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Recent decades have witnessed a growing interest in the possibilities of non-pharmacological modulation of cognitive functions in older patients using cognitive interventions, such as cognitive training, cognitive stimulation and cognitive rehabilitation. These approaches are of particular importance in the group of patients with mild cognitive impairment. Since the increased risk of dementia coincides with the possibility of improving cognitive functioning, mild cognitive impairment is considered a condition potentially prone to intervention. The paper presents a systematic literature review of papers that synthesise the results of research on the efficacy of cognitive interventions in patients with mild cognitive impairment. We included 14 out of 136 publications in the review: 4 meta-analyses and 10 systematic reviews, which yielded a total number of 76 studies. The literature analysis led us to conclude that there seems to be clear evidence indicating beneficial, though modest, effects of cognitive training on cognitive functioning, memory in particular. Although the conclusions are less clear in the case of cognitive rehabilitation, they suggest improved behavioural indicators. Studies on the efficacy of cognitive stimulation in mild cognitive impairment are virtually missing in meta-analyses and systematic reviews. At the same time, authors of most of the analysed papers express some methodological reservations regarding these studies. Furthermore, the used interventions and diagnostic criteria are very heterogeneous, which makes the synthesis difficult. As a result of the current quality of evidence for the efficacy of cognitive interventions in patients with mild cognitive impairment, these interventions are assigned not more than the lowest clinical recommendation level. However, in the light of possible improvement of research methodology and the lack of recommendations for any of the available pharmacological therapies for mild cognitive impairment, cognitive interventions remain a promising approach.

As in other medical fields, the efficacy of neuropharmacotherapy depends on both psychosocial and biological characteristics of the patient. Patient’s gender is one of the latter. Although women are more likely to experience adverse drug effects, they still represent the minority in the first two phases of clinical trials. This results in fragmentary knowledge of potential dosage modifications in women. The paper presents an outline of sex differences that need to be considered in neuropharmacotherapy. The reported differences in pharmacokinetics are based on, among other things, different absorption due to lower gastric pH in women, longer gastrointestinal transit and lower P-glycoprotein expression. Drug distribution, which varies between men and women as a result of the different body fat percentage, also has an impact on the pharmacological response. Furthermore, there are also differences in the activity of drug metabolising enzymes, probably due to oestrogens. Additionally, a lower excretion rate may lead to insufficient drug elimination and subsequent side effects. The paper also presents examples of pharmacodynamic disparities. Neglecting gender differences in neurological pharmacotherapy may result in avoidable adverse effects or poor therapeutic outcome. Understanding the source of pharmacotherapeutic differences promotes therapy individualisation, and thus improved treatment outcomes and reduced adverse events, both in women and men.

Throughout the years, the clock test has achieved widespread clinical use in assessing cognitive function in patients with dementia. Both the clock test and Mini-Mental State Examination scale are the most common and simple tools for assessing cognitive functions. They are also part of numerous more complex screening methods. There are several versions of clock test, which vary in their scoring systems and can be performed in different ways. Initially, the test was primarily used for the hemispatial neglect. With time, however, it has become one of the main screening tools for cognitive functions in Alzheimer’s disease and vascular dementia. It is also used in other types of dementia, which are dominated by executive function disorders and visuospatial deficits, such as dementia with Lewy bodies and dementia in Parkinson’s disease. The availability of different versions of the clock test allows for the choice of an appropriate scoring system depending on time available, skills, experience and knowledge of the medical personnel. As a psychometric tool, the clock test is a screening method to be used by doctors, which should help quickly and easily identify dysfunctions and their severity. For this reason, most versions of the test are quantitative, the scoring system is simple, and the evaluation procedure is easy to conduct. The aim of this paper was to analyse and compare the quantitative and qualitative scoring systems of this valuable screening tool.

Due to worldwide elderly population growth and lifespan extension, the number of patients with dementia, most often caused by Alzheimer’s disease, will probably increase exponentially and will be a challenge for European societies. Early diagnosis of cognitive impairment in preclinical phase (mild cognitive impairment) provides opportunity to slow the progression of Alzheimer’s disease and delay dementia onset by taking appriopriate action such as: cognitive training, physical activity and dietary interventions. Since the inflammation hypothesis of the Alzheimer’s disease gained considerable significance, there is a pressing demand in finding dietary factors which can modulate inflammation, prevent or delay the onset, and slow down the progression of the disease. A recently published data reveal that omega-3 long-chain polyunsaturated fatty acids (eicosapentaenoic and docosahexaenoic acids) show multi-directional anti-inflammatory actions by producing anti-inflammatory cytokines and specialised pro-resolving mediators or decreasing pro-inflammatory eicosanoids. Current evidence clearly shows that synergistic action of combined dietary intervention provides stronger benefits than any single component considered separately. Especially the combination of omega-3 with vitamin B complex, vitamin D3, resveratrol and curcumin could be helpful. In this paper, we review the impact, mechanisms, and evidence for the effect of single and combined supplementation on inflammatory processes in Alzheimer’s disease and mild cognitive impairment. Since there is still no cure for dementia, and the available treatment strategies bring only symptomatic benefits, the anti-inflammatory dietary interventions should be considered as a crucial factor in Alzheimer’s disease treatment.

Epilepsy is the most common neurological disorder in pregnant women. Epileptic seizures can be dangerous both for the mother and the foetus. Most pregnant women with epilepsy must use antiepileptic drugs. The aim of the treatment is to gain optimal seizure control while minimising the risk to the foetus (a potential teratogenic effect of antiepileptic drugs). The physiological changes in the pregnant woman’s body may affect the effectiveness of these agents. As pregnancy progresses, their serum concentrations decrease due to the increase in extracellular fluid volume, impaired intestinal absorption, increased renal clearance and enhanced hepatic metabolism. This is true for most antiepileptics, both old and new. Particularly significant fluctuations of serum concentrations are observed for new antiepileptics. The level of lamotrigine and levetiracetam decreases in the third trimester of pregnancy by even 50%, and the level of oxcarbazepine falls by 30–40%. The dosage of antiepileptic drugs should depend primarily on the clinical picture, and it is helpful to determine their serum levels during pregnancy. It is recommended to test the concentration of antiepileptic drugs before pregnancy, at the beginning of each trimester, during the last month of pregnancy and during the eighth week after delivery. The paper presents two cases of pregnant women who experienced a decrease in the level of new-generation antiepileptic drugs during pregnancy. The knowledge about the levels of these drugs was a valuable guide for optimising treatment.

Devic’s disease (neuromyelitis optica, NMO) was first described under this name in 1894, and it was originally thought of as a variant of multiple sclerosis. However, following the discovery of anti-aquaporin-4 antibodies (anti-Aq4-Ab), neuromyelitis optica was reported as a new nosological entity, and more insights were gained into its pathophysiology. At present, neuromyelitis optica spectrum disorder (NMOSD) is divided into seropositive and seronegative subgroups. Seropositive NMOSD is associated with the presence of anti-aquaporin-4 antibodies, and in the seronegative variant the antibodies are absent. The presence of a third variant, isolated from the seronegative form of NMOSD has also been postulated, characterised by the presence of antibodies against myelin oligodendrocyte glycoprotein (anti-MOG). In 2015, Wingerchuk et al. published updated consensus diagnostic criteria for neuromyelitis optica spectrum disorders. NMOSD is a group of inflammatory demyelinating disorders of the central nervous system characterised by spinal cord and optic nerve involvement. The most common manifestations include recurrent optic neuritis or bilateral optic neuritis, and longitudinally extensive transverse myelitis. The clinical spectrum of neuromyelitis optica also comprises less common presentations such as area postrema syndrome, acute brain stem syndrome, symptomatic narcolepsy or acute diencephalic syndrome. Identification of the new nosological entity has contributed to the verification of conventional medical management, and brought improvements in patient therapy. The paper aims to present updated diagnostic criteria and proposed therapeutic modalities for the management of exacerbations as well as maintenance treatment based on the latest clinical evidence.

Stroke is a ma jor challenge for medicine in the 21st century. Despite modern diagnostics and even revolutionary methods of treatment, stroke is still the main cause of permanent disability and the second cause of death worldwide. Recent clinical trials have led to a breakthrough in the treatment of stroke. On their basis, many scientific societies updated the guidelines for the management of stroke. We present the most important changes in prehospital care, emergency evaluation, in-hospital non-specific treatment and specific treatment with intravenous thrombolysis and endovascular therapies. The paper is based on the recent recommendations of American Heart Association/American Stroke Association; Canadian Stroke Consortium and the Canadian Association of Emergency Physicians; European Stroke Organisation and Polish Neurological Society. Problems related to the pre- and in-hospital management of patients with acute ischaemic stroke, with a particular emphasis on the dilemma on whether to bypass a primary stroke centre to transport the patient to a comprehensive stroke centre offering endovascular thrombectomy, and the problem of reducing door-to-needle time for intravenous thrombolysis are discussed. The recommendations for the treatment of arterial hypertension and hyperglycaemia in acute ischaemic stroke and the problem of extended time window for intravenous thrombolysis and endovascular thrombectomy are also discussed.

The aim of the work is to present current knowledge on epidemiology, causes, symptomatology and diagnosis of hereditary neuropathy with liability to pressure palsy. This neuropathy usually manifests itself in the 2nd and 3rd decade of life, but also can occur at any age. Its genetic basis is the deletion or, less frequently, a point mutation of the PMP22 gene in chromosome 17p11. Symptoms appear after a small extension or compression of a nerve. In the recent years, special attention has been paid to its occurrence in the course of intense physical exercises. The most common clinical syndromes occurring in the course of the disease are paresis and sensory disturbances in the area of the median, ulnar, radial and peroneal nerves as well as brachial plexus palsy. Presence of structures called tomaculas in a nerve biopsy is characteristic for the disease. Electrophysiological and genetic studies play a key role in diagnostics. In the light of the recent studies, the frequency of occurrence of hereditary neuropathy with liability to pressure palsy seems to be significantly underestimated and ranges from 0.84 to 58.9 per 100,000. Hereditary neuropathy with liability to pressure palsies should be differentiated from compression syndromes, hereditary motor and sensory neuropathy (HMSN IA), multifocal axonal neuropathy and familial brachial plexus palsy. After recognising the syndrome, it is important to properly rehabilitate and avoid situations where there may be compression on peripheral nerves. In addition, the paper presents a case of genetically confirmed familial neuropathy with hypersensitivity to pressure in a 24-year-old male patient with a negative family history.

Smith–Magenis syndrome is a syndrome of congenital malformations, classified as rare diseases. It appears in one child in 15,000–25,000 births. The disorder is caused by deletion of chromosome 17p11.2 or mutations in the RAI gene. The image of the disfunction is heterogeneous and includes numerous neuropsychological deficits. Changes in the chromosomal system lead to phenotypic changes typical for this syndrome, delayed psychomotor development, delayed speech development, intellectual disability, and emotional and behavioural disorders. The Smith–Magenis syndrome also includes serious sleep disorders. This paper presents the clinical case of a girl with Smith–Magenis syndrome. The aim of this study is to increase theoretical and practical clinical knowledge about this disorder, and to understand characteristic features of the child’s functioning based on neurological, neuropsychological and behavioural symptoms.

Epilepsy is one of the most frequent diseases of the central nervous system and affects about 50 million people in the world. It is a heterogeneous disease entity associated with various clinical manifestations and coexisting symptoms (such as neurodevelopmental disorders), resulting in different response to medication and different prognosis. Clinical evidence points to the existence of epilepsy and epilepsy syndromes dependent on sex. Female and male sex hormones affect the brain convulsion threshold. Catamenial epilepsy is a well-known example here, in which the neurohormonal mechanisms dependent on the menstrual cycle affect the occurrence of convulsions. Progesterone is an anticonvulsant hormone, while oestrogens can be both pro- and anticonvulsant, depending on the physiological state. Unlike in the case of progesterone, the influence of the potential convulsion threshold modulation of testosterone is complex. In animal models, but also in clinical trials, testosterone intensifies the occurrence of convulsions through its metabolism to oestrogens. The paper presents the effects of antiepileptic drugs on the offspring of mothers with epilepsy (congenital malformations, lower birth weight, and neurodevelopmental disorders). Aggregate data indicate the highest teratogenicity of the exposure to valproic acid and other antiepileptics used in polytherapy. Other factors may also influence foetal development: severity of epilepsy itself, the type of seizures, mother’s intelligence quotient and socioeconomic status as well as the exposure to toxic agents (including alcohol and other stimulants). The optimal selection of antiepileptic drugs should be sought even before the planned pregnancy in the care of women at childbearing age suffering from epilepsy.

Objectives: The aim of the paper was to: (1) evaluate the effectiveness of the physiotherapeutic program in writer’s cramp, (2) compare the brain activity while writing in patients with writer’s cramp and in healthy controls, (3) compare the brain activity of subjects with writer’s cramp before and after the physiotherapy. Material and methods: Nine patients with diagnosed writer’s cramp and nine age-matched healthy controls were studied. The functional magnetic resonance imaging while writing was performed in the writer’s cramp subjects and in the controls. The patients with writer’s cramp participated in a 3-week therapeutic program of individualised exercises in combination with the immobilisation of the affected limb. The functional magnetic resonance imaging was repeated after completing the therapeutic program. Results: Only the results of the coil drawing test significantly improved after completing the therapeutic program. All other clinical tests did not reveal any significant changes after the therapy. Activation of primary motor cortex, premotor cortex and primary sensory cortex was observed while writing in the subjects with writer’s cramp and in the controls. Brain activation in clusters located in the areas BA4, BA7, BA18 and BA37 was more pronounced in the writer’s cramp group. Individual analysis revealed a significantly increased activation of the cerebellum in the writer’s cramp patients and it decreased after physiotherapy. Conclusion: In the writer’s cramp subjects, functional magnetic resonance imaging revealed increased – when compared to the controls – activity of several brain structures while writing. This activity was modified by individualised physiotherapeutic program.

Objectives: The aim of this paper was to assess the effects of aerobic training on the quality of life and fatigue in patients with multiple sclerosis. Material and methods: A total of 53 patients with known multiple sclerosis (ICD G35.0) who began a standard 4-week rehabilitation programme were included in the study. Patients were divided into two groups: AT (aerobic training) patients (n = 21), who additionally underwent training on a lower limb cycle ergometer (three 10-minute sessions per day with an hour interval), and non-AT group of patients (n = 32). Life quality assessment based on the WHOQOL-BREF scale (World Health Organization Quality of Life), an assessment of motor impairment based on the Expanded Disability Status Scale by Kurtzke (EDSS) and an assessment of the severity of fatigue using the Fatigue Severity Scale (FSS) were performed at baseline and after four weeks. Results: After completing rehabilitation programmes, an improvement in the quality of life was observed both in AT and non-AT group. However, a more significant improvement in the two evaluated aspects, physical (p = 0.001 vs. 0.01) and psychological (p = 0.001 vs. 0.05), was observed in the AT group. However, no improvement in social terms was observed. There was also a reduction in the severity of fatigue (0.03 for AT group vs. 0.15 for non-AT group). There was no statistically significant improvement in the EDSS score in any of the groups. Conclusions: Aerobic training has beneficial effects on the quality of life and the severity of fatigue in patients with multiple sclerosis.

Organophosphate insecticides have been widely used for pest control. They have been readily used as a suicidal agent in developing countries. This paper reports the case of a middle aged male patient with acute organophosphate compound poisoning who in turn had acute cholinergic crisis and was put on ventilator. Within one week, he developed flaccid areflexic paraplegia with preserved sensation. Two weeks later, he had spasticity in both lower limbs with hyperreflexia. The reported case demonstrates the myelopathic presentation of organophosphate-induced delayed polyneuropathy.