Stiff Man Syndrome

[vs-eh?]

Oh hello...

While not overly complex with regard to assessment and subsequent treatment, this is literally a one in a million patient that you likely will never see. Come with me my friends...

You are called to the basement of a gym during a spinning class, where a 30'ish year old female is complaining of CP and SOB. As you roll your eyes and yet again think BS, further updates dance across your screen. The updates insist that (per caller) this is not a cardiac/pulmonary event and in fact this pt. has "stiff person syndrome" and requires versed to attenuate her circumstance. Hmmmmm, you say to yourself as you pull up to the scene.

You lumber down 3 flights of stairs (calling Jesus all sorts of names in the process) and walk into an active spin class (wit da fly hunnies in tow) and are eventually greeted by the fire department performing the standard treatment on all patients - NRB blasting in the patients face and the circle of life (kidding boys and girls). As you intrude into the circle, you discover the following...

A young, athletic woman who is conscious, alert, and oriented in a full body tonic/spasm. She is literally stiff as a board. She is perfusely diaphoretic and appears quite uncomfortable. Her anxious sister hands you a letter. The letter is from a neurologist from a nearby university hospital that states the the patient has "stiff person syndrome". It briefly outlines signs and symptoms, treatment modalities, and the doctors name and contact information. The treatment is either midazolam or propofol. The versed tx is an inital 5mg dose IV with follow up doses q 10 mins if the activity doesn't cease. Honestly I don't remember the propofol dose, as we don't carry it and the patient basically always gets the versed. The patient has no other medical problems and is currently on diazepam and bacofen daily for the same condition. She states 5mg of versed breaks the activity almost always, and she has only had follow up doses once.

What is a paramedic to do? Patch of course...

The patch doctor had not heard of this syndrome, and neither has any doctor I've spoken to since. She agreed to the 5mg of versed, but denied any follow up doses and to let the hospital decide subsequent treatment should it be required. My partner had already started an IV, vitals, and drawn up 10mg of versed as I finished the consult. Her vitals where to be expected with a person in 10/10 pain. Five minutes following the versed, she relaxed. Five minutes after that she walked up the 3 flights of stairs with our assistance (thank god, would have been a huge hastle for all involved, not the least of which was the patient). One hour following that, while we where still waiting for an ER bed (LOL... We did take her to a neuro hospital just in case) she wanted to leave. I d/c'd the IV and she walked out with her sister AMA. She was cool, she said nothing else could be done and she would follow up with her neurologist. She was currently undergoing plasmaphoresis as a treatment as well.

You guys can google it if you care. Just an interesting case to liven up an otherwise routine set of shifts. Oh, and apparently the syndrome was originally called "stiff man syndrome", but those damn hippy liberals and PC elitists changed it to "stiff person syndrome".

PHFTTTTTTTTTTTTTTTTTTTTTTTTT

[theotherphil]

Thanks for sharing....something I have never heard of before. I have researched it and it does indeed seem very unusual.

Treatment for me would have been the same regardless. If I couldn't justify Midaz for a seizure, I certainly could under my "patient management" guideline.

[HERBIE1]

New one on me...

[aussiephil]

This is indeed an interesting & rare disease, also known as Stiff Person Syndrome.

I have treated a patient with this, post diagnosis. The patient was on high doses of Codeine, valium as well as anti depressants.

When we were called to this patient, it was usually at their darkest time with pain in the extreme. All we could do was pain manage them until we got to hospital so they could implement further stratergies developed by this patients neurologist.

I pity any person diagnosed with this illness. It is truly a case of knowing that someone is really worse off than you are.

[akflightmedic]

I have a thread on this from a couple years ago.

We had a lady we went on several times for this disease. I truly thought she was BSing when she was telling me she could not move after we gained access to her house. I was thinking psych more than anything but she was prepared. Then when she told us she needed valium, I was like uh huh really you do.

I called the doc and he asked how much valium we had. He said to start giving it as it usually took this lady 20-40mg injected before she started to get relief. It was weird watching her respond to the valium, how body parts slowly started coming "back to life".

I will try to find the thread.

Can't find it yet...but the proper name of disease is Moersch-Woltmann Syndrome