Cílem léčby je odstranění záchvatů, nebo alespoň omezení jejich frekvence a intenzity, tam kde eliminace záchvatů není možná. ! Kvalita života ! 1/ Životospráva 2/ Farmakoterapie 3/ Chirurgická léčba Dotknu se i otázky farmakorezistence a léčby operační.
Examination of higher cerebral functions
Examination of higher cerebral (mental) functions
It should be a requisite part of standard neurologic examination – at least Mini Mental State Examination should be performed in neurologic pts.
It has to be systematic and hierarchic
(level of consciousness directed attention cognition, mood, speech)
Golden neurologic rule „to localize a lesion“ should be applied for mental functions too (neuronal networks).
Extremely important is thorough history taking (changes in pt ’ s behavior) and focusing on the pt ’ s behavior during the examination (evaluation of his/her appearance, cooperation, attention, memory, mental flexibility, social adaptability, ability of nonverbal communication, depressive symptomatology, etc.).
Luria sketch (visual completion test) (alternating square and pointed figs.)
Continuous performance test
After registering target digit in presented digit chain a subject has to knock on a table
4 -9-1-7-5- 4 -0-7-9-2- 4 -3-7-5-0-2
Digit span test (3-7) – subject has to learn and repeat long digit chains of random numbers ( also test on short-term memory )
Large-scale neural network for directed attention (Mesulam MM)
Neglect syndrome = a failure to report, respond, or orient to contralateral novel stimuli that is caused by damage of large-scale neural network for directed attention and not by an elemental sensorimotor deficit. It is a form of selective unawareness . Pts with neglect syndrome often appears to be unaware of contralateral stimuli, they ignore these items, and do not react to them. Within neglect there can be hemiakinesia ( motor neglect = movement deficiency = pseudohemiparesis ), anosognosia ( inability to recognise and to understand own physical disability /especially motor deficit – hemiplegia/ that is actually denying by the patient) and/or anosodiaforia (absence of concomitant emotions for serious functional deficit).
Testing requires alertness and is not possible in a confused or dysphasic patient!
Short-term memory – DIGIT SPAN TEST – ask the patient to repeat a sequence of 5, 6, or 7 random numbers.
Long-term memory – ask the patient to describe present illness, duration of hospital stay or recent events in the news (RECENT MEMORY), ask about events and circumstances occuring more than five years previously (REMOTE MEMORY).
Verbal memory – ask the patient to remember a sentence or a short story and test after 15 minutes.
Visual memory – ask the patient to remember objects on a tray and test after 15 minutes
Interview about writing, eating with spoon, throwing a ball, kicking, step; tapping – domin. hand 50/min, nondomin. hand 45/min.
Left hemisphere is dominant in 95% right-handers and 60% left-handers!
Left hemisphere – dominant for speech and motor functions, reading, writing, counting, recognition of colors, verbal memory, important for linguistic thinking, ...
Right hemisphere – dominant for attentional functions, prosopognosia, prosodia (affective component of speech), nonverbal communication (ability to „read from face“), visuo-spatial perception , visual and topographical memory, recognition of music, …