A Rare Case Report of Neurological Condition: Moersch-Woltman Syndrome with Positive Anti-GAD Antibodies
Keywords:Stiff-Person Syndrome, Dyskinesias/etiology, Movement disorders, Muscle Cramp/physiopathology, Moersch-Woltman Syndrome, Antibodies to glutamic acid decarboxylase (anti-GAD), Glutamic acid decarboxylase, Glutamic acid decarboxylase antibodies, Autoimmune Diseases, Neurology, Neurological Examination, Hereditary Hyperekplexia, Autoimmune Diseases of the Nervous System, Spinal Cord Diseases, Neuromuscular Diseases, Nervous System Diseases
Background: Moersch-Woltman Syndrome (MWS), also known as Stiff person syndrome (SPS), is a rare, progressive condition of the central nervous system. Symptoms can include severe immobility, rigidity, and painful muscle spasms in the trunk and limbs. Muscle spasms can occur in MWS patients because they are more sensitive to noise, rapid movements, and mental disturbance. The condition affects women twice as frequently as it does males. It is a rare disease, affecting only 1-2 people per million. The case report aims to highlight the importance of the diagnostic challenges associated with MWS and the significance of glutamic acid decarboxylase (GAD) antibodies.
The case: A 57-year-old female patient presents with history of migraine headaches, anxiety, and depression. The patient experienced widespread and distressing muscle spasms affecting the shoulders, upper and lower back, and limited range of motion in the neck. Physical examination revealed dense diffuse muscle stiffness throughout the body. Further investigations were ordered, including a comprehensive range of laboratory tests and imaging tests. A positive test for GAD antibodies confirmed the diagnosis of MWS. Treatment included administration of Clonazepam and Baclofen. A follow-up appointment, three weeks later, indicated a noticeable 15-20% reduction in spasticity.
Conclusion: This case highlights the crucial role of anti-GAD antibodies in confirming the diagnosis of SPS. Healthcare professionals should consider testing for these antibodies in patients presenting with the described symptoms. A multidisciplinary approach involving neurologists, physical therapists, psychiatrists, and orthopedic surgeons is essential to provide comprehensive care and optimizing outcomes for individuals with MWS.
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