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Vztahy mezi oscilacemi a jejich využití u adaptivní hluboké mozkové stimulace
Lamoš, Martin ; Bočková, Martina ; Daniel, Pavel ; Baláž, Marek ; Chrastina, Jan ; Rektor, Ivan
Hluboká mozková stimulace (DBS) patří vedle dopaminergní léčby k nejvýznamnějším terapeutickým přístupům u Parkinsonovy nemoci (PN). Snaha potlačit některé limitace této terapie vede ke zvýšenému zájmu o přístupy jako je adaptivní DBS (aDBS). Stimulace s uzavřenou smyčkou řízená fluktuacemi výkonu v beta pásmu však nemusí být optimální pro všechny pacienty s PN. S cílem nalézt více senzitivní ukazatel než samotnou beta aktivitu byly analyzovány vztahy mezi jednotlivými oscilacemi v kontextu optimální stimulace subthalamického jádra (STN). Vztah fáze beta rytmu a amplitudy vysokofrekvenčních oscilací se jeví jako vhodný parametr pro cílení stimulace.
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Functional and Pathophysiological-morphological Correlates of Neurodegenerative Diseases
Dušek, Pavel ; Roth, Jan (advisor) ; Baláž, Marek (referee) ; Menšíková, Kateřina (referee)
This doctoral thesis pictures neurodegenerative diseases as a multilevel process, describes various correlates on each pathophysiological level, and presents selected correlates in Huntington's disease and mitochondrial membrane protein-associated neurodegeneration (MPAN). It uses various methodological approaches such as basic laboratory research, clinical work, imaging, database formation, and database summary. Changes in the amount of respiratory chain complex I and respiratory chain complex IV in buccal ep- ithelial cells of Huntington's disease patients are described. The insufficient power of optical coherence tomography as a biomarker in Huntington's disease is demonstrated. Various phenotypes of MPAN are summarized, and an association between C19orf12 mutation and visual impairment is confirmed. A phenotype of a well-documented case of MPAN is presented. Keywords: C19orf12 mutation; color discrimination; contrast sensitivity; huntingtin; Huntington's disease; iron accumulation; mitochondrial membrane-protein associated neurodegeneration; multilevel process; neurodegeneration; optical coherence tomogra- phy; parkinsonism; respiratory chain complex; retinal nerve fiber layer thickness
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Respiratory physiotherapy in neurology
Srp, Martin ; Jech, Robert (advisor) ; Baláž, Marek (referee) ; Konečný, Petr (referee)
Pneumonia is the leading cause of death in a large proportion of neurological diseases. Respiratory physiotherapy serves as a non-pharmacological option for supporting airway hygiene. However, current awareness of respiratory physiotherapy in neurological patients is not satisfactory. The aim of this thesis is to verify the effectiveness of expiratory muscle strength training (EMST) in three neurological diseases: multiple sclerosis (MS), Parkinson's disease (PD) and multiple system atrophy (MSA). The results of this thesis show: 1) EMST led to a significant increase in expiratory muscle strength and voluntary peak cough flow in patients with MS. Therefore, we have shown that EMST is an effective method of respiratory physiotherapy in promoting airway hygiene in patients with MS. 2) We found in a demographic study that the PD healthcare model in Czechia is suboptimal. The utilization of a respiratory physiotherapy is low, and therefore its reorganization is needed. 3) We developed and patented a mobile application SpiroGym which provides visual feedback during training and sends the training results via a secure server directly to the therapist for telemedicine needs. In a pilot study, we verified its feasibility in patients with PD. The study results indicate that EMST coupled with the SpiroGym...
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Clinical variability of rare dementias: manifestations and possible reasons
Tesař, Adam ; Rusina, Robert (advisor) ; Baláž, Marek (referee) ; Hort, Jakub (referee)
Clinical variants of dementia are limiting their diagnosis and can leads to underdiagnosing or substitution of two different diseases with the same symptomatology. The aim of this study is a better understanding of a factors involved in the clinical variability of rare dementias. Progressive supranuclear palsy and Gerstmann-Sträussler-Scheinker syndrome caused by mismatch mutation P102L in Prion protein are used as model diseases. In this thesis, we firstly demonstrate the influence of the distribution of neuropathology and its spread on the clinical phenotype of the disease. Although a single neurodegenerative disease increases the risk of neurodegenerative comorbidity, this other neuropathology does not affect the phenotypic presentation of the primary disease. Monogenetically inherited proteinopathies can have a different clinical subtype, which is not only conditioned by causal protein polymorphisms, but can be influenced by the wild type allele of causal protein. A more accurate understanding of the symptomatic variability in dementias will allow a better focus of a drug studies and, in the future a treatment, but it will also lead to a better understanding of the pathogenesis of neurodegenerative diseases. Keywords: dementia, Progressive supranuclear palsy, Gerstmann-Sträussler-Scheinker...
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Gait impairment in movement disorders.
Poláková, Kamila ; Brožová, Hana (advisor) ; Čakrt, Ondřej (referee) ; Baláž, Marek (referee)
Summary: Movement disorders are caused by impairment of the basal ganglia and extrapyramidal connections. The most common is Parkinson's disease (PD), characterised by hypokinesia together with resting tremor and / or rigidity, which may be influenced by dopaminergic therapy or invasive methods, including deep brain stimulation (DBS). Gait and balance disorders are part of the Parkinson's syndrome, progress during the disease course and limit daily activities, quality of life, may lead to falls and contribute to higher mortality of the patients in the late stages. Therapy is difficult. Gait disorders and parkinsonism may occur also in other diseases, including intoxications which may also lead to basal ganglia impairment. The theoretical part include the physiology of gait, gait disorders and examination. The section devoted to movement disorders focuses on Parkinson's disease and methanol intoxication. The practical part consists of 3 studies evaluating gait disorder in patients with advanced PD and possibilities of the treatment, the 4th study documents gait disorder in survivors after mass methanol poisoning with outbreak between 2012 and 2014 in the Czech Republic. The result confirm the effect of DBS in step length prolongation and gait speed increment in patients with PD. Compensation strategies using...
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Sensory and sensitive dysfunctions in neurodegenerative disorders of the basal ganglia.
Kopal, Aleš ; Roth, Jan (advisor) ; Baláž, Marek (referee) ; Laczó, Jan (referee)
Complex functions of the basal ganglia are affected by numerous sensory and sensitive stimuli. In our studies, we investigated parameters of sense of smell and vision in neurodegenerative diseases of the basal ganglia - Parkinson's disease (PD) and Huntington's disease (HD). In the first study, we use Odourized Markers Test (OMT) to determine its applicability in PD patients, and to determine whether it distinguishes olfactory disorders between neurodegenerative and other disorders. Results show that OMT is applicable for PD patients and comparable to Sniffin' Sticks as it demonstrates gains of lower scores in PD patients compared to healthy subjects, but they do not differentiate other etiology of olfactory disorders. In the next study, we tested the pleasantness of odor stimulants in PD patients using New test of odor pleasantness (NTOP). We investigated suitability and validity of its use. We found that PD patients had lower odor rating score compared to healthy group correlated with Sniffin' Sticks and OMT. In the following study, we examined whether PD patients with visual hallucinations (PDH+) have structural retinal changes measured by optical coherence tomography (OCT) and functional retinal changes examined by 2,5% contrast sensitivity test compared to PD patients without hallucinations...
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Weight changes in patients with Parkinson's disease treated with Deep Brain Stimulation.
Undus, Lucie ; Růžička, Evžen (advisor) ; Baláž, Marek (referee) ; Haninec, Pavel (referee)
1 Abstract Body weight changes have been described in the course of Parkinson's disease (PD) as well as following bilateral deep brain stimulation of the subthalamic nucleus (STN DBS) performed in advanced PD. According to the literature weight changes occur in 50-100% of patients who undergo STN DBS. In the last 15 years extensive efforts have been put in understanding the underlying mechanisms behind the weight changes following STN DBS in advanced PD patients however many sources still report conflicting evidence. Improved motor status, reduction in dyskinesias, decrease in energy expenditure, dopaminergic medication reduction, modification of food intake, hormonal factors, regional effects of stimulation were all speculated to cause this weight gain. We hypothesized that patients who underwent STN DBS procedure in our center would gain weight as reported in the literature (study 1, study 2). The etiology of post STN DBS weight gain has not been fully elucidated up to date, in our second study we further hypothesized that the weight changes are due to dysregulation of food related hormones and parameters (study 2). In the third study we hypothesized that weight gain is associated with position of active electrode contact (study 3). Aims of the study: The primary aims of our studies were to assess body...
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