Antibiotics: In order to eliminate infection in the region, tetracyclines can be prescribed due to their selective uptake by bone. Penicillin antibiotics can also be used because of their superficial contamination with oral bacteria. Ultrasound therapy: First introduced as a treatment modality in 1992, it involves the application of high-frequency sound waves to induce angiogenesis and improve blood circulation to muscles. Harris demonstrated that 48% of cases showed healing when 15 minutes of ultrasound therapy was applied daily on the skin affected by ORN, while combined with debridement. Hyperbaric oxygen therapy (HBO): First described in 1973, HBO was intended to be an adjunctive treatment method in ORN. The theoretical basis behind this treatment was the fact that it causes an increase in tissue oxygen tension and an improvement in collagen synthesis, angiogenesis and epithelialization. However, its use as the only method in the management of ORN is controversial. There is little evidence to show any clinical benefit, and that it may not have therapeutical significance over a placebo. Surgical
Multidisciplinary approach (HBO + Surgery): Studies have shown support of combining HBO therapy and a surgical approach to treat ORN. This is in order to improve local blood circulation, with resection of necrotic bone and reconstruction with a free flap. However, some studies still state lack of benefit HBO therapy brings. It does not revive dead bone, therefore microvascular reconstruction without the use of HBO therapy is still a successful method of treating ORN.
Some patients require mobility aids due to the risk of falls. About 65 percent of SPS patients are unable to function independently. About ten percent of SPS patients require intensive care at some point; sudden death occurs in about the same number of patients. These deaths are usually caused by metabolic acidosis or an autonomic crisis. Epidemiology
SPS is estimated to have a prevalence of about one per million. Underdiagnosis and misdiagnosis hinder epidemiological information about the condition and may have led to its prevalence being underestimated. In the United Kingdom, 119 cases were identified between 2000 and 2005. It does not predominantly occur in any racial or ethnic group. The age of onset varies from about 30 to 60, and it most frequently occurs in people in their 40s. Five to ten percent of patients with SPS have the paraneoplastic variant of the condition. In one group of 127 patients, only 11 of them had paraneoplastic symptoms. About 35 percent of SPS patients have type I diabetes. History
SPS was first described by Moersch and Woltman in 1956. Their description of the disease was based on 14 cases that they had observed over 32 years. Using electromyography, they noted that motor-unit firing suggested that voluntary muscle contractions were occurring in their patients. Previously, cases of SPS had been dismissed as psychogenic problems. Moersch and Woltman initially called the condition "stiff-man syndrome", but the first female patient was confirmed in 1958 and a young boy was confirmed to have it in 1960.