[Two stiff person cases misdiagnosed as conversion disorder]

Area of Science:

• Neurology
• Psychiatry
• Immunology

Context:

• Conversion disorder (CD) and dissociative motor disorder are psychiatric diagnoses for unexplained neurological symptoms.
• Misdiagnosis rates for conversion symptoms, particularly gait and movement disturbances, are notably high.
• Stiff-person syndrome (SPS) is a rare autoimmune neurological disorder characterized by muscle rigidity and contractions.

Purpose:

• To highlight the psychiatric presentations of Stiff-person syndrome (SPS).
• To emphasize the importance of comprehensive neurological and psychiatric assessments in differentiating SPS from conversion disorder.
• To draw attention to the diagnostic challenges posed by SPS's overlapping symptoms with conversion disorder.

Summary:

• Two patients initially referred for psychiatric assessment due to unexplained neurological symptoms were diagnosed with Stiff-person syndrome (SPS).
• SPS involves severe muscle rigidity, sudden contractions, and gait disturbances, often triggered by stressors.
• Antibodies against glutamic acid decarboxylase (GAD) are associated with SPS pathophysiology.

Impact:

• This case report underscores the need for thorough differential diagnosis in patients presenting with conversion disorder symptoms.
• Highlights the critical role of neurological examination, brain imaging, and electrophysiological studies in diagnosing SPS.
• Aims to improve diagnostic accuracy and patient outcomes by raising awareness of SPS's psychiatric manifestations.