Subacute encephalomyelitis presenting as stiff-person syndrome: Clinical, polygraphic, and pathologic correlations

Carmel Armon, Jerry W. Swanson, John M. McLean, Philip R. Westbrook, Haruo Okazaki, Paul J. Kurtin, Uma P. Kalyan-Raman, Moses Rodriguez

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

A 60-year-old woman presented with stiff-person syndrome (SPS). Treatment with diazepam controlled her painful spasms initially. Two and one-half years after the onset of SPS, new spells of paroxysmal leg jerking and apnea developed. A spell was recorded with simultaneous video and polygraphic techniques that revealed simultaneous firing of motor unit potentials in several muscles (paraspinal, internal hamstring, and abdominal muscles). Apnea was associated with arterial oxygen desaturation. An increase in the dose of diazepam decreased the number and severity of these episodes. Seventeen months later, the patient began to taper the diazepam dose. Shortly thereafter, she had a cardiorespiratory arrest and subsequently died. Autopsy showed small chronic inflammatory foci in the pancreas (some associated with islets) and findings of disease encephalomyelitis characterized by perivascular cuffing in the spinal cord, brainstem, thalamus, hippocampus, and amygdala and a dense mononuclear infiltrate in the anterior horns of the lumbar and cervical cord, with relative preservation of axons and myelin. Cell typing showed this infiltrate was polyclonal and reactive. There have been rare cases of SPS associated with encephalomyelitis reported previously, Although the prolonged course in our patient suggested that SPS may have preceded encephalomyelitis, the more likely explanation is that the patient had an unusually long course of encephalomyelitis alone.

Original languageEnglish (US)
Pages (from-to)701-709
Number of pages9
JournalMovement Disorders
Volume11
Issue number6
DOIs
StatePublished - Nov 26 1996

Keywords

  • Encephalomyelitis
  • Stiff-person syndrome
  • Surface electromyography
  • Video/electroencephalograhic

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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    Armon, C., Swanson, J. W., McLean, J. M., Westbrook, P. R., Okazaki, H., Kurtin, P. J., Kalyan-Raman, U. P., & Rodriguez, M. (1996). Subacute encephalomyelitis presenting as stiff-person syndrome: Clinical, polygraphic, and pathologic correlations. Movement Disorders, 11(6), 701-709. https://doi.org/10.1002/mds.870110616