{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T18:30:10Z","timestamp":1783017010735,"version":"3.54.6"},"reference-count":13,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T00:00:00Z","timestamp":1618876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Stiff person syndrome (SPS) is a rare autoimmune disease characterised by axial stiffness and episodic painful spasms. It is associated with additional autoimmune diseases and cerebellar ataxia. Most patients with SPS have high levels of glutamic acid decarboxylase (GAD) antibodies. The aetiology of SPS remains unclear but autoimmunity is thought to play a major part. We have previously demonstrated overlap between anti-GAD ataxia and gluten sensitivity. We have also demonstrated the beneficial effect of a gluten-free diet (GFD) in patients with anti-GAD ataxia. Here, we describe our experience in the management of 20 patients with SPS. The mean age at symptom onset was 52 years. Additional autoimmune diseases were seen in 15\/20. Nineteen of the 20 patients had serological evidence of gluten sensitivity and 6 had coeliac disease. Fourteen of the 15 patients who had brain imaging had evidence of cerebellar involvement. Twelve patients improved on GFD and in seven GFD alone was the only treatment required long term. Twelve patients had immunosuppression but only three remained on such medication. Gluten sensitivity plays an important part in the pathogenesis of SPS and GFD is an effective therapeutic intervention.<\/jats:p>","DOI":"10.3390\/nu13041373","type":"journal-article","created":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T05:35:25Z","timestamp":1618896925000},"page":"1373","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Stiff Person Syndrome and Gluten Sensitivity"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2542-8954","authenticated-orcid":false,"given":"Marios","family":"Hadjivassiliou","sequence":"first","affiliation":[{"name":"Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8567-3092","authenticated-orcid":false,"given":"Panagiotis","family":"Zis","sequence":"additional","affiliation":[{"name":"Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Sanders","sequence":"additional","affiliation":[{"name":"Academic Department of Gastroenterology, Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel","family":"Hoggard","sequence":"additional","affiliation":[{"name":"Department of Infection, Immunity &amp; Cardiovascular Disease, University of Sheffield, Sheffield S10 2JF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8380-8755","authenticated-orcid":false,"given":"Ptolemaios G.","family":"Sarrigiannis","sequence":"additional","affiliation":[{"name":"Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/0163-7258(95)00016-A","article-title":"GABA receptors","volume":"67","author":"Kerr","year":"1995","journal-title":"Pharm. 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Neuropath"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1111\/j.1600-0404.2010.01356.x","article-title":"GAD antibody-associated neurological illness and its relationship to gluten sensitivity","volume":"123","author":"Hadjivassiliou","year":"2011","journal-title":"Acta Neurol. Scand"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s12311-020-01203-w","article-title":"Clinical Characteristics and Management of 50 Patients with Anti-GAD Ataxia: Gluten-Free Diet Has a Major Impact","volume":"20","author":"Hadjivassiliou","year":"2021","journal-title":"Cerebellum"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/s00415-020-10054-8","article-title":"Autologous haematopoietic stem cell transplantation for refractory stiff-person syndrome: The UK experience","volume":"268","author":"Snowden","year":"2021","journal-title":"J. Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1097\/00042737-200304000-00012","article-title":"A primary care cross-sectional study of undiagnosed adult coeliac disease","volume":"15","author":"Sanders","year":"2003","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1007\/s12311-020-01132-8","article-title":"Diagnostic Criteria for Primary Autoimmune Cerebellar Ataxia\u2014Guidelines from an International Task Force on Immune-Mediated Cerebellar Ataxias","volume":"19","author":"Hadjivassiliou","year":"2020","journal-title":"Cerebellum"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/2053-8871-1-11","article-title":"Myoclonus Ataxia and Refractory Coeliac Disease","volume":"1","author":"Sarrigiannis","year":"2014","journal-title":"Cerebellum Ataxias"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1053\/gast.1999.0029900297","article-title":"Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease","volume":"117","author":"Ventura","year":"1999","journal-title":"Gastroenterology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1002\/ana.21123","article-title":"Effects of anti-glutamic acid decarboxylase antibodies associated with neurological diseases","volume":"61","author":"Manto","year":"2007","journal-title":"Ann. Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1870","DOI":"10.1056\/NEJMoa01167","article-title":"High-Dose Intravenous Immune Globulin for Stiff-Person Syndrome","volume":"345","author":"Dalakas","year":"2001","journal-title":"N. Engl. J. Med."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/4\/1373\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:50:01Z","timestamp":1760161801000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/4\/1373"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,20]]},"references-count":13,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["nu13041373"],"URL":"https:\/\/doi.org\/10.3390\/nu13041373","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,20]]}}}