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Stem cell transplant eases symptoms of rare ‘stiff person syndrome’: study

Stem cell transplants have been used to treat patients with other
auto-immune diseases, among them multiple sclerosis, scleroderma and
Crohn’s disease, but this may be the first time the procedure has been
employed to alleviate the symptoms of stiff person syndrome, or SPS, the
researchers reported Monday in the journal JAMA Neurology.

SPS
is characterized by episodes of stiffness in the muscles and painful
muscle spasms, which can be brought on by stress, loud noises or
emotional distress. Some people with the disorder are so disabled they
are unable to walk or move and may isolate themselves at home to avoid
triggering an attack.

“Sometimes this happens when they’re
startled,” said Dr. Harry Atkins of the Blood and Marrow Transplant
Program at the Ottawa Hospital, who headed a team that transplanted stem
cells into two women with the disease.

“So you can imagine
walking across the street and someone honks the horn and you can’t move,
or you start falling and because your muscles can’t move, you just fall
and you hurt yourself,” Atkins said Monday from Ottawa.

“It really does provide a barrier with just going on with your life.”

Tina
Ceroni of Toronto is one of the two SPS patients who had the stem-cell
transplant – and she said it has given back her life.

The
personal fitness trainer, now 36, started getting severe symptoms in her
late 20s. Initially she was diagnosed with hyponatremia, or low blood
sodium, thought to be related to her heavy training schedule for a
half-ironman competition.

But when she tried to water-ski at a
friend’s cottage and had to be helped from the water because she was
unable to move, Ceroni “knew that there was something definitely not
right.”

“My legs stiffened up like they were two complete boards.
I had no ability to relax the muscles. They started to constrict to a
point where I thought a bone might break or a tendon might rupture, and I
was in pain for about eight hours.”

She eventually was diagnosed
with stiff person disease, which not only affected her legs but also
the muscles in her arms and torso, leaving her unable to breathe
properly when the muscles that control respiration would contract and go
into spasm.

The year before her stem-cell transplant, she was
rushed to the hospital 47 times because of life-threatening respiratory
distress.

Ceroni had been living with her twin sister in Toronto
but had to move back with her parents in nearby Burlington, Ont.,
because she couldn’t be left alone.

“I started to withdraw from
social events and social gatherings or being in a situation that was
slightly unpredictable or if there was a potential for a loud noise,
even walking down the street,” she said. “If a car drove by and honked
its horn and I was startled … within minutes I could be on the ground.

“I wasn’t able to live a normal life at all. The disease was dictating my life entirely. It became very, very isolating.”

Ceroni had her stem-cell transplant in May 2011, and she said her symptoms have disappeared.

“My body doesn’t react to noise. I can go to concerts now. I have no sensitivity to the triggers anymore.”

The
other patient, who was not identified, had her transplant in 2009, and
she too has seen her symptoms abate, allowing her to return to work and
resume activities such as skiing and cycling, the researchers reported.

“I
think for the period we’ve commented on for both patients, they’ve done
very, very well,” said Atkins. “And it’s nice to see them back enjoying
life.”

Conventional treatment involves a number of medications,
including anti-anxiety drugs, muscle relaxants, anti-convulsants and
pain relievers. Intravenous immunoglobulin can also reduce muscle
stiffness and lower sensitivity to noise and other triggers. While such
treatments can ease symptoms, they don’t cure the disorder, and not all
patients get relief from the drugs.

Still, Atkins stressed that
not every patient with SPS would be considered for a stem-cell, or
bone-marrow, transplant, which requires that the person’s immune system
be destroyed with high-dose chemotherapy before their previously removed
and purified stem cells are reintroduced to create a new, disease-free
immune system.

“It should only be considered where nothing more
conventional is working … the symptoms have to be severe and the
impact on their life very, very profound because there are risks
associated with this,” he said, adding that one in 20 patients who
receives a bone marrow transplant to treat leukemia, lymphoma or an
auto-immune disorder will die of a complication.

“And we don’t think stiff person syndrome patients … would have a lower risk,” he said.

There
are also other complications from the chemo, including infertility and
premature disorders such as heart disease and diabetes.

“I think
for the right patient it might offer some benefit in helping them
improve, but it’s too early to say that this is the answer to stiff
person syndrome. It’s a pretty dramatic treatment and we need to keep
thinking about better ways to do what we’re doing – getting rid of the
immune system perhaps with less toxicity and being able to grow back a
new one more quickly.

“So I think there are a lot of unanswered questions yet.”

Despite the risks, Ceroni said she had no qualms about going ahead with the transplant.

“I
saw it as my only hope for a better future and my only hope to even
lessen the disease. Any kind of improvement would have been remarkable
for me.

“I saw this transplant as being given a gift of life, literally.”