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547 - Stretching and Strengthening for Stiff Person Syndrome: A Case Report

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

BB

Brandon J. Burg, DO

Resident Physician
NYU Langone Rusk
Syosset, New York, United States

Co-Author(s)

SM

Sara Mermelstein, DO

PGY-1
NYU Langone Rusk
New York, New York, United States
DB

Dylan Banks, MD

PGY-3 PM&R Resident
Nyu Langone
New York, New York, United States
Heidi Fusco, MD

Attending
NYU Langone Rusk
New York, New York, United States

Case Diagnosis: Stiff Person Syndrome

Case Description: 64 year old male with history of renal cell carcinoma, on cabozantinib, nivolumab, presented for evaluation of progressing left leg paresis, dysarthria, and dysphagia. Exam revealed left facial weakness, left arm paresis, left leg paresis. Hyperreflexia was observed on both legs. Labs notable for high anti-GAD ( >250), elevated inflammatory markers and CK. He was diagnosed with GAD 65 positive Stiff Person Syndrome (SPS) in the setting of renal cell carcinoma status post immunotherapy. He completed a course of IVIG and 3 doses of IV steroids. During his acute rehabilitation stay, he did not tolerate oral baclofen or klonopin. Ultimately, Botox was administered. The patient made significant functional gains with intense inpatient therapies throughout his rehabilitation stay. He went from nonambulatory to ambulating 118 meters with a walker and minimal assistance. He became independent in all BADLs. He also made swallowing improvements and had improved speech intelligibility on discharge.

Discussions: SPS is a rare disorder, characterized by fluctuating rigidity of axial and proximal lower limb muscles with painful spasms occurring after sudden stimuli. It often shows continuous motor unit activity on electromyography. It is underdiagnosed with limited literature available. Significant research has shown the therapeutic effects of benzodiazepines, botulinum toxin, baclofen and IVIG on SPS, but limited research has been done to demonstrate the benefits of physical therapy on SPS treatment. Active range of motion, stretching, low back exercises and gait training can be beneficial for these patients. This case highlights the benefit of physical therapy on decreasing stiffness, increasing range of motion, and increasing independence in an SPS patient.

Conclusions: This case highlights the key role that quality therapy services can play in the treatment of SPS.