{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T08:40:02Z","timestamp":1756284002535,"version":"3.44.0"},"reference-count":16,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,12,16]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>Stiff-Person syndrome (SPS) is a rare autoimmune neurological disorder characterised by episodic painful muscle rigidity and violent spasms. A significant trigger for the painful spasms experienced by patients is pain itself, making optimal pain management and avoidance a necessity. While first-line and second-line therapies for spasm prevention and termination are known, there is a paucity of evidence to guide pain management. We report the case of a 26-year-old woman with SPS referred for excruciating muscle cramping and rigidity with pain lasting beyond the episodes themselves. We report the novel use of ketamine and intravenous magnesium sulfate which may provide analgesia, spasm avoidance and early termination of exacerbations in SPS.<\/jats:p>","DOI":"10.1136\/bcr-2020-237814","type":"journal-article","created":{"date-parts":[[2021,1,12]],"date-time":"2021-01-12T09:32:12Z","timestamp":1610443932000},"page":"e237814","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Management of refractory pain in Stiff-Person syndrome"],"prefix":"10.1136","volume":"14","author":[{"given":"Frank Arthur","family":"Cirnigliaro","sequence":"first","affiliation":[{"name":"Acute Pain Service, Northern Hospital, Epping, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Gauthier","sequence":"additional","affiliation":[{"name":"Acute Pain Service, Northern Hospital, Epping, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moira","family":"Rush","sequence":"additional","affiliation":[{"name":"Acute Pain Service, Northern Hospital, Epping, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,1,11]]},"reference":[{"key":"2025082701085967000_14.1.e237814.1","first-page":"427","article-title":"Recent advances and review on treatment of stiff person syndrome in adults and pediatric patients","volume":"7","author":"Bhatti","year":"2015","journal-title":"Cureus"},{"key":"2025082701085967000_14.1.e237814.2","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1002\/mus.23234","article-title":"Autoimmune stiff person syndrome and related myelopathies: understanding of electrophysiological and immunological processes","volume":"45","author":"Rakocevic","year":"2012","journal-title":"Muscle Nerve"},{"key":"2025082701085967000_14.1.e237814.3","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-131-7-199910050-00008"},{"key":"2025082701085967000_14.1.e237814.4","first-page":"421","article-title":"Progressive fluctuating muscular rigidity and spasm (\"stiff-man\" syndrome); report of a case and some observations in 13 other cases","volume":"31","author":"Moersch","year":"1956","journal-title":"Proc Staff Meet Mayo Clin"},{"key":"2025082701085967000_14.1.e237814.5","doi-asserted-by":"crossref","first-page":"340","DOI":"10.5334\/tohm.316","article-title":"Clinical spectrum of stiff person syndrome: a review of recent reports","volume":"6","author":"Sarva","year":"2016","journal-title":"Tremor Other Hyperkinet Mov"},{"key":"2025082701085967000_14.1.e237814.6","doi-asserted-by":"publisher","DOI":"10.1159\/000107973"},{"key":"2025082701085967000_14.1.e237814.7","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1212\/WNL.31.9.1162","article-title":"Improvement of stiff-man syndrome with sodium valproate","volume":"31","author":"Spehlmann","year":"1981","journal-title":"Neurology"},{"key":"2025082701085967000_14.1.e237814.8","first-page":"1","article-title":"Stiff person syndrome: a rare neurological disorder, heterogeneous in clinical presentation and not easy to treat","volume":"2015","author":"Buechner","year":"2015","journal-title":"Case Rep Neurol Med"},{"key":"2025082701085967000_14.1.e237814.9","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.47.3.280"},{"key":"2025082701085967000_14.1.e237814.10","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000000281"},{"key":"2025082701085967000_14.1.e237814.11","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1002\/mds.10043","article-title":"Effect of treatment with intravenous immunoglobulin on quality of life in patients with stiff-person syndrome","volume":"17","author":"Gerschlager","year":"2002","journal-title":"Mov Disord"},{"key":"2025082701085967000_14.1.e237814.12","first-page":"1387","article-title":"Evaluation of treatment outcomes in patients with stiff person syndrome with rituximab vs. standard of care","volume":"9","author":"Rineer","year":"2017","journal-title":"Cureus"},{"key":"2025082701085967000_14.1.e237814.13","doi-asserted-by":"crossref","first-page":"4","DOI":"10.4097\/kjae.2013.65.1.4","article-title":"Magnesium: a versatile drug for anesthesiologists","volume":"65","author":"Do","year":"2013","journal-title":"Korean J Anesthesiol"},{"key":"2025082701085967000_14.1.e237814.14","doi-asserted-by":"publisher","DOI":"10.1017\/S026502150200008X"},{"key":"2025082701085967000_14.1.e237814.15","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/0952-8180(95)00230-8","article-title":"An effect of magnesium on neuromuscular function in parturients","volume":"8","author":"Ross","year":"1996","journal-title":"J Clin Anesth"},{"key":"2025082701085967000_14.1.e237814.16","unstructured":"Neubert L , Green P , Green MS . Anesthetic care of stiff person syndrome in the outpatient setting. J Clin Anesth 2013;2."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-237814","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T08:09:08Z","timestamp":1756282148000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-237814"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,11]]},"published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1136\/bcr-2020-237814"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-237814","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,1]]}}}