• stiff man syndrome
• back pain

Stiff man syndrome (SMS) is a rare, disabling neurological disorder characterised by progressive muscle rigidity and painful episodic spasms of the axial and proximal limb muscles. Diagnosis is based on the recognition of typical clinical features and characteristic EMG findings.¹ However, although it is well described, SMS is probably underdiagnosed because of a lack of awareness of its clinical manifestations. It may present to a range of specialties and should be considered in all patients with unexplained back pain, stiffness, and muscle spasms. We present a typical case of stiff man syndrome in a patient who was referred to our unit, having previously been seen by a number of doctors and a neurosurgeon, without a diagnosis.