Stiff-man syndrome presenting with complete esophageal obstruction. Report of a case

Paraneoplastic "stiff person syndrome" with metastatic adenocarcinoma and anti-Ri antibodies

A 43-year-old woman presented with clinical and electrophysiologic features of stiff person syndrome (SPS), without abdominal or lumbar paraspinal muscle involvement. Investigations revealed metastatic adenocarcinoma of the lung with positive anti-Ri antibodies. Her clinical condition improved with diazepam, baclofen, tizanidine, and palliative chemotherapy. Screening for an underlying malignancy and anti-Ri antibodies should be considered in patients with SPS when clinical presentation is atypical.

Gastrointestinal involvement in neurologic disorders: Stiff-man and Charcot-Marie-Tooth syndromes

Many neurologic conditions can affect the striated muscle of the gastrointestinal tract, resulting in dysphagia. In this article, two patients with rare neurologic disorders are reported (Stiff-man syndrome and Charcot-Marie-Tooth syndrome). Both patients had pharyngeal dysphagia. In addition, there was evidence of smooth muscle involvement in other areas of the gastrointestinal tract, specifically abnormal esophageal motility and delayed gastric emptying. In the English literature, there are only two reports of Stiff-man syndrome and dysphagia, and there are no reports of Charcot-Marie-Tooth syndrome. These represent the first accounts of smooth muscle dysfunction in those uncommon neurologic disorders.

Stiff-person syndrome: an autoimmune disease

Stiff-person syndrome (SPS) is characterized by progressive, usually symmetric rigidity of the axial muscles with superimposed painful spasms precipitated by tactile stimuli, passive stretch, volitional movement of affected or unaffected muscles, startling noises, and emotional stimuli. Electromyography demonstrates continuous normal motor unit potentials in the affected muscles. Both the rigidity and the spasms are relieved by sleep, general anesthesia, myoneural blockade, peripheral nerve blockade, and partially by diazepam. Evidence for an autoimmune etiology of SPS includes its association with other autoimmune diseases and autoantibodies and the presence of antibodies against glutamic acid decarboxylase (GAD) in the cerebrospinal fluid (CSF) of many affected patients. We describe two patients with this syndrome who had GAD antibodies in both CSF and serum. Partial relief of the symptoms in these patients by corticosteroid therapy provides additional evidence of an autoimmune etiology of SPS and of the role of immunotherapy in its treatment.

Stiff-man syndrome updated

Stiff-man syndrome, a rare disorder characterized by intermittent spasms and stiffness of the axial muscles, is associated with an electromyographic pattern of continuous motor unit activity in affected muscles. Since the initial description in 1956, the stiff-man syndrome has been reported to occur in various clinical and neurologic settings. In this study, we reviewed the current state of knowledge about this syndrome, defined diagnostic criteria, provided a long-term follow-up of the disorder, and assessed rehabilitative attempts in affected patients. Use of rigorous criteria that identify patients who have the stiff-man syndrome is important because the initial clinical manifestations are similar to those of other neuromuscular diseases. Analysis of 13 patients with stiff-man syndrome examined at the Mayo Clinic during the past 30 years revealed that treatment with diazepam decreased the muscle spasms. Because some muscle spasms usually persist, rehabilitation is an important adjunct that may further improve function when it is centered on the treatment of low-back pain and hyperlordosis, mobility problems, gait abnormalities, and muscular stiffness.