Intravenous Immunoglobulin (IVIg) for the Treatment of Stiff-Man Syndrome (SMS)
Information source: National Institutes of Health Clinical Center (CC)
Information obtained from ClinicalTrials.gov on June 20, 2008
Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Muscle Rigidity; Spasm; Stiff Man Syndrome
Intervention: IVIg (Drug)
Phase: Phase 1
Sponsored by: National Institute of Neurological Disorders and Stroke (NINDS)
Stiff-man Syndrome (SMS) is a chronic, progressive disorder of the nervous system. It is
associated with painful muscle spasms and rigidity involving muscles of the limbs, trunk, and
neck. The cause of the disease is unknown, but researchers believe it may be a result of an
autoimmune process. Patients with Stiff-man Syndrome may produce antibodies that attack
enzymes required for the normal function of the nervous system.
Steroids, plasmapheresis, and intravenous immunoglobulin (IVIg) have been given to relieve
some of the symptoms of Stiff-man Syndrome. However, none of these therapies have proven to
be significantly effective.
This study will attempt to determine the effectiveness of intravenous immunoglobulin (IVIg)
for the treatment of Stiff-mann Syndrome. Patients participating in this study will be
divided into two groups. Group one will receive 2 injections of IVIg once a month for three
months. Group two will receive 2 injections of placebo "inactive sterile water" once a month
for three months. Following the three months of treatment, group one will begin taking the
placebo and group two will begin taking IVIg for an additional 3 months. The drug will be
considered effective if patients receiving it experience a significant improvement in muscle
function, mobility, and stiffness.
Official title: The Efficacy of High-Dose Intravenous Immunoglobulin Therapy in Patients With Stiff-Man Syndrome: A Double-Blind, Placebo-Controlled Trial
Study design: Treatment, Safety Study
Stiff-man Syndrome (SMS) is a chronic, disabling neurological disorder characterized by
severe and painful axial and limb rigidity enhanced by anxiety, sudden motion or external
stimuli. Although the cause of SMS is unknown, immunologic mechanisms have been implicated
on the basis of circulating autoantibodies in the patient's serum and CSF, against GAD
(glutamic acid decarboxylase), the enzyme involved in the synthesis of GABA (gamma
aminobutyric acid). Uncontrolled studies have also shown that plasmapheresis,
corticosteroids and high dose intravenous immunoglobulin (IVIg) are variably effective in
improving the clinical symptoms of these patients. The purpose of the present study is to
demonstrate in a double blind, placebo-control design, the efficacy of IVIg in patients with
SMS. The effect of IVIg will be assessed with a series of objective measurements including
muscle function, mobility and stiffness. Changes in the circulating anti-GAD antibodies will
be also examined and their pathogenetic role in the cause of SMS will be determined. If IVIg
proves effective, it will be a valuable tool in the treatment of these patients who are
currently dependent on high doses of Valium (up to 60-100 mg daily), or steroids and
experience significant side effects.
Minimum age: N/A.
Maximum age: N/A.
Men and non-pregnant women, between 18-75 years of age, who meet a defined criteria for the
diagnosis of Stiff-man syndrome (SMS) will be screened as inpatients or in the outpatient
If the diagnosis is confirmed, the patients will be enrolled into the protocol, provided
their disease remains symptomatic and poorly responsive to benzodiazepines.
Only patients with anti-GAD antibodies will be included.
Patients who have not received IVIg in the past 6 months may be included.
No pregnant or nursing women (confirmed by a pregnancy screening test).
No critically ill patients, such as those with severe cardiomyopathy, and respiratory
insufficiency and severely incapacitated patients that require help for self care.
No patients with severe renal or hepatic disease, COPD or severe coronary artery disease.
No patients with serum IgA level less than 11 mg/dl.
Locations and Contacts
National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, Maryland 20892, United States
Solimena M, Folli F, Denis-Donini S, Comi GC, Pozza G, De Camilli P, Vicari AM. Autoantibodies to glutamic acid decarboxylase in a patient with stiff-man syndrome, epilepsy, and type I diabetes mellitus. N Engl J Med. 1988 Apr 21;318(16):1012-20.
Solimena M, Folli F, Aparisi R, Pozza G, De Camilli P. Autoantibodies to GABA-ergic neurons and pancreatic beta cells in stiff-man syndrome. N Engl J Med. 1990 May 31;322(22):1555-60.
Grimaldi LM, Martino G, Braghi S, Quattrini A, Furlan R, Bosi E, Comi G. Heterogeneity of autoantibodies in stiff-man syndrome. Ann Neurol. 1993 Jul;34(1):57-64.
Starting date: April 1996
Ending date: May 2002
Last updated: July 13, 2006