Hassan AlHussein^1,, Syed Ali Raza¹, Roger E. Kelley¹

We report the apparent rare association of longstanding relapsing/remitting multiple sclerosis and stiff person syndrome. This middle-aged woman presented with truncal and lower extremities stiffness and spasm not responsive to a course of intravenous methylprednisolone or to high dose muscle relaxants. Her discomfort had progressed, over a one-month period, to being wheelchair bound and considering herself desperate for some type of relief. Of interest, she pursued the medical literature, as a registered nurse, and became convinced that she has stiff person syndrome superimposed on her multiple sclerosis which has not been previously reported. She was found to have an elevated anti-glutamic acid decarboxylase (GAD)-65 antibody titer supporting this association. She was responsive, at least over the short term, to a course of intravenous gamma globulin along with the addition of dantrolene to her regimen.

multiple sclerosis, stiff person syndrome, anti-glutamic acid decarboxylase (GAD) antibodies, progressive encephalomyelitis with rigidity and myoclonus (PERM)