SPS & Pregnancy

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Published data regarding stiff-person syndrome and pregnancy is limited. While not impossible, pregnancy poses certain challenges.

1. Goldkamp J. Blaskiewicz R. Myles T. Stiff-person syndrome and pregnancy. Obstet Gynecol. 2011 Aug; 118(2 pt 2):454-7 doi: 10.1097?AOG.0b013e31821696b.

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A woman diagnosed with stiff person syndrome became pregnant 2 months after her diagnosis. Her medication regimen was adjusted because of pregnancy, and anesthesia was initiated early in labor to control her pain. She was able to have a full-term pregnancy with few complications. Stiff person syndrome may be successfully managed in pregnancy. Patients can deliver vaginally with adequate pain control to avoid muscle spasms.

2. Amyradakis G, Carlan SJ, Bhullar A, Eastwood, J. Pregnancy and Stiff Person Syndrome. The American Journal of Medicine Volume 125, Issue 3, Pages e1–e2, March 2012.

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The patient was taken off diazepam at 10 weeks and started on methocarbamol. Three weeks later she had with difficulty swallowing and inability to close her right eye. She was given artificial tears and prescribed gabapentin at 300 mg 3 times per day. She returned 6 weeks later at 19 weeks gestation with intractable facial paralysis and muscle pain. The neurology consultant prescribed diazepam again at 20 mg 3 times per day and the duration of her pregnancy was characterized by gestational diabetes but no exacerbation of her muscle spasm. The patient returned at 35 weeks' gestation with spontaneous rupture of membranes in active labor. Nonreassuring fetal heart tone changes occurred, and she delivered by cesarean a 9-lb infant with Apgar scores 3 and 9. The postpartum course was complicated by endometritis treated by intravenous antibiotics and muscle stiffness treated with oral diazepam. She left the hospital on postoperative day 4 in stable condition.

3. Cerimagic D, Bilic E. Stiff-person syndrome first manifesting in pregnancy. Gynecol Obstet Invest. 2009;67(2): 134-6. Doi: 10.1159/000172804/

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We present a case of the autoimmune form of glutamate decarboxylase-positive SPS that initially manifested in pregnancy. The diagnosis was made based on clinical, laboratory and electromyoneurographic criteria. The patient was administered low doses of diazepam and baclofen. Considering the clinical picture of SPS patients, caesarean section is the method of choice for pregnancy termination.

STIFF-PERSON SYNDROME AND PREGNANCY