Stiff Person Syndrome: A Case Study

Original Editor - Kathleen Li Top Contributors - Cassandra Bodrucky, Nupur Smit Shah, Kathleen Li, Joseph Balasundaram, Benjamin Prance and Kim Jackson

Client Characteristics

Mr. Reed is a 75-year-old male. He is a retired data analyst, who lives at home with his wife in Kingston, Ontario. Mr. R began noticing he had decreased balance two and a half years ago with increased amounts of falls (last fall ~two weeks ago) which has progressively gotten worse with low back pain starting a year and a half ago. Within the last year, he noticed increased pain in his lower extremities with muscle spasms particularly affecting the left leg. He was referred to a neurologist and diagnosed with SPS. He received a referral for outpatient physiotherapy to perform a falls risk assessment, help with his balance and gait, manage muscle rigidity and spasms, and maintain his independence and quality of life.

Examination Findings

Subjective

• Patient Profile (PP): 75 y/o male, right hand dominant
• History of Present Illness (HPI): diagnosed with stiff person syndrome 1 year ago, left plantar flexor contracture (~2 months), muscle spasms, and progressive rigidity (~ 1 year) and lower extremity pain (~6 months), chronic low back pain (~1.5 years).
• Past medical history: Type 1 diabetes, hypertension, high cholesterol.
• Medications: Oral diazepam, gabapentin (1), and insulin
• Health Habits: Non-smoker, drinks occasionally (~2 drinks a week).
• Psychosocial: The patient describes feeling lonely due to COVID-19 as well as frustrated with the diagnosis. Over the past 6 months, he has avoided gardening and groceries due to feeling unsteady and having a fear of falling. He lives with his wife and his son lives 20 minutes away and visits weekly where his daughter lives 1 hour away and visits monthly.
• Home: Bungalow, 5 stairs into the home with railings on the right at both front and back door. The bathroom has a stand-up shower with railings.
• Previous Functional Status: Able to ambulate more than 200m with no gait aid, active in gardening and golfing, no issues performing activities of daily living (ADLs)  
• Current Functional Status: Less confident walking outdoors, feeling unsteady, rigidity and painful spasms in both lower extremities prevented him from engaging in his hobbies (gardening, watching golf, sailing)
• Imaging/Diagnostic testing: MRI and X-ray for chronic low back pain (all negative), Blood tests (Anti-GAD body 92.5 units/mL), nerve conduction studies (No abnormalities)
• Precautions/Contraindications: None
• Chief complaint: decreased balance control, increased rigidity and painful spasms in lower extremities particularly in the left leg limiting his ability to do ADLs.

Objective

General

• Vital signs
  • Pulse 80bpm, BP 145/95mm HG, RR 15 bpm
• Pain
  • Visual analogue scale
    • 3/10 constant pain in the lower back
    • 4/10 during painful spasms in the right lower extremity, due to hot weather and stress
    • 7/10 during painful spasms in left lower extremities, due to hot weather and stress

Posture

• Thoracic kyphosis
• Hyper-lordosis

Tone

• Increased tone in the lower extremities, more increased tone on the left
• Mild plantar flexion contracture, as well as lack of knee extension