From the Guidelines
Treatment for myokymia typically depends on its cause and severity, and may involve addressing underlying triggers, medications such as carbamazepine, phenytoin, or gabapentin, or botulinum toxin injections for focal myokymia. For mild cases, no specific treatment may be needed as symptoms often resolve spontaneously. When treatment is necessary, first-line approaches include:
- Addressing underlying triggers such as stress reduction, adequate sleep, limiting caffeine and alcohol consumption, and correcting electrolyte imbalances.
- Medications may be prescribed including:
- Botulinum toxin injections can be effective for focal myokymia, particularly for eyelid myokymia, with effects lasting 3-4 months.
- Benzodiazepines like clonazepam (0.5-1 mg twice daily) may help in some cases. For myokymia associated with multiple sclerosis or other neurological conditions, treating the underlying disorder is essential. These treatments work by stabilizing overactive nerve membranes or reducing muscle contractions. Patients should consult healthcare providers before starting any medication to ensure appropriate dosing and to monitor for potential side effects. It's also important to note that the provided evidence does not directly address the treatment of myokymia, but rather discusses various other medical conditions and their treatments, such as multiple myeloma, immune-related adverse events, and idiopathic inflammatory myopathies 1.
From the Research
Treatment Options for Myokymia
- Myokymia is generally benign with self-resolution, although symptomatic treatment with benzodiazepines, anticonvulsants, and muscle relaxants can be used 2
- Botulinum toxins can also be utilized, although they are mostly used for symptomatic facial myokymia 2
- Chemodenervation with botulinum A toxin has been shown to be effective in patients with symptomatic segmental continuous hypertrophic myokymia, and may be considered first-line therapy 2
- Treatment for superior oblique myokymia ranges from observation and reassurance to various topical and systemic medications, with strabismus surgery and neurosurgery reserved for patients who fail medical therapy or are intolerant to medication secondary to side effects 3
- Topical beta blockers, such as levobunolol, have been used to manage symptoms of superior oblique myokymia 4
Considerations for Treatment
- Maintaining the balance of fluid and electrolytes is crucial to the care of patients, and electrolyte disturbances can have neurologic manifestations involving both the central and peripheral nervous systems 5, 6
- Effective management of electrolyte disturbances requires identification and treatment of the underlying primary disorder 6
- Neurological symptoms of electrolyte disorders are generally functional rather than structural, and are typically reversible 6