What is the treatment for myoclonic jerks?

From the Guidelines

Treatment for myoclonic jerks should be initiated with propofol, clonazepam, sodium valproate, or levetiracetam, as these medications have been shown to be effective in suppressing post-anoxic myoclonus. According to the European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care 1, myoclonus can be particularly difficult to treat, and phenytoin is often ineffective.

Some key points to consider when treating myoclonic jerks include:

• Using intermittent electroencephalography (EEG) to detect epileptic activity in patients with clinical seizure manifestations 1
• Considering continuous EEG to monitor patients with a diagnosed status epilepticus and effects of treatment 1
• Treating seizures, including myoclonus, with medications such as sodium valproate, levetiracetam, phenytoin, benzodiazepines, propofol, or a barbiturate, as they may increase the cerebral metabolic rate and exacerbate brain injury caused by cardiac arrest 1
• Starting maintenance therapy once potential precipitating causes, such as intracranial hemorrhage or electrolyte imbalance, are excluded 1

It is essential to note that the use of prophylactic anticonvulsant drugs after cardiac arrest in adults has been insufficiently studied, and routine seizure prophylaxis in post-cardiac arrest patients is not recommended due to the risk of adverse effects and poor response to anti-epileptic agents 1.

In terms of prognosis, myoclonus and electrographic seizure activity, including status epilepticus, are related to a poor prognosis, but individual patients may survive with a good outcome, and prolonged observation may be necessary after treatment of seizures 1.

From the FDA Drug Label

The effectiveness of levetiracetam as adjunctive therapy (added to other antiepileptic drugs) in patients 12 years of age and older with juvenile myoclonic epilepsy (JME) experiencing myoclonic seizures was established in one multicenter, randomized, double-blind, placebo-controlled study, conducted at 37 sites in 14 countries The primary measure of effectiveness was the proportion of patients with at least 50% reduction in the number of days per week with one or more myoclonic seizures during the treatment period (titration + evaluation periods) as compared to baseline. Table 5 displays the results for the 113 patients with JME in this study Placebo(N=59)Levetiracetam(N=54) * statistically significant versus placebo Percentage of responders23.7%60. 4%*

The treatment for myoclonic jerks is levetiracetam as an adjunctive therapy, which has been shown to be effective in reducing the number of days per week with one or more myoclonic seizures in patients 12 years of age and older with juvenile myoclonic epilepsy (JME) 2.

• Key points:
  • Levetiracetam is used as an adjunctive therapy
  • Effective in reducing myoclonic seizures in patients with JME
  • Target dose of 3000 mg/day
  • Statistically significant reduction in myoclonic seizure frequency compared to placebo

From the Research

Treatment Options for Myoclonic Jerks

The treatment for myoclonic jerks, also known as myoclonus, typically involves pharmacological interventions aimed at reducing the frequency and severity of the jerks. The choice of treatment depends on the underlying cause and classification of the myoclonus.

• Pharmacological Treatment:
  • Valproate is commonly used as the first-line treatment for myoclonic seizures, including those associated with idiopathic generalized epilepsies or epileptic encephalopathies 3.
  • Levetiracetam is also widely used, particularly for cortical myoclonus, and is suggested as a first-line treatment for this type of myoclonus 4.
  • Clonazepam may be helpful for all types of myoclonus, including subcortical-nonsegmental and segmental myoclonus 5, 4.
  • Other antiepileptic drugs, such as lamotrigine and zonisamide, may be effective in specific syndromes, such as juvenile myoclonic epilepsy and progressive myoclonus epilepsies 6.

Classification-Based Treatment

The treatment strategy for myoclonus is best derived from the neurophysiology classification scheme categories:

• Cortical Myoclonus: Levetiracetam is suggested as first-line treatment, but valproic acid and clonazepam are commonly used 4.
• Cortical-Subcortical Myoclonus: Valproic acid has demonstrated efficacy, with other medications providing an adjunctive role 4.
• Subcortical-Nonsegmental Myoclonus: Clonazepam is used, but other treatments may be used depending on the syndrome 4.
• Segmental Myoclonus: Clonazepam and botulinum toxin are used, but treatment is often difficult 4.
• Peripheral Myoclonus: Botulinum toxin is used for focal examples 4.

Additional Considerations

• Avoidance of Aggravating Medications: Certain medications, such as carbamazepine and phenytoin, may aggravate myoclonic seizures and should be avoided 3.
• Combination Therapy: A single pharmacological agent rarely controls myoclonus, and polytherapy with a combination of drugs is often needed 5.
• Electrophysiological Tests: These tests are helpful in determining the underlying physiology of the myoclonus and guiding treatment 5, 4.