patients generally require increased dosages, leading to more side effects. Benzodiazepines Benzodiazepines (such as diazepam and clonazepam) are psychoactive drugs that enhance a GABA neurotransmitter's effect at the GABA receptor in enhancing inhibitory circuits. The drug has been used as sedative, muscle relaxant, and anticonvulsant. Patients with classic or partial SMS and GAD-65-positive antibody have shown improvement in stiffness and spasm symptoms with long-term benzodiazepine treatment. However, this change cannot solely be attributed to monotherapy of benzodiazepine as adjunct medications were also commonly administered. Currently, diazepam is the mainstay of therapy. Most patients respond well to diazepam. Oral and Intrathecal Baclofen Baclofen, a GABAB agonist, is generally used when individuals taking high doses of benzodiazepines have high side effects. In some cases, it has shown improvements in electrophysiological and muscle stiffness when administered intravenously. Intrathecal baclofen administration may not have long-term benefits though, and there are potential serious side effects. Levetiracetam (LEV) A 2008 small (n=3) single-blind, placebo-controlled study where participating patients were treated with oral LEV of 500 mg twice daily. The study noted that showed that the patients had improvement in axial rigidity and disappearance of the paroxysmal respiratory arrests within three days after starting therapy. A similar improvement was noted in the other two patients with a marked reduction in legs' stiffness and difficulty walking. On LEV treatment, all patients improved as assessed by all outcome measures. In particular, at EMG recordings, patients relaxed their musculature better. However, no long-term studies on LEV on patients with SPS have been done. Pregabalin Pregabalin works by inhibiting calcium influx and subsequent release of excitatory neurotransmitters, including glutamate and norepinephrine. As a possible mechanism of action in SPS, pregabalin might have compensated for the imbalance between inhibitory and excitatory intracortical circuits. The prolongation of the GABA-B supports this hypothesis-mediated cortical silent period (CSP) after pregabalin introduction. Propofol A 2020 review article by Ortiz, Ghani, Cox, and Tambo, noted a case report, where a SPS patient reporting persistent, severe symptoms and taking high-dose benzodiazepines, baclofen, corticosteroids, LEV, IVIG, and IV ethanol. After that, the patient received a small dose of propofol, which improved the patient's reported symptoms. Additionally, the authors documented a patient with stiff-limb syndrome (a variant of SPS) with refractory therapy who also responded well to propofol. The mechanism by which propofol interacts in the nervous system is not entirely understood. Nevertheless, it is suggested that it might be