Case 1 A 55-year-old previously healthy woman presented with a year-long history of progressive rigidity of the lower limb muscles. She had experienced constant thigh pain on both sides and difficulty in walking. She occasionally fell to the ground because of a sudden spasm precipitated by startle. Therefore, she was required the use of a walker. Physical examination revealed a generalized rigidity and hyperreflexia in both the upper and lower extremities. Examination of the cranial nerve, motor and sensory functions were intact. Findings from magnetic resonance imaging (MRI) of the brain and cervical/thoracic spine were normal. Laboratory analyses, including thyroid function tests and vitamin B12 and folate levels, were unremarkable. However, anti-GAD antibody was elevated at 93.57 U/mL. Electromyography showed continuous motor unit activity in agonist and antagonist muscle. She responded favorably to diazepam. By taking diazepam up to 30 mg per day, the rigidity and spasm were improved. ????
