Syndrome of Subacute Generalized Muscular Stiffness and Spasm

Abstract

THE OCCURRENCE of "progressive muscular tautness" was termed the "stiff-man" syndrome by Moersch and Woltman in 1956.¹Once hysteria or extrapyramidal disease are eliminated from consideration, there remains a group of patients with striking axial stiffness, sometimes with superimposed muscle spasms, in whom no apparent pathology can be found. Exacting clinical, metabolic, and electromyographic (EMG) criteria for this diagnosis were set forth in 1964.²As a result a number of clinically similar conditions were excluded. Olafson et al in 1964²suggested that this disorder might arise because of a disturbance in spinal reflex mechanisms. They advanced this hypothesis because of similarities between the stiff-man syndrome and disorders such as tetanus, in which there is good theoretical, physiological, and anatomical evidence for interference with the normal reflex inhibitors of anterior horn cell activity. Because of certain clinical observations, Allsop argued in 1963³that the spinal reflex disturbance