Stiffness and cramps

According to the S1 guideline »Stiff Man Syndrome« published by the German Neurological Society in 2017, physiotherapy is helpful in most cases. It can only exacerbate symptoms under certain circumstances if there is a high level of stimulus sensitivity - i.e. hypersensitivity to external stimuli. According to the guideline, behavioural therapy can also have a positive influence on the course of the illness, but is usually not very effective in the treatment of anxiety attacks.

Benzodiazepines such as diazepam or clonazepam have a muscle relaxant and anxiolytic effect and are usually effective even at low doses. However, continuous dose adjustment is often necessary due to the development of tolerance. Addictive misuse is rare, even at higher doses. Alternatively, patients can be given muscle relaxants such as baclofen or tizanidine as well as anticonvulsants such as valproate, gabapentin or carbamazepine. In selected cases - for example if there is a risk of joint damage due to spasticity - an injection of botulinum toxin is also possible.

If symptomatic therapy is not sufficient, treatment with corticosteroids - such as prednisolone or methylprednisolone - may be considered, although the potential side effects of long-term use must be taken into account. Intravenous administration of immunoglobulins (IgG) is also an option. The effect usually sets in quickly and lasts for around two to three months after two infusions.