A Rare Case Report of Neurological Condition: Moersch-Woltman Syndrome with Positive Anti-GAD Antibodies


  • Aakanksha Pitliya MBBS, Extern, Neurology Services Inc, Alexandria, Virginia, USA.


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.


Metrics Loading ...


McEvoy KM. Stiff-man syndrome. Mayo Clin Proc. 1991;66(3):300-4.

Hicken J, Ramirez D, Rigby M, Minasian A. Stiff-Person Syndrome: Seeing Past Comorbidities to Reach the Correct Diagnosis. Case Rep Neurol Med. 2021;2021:6698046.

Rakocevic G, Floeter MK. Autoimmune stiff person syndrome and related myelopathies: understanding of electrophysiological and immunological processes. Muscle Nerve. 2012;45(5):623–34.

Nasri A, Gharbi A, Ouali U, Mrabet S, Souissi A, Jomli R, et al. Psychiatric Symptoms in Stiff-Person Syndrome: A Systematic Review and a Report of Two Cases. J Acad Consult Liaison Psychiatry. 2022;(2):S2667-2960.

Alexopoulos H, Dalakas MC. A critical update on the immunopathogenesis of Stiff Person Syndrome. Eur J Clin Invest. 2010;40(11):1018–25.

Ortiz JF, Ghani MR, Morillo Cox Á, Tambo W, Bashir F, Wirth M. et al. Stiff-Person Syndrome: A Treatment Update and New Directions. Cureus. 2020;12(12):e11995.

Dalakas MC. Stiff person syndrome: advances in pathogenesis and therapeutic interventions. Curr Treat Options Neurol. 2009;11(2):102-10.

Ciccotto G, Blaya M, Kelley RE. Stiff person syndrome. Neurol Clin. 2013;31(1):319-28.

Hadavi S, Noyce AJ, Leslie RD, Giovannoni G. Stiff person syndrome. Pract Neurology. 2011;11(5):272-82.

Ogilvie RJ, Kolski HK. Adolescent Stiff Person Syndrome: Long-Term Symptom Remission on Immunomodulatory Therapy. Can J Neurol Sci. 2019;46(5):631-2.

Pringle CE, Hudson AJ, Munoz DG, Kiernan JA, Brown WF, Ebers GC. Primary Lateral Sclerosis: Clinical Features, Neuropathology and Diagnostic Criteria. Brain. 1992;115(2):495–520 .

Dalakas MC. Therapies in Stiff-Person Syndrome Advances and Future Prospects Based on Disease Pathophysiology. Neurol Neuroimmunol Neuroinflamm. 2023;10(3):e200109.

Saigal R, Goyal L, Yadav RN, Agrawal A, Mital P, Patel B. Stiff Person Syndrome. J Assoc Physicians India. 2015;63:0004-5772.

Galli JR, Austin SD, Greenlee JE, and Clardy SL. Stiff person syndrome with anti-GAD65 antibodies within the national veterans affairs health administration. Muscle Nerve. 2018;58(6):801–4.



How to Cite

Pitliya, A. (2023). A Rare Case Report of Neurological Condition: Moersch-Woltman Syndrome with Positive Anti-GAD Antibodies. International Journal of Medical Students, 11(3), 233–236. Retrieved from https://ijms.info/IJMS/article/view/2053



Case Report