What is your approach to escalating therapies for stiff person syndrome that is refractory to IVIG and steroids?

Step 1: Make sure the diagnosis is correct, especially if seronegative, or very weakly positive for GAD65 antibodies.

Misdiagnosis of SPS is common and diagnostic criteria have been recently proposed (Reference 1). Patients who complain of subjective stiffness/muscle spasms, but do not have objective...