521 - From Wheelchair Bound to Working: A Case Study of Intravenous Ketamine Infusions in Treating Stiff Person Syndrome

Case Diagnosis: Stiff Person Syndrome is an autoimmune condition marked by extremely painful muscle spasms, stiffness, and rigidity throughout the body. Its rarity often translates to limited treatment options for patients and challenges in obtaining a definitive diagnosis. SPS also impacts patients' mental health, social and economic involvement, and overall quality of life.

Case Description: A 43-year-old man was diagnosed with SPS by a neurologist and confirmed by anti-GAD antibody testing. His Pain Management doctor subsequently offered intravenous ketamine treatment, which he found to positively impact the treatment of similar disorders. After an initial 10-day infusion, the patient reported improvement in pain and function. After months of treatment, the patient reported improvement in all aspects of his disease and was able to return to work and experience an enhanced quality of life.. The patient was able to discontinue the use of fentanyl patches and continued taking ketamine lozenges, oxycodone-acetaminophen, and dextromethorphan for pain management.

Discussions: The patient in this case report initially received ketamine and anti-GAD antibody infusions. Although anti-GAD antibodies are commonly administered to patients with SPS exhibiting GAD antibodies, there is no protocol for treatment if a patient ceases to respond to these infusions. Fortunately, the patient had been undergoing ketamine infusions. Ketamine is gaining traction as an effective treatment for alleviating symptoms associated with neurological and autoimmune disorders, demonstrating notable efficacy. The patient under examination in this report experienced symptom relief in all aspects of his disease, including pain, muscle rigidity and spasms, mental clarity, and depression. He can now walk unassisted and has successfully returned to work.

Conclusions: This case illustrates the benefits of ketamine treatment for patients with treatment-resistant SPS and similar neurologic disorders. Examining treatment alternatives for rare syndromes is crucial for achieving optimal patient outcomes. Documenting cases offers insights into the mechanism of ketamine beyond these syndromes.