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Stiff-person spectrum disorder — SCE Neurology MCQ

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HardNeurogenetics and NeuroimmunologyStiff-person spectrum disorderSCE Neurology

A patient has axial rigidity and stimulus-triggered painful spasms with continuous motor-unit activity and high anti-GAD antibodies. Which evidence-based immunotherapy may be considered when symptomatic treatment is inadequate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Intravenous immunoglobulin after specialist assessment

The best answer is “Intravenous immunoglobulin after specialist assessment”. UK stroke guidance supports urgent vascular imaging and reperfusion selection, short-course dual antiplatelet therapy for eligible minor stroke or high-risk TIA, decompression for life-threatening swelling, and secondary prevention matched to mechanism. The alternatives “Long-term levodopa for presumed axial parkinsonism”, “Acetylcholinesterase inhibition for neuromuscular-junction failure”, “Dopamine blockade to suppress stimulus-triggered spasms”, “Carbamazepine monotherapy for presumed focal seizures” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/