Abstract 173: A glimpse into the neurological autoimmune spectrum of diabetes mellitus

Introduction: Stiff Person Syndrome (SPS) is a rare disease characterized by progressive muscle rigidity and spasms, which can lead to functional disability. Circulating anti-glutamic acid decarboxylase (anti-GAD) antibodies are thought to create a γ- aminobutyric acid (GABA)-scarce environment within the body. These autoantibodies, although orders of magnitude greater in SPS, are also associated with type 1 diabetes mellitus (T1DM). Objective: Presenting a case of SPS (Stiff Person Syndrome) in a case of a 40-year-old man with Latent Autoimmune Diabetes in Adults (LADA). Case Report: A 40-year-old man with Diabetes presented to us with chief complaints of progressive weakness and abnormal gait with inability to maintain imbalance since 3 months. He had a wide based gait, Power in all four limbs was 4+/5. Tone was increased symmetrically with rigidity present. Reflexes were 2+ and Bilateral plantar were flexor. No sensory involvement was present. Cerebellar signs were positive bilaterally. Higher Mental Functions were intact. No spinal deformity or history of trauma was present. He also had history of Diabetes for 1 year for which he was taking insulin injections. All causes of chronic symmetrical progressive cerebellar involvement were ruled out and a probable diagnosis of SPS was made. MRI Brain was suggestive of cerebellar atrophy. MRI Spine was normal. Patient was also evaluated for Diabetes mellitus and antibodies causing LADA were evaluated. Patient's blood reports were positive for Anti-GAD antibodies which are also the causative factor behind SPS. Other autoimmune conditions were ruled out. Other diagnostic features as mentioned in Dallas criteria were also present. Hence the diagnosis of SPS was confirmed. The patient has been currently using clonazepam, with overall improvement in all symptoms. Discussion: Stiff person syndrome (SPS) is a rare immune-mediated disorder characterized by rigidity and episodic spasms that can be progressive and fatal. Circulating anti-glutamic acid decarboxylase (anti-GAD) antibodies are thought to create a γ- aminobutyric acid (GABA)-scarce environment within the body. These autoantibodies, although orders of magnitude greater in SPS, are also associated with type 1 diabetes mellitus (T1DM).