Higher concentrations of free Gc-globulin in blood plasma and CSF collected from patients suffering from neurodegenerative diseases may indicate a potential role of this protein in their pathogenesis, and represent a potential tool for the diagnosis of CNS diseases.

We present a case of a 39-year-old patient, who was diagnosed and treated for a tick-borne meningoencephalitis. Three months after the treatment he started to complain of annoying, cracks-resembling, rhythmical sounds, coming from the inside of his head to both his ears. Physical examination revealed rhythmical oscillations of the soft palate with a frequency of 100-120 per minute and a clock ticking noise synchronic with the palate tremor. Electromyography revealed continuous motor unit activity at rest in the tensor veli palatini muscle. Palatal myoclonus (PM) as a result of tick-borne meningoencephalitis was diagnosed. Treatment with several medications was started with no effect, then botulinum toxin was administered under EMG guidance to both sides of the patient's soft palate with great improvement. A 5-year follow-up and continuation of botulinum toxin injections with only minor and reversible side effects proved the treatment efficacy and safety. In the article we present a case of symptomatic palatal myoclonus with ear click and shortly discuss its aetiology, types and treatment options. We also stress the efficacy and safety of PM treatment with repetitive injections of botulinum toxin.

A 41-year-old female with history of Graves' disease, bilateral cataract, paroxysmal atrial fibrillation was admitted because of muscle weakness, daytime sleepiness, fatigability, drowsiness, bilateral eyelid ptosis, descending of head and lower jaw. On neurological examination the patient was presented with muscle weakness, muscle atrophy (in face and sternocleidomastoid muscles), features of myotonia and apocamnosis (orbicular muscles). Electromyography revealed myopathic changes, myotonic and pseudomyotonic discharges, positive repetitive nerve stimulation test in proximal muscles. Myotonic dystrophy (MD) diagnosis was confirmed by genetic testing and myasthenia gravis (MG) by a positive titer of cholinergic receptor autoantibodies. In the CSF concentration of hypocretin was significantly decreased.

Purpose Carpal tunnel syndrome (CTS) is the most common compression neuropathy, which is associated with a significant psy- chosocial and economic burden. In this paper, the literature on the current knowledge about the physiology and pathology of peri- pheral nerves during the course of CTS is reviewed, with a focus on currently used treatment options and the rationale for their use. Epidemiology, risk factors, etiology, clinical features and conservative treatment have been searched for, with all full-text, English language articles being included in the study. This paper aims to present the recent findings on CTS treatment while also suggesting a direction for further clinical trials. Views The search in PubMed and Google Scholar Databases revealed 229 articles of which 71 met the research criteria. The evi- dence regarding standard treatment methods of conservative CTS treatment is presented. CTS is a relatively common condition, which affects women more often than men. It is a multifactorial disease, and its clinical presentation mostly consists of symptoms distal to the entrapment site, including numbness, tingling, weakness and pain. Electrodiagnostic studies are considered to be the gold standard in CTS diagnosis. The conservative treatment methods reviewed are acupuncture, extracorporeal shock wave the- rapy, hydrodissection, kinesiotaping, corticosteroid injection, low level laser therapy, splints, platelet-rich plasma injection, manual therapy, ultrasound and phonophoresis. Conclusions Based on the current body of knowledge, we conclude that the conservative CTS treatment is very safe, but the effec- tiveness of reviewed methods differs. The first promising results presented by various studies motivate the need for further research on novel treatment methods.

We examined the safety and effectiveness of a low dose of analog granulocyte-colony stimulating factor in a 15-year-old boy with facioscapulohumeral dystrophy. The onset of disease was noted at 12 years of age. The physical examination noted general muscle atrophy more pronounced at left side of the body. He was able to walk 300 meters within 6 minute walk test. Granulocyte colony-stimulating factor 5 μg/kg was given subcutaneously daily for 5 days/month for 1, 2, 3, 6 and 12 months. Clinical examination, laboratory tests including blood, biochemical tests, and CD34+ cells were performed. A significant increase of muscle strength in the lower and upper limbs between baseline, and after 3 months of treatment, after 6, and after 12 months was found. He was able to walk 480 meters within 6 minutes after 12 months. Electromyography demonstrated increase of amplitude in the examined in upper and lower limbs after six months compared to baseline. Leukocyte levels remained below 25000/μL. CD34+ increased significantly at day 5 of granulocyte colony-stimulating factor admini-stration. It was safe and well tolerated by the patient. A significant increase in muscle strength in this patient with facioscapulohumeral dystrophy after 3 months of treatment, after 6, and after 12 months since the first treatment course was completed may indicate beneficial effects of granulocyte colony-stimulating factor in this disorder.