{"id":42770,"date":"2023-10-12T08:53:15","date_gmt":"2023-10-12T06:53:15","guid":{"rendered":"https:\/\/www.invarena.cz\/?p=42770"},"modified":"2023-10-12T08:53:16","modified_gmt":"2023-10-12T06:53:16","slug":"jak-na-krece-v-nohou","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=42770","title":{"rendered":"Jak na k\u0159e\u010de v nohou\u00a0\u00a0"},"content":{"rendered":"\n

Co dok\u00e1\u017ee zabrat na k\u0159e\u010d v l\u00fdtku, ve stehn\u011b atd., kter\u00e1 b\u00fdv\u00e1 typicky v noci? Ve vys\u00edl\u00e1n\u00ed \u010cRo radila MUDr. Lenka Satke, neurologick\u00e1 klinika Fakultn\u00ed nemocnice Olomouc.

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pan\u00ed doktorko, prim\u00e1rn\u011b se v\u011bnujete spasm\u016fm, spasticit\u00e1m po t\u011bch \u00farazech a neurologick\u00fdch onemocn\u011bn\u00edch, kdy\u017e u\u017e nastoup\u00ed k\u0159e\u010de, t\u0159eba v noci, v n\u011bjak\u00e9 poloze, jak\u00e9 rozcvi\u010den\u00ed, kdy\u017e by n\u011bkdo nev\u011bd\u011bl s\u00e1m, byste navrhovala?


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tak v tom nejv\u011bt\u0161\u00edm, nejhor\u0161\u00edm svalov\u00e9m stahu s t\u00edm svalem neud\u011bl\u00e1me skoro nic, to je samoz\u0159ejm\u011b pravda, tak\u017ee ho zkusit nechat v klidu, zkusit ho zah\u0159\u00e1t a pomali\u010dku by ta k\u0159e\u010d m\u011bla povolit, v\u011bt\u0161inou je to fakt v \u0159\u00e1du sekund, minut, a pokud by to nepovolovalo, tak za\u010d\u00edt pomali\u010dku protahovat a nej\u010dast\u011bj\u0161\u00ed jsou, jak u\u017e tady sly\u0161\u00edme, ty k\u0159e\u010de v l\u00fdtk\u00e1ch, kter\u00e9 takhle bud\u00ed v noci, tak\u017ee prost\u011b prot\u00e1hnout chodidlo, zvedat \u0161pi\u010dku nahoru a pomali\u010dku se sna\u017eit ten sval lehou\u010dce prot\u00e1hnout, samoz\u0159ejm\u011b ne proti bolesti, a\u0165 si neud\u011bl\u00e1me je\u0161t\u011b n\u011bjak\u00e9 v\u011bt\u0161\u00ed zran\u011bn\u00ed, ale nechat v klidu zah\u0159\u00edvat a \u010dekat, a\u017e odezn\u00ed.


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A te\u010f zase naskok jenom do fyzioterapie. Jenom jedna v\u011bti\u010dka. Oni na to maj\u00ed samoz\u0159ejm\u011b i techniky, vlastn\u011b fyzioterapeut, pohybov\u00fd l\u00e9ka\u0159 nebo fyzioterapeut, magistr bakal\u00e1\u0159 by mohl taky navrhnout n\u011bco po sv\u00e9m. Tam bude, tu\u0161\u00edm, typick\u00e1 mo\u017enost t\u0159eba procvi\u010dit zrovna p\u0159ed tou noc\u00ed, pokud nejsem bolav\u00fd, po velk\u00e9m \u00farazu a operaci samoz\u0159ejm\u011b, tak kdybyste mohla tu techniku lehce p\u0159ipomenout proti t\u00e9 zdi, lehce prost\u011b jenom se op\u0159\u00edt rukama?

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z\u00e1le\u017e\u00ed na tom, kter\u00e1 ta svalov\u00e1 skupina zlob\u00ed, kdy\u017e je to l\u00fdtko, tak op\u0159\u00edt se o tu ze\u010f rukama sm\u011brem jako ke zdi a pomali\u010dku nat\u00e1hnout tu kon\u010detinu a protahovat, p\u0159itla\u010dit patu k zemi a postre\u010dovat, vylo\u017een\u011b stre\u010dovat, oddalovat se od t\u00e9 zdi pomali\u010dku a sna\u017eit se tu patu dr\u017eet na t\u00e9 zemi.

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Jestlipak se d\u00e1 zjistit p\u0159\u00ed\u010dina, a\u0165 u\u017e t\u011bchto b\u011b\u017en\u011bj\u0161\u00edch k\u0159e\u010d\u00ed, anebo potom zase m\u016f\u017eeme p\u0159ej\u00edt k tomu, \u010demu se v\u011bnujete vy? K t\u011bm velk\u00fdm spasticit\u00e1m? P\u0159\u00ed\u010dina k\u0159e\u010de?


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Tak pokud se jedn\u00e1 o takov\u00e9 ty b\u011b\u017en\u011bj\u0161\u00ed k\u0159e\u010de, pokud zlob\u00ed, \u010dasto je tam vysok\u00e1 frekvence t\u011bch k\u0159e\u010d\u00ed, tak by se m\u011blo ud\u011blat n\u011bjak\u00e9 aspo\u0148 z\u00e1kladn\u00ed vy\u0161et\u0159en\u00ed, kter\u00e9 m\u016f\u017ee ud\u011blat praktick\u00fd l\u00e9ka\u0159, ten z\u00e1kladn\u00ed screening, i co se t\u00fd\u010de t\u011bch miner\u00e1l\u016f, hormon\u00e1ln\u00ed screening, tak\u017ee \u0161t\u00edtn\u00e1 \u017el\u00e1za, a ostatn\u00ed. Nemus\u00ed to b\u00fdt jenom ta oby\u010dejn\u00e1 p\u0159\u00ed\u010dina, kdy takzvan\u011b sta\u010d\u00ed jenom doplnit miner\u00e1ly, ale t\u0159eba i endokrinn\u00ed onemocn\u011bn\u00ed.

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dal\u0161\u00ed opravdu v\u011bcn\u00fd dotaz. Maminka 81 let, tr\u00e1p\u00ed ji posledn\u00ed rok k\u0159e\u010de v l\u00fdtk\u00e1ch. M\u00e1 je tedy hlavn\u011b v noci, n\u011bkdy i p\u0159es den. Ho\u0159\u010d\u00edk bere pravideln\u011b taky t\u0159eba koenzym. Q asi 10 nebo q 30 tady je a ten p\u0159\u00edpravek jeden na klouby bere taky, ale l\u00e9ky na tlak a na \u0159ed\u011bn\u00ed krve pracuje b\u011b\u017en\u011b, kdy\u017e to jde na zahr\u00e1dce. S ch\u016fz\u00ed nem\u00e1 pot\u00ed\u017ee. Tak\u00e9 mohou n\u011bkter\u00e9 k\u0159e\u010de b\u00fdt t\u0159eba z n\u011bkter\u00fdch l\u00e9k\u016f? Poslucha\u010dka Martina.

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samoz\u0159ejm\u011b m\u016f\u017eou, n\u011bkter\u00e9 kardiologick\u00e9 l\u00e9ky m\u016f\u017eou m\u00edt jako jeden z ne\u017e\u00e1douc\u00edch \u00fa\u010dink\u016f ur\u010dit\u011b i svalov\u00e9 k\u0159e\u010de a samoz\u0159ejm\u011b je tam pot\u0159ebn\u00e9 br\u00e1t v potaz i kombinaci jednotliv\u00fdch l\u00e9k\u016f, tak\u017ee pod\u00edvat se na to komplexn\u011b, proto\u017ee jednotliv\u00e9 l\u00e9ky m\u016f\u017eou vyvolat pr\u00e1v\u011b tyto ne\u017e\u00e1douc\u00ed \u00fa\u010dinky, kdy\u017e jsou v n\u011bjak\u00fdch kombinac\u00edch, tak\u017ee ur\u010dit\u011b ty l\u00e9ky by m\u011bl proj\u00edt ten praktick\u00fd l\u00e9ka\u0159 komplexn\u011b, a podle toho, eventueln\u011b revidovat tro\u0161ku tu medikaci.

se te\u010fka budeme v\u011bnovat hodn\u011b t\u0159eba t\u011bm prav\u00fdm, velk\u00fdm, z\u00e1sadn\u00edm spasm\u016fm spasticit\u011b. P\u0159ipome\u0148te, pros\u00edm. tedy vlastn\u011b va\u0161i pacienti, kter\u00fdm pom\u00e1h\u00e1te, jak vy\u0161et\u0159ujete, diagnostikuje, jak\u00e1 potom m\u016f\u017ee b\u00fdt ta terapie?

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Tak to hlavn\u00ed spektrum pacient\u016f tvo\u0159\u00ed pacienti po c\u00e9vn\u00ed mozkov\u00e9 p\u0159\u00edhod\u011b, jestli se jedn\u00e1 o krv\u00e1cen\u00ed v mozku nebo uz\u00e1v\u011br s nedostate\u010dn\u00fdm prokrven\u00edm, tak po ur\u010dit\u00e9 dob\u011b u nich m\u016f\u017ee doj\u00edt ke vzniku t\u00e9 spasticity, tak\u017ee u t\u00e9 kon\u010detiny doch\u00e1z\u00ed k zv\u00fd\u0161en\u00ed svalov\u00e9ho nap\u011bt\u00ed, kon\u010detina se krout\u00ed, doch\u00e1z\u00ed k stah\u016fm prst\u016f, z\u00e1p\u011bst\u00ed, v lokti nebo pr\u00e1v\u011b i na t\u00e9 doln\u00ed kon\u010detin\u011b a v\u00fdrazn\u011b to limituje pacienta v t\u011bch b\u011b\u017en\u00fdch denn\u00edch \u010dinnostech.

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C\u00edt\u00ed subjektivn\u011b t\u0159eba takov\u00e9to nap\u011bt\u00ed, tu bolest jako v t\u011bch oby\u010dejn\u00fdch norm\u00e1ln\u00edch k\u0159e\u010d\u00edch v l\u00fdtk\u00e1ch v noci nebo tam je i jin\u00e9 vn\u00edm\u00e1n\u00ed?

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M\u016f\u017eou tam b\u00fdt i ty norm\u00e1ln\u00ed, b\u011b\u017en\u00e9 k\u0159e\u010de, tak\u017ee to samoz\u0159ejm\u011b ano, a my jim dok\u00e1\u017eeme pomoci i od t\u011bch velk\u00fdch k\u0159e\u010d\u00ed, od t\u00e9 velk\u00e9 spasticity a povolit ten svalov\u00fd tonus, to svalov\u00e9 nap\u011bt\u00ed v t\u011bch jednotliv\u00fdch svalov\u00fdch skupin\u00e1ch. Tak\u017ee konkr\u00e9tn\u011b pr\u00e1v\u011b aplikaci botulotoxinu, co\u017e je l\u00e9k, kter\u00fd my u n\u00e1s aplikujeme na na\u0161\u00ed klinice do t\u011bch nejv\u00edc sta\u017een\u00fdch svalov\u00fdch skupin a dok\u00e1\u017eeme ten sval na n\u011bjakou omezenou dobu \u010d\u00e1ste\u010dn\u011b povolit, samoz\u0159ejm\u011b ten l\u00e9k s\u00e1m o sob\u011b neud\u011bl\u00e1 \u00fapln\u00fd z\u00e1zrak, jenom nen\u00ed to napo\u0159\u00e1d, je to jednor\u00e1zov\u00e9 \u0159e\u0161en\u00ed a je tam nutnost spolupr\u00e1ce pacienta, spolupr\u00e1ce s rehabilitac\u00ed, taky pravideln\u00e9 cvi\u010den\u00ed, protahov\u00e1n\u00ed.

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Je to z\u00e1konit\u00e9, \u017ee po c\u00e9vn\u00ed mozkov\u00e9 p\u0159\u00edhod\u011b je sklon k takov\u00fdmto spasticit\u00e1m nebo u n\u011bkoho ano, u n\u011bkoho ne?

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Z\u00e1le\u017e\u00ed, kter\u00e1 \u010d\u00e1st mozku je posti\u017eena


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ta neurologick\u00e1 podstata, co se to d\u011bje vlastn\u011b v tom syst\u00e9mu nervov\u00e9m \u010di v tom mozku?

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Tak \u010d\u00e1st mostku je, d\u00e1 se \u0159\u00edct, zni\u010dena c\u00e9vn\u00ed mozkovou p\u0159\u00edhodou a nen\u00ed tam dostate\u010dn\u011b dobr\u00e1 komunikace. Mezi tou periferi\u00ed a mozkem, informac\u00ed z periferie, z t\u00e9 kon\u010detiny a zpracov\u00e1n\u00edm t\u00e9 informace v tom centr\u00e1ln\u00edm nervov\u00e9m syst\u00e9mu, a ten sval na to reaguje spasticitou. Samoz\u0159ejm\u011b u n\u011bkter\u00fdch pacient\u016f v\u00fdrazn\u011bji, u n\u011bkter\u00fdch m\u00ed\u0148, to z\u00e1le\u017e\u00ed podle toho, kter\u00e1 \u010d\u00e1st toho mozku byla posti\u017eena tou c\u00e9vn\u00ed mozkovou p\u0159\u00edhodou.

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To jsou mozkov\u00e9 p\u0159\u00edhody, je\u0161t\u011b t\u0159eba n\u011bjak\u00e1 dal\u0161\u00ed onemocn\u011bn\u00ed?

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Hodn\u011b pacient\u016f m\u00e1me i s roztrou\u0161enou skler\u00f3zou, kter\u00e9 maj\u00ed mimo\u00a0posti\u017een\u00ed<\/strong>\u00a0mozku i\u00a0posti\u017een\u00ed<\/strong>\u00a0m\u00edchy hodn\u011b \u010dasto, tak\u017ee ta spasticita m\u016f\u017ee b\u00fdt pr\u00e1v\u011b v\u00edc vyj\u00e1d\u0159ena pr\u00e1v\u011b na doln\u00edch kon\u010detin\u00e1ch a hodn\u011b jich limituje, i kdy\u017e u\u017e nejsou mobiln\u00ed. Ale pr\u00e1v\u011b je tr\u00e1p\u00ed ty svalov\u00e9 k\u0159e\u010de, svalov\u00e9 bolesti a dok\u00e1\u017eeme ty svaly uvolnit a zlep\u0161it jim ten stav, i co se t\u00fd\u010de prost\u011b z\u00e1kladn\u00ed sebep\u00e9\u010de, hygieny a podobn\u011b.

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Je\u0161t\u011b t\u0159eba n\u011bjak\u00e9 diagn\u00f3zy, ty prim\u00e1rn\u00ed, neurologick\u00e9?

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Nap\u0159\u00edklad po traumatech, \u00farazy, traumata m\u00edchy nebo mozku.

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J\u00e1 jsem v\u00e1m kdysi \u0159\u00edkal o n\u011bjak\u00e9 zku\u0161enosti ze \u0161ir\u0161\u00ed rodiny, kdy opravdu ka\u017edou noc nep\u0159\u00edjemn\u00e9, ale obrovsk\u00e9 probl\u00e9my, k\u0159e\u010de po \u00faraze, paraplegika, ochrnut\u00ed, \u00faraz m\u00edchy a tak, ale byla to doba minul\u00e1, t\u0159eba ti pacienti po t\u011bch \u00farazech nebo po c\u00e9vn\u00edch mozkov\u00fdch p\u0159\u00edhod\u00e1ch, nev\u011bd\u00ed, netu\u0161\u00ed, \u017ee ta pomoc tady je. Tak vy se s t\u00edm setk\u00e1v\u00e1te, \u017ee jsou pak p\u0159ekvapen\u00ed. Douf\u00e1m, \u017ee p\u0159\u00edjemn\u011b, \u017ee pomoc opravdu existuje.<\/p>\n\n\n\n

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setk\u00e1v\u00e1me se s t\u00edm, dnes a denn\u011b, \u017ee taky pacienti se k n\u00e1m prost\u011b dost\u00e1vaj\u00ed s doporu\u010den\u00edm i praktick\u00e9ho l\u00e9ka\u0159e, a skute\u010dn\u011b hodn\u011b pacient\u016f je i p\u0159ekvapen\u00fdch, jak moc jim dok\u00e1\u017eeme pomoci, kdy\u017e je tam ta spolupr\u00e1ce pacienta a doch\u00e1z\u00ed na pravideln\u00e9 rehabilitace. Cvi\u010d\u00ed se s tou kon\u010detinou, aktivuje se, a opravdu ta kvalita \u017eivota se m\u016f\u017ee v\u00fdrazn\u011b zlep\u0161it.<\/p>\n\n\n\n

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Te\u010f tedy to d\u016fle\u017eit\u00e9. Aplikac\u00ed botoxu, botulotoxinu, ne toho pro kosmetiku, ten l\u00e9k je speci\u00e1ln\u011b p\u0159ipraven, upraven?<\/p>\n\n\n\n

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Samoz\u0159ejm\u011b je to farmaceutick\u00fd p\u0159\u00edpravek, je to medic\u00ednsk\u00fd l\u00e9k schv\u00e1len\u00fd l\u00e9kov\u00fdmi komisemi, kter\u00fd se pou\u017e\u00edv\u00e1 pr\u00e1v\u011b k lok\u00e1ln\u00ed aplikaci do ur\u010dit\u00e9ho svalu. Samoz\u0159ejm\u011b, kdy\u017e je ta spasticita n\u011bjak v\u00fdrazn\u011bji roz\u0161\u00ed\u0159en\u00e1, postihuje v\u00edce svalov\u00fdch skupin, tak tam ur\u010dit\u011b limitace m\u00e1me, nem\u016f\u017eeme j\u00edt do n\u011bjak\u00fdch vysok\u00fdch d\u00e1vek, ale zam\u011b\u0159\u00edme se na ty nejv\u00edc\u00a0posti\u017een\u00e9<\/strong>\u00a0svalov\u00e9 skupiny.<\/p>\n\n\n\n

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A t\u0159eba p\u0159edt\u00edm m\u016f\u017ee ten neurolog v ter\u00e9nu, v ambulanci, va\u0161i kolegov\u00e9, \u0159ekn\u011bme, v uvozovk\u00e1ch v ni\u017e\u0161\u00edm stupni t\u00e9 neurologie ve sv\u00fdch ordinac\u00edch, vyzkou\u0161et p\u0159ed t\u00edm je\u0161t\u011b n\u011bco, je\u0161t\u011b p\u0159ed t\u00edm botoxem?<\/p>\n\n\n\n

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M\u016f\u017eou si samoz\u0159ejm\u011b vyzkou\u0161et l\u00e9ky na uvoln\u011bn\u00ed toho svalov\u00e9ho nap\u011bt\u00ed, myorelaxancia, kter\u00e9 ale p\u016fsob\u00ed, generalizovan\u011b, nep\u016fsob\u00ed jenom v tom dan\u00e9m svalu.<\/p>\n\n\n\n

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Na cel\u00e9 t\u011blo, na v\u0161echny…?<\/p>\n\n\n\n

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Svaly, p\u0159esn\u011b tak, tak\u017ee z\u00e1le\u017e\u00ed od typu pacienta, jak\u00e9 m\u00e1\u00a0posti\u017een\u00ed<\/strong>, jestli to je v\u00fdrazn\u011b generalizovan\u00e9, nebo je sp\u00ed\u0161 lokalizovan\u00e9, tak\u017ee podle toho pak diferencujeme pacienty, kter\u00fd jsou sp\u00ed\u0161 indikov\u00e1ni k l\u00e9\u010db\u011b bototoxinem nebo sp\u00ed\u0161e k n\u011bjak\u00fdm jin\u00fdm terapi\u00edm, nap\u0159\u00edklad t\u011bmi biorelaxencemi nebo dal\u0161\u00edmi pokro\u010dil\u00fdmi mo\u017enostmi.<\/p>\n\n\n\n

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Ale zrovna tu aplikaci injek\u010dn\u011b botox, tak tu t\u0159eba v ter\u00e9nu asi praktik, praktick\u00fd l\u00e9ka\u0159 d\u011blat nebude, ani mo\u017en\u00e1 ten neurolog ne?<\/p>\n\n\n\n

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To ur\u010dit\u011b ne, je to v\u011bt\u0161inou v\u00e1z\u00e1no pr\u00e1v\u011b na centra, na neuromuskul\u00e1rn\u00ed centra nebo na rehabilita\u010dn\u00ed \u00fastavy a podobn\u011b.<\/p>\n\n\n\n

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Tak\u017ee v nemocnic\u00edch, odd\u011blen\u00ed nebo kliniky neurologick\u00e9. <\/p>\n\n\n\n

Usly\u0161\u00edme od pan\u00ed poslucha\u010dky, v\u00edt\u00e1me v\u00e1s, dobr\u00fd den.<\/p>\n\n\n\n

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Dobr\u00fd den. Tady Libu\u0161e Prost\u011bjov. J\u00e1 prost\u011b m\u00e1m probl\u00e9m, \u017ee v noci m\u011b bud\u00ed sp\u00ed\u0161 takov\u00e1 horkost v noh\u00e1ch, asi dvakr\u00e1t, t\u0159ikr\u00e1t za noc a jestli to chlad\u00ed, jestli je to dob\u0159e nebo \u0161patn\u011b, ale prost\u011b takhle, a pak je\u0161t\u011b bych cht\u011bla, p\u0159es den m\u00e1m ty nohy takov\u00fd oslaben\u00fd, tak\u017ee co by m\u011b pan\u00ed doktorka na to \u0159ekla? Proto\u017ee byla jsem u neurolo\u017eky na vy\u0161et\u0159en\u00ed, je to za\u010d\u00e1tek neuropatie a \u0159ekla m\u011b, \u017ee na to v\u016fbec nic neexistuje. Cvi\u010d\u00edm dvakr\u00e1t denn\u011b, beru vitaminy magn\u00e9ziium a b\u00e9\u010dka.<\/p>\n\n\n\n

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Diabetick\u00e1 neuropatie, m\u00e1te n\u00e1b\u011bh, t\u0159eba na ten prediabetes?<\/p>\n\n\n\n

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Diabetes nem\u00e1m, nic neberu \u017e\u00e1dn\u00fd jako na \u0159ed\u011bn\u00ed krve, nic jako neberu takov\u00e9ho.<\/p>\n\n\n\n

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A tu neuropatii v\u00e1m diagnostikovala va\u0161e neurolo\u017eka nebo?<\/p>\n\n\n\n

——————–
No, ta neurolo\u017eka, no.<\/p>\n\n\n\n

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Tak pokud se jedn\u00e1 o neuropatii, tak ta se diagnostikuje elektrofyziologick\u00fdm vy\u0161et\u0159en\u00edm a pokud by se jednalo skute\u010dn\u011b o neuropatii, kter\u00e1 m\u016f\u017ee zp\u016fsobovat takov\u00e9 pocity brn\u011bn\u00ed, p\u00e1len\u00ed na t\u011bch noh\u00e1ch, ur\u010dit\u011b tam l\u00e9\u010dba je, je tam l\u00e9\u010dba bu\u010f symptomatick\u00e1, n\u011bjak\u00e9 l\u00e9ky se na to ps\u00e1t daj\u00ed, nejsou samoz\u0159ejm\u011b voln\u011b dostupn\u00e9, ale ta l\u00e9\u010dba se odv\u00edj\u00ed od t\u00e9 prim\u00e1rn\u00ed p\u0159\u00ed\u010diny, tak\u017ee bu\u010f se vylu\u010duje se ta cukrovka, nebo pak n\u011bjak\u00e9 dal\u0161\u00ed hormon\u00e1ln\u00ed poruchy, kter\u00fd m\u016f\u017eou zp\u016fsobovat a tak d\u00e1le, prost\u011b p\u00e1tr\u00e1 se po t\u00e9 p\u0159\u00ed\u010din\u011b, kter\u00e1 tu neuropatii vyvol\u00e1v\u00e1, ale ta samoz\u0159ejm\u011b l\u00e9\u010diteln\u00e1 je.<\/p>\n\n\n\n

——————–
A neuropati\u010dt\u00ed diabeti\u010dt\u00ed pacienti jsou vlastn\u011b taky va\u0161i klienti, to je tam ta prim\u00e1rn\u00ed diagn\u00f3za, kter\u00e1 m\u016f\u017ee pak vyvol\u00e1vat spasticitu, anebo sp\u00ed\u0161 necitlivost?<\/p>\n\n\n\n

——————–
Sp\u00ed\u0161 necitlivost, neuropatie vylo\u017een\u011b jako onemocn\u011bn\u00ed perifern\u00edch nerv\u016f a spasticita samotn\u00e1 vznik\u00e1 pr\u00e1v\u011b\u00a0posti\u017een\u00ed<\/strong>m\u00a0centr\u00e1ln\u00edho nervov\u00e9ho syst\u00e9mu, tak\u017ee neuropatie samoz\u0159ejm\u011b spad\u00e1 do spektra neurologick\u00fdch diagn\u00f3z, l\u00e9\u010d\u00edme to u n\u00e1s na na\u0161\u00ed klinice, ale metody t\u00e9 l\u00e9\u010dby jsou samoz\u0159ejm\u011b \u00fapln\u011b odli\u0161n\u00e9 od t\u00e9 spasticity.<\/p>\n\n\n\n

——————–
zazn\u011blo ale vy\u0161et\u0159en\u00ed emg, t\u00edm se potvrd\u00ed t\u0159eba ta po\u010d\u00ednaj\u00edc\u00ed neuropatii. Ano, ur\u010dit\u011b p\u0159ipome\u0148te, v \u010dem spo\u010d\u00edv\u00e1?<\/p>\n\n\n\n

——————–
spo\u010d\u00edv\u00e1 to v nalepen\u00ed elektrod na svaly a elektrick\u00e9 stimulaci dan\u00fdch nerv\u016f a my zji\u0161\u0165ujeme, jestli ty nervy fungujou dostate\u010dn\u011b, jestli vedou ty nervov\u00e9 vzruchy adekv\u00e1tn\u011b a n\u00e1sledn\u011b to emg vy\u0161et\u0159en\u00ed je dopln\u011bn\u00e9 jehlou EMG, kdy se vprav\u00ed jehla do sval\u016f a sn\u00edm\u00e1 se aktivita dan\u00e9ho svalu a dostate\u010dnost toho nervov\u00e9ho z\u00e1soben\u00ed.<\/p>\n\n\n\n

——————–
Tak by se vlastn\u011b mo\u017en\u00e1 potvrdilo nebo vyvr\u00e1tilo, \u017ee ty oby\u010dejn\u00e9 no\u010dn\u00ed k\u0159e\u010de v l\u00fdtk\u00e1ch, \u017ee vlastn\u011b nejsou neurologick\u00e9ho p\u016fvodu, \u017ee to nervstvo funguje. Dotaz esemeskov\u00fd na osteofyty, pan\u00ed doktorko.
——————–
J\u00e1 m\u00e1m na kr\u010dn\u00ed p\u00e1te\u0159i v\u00fdrazn\u00e9 osteofyty, m\u00e1m od toho pot\u00ed\u017ee, kter\u00e9 mi jdou a\u017e do hlavy do o\u010d\u00ed do \u010dela a souvis\u00ed to s tou kr\u010dn\u00ed p\u00e1te\u0159\u00ed a s t\u011bmi v\u00fdr\u016fstky, osteofyty.<\/p>\n\n\n\n

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Tak degenerativn\u00ed zm\u011bny kr\u010dn\u00ed p\u00e1te\u0159e m\u016f\u017eou zlobit v na\u0161\u00ed populaci v\u00fdrazn\u011b, ur\u010dit\u011b tam m\u016f\u017ee doch\u00e1zet k lok\u00e1ln\u00edm svalov\u00fdm spasm\u016fm, k lok\u00e1ln\u00edmu p\u0159et\u011b\u017eov\u00e1n\u00ed ur\u010dit\u00fdch svalov\u00fdch skupin a naopak pak nedostate\u010dn\u00e9 funkci jin\u00fdch svalov\u00fdch skupin a t\u00edm, \u017ee je tam tahle svalov\u00e1 dysbalance, tak to vyvol\u00e1v\u00e1 ty bolestiv\u00e9 vjemy, ur\u010dit\u011b prim\u00e1rn\u011b zam\u011b\u0159it se na rehabilitaci, na pos\u00edlen\u00ed t\u011bch ochabl\u00fdch svalov\u00fdch skupin a na uvoln\u011bn\u00ed t\u011bch p\u0159et\u011b\u017eovan\u00fdch, samoz\u0159ejm\u011b z\u00e1le\u017e\u00ed u\u017e od konkr\u00e9tn\u00edho typu\u00a0posti\u017een\u00ed<\/strong>, kter\u00e9 pacientka m\u00e1, jestli tam je i n\u011bjak\u00fd \u00fatlak n\u011bkter\u00fdch nervov\u00fdch struktur, nebo se jedn\u00e1 pr\u00e1v\u011b jenom o ty kostn\u00ed v\u00fdr\u016fstky, kter\u00e9 dr\u00e1\u017ed\u00ed ty lok\u00e1ln\u00ed svalov\u011b vazivov\u00e9 struktury.<\/p>\n\n\n\n

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Dobr\u00fd den. M\u016f\u017eete se pt\u00e1t.<\/p>\n\n\n\n

—
Pros\u00edm v\u00e1s, j\u00e1 m\u00e1m probl\u00e9m. Je u\u017e to asi \u010dty\u0159i m\u011bs\u00edce, co mn\u011b p\u00edchlo v pat\u011b a jako napuchla mi noha a pak tohleto i do prav\u00e9. A u\u017e\u00edv\u00e1m l\u00e9k. Byl jsem u pan\u00ed doktorky, no, a nem\u016f\u017eu chodit, m\u00e1m nohu jak kdyby d\u0159ev\u011bnou.<\/p>\n\n\n\n

mluv\u010d\u00ed 3,
——————–
Tak ta p\u0159\u00ed\u010dina, tam jsem u\u017e z\u0159ejm\u011b m\u016f\u017ee b\u00fdt r\u016fznorod\u00e1, jestli tam byl n\u011bjak\u00fd \u00faraz vstupn\u011b nebo sp\u00ed\u0161 jenom pr\u00e1v\u011b n\u011bjak\u00e9 svalov\u00e9 p\u0159et\u00ed\u017een\u00ed, t\u011b\u017eko \u0159\u00edct, v ka\u017ed\u00e9m p\u0159\u00edpad\u011b ur\u010dit\u011b, pokud v\u00e1s vid\u011bla praktick\u00e1 l\u00e9ka\u0159ka, tak si v\u00e1s adekv\u00e1tn\u00ed ur\u010dit\u011b vy\u0161et\u0159ila, pokud by bylo nutn\u00e9 tak vyhledat mo\u017en\u00e1 ortopedick\u00fd vy\u0161et\u0159en\u00ed, pokud ty pot\u00ed\u017ee za\u010daly v oblasti pat, z\u00e1le\u017e\u00ed od konkr\u00e9tn\u00edch jednotliv\u00fdch p\u0159\u00edznak\u016f.<\/p>\n\n\n\n

——————–
Jak d\u0159ev\u011bn\u00e9. M\u011bl jsem 75 let.<\/p>\n\n\n\n

——————–
Co by mohlo nab\u00eddnout neurologie?<\/p>\n\n\n\n

——————–
Samoz\u0159ejm\u011b, ale bez klinick\u00e9ho vy\u0161et\u0159en\u00ed pacienta je to hodn\u011b sv\u00edzeln\u00e9, jenom po telefonu takhle poradit, tak z\u00e1le\u017e\u00ed, jestli ta kon\u010detina je oslaben\u00e1, nebo je to limitov\u00e1no jenom bolest\u00ed, nebo jestli je otekl\u00e1, jestli tam je c\u00e9vn\u00ed z\u00e1soben\u00ed dostate\u010dn\u00e9…<\/p>\n\n\n\n

——————–
t\u0159eba neurolog v ter\u00e9nu, jak \u0159\u00edk\u00e1m, v t\u011bch ambulanc\u00edch, va\u0161i kolegov\u00e9 v ter\u00e9nu by asi vy\u0161et\u0159ovali t\u00edm poklepem t\u011bmi klad\u00edvky?<\/p>\n\n\n\n

——————–
Je to samoz\u0159ejm\u011b sou\u010d\u00e1st toho vy\u0161et\u0159en\u00ed, kdy se vy\u0161et\u0159uj\u00ed reflexy a odpov\u011b\u010f na tu perifern\u00ed stimulaci, jestli ty nervy fungujou dostate\u010dn\u011b a stimuluj\u00ed ty svaly dostate\u010dn\u011b.<\/p>\n\n\n\n

——————–
Poj\u010fme se vr\u00e1tit k t\u011bm prav\u00fdm velk\u00fdm spasm\u016fm?

——————–
Tak u t\u011bch vylo\u017een\u011b neurologick\u00fdch projev\u016f spasticity dok\u00e1\u017eeme pacient\u016fm v r\u00e1mci neurologick\u00e9 kliniky ur\u010dit\u011b nab\u00eddnout pomoc. Dok\u00e1\u017eeme jim zlep\u0161it kvalitu \u017eivota, a to lok\u00e1ln\u00ed aplikaci botolotoxinu do t\u011bch jednotliv\u00fdch svalov\u00fdch skupin, kter\u00e9 jsou nejv\u00edc\u00a0posti\u017een\u00e9<\/strong>, tak\u017ee pokud n\u00e1s sly\u0161\u00ed pacienti, kter\u00fd nap\u0159\u00edklad prod\u011blali c\u00e9vn\u00ed mozkovou p\u0159\u00edhodu a maj\u00ed n\u011bjak\u00e9 v\u00fdrazn\u00e9 zkr\u00e1cen\u00ed sval\u016f, trp\u00ed na svalov\u00e9 k\u0159e\u010de, na bolesti, tak ur\u010dit\u011b, a\u0165 se obr\u00e1t\u00ed na sv\u00e9ho praktick\u00e9ho l\u00e9ka\u0159e, kter\u00fd m\u016f\u017ee nasm\u011brovat k n\u00e1m na neurologickou kliniku, k n\u011bjak\u00e9 specifick\u00e9 l\u00e9\u010db\u011b.<\/p>\n\n\n\n

——————–
A m\u00e1te tu zku\u0161enost, \u017ee \u010dastokr\u00e1t to pom\u016f\u017ee, kdy\u017e ta neurologick\u00e1 p\u0159\u00ed\u010dina tam opravdu je, ale do jak\u00e9 m\u00edry vlastn\u011b je vid\u011bt t\u0159eba opravdu vizu\u00e1ln\u011b ten efekt, kdy\u017e jsme mluvili o tom postaven\u00ed prstu na rukou, na nohou atd.<\/p>\n\n\n\n

——————–
ten efekt l\u00e9\u010dby nen\u00ed okam\u017eit\u00fd, to znamen\u00e1, \u017ee my aplikujeme botuotox, a ten efekt za\u010dne p\u0159ibli\u017en\u011b za 4-7 dn\u016f a n\u00e1sledn\u011b ta kon\u010detina za\u010dne b\u00fdt st\u00e1le v\u00edc a v\u00edc voln\u011bj\u0161\u00ed, v ka\u017ed\u00e9m p\u0159\u00edpad\u011b k n\u00e1m pacienti chod\u00ed p\u0159ibli\u017en\u011b co 3-4 m\u011bs\u00edce, tak\u017ee my je vid\u00edme v\u017edycky v tom nejhor\u0161\u00edm a to zlep\u0161en\u00ed od nich zji\u0161\u0165ujeme anamnesticky, od nich a od jejich rodinn\u00fdch p\u0159\u00edslu\u0161n\u00edk\u016f, kter\u00fd n\u00e1m pr\u00e1v\u011b dok\u00e1\u017eou sd\u011blit, \u017ee ta kon\u010detina byla pot\u00e9 o mnoho voln\u011bj\u0161\u00ed, dok\u00e1zalo se s n\u00ed cvi\u010dit a byla i n\u011bjak\u00e1 funkce.<\/p>\n\n\n\n

——————–
Po t\u00e9 injekci botox\u016f, to bylo dobr\u00e9, ale do\u010dasn\u00e9?<\/p>\n\n\n\n


——————–
P\u0159esn\u011b tak, je to v\u017edycky do\u010dasn\u00e9, ten efekt je v\u017edycky jenom p\u0159echodn\u00fd a mus\u00ed se pokra\u010dovat v l\u00e9\u010db\u011b dlouhodob\u011b.<\/p>\n\n\n\n

———————————–<\/p>\n\n\n\n

Pan\u00ed Dr. Lenka Satke z neurologick\u00e9 kliniky Fakultn\u00ed nemocnice Olomouc, d\u00edky za n\u00e1v\u0161t\u011bvu.<\/p>\n\n\n\n

\u010cesk\u00fd rozhlas Olomouc<\/p>\n","protected":false},"excerpt":{"rendered":"

Co dok\u00e1\u017ee zabrat na k\u0159e\u010d v l\u00fdtku, ve stehn\u011b atd., kter\u00e1 b\u00fdv\u00e1 typicky v noci? Ve vys\u00edl\u00e1n\u00ed \u010cRo radila MUDr. Lenka Satke, neurologick\u00e1 klinika Fakultn\u00ed […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":15606,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-42770","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravi"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/42770","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=42770"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/42770\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/15606"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=42770"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=42770"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=42770"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}