spray was investigated in this 38-week open-label extension study. In total, 380 patients with PNP associated with diabetes or allodynia entered this study from two parent randomised, co...

We report the case of a 55-year-old woman with a 6-month history of progressive paresis of the right radial nerve. Perioperative imaging detected a spindle-shaped expansion of the radial nerve caused by an isolated local deposit of amyloid (amyloidoma). The deposit was resected in 2 phases and the resulting defect was bridged by a sural nerve autog...

Peripheral neuropathic pain (PNP) associated with allodynia poses a significant clinical challenge. The efficacy of Δ(9) -tetrahydrocannabinol/cannabidiol (THC/CBD) oromucosal spray, a novel cannabinoid formulation, was investigated in this 15-week randomized, double-blind, placebo-controlled parallel group study. In total, 303 patients with PNP as...

Aim: In 2011, a study was carried out focusing on the prevalence and degree of subjective swallowing difficulties in older adults. The aim was to extend this scrutiny and using the already existing data, to conduct a comprehensive analysis of relationships between the individual items of the assessment tool. Methods: 160 older adults from 5 institu...

Introduction Myasthenia gravis is an autoimmune disease that causes neuromuscular transmission disorder manifested by muscle weakness and fatigue, in particular predilection muscle groups. Most cases are mediated by T lymphocyte-dependent polyclonal antibody directed against acetylcholine receptors. Approximately 10–15% of cases are etiological ass...

Background Stiff person syndrome (SPS) is a rare, insidiously progressive disease of central nervous system characterized by axial and limb rigidity with superimposed stimulus-sensitive spasms. SPS can be divided to classical generalized form, stiff limb syndrome, jerking SPS and progressive encephalomyelitis with rigidity and myoclonus (PERM). The...

Background Many women with multiple sclerosis do become pregnant, though there are some controversies about fertility, immunomodulating therapy, conceptions, or decision making to become pregnant. During pregnancy the number of MS relapses is reduced, but after delivery the curve of disease activity rises steeply There are some therapeutic schedule...

Background Multiple sclerosis still remains a severe neurologic problem, though in last years a tremendous progress in diagnostics and therapy was achieved. On the evidence of randomized controlled studies it was documented, that only early beginning of immune modulating therapy with subsequent further escalation therapy can slow down and even stop...

Studies have shown slow healing of peripheral nerve injury in elderly patients. Carpal tunnel syndrome (CTS) is the most frequent compressive mononeuropathy, affecting mostly older people and females. Few studies have assessed electrophysiological differences between younger and older patients. We aimed to evaluate age-dependent differences in elec...

Stiff-person syndrome (SPS) is manifested by increased tone of the trunk muscles that gradually spreads to the limbs. The mechanism underlying this muscle hypertonia involves derangement of the inhibitory action of γ-aminobutyric acid (GABA) at cortical and spinal levels with subsequent continuous motor unit activity. A co-contraction mechanism wit...

Rapidly progressive movement disorder of the eye bulb associated with pain is a rare clinical presentation, which requires prompt diagnostics and therapy. Painful ophtal-moplegia appears in case of the lesion of cavernous sinus, extraocular muscles or ret-robulbar tissue, but could be caused also by the damage of the brainstem. Although modern imag...

Aim of the study: Muscle-tendon transfers are used as part of a complex approach in management of spasticity. The aim of the study was to highlight varied activation of individual muscles in a spastic upper extremity, and to emphasise that it is absolutely necessary to implement a functional EMG assessment before each reconstructive intervention. M...

Introduction: Arthritis of the wrist is a frequent consequence of inadequately treated wrist injuries. A range of methods has been published for pain reduction but these frequently limit, or completely eliminate, movement. Selective denervation of the wrist is method that can be used to reduce wrist pain. Patients and methods: The authors present a...

After 2-year period of persistent pain of lumbar spine with increasing intensity of lower extremities claudication a vast tumor of L3 vertebra extending to the retroperitoneum was diagnosed in a 61-year old woman. The total L3 vertebrectomy as well as complete tumor removal has been performed and situation was reconstructed and stabilized. Pronounc...

Objective: The objective of the study was to set normative values of conduction parameters of the median (NM) and ulnar nerves (NU) on a sufficiently large group of healthy volunteers using standardized methodology. The examination of NU focused on conduction across the elbow region. The differences in conduction parameters between males and female...