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1.  Differential diagnosis and treatment of muscle hypertonia as practiced in Zagreb's Centre/Institute for Neuromuscular Diseases 
Acta Myologica  2013;32(3):170-173.
Because I am a neuromyologist that has dealt for many years with muscle hypertonia, I decided to write my memories in order to motivate younger researchers to try to duplicate the same observations and experiences.
We defined a whole range of conditions and symptoms, partly or in full. That is the first crucial step on the way to suppressing or relieving suffering. In some cases there was nothing we could do. In the other cases, we managed to diminish the uncomfortable symptoms. In still other cases, we cured the diseases, at least for a while. My conclusion is that great and systematic effort is always worth the trial. Maybe someone will follow us?!
Always again, I used to repeat to myself and to the others that, when approaching the patient, always the following rules should be respected: watch, listen and use your own common sense to evaluate what you observe; analyse why the symptoms occur in a concrete case; include the therapy in the logic of symptom development; continue to follow the patient and ask questions of yourself and of your colleagues; consult the literature; find the differences; ask again and again what else could be done ... and the solutions will appear unexpectedly.
PMCID: PMC4006277  PMID: 24803845
Spasticity; cramps; neuromyotony
2.  Introducing corticosteroids therapy from 1969 to 1990 at the Centre/Institute for Neuromuscular Diseases, KBC Rebro, Zagreb, Croatia 
Acta Myologica  2012;31(2):156-160.
The author presents the chronological development of therapy by corticosteroids in myasthenia gravis (MG), as well as dilemmas connected to this kind of treatment at the Centre/Institute Zagreb, she founded. The improvement of postoperative prognosis of thymectomy with corticosteroids is described and transfer of positive experiences to other neurological diseases. The side effects can be reduced significantly by respecting the basic rules: the choice of corticosteroids (fluocortolone, methyprednisolone, no dexamethasone), single dose administered in the morning, not later than 8 a.m. (respecting the circadian rhythm of concentration of cortisol in blood). Initially, the high dose is administered daily, until the stabilisation of signs and symptoms improvement. Then, in my early modification, the initial dose, administered every other day, becames gradually lowered. The diet is similar to diabetic, with the potassium added. In the period from 1973 to 1990, 212 myasthenia gravis and 37 polymyositis patients were treated that way.
We recommend to continue endocrinological research, on which we already reported, now with contemporary methods. The value of the "pulse therapy" should be analysed in more details, with peroral corticosteroids added afterwards.
PMCID: PMC3476860  PMID: 23097609
Myasthenia gravis; corticosteroids
3.  Progressive Encephalomyelitis With Rigidity: A Case Report 
The most prominent clinical features of progressive encephalomyelitis with rigidity (PER) are painful spasms and rigidity accompanied by clinical signs of brainstem and spinal cord involvement. In initial reports, PER had fatal outcome. Later, clinical improvement related to corticosteroid therapy has been described in some cases. The objective of this study was to signify a reputed clinical significance of corticosteroid therapy in PER.
Case report.
A 50-year-old man developed progressive syndrome of tonic extensor spasms. Magnetic resonance imaging (MRI) showed areas of signal changes in cervical spinal cord and lower brainstem, whereas cerebrospinal fluid analysis indicated subacute encephalomyelitis. His condition dramatically improved on oral corticosteroid therapy. Clinical improvement was accompanied by normalization of MRI findings.
For this patient with PER, corticosteroid therapy was a dramatically effective and life-saving treatment, although initiated rather late in the course of the disease.
PMCID: PMC2853333  PMID: 20397447
Spasticity; Muscle spasms, tonic; Encephalomyelitis, progressive; Corticosteroid therapy; Methylprednisolone; Magnetic resonance imaging; Decerebrate posture
4.  Nerve potentials and afferent conduction velocities in the differential diagnosis of amyotrophy of the hand 
Nerve action potentials recorded over the elbow after stimulation of the wrist were studied in patients with hand amyotrophy of different origin. In amyotrophic lateral sclerosis the amplitude of nerve action potentials does not change significantly even with extreme muscle wasting and loss of motor units.
Studies of multisegmental afferent conduction velocities may demonstrate a strictly localized lesion with normal values above the compression.
PMCID: PMC494193  PMID: 4346024

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