What Is the First-Line Treatment for Stiff Person Syndrome?
Stiff Person Syndrome (SPS) is characterised by progressive rigidity of the truncal and proximal limb muscles and superimposed painful spasms that substantially impair gait and daily function. First-line pharmacological management addresses the neurophysiological basis of this stiffness and spasm pattern.
Meaningful reduction in truncal and proximal limb muscle stiffness, decreased frequency and severity of painful muscle spasms, and measurable improvement in gait.
The first-line strategy uses a combination of GABA-enhancing antispasmodic agents drawn from more than one drug class, chosen for their complementary effects on inhibitory neurotransmission. The complete regimen — including agent selection, sequencing, titration, and alternatives — is available in the full structured protocol.
References
DOI: 10.1212/NXI.0000000000200109
- Collectively, the first choice of all antispasmodics is oral baclofen, combined with gabapentin and low doses of diazepam; the other aforementioned agents are reasonable alternates if well tolerated.
- These are the first-line therapies because they improve GABAergic inhibitory neurotransmission, suppress cortical hyperexcitability, or increase CNS GABA exerting a positive effect on impaired reciprocal inhibition and improving the 4 fundamental SPS symptoms mentioned earlier.