Anti-glycine receptor antibody-positive progressive encephalomyelitis with rigidity and myoclonus initially presenting with one-sided stiff face: A case report

Neurophysiological Insights into the Pathophysiology of Stiff-Person Spectrum Disorders

BACKGROUND

Stiff Person Spectrum Disorders (SPSD) are classically defined by the presence of muscle stiffness, spasms and hyperactivity of the central nervous system. There is a notable correlation between neurophysiological features and the clinical hallmark of SPSD, which has greatly encouraged the use of these techniques for diagnostic purposes. Besides, electrophysiological techniques allow for a functional evaluation of the 'hyperactivity of the CNS', thus offering the opportunity to clarify the mechanisms underlying this disorder. This review delves into the current knowledge on the electrophysiological aspects of SPSD, highlighting the pivotal role of various studies in unravelling its pathophysiology.

METHODS

Literature review for studies on SPSD that included a neurophysiological evaluation.

RESULTS

We first examined the abnormal neurophysiological findings of SPSD across the central nervous system, from the spinal circuit to the motor cortex. Subsequently, we discussed their pathological implications and explored how these findings can be interpreted within the framework of an immune-mediated disorder.

CONCLUSIONS

Two primary questions remain unanswered: the localization of the primary abnormality within the central nervous system and the connection between the autoimmune basis of SPSD and its neurophysiological aspects. Addressing these questions could provide invaluable insights into SPSD etiology and targeted therapeutic strategies.

Stiff person spectrum disorder: overview with emphasis on head and neck comorbidities

Stiff person spectrum disorder (SPSD) is a rare progressive autoimmune neuromuscular syndrome, primarily resulting in severely painful spasms and rigidity of the axial and appendicular musculature. Affected individuals are predisposed to develop an array of other neuropathies, including cerebellar ataxia and seizure activity, ophthalmologic abnormalities, and other autoimmune-based systemic diseases, notably type 1 diabetes mellitus, thyroiditis, pernicious anemia, and malignancy. Limited information exists in the oral medicine literature regarding SPSD. Thus, the objective of this paper is to review the clinicopathologic features of SPSD, with particular emphasis on head and neck involvement. Additionally, clinical guidelines for dental management of affected individuals and a summary of surgical procedures and outcomes performed in the head and neck are provided. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).

Progressive encephalomyelitis with rigidity and myoclonus (PERM) associated with anti-glycine receptor antibodies and urothelial carcinoma: a case report

BACKGROUND

Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a rare neurological condition with paraneoplastic etiology in about 20% of cases, usually presenting before or shortly after the oncological diagnosis is established. PERM associated with anti-glycine receptor antibodies is not previously reported in a patient with bladder cancer.

CASE PRESENTATION

A 72-years-old Caucasian male was admitted with acute onset of dysarthria, dysphagia and trismus three years after initial surgical treatment for bladder cancer. The condition was initially diagnosed as tetanus and treated accordingly, but the diagnosis was reconsidered because of progression despite adequate treatment. Diagnostic workup on readmission revealed lung and paraaortal metastases from bladder cancer and anti-glycine receptor (anti-GlyR) antibodies both in the cerebrospinal fluid and in serum, which supplemented with the clinical presentation led to the diagnosis of PERM, presumably related to bladder cancer. The patient showed improvement and stabilization after treatment with intravenous immunoglobulin and chemotherapy against metastatic bladder cancer.

CONCLUSION

To the best of our knowledge, this is the first reported case of anti-GlyR antibody positive PERM related to urothelial carcinoma. The symptoms mimicked tetanus, and responded to chemotherapy and immunotherapy.