Síndrome de Stiff-Person: Revisão
DOI:
https://doi.org/10.46531/sinapse/AR/220033/2022Keywords:
Stiff-Person Syndrome/ diagnosis, Stiff-Person Syndrome/ etiology, Stiff-Person Syndrome/therapyAbstract
Stiff-person syndrome is a rare autoimmune neurologic disorder characterized by progressive muscular rigidity and painful muscle spasms predominantly affecting the axial and the proximal limb muscles. Most patients with stiff-person syndrome have antibodies directed against the glutamic acid decarboxylase, the rate-limiting enzyme for the production of inhibitory neurotransmitter gamma-aminobutyric acid. Paraneoplastic stiff-person syndrome is commonly associated with anti-amphiphysin antibodies and breast cancer. Treatment of stiff-person syndrome with drugs that increase the GABAergic tone, including the benzodiazepines, combined with immunotherapy can improve the neurological manifestations of these patients. However, the prognosis is unpredictable and spontaneous remissions are unlikely. The literature on this topic is still scarce and, as it is a rare entity, it is poorly recognized and probably underdiagnosed. This review article will describe important updates and organize the existing information about this topic.Downloads
References
Moersch FP, Woltman HW. Progressive fluctuating muscular rigidity and spasm (stiff-man syndrome): report of a case and some observations in 13 other cases. Proc Staff Meet Mayo Clin. 1956;31:421–7.
Baizabal-Carvallo JF, Jankovic J. Movement disorders in autoimmune diseases. Mov Disord. 2012;27:935–46. doi: 10.1002/mds.25011
Hadavi S, Noyce AJ, David LR, Giovannoni G. Stiff person syndrome. Pract Neurol. 2011;11:272–82. doi: 10.1136/ practneurol-2011-000071
Dalakas MC. Stiff person syndrome: advances in pathogenesis and therapeutic interventions. Curr Treat Options Neurol. 2009;11:102–10. doi: 10.1007/s11940-009-0013-9
Dalakas MC. Stiff-person Syndrome and GAD Antibody-spectrum Disorders: GABAergic Neuronal Excitability, Immunopathogenesis and Update on Antibody Therapies. Neurotherapeutics. 2022 ;19:832-47. doi: 10.1007/s13311022-01188-w.
Bilic E, Bilic E, Sepec BI, Vranjes D, Zagar M, Butorac V, et al. Stiff-person syndrome, type 1 diabetes, dermatitis herpetiformis, celiac disease, microcytic anemia and copper deficiency. Just a coincidence or an additional shared pathophysiological mechanism? Clin Neurol Neurosurg. 2009;111:644–5. doi: 10.1016/j.clineuro.2009.04.006
Fenalti G, Buckle AM. Structural biology of the GAD autoantigen. Autoimmun Rev. 2010;9:148–52. doi: 10.1016/j. autrev.2009.05.003.
Ali F, Rowley M, Jayakrishnan B, Teuber S, Gershwin ME, Mackay IR. Stiff-person syndrome (SPS) and anti-GAD-related CNS degenerations: protean additions to the autoimmune central neuropathies. J Autoimmun. 2011;37:79–87. doi: 10.1016/j.jaut.2011.05.005
Levy LM, Levy-Reis I, Fujii M, Dalakas MC. Brain gammaaminobutyric acid changes in stiff-person syndrome. Arch Neurol. 2005;62:970–4. doi: 10.1001/archneur.62.6.970
Holmoy T, Geis C. The immunological basis for treatment of stiff person syndrome. J Neuroimmunol. 2011;231:55–60. doi: 10.1016/j.jneuroim.2010.09.0149.
Raju R, Hampe CS. Immunology of stiff-person syndrome. Int Rev Immunol. 2008; 27:79–92. doi: 10.1080/08830180701883240
Manto MU, Laute MA, Aguera M, Rogemond V, Pandolfo M, Honnorat J. Effects of anti-glutamic acid decarboxylase antibodies associated with neurological diseases. Ann Neurol. 2007;61:544–51. doi: 10.1002/ana.21123
Muñoz-Lopetegi A, de Bruijn MA, Boukhrissi S, Bastiaansen AE, Nagtzaam MM, Hulsenboom ES, et al. Neurologic syndromes related to anti-GAD65: Clinical and serologic response to treatment. Neurol Neuroimmunol Neuroinflamm. 2020;7:e696. doi: 10.1212/NXI.0000000000000696.
Rosin L, De Camilli P, Butler M, Solimena M, Schmitt HP, orgenthaler N, et al. Stiff-man syndrome in a woman with breast cancer: an uncommon central nervous system paraneoplastic syndrome. Neurology. 1998;50:94–8. doi: 10.1212/wnl.50.1.94
Butler M, Hayashi A, Ohkoshi N, Villmann C, Becker CM, Feng G, et al. Autoimmunity to gephyrin in stiff-man syndrome. Neuron. 2000;26:307–12. doi: 10.1016/s08966273(00)81165-4
Pittock SJ, Lucchinetti CF, Parisi JE, Benarroch E, Mokri B, Stephan CL, et al. Amphiphysin autoimmunity: paraneoplastic accompaniments. Ann Neurol. 2005;58:96–107. doi: 10.1002/ana.20529
Meinck HM. Stiff man syndrome. CNS Drugs. 2001;15:51526. doi: 10.2165/00023210-200115070-00002.
Gershanik OS. Stiff-person syndrome. Parkinsonism Relat Disord. 2009;15:S130–4. doi: 10.1016/S13538020(09)70799-0
Economides JR, Horton JC. Eye movement abnormalities in stiff person syndrome. Neurology. 2005;65:1462–4. doi: 10.1212/01.wnl.0000183068.42803.33
Mitsumoto H, Schwartzman MJ, Estes ML, Chou SM, Franchise EF, Camilli PD, et al. Sudden death and paroxysmal autonomic dysfunction in stiff-man syndrome. J Neurol 1991;238:91–6. doi: 10.1007/BF00315688
Tinsley JA, Barth EM, Black JL, Williams DE. Psychiatric consultations in stiff-man syndrome. J Clin Psychiatry. 1997;58:444–9. doi: 10.4088/jcp.v58n1007
Ameli R, Snow J, Rakocevic G, Dalakas MC. A neuropsychological assessment of phobias in patients with stiff person syndrome. Neurology. 2005;64:1961–3. doi: 10.1212/01. WNL.0000163984.71993.FE
Barker RA, Revesz T, Thom M, Marsden CD, Brown P. Review of 23 patients affected by the stiff man syndrome: clinical subdivision into stiff trunk (man) syndrome, stiff limb syndrome, and progressive encephalomyelitis with rigidity. J Neurol Neurosurg Psychiatry. 1998;65:633–40. doi: 10.1136/jnnp.65.5.633
Damásio J, Leite MI, Coutinho E, Waters P, Woodhall M, Santos MA, et al. Progressive encephalomyelitis with rigidity and myoclonus: the first pediatric case with glycine receptor antibodies. JAMA Neurol. 2013;70:498-501. doi: 10.1001/jamaneurol.2013.1872.
Mas N, Saiz A, Leite MI, Waters P, Baron M, Castaño D, et al. Antiglycine-receptor encephalomyelitis with rigidity. J Neurol Neurosug Psychiatry. 2011;82:1399–401. doi: 10.1136/jnnp.2010.229104
Baizabal-Carvallo JF, Jankovic J. Stiff-person syndrome: insights into a complex autoimmune disorder. J Neurol Neurosurg Psychiatry. 2014;0:1–9. doi: 10.1136/jnnp-2014309201
Duddy ME, Baker MR. Stiff person syndrome. Front Neurol Neurosci. 2009;29:147–65. doi: 10.1159/000212375
Balint B, Thomas R. Hereditary Hyperekplexia Overview. 2007 Jul 31 [Updated 2019 Dec 19]. In: Adam MP, Mirzaa GM, Pagon RA, et al, editors. GeneReviews® [Internet]. Seattle: University of Washington, Seattle; 2022.
Mine J, Taketani T, Yoshida K, Yokochi F, Kobayashi J, Maruyama K, et al. Clinical and genetic investigation of 17 Japanese patients with hyperekplexia. Dev Med Child Neurol. 2015;57:372-7. doi: 10.1111/dmcn.12617.
Thomas RH, Chung SK, Wood SE, Cushion TD, Drew CJ, Hammond CL, Vanbellinghen JF, Mullins JG, Rees MI. Genotype-phenotype correlations in hyperekplexia: apnoeas, learning difficulties and speech delay. Brain. 2013;136:308595. doi: 10.1093/brain/awt207.
Alberca R, Romero M, Chaparro J. Jerking stiff-man syndrome. J Neurol Neurosurg Psychiatry. 1982;45:1159-60. doi: 10.1136/jnnp.45.12.1159.
Dalakas MC, Fujii M, Li M, McElroy B. The clinical spectrum of anti-GAD antibody-positive patients with stiff-person syndrome. Neurology. 2000;55:1531–5. doi: 10.1212/ wnl.55.10.1531
Newsome SD, Johnson T. Stiff person syndrome spectrum disorders; more than meets the eye. J Neuroimmunol. 2022;369:577915. doi: 10.1016/j.jneuroim.2022.577915
Vedeler CA, Antoine JC, Giometto B, Graus F, Grisold W, Hart IK, et al. Management of paraneoplastic neurological syndromes: report of an EFNS Task Force. Eur J Neurol. 2006;13:682-90. doi: 10.1111/j.1468-1331.2006.01266.x.
Nolan JD, Nicholas JA. Stiff-Person Syndrome – treatment consists of immunomodulatory therapies and symptom management. Practical Neurology. 2020;61-4.
Ortiz JF, Mohammad RG, Cox AM, Tambo W, Bashir F, Wirth M, et al. Stiff-Person Syndrome: a treatment update and New directions. Cureus. 2020;12: e11995. doi: 10.7759/ cureus.11995
Zappaterra M, Shouse E, Levine RL. Low-dose naltrexone reduces symptoms in stiff-person syndrome. Med Hypotheses. 2020;137:109546. doi: 10.1016/j.mehy.2019.109546
Dalakas MC, Fujii M, Li M, Lutfi B, Kyhos J, McElroy B. High-dose intravenous immune globulin for stiff-person syndrome. N Engl J Med. 2001;345:1870–6. doi: 10.1056/ NEJMoa01167
Sanchez K, Ullah A, Waler AR, Chakfe Y. Improving ambulation and minimizing disability with therapeutic plasma exchange in a stiff-person syndrome patient with recurrent falls. Cureus. 2019;11:e6209. doi: 10.7759/cureus.6209
McKeon A, Robinson MT, McEvoy KM, Matsumoto JY, Len-non VA, Ahlskog JE, et al. Stiff-man syndrome and variants: clinical course, treatments, and outcomes. Arch Neurol. 2012;69:230-8. doi:10.1001/archneurol.2011.991
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Ana Azevedo, Rita Gomes, Joana Damásio, Ernestina Santos
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.