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Discussion. This patient presented with hyperekplexia, rigidity, brainstem signs, and CSF lymphocytosis consistent with PERM. 1 Following an initial therapeutic response he relapsed; after more aggressive immunosuppressive therapy he was eventually able to return to work. Although PERM is clinically distinct, patients with SPS may progress to PERM, 1 there are common neurophysiologic abnormalities, 6 and both may have anti-GAD antibodies. 1 Although we did not find antibodies to GlyR in the SPS sera that we tested here, it is possible that others will be positive. Whether anti-GAD antibodies are pathogenic in SPS remains unclear. 7 By contrast, the antibodies binding to GlyR expressed on the cell surface,