From the Guidelines
Medications used to treat myoclonus include clonazepam, sodium valproate, and levetiracetam, with propofol being effective in suppressing post-anoxic myoclonus. When considering treatment options for myoclonus, it is essential to evaluate the underlying cause and potential precipitating factors, such as intracranial hemorrhage or electrolyte imbalance 1. Some key points to consider when treating myoclonus include:
- Clonazepam, sodium valproate, and levetiracetam are antimyoclonic drugs that may be effective in post-anoxic myoclonus 1.
- Phenytoin is often ineffective in treating myoclonus, while propofol has been shown to be effective in suppressing post-anoxic myoclonus 1.
- The use of prophylactic anticonvulsant drugs after cardiac arrest in adults has been insufficiently studied, and routine seizure prophylaxis is not recommended due to the risk of adverse effects and poor response to anti-epileptic agents 1.
- Treatment should be started at low doses and gradually increased to minimize side effects, with regular follow-up to monitor effectiveness and adjust dosing as needed. In terms of specific treatment regimens, clonazepam, sodium valproate, and levetiracetam are the primary medications used to treat myoclonus, with dosing and treatment duration depending on the individual patient's response and underlying condition 1.
From the Research
Medications for Myoclonus
The treatment of myoclonus involves various medications, depending on the underlying physiology and etiology of the condition. Some of the commonly used medications include:
- Sodium valproic acid: effective in cortical myoclonus and cortical-subcortical myoclonus 2, 3, 4
- Clonazepam: used in cortical myoclonus, subcortical-nonsegmental myoclonus, and reticular reflex myoclonus 2, 3, 5
- Levetiracetam: suggested as first-line treatment for cortical myoclonus and used in cortical-subcortical myoclonus 3, 5, 4
- Piracetam: effective in cortical myoclonus, especially when used in combination with other antimyoclonic drugs 2, 6
- Lamotrigine: used in cortical-subcortical myoclonus, either alone or in combination with valproic acid 2
- Ethosuximide, zonisamide, and botulinum toxin: used as adjunct therapy or in specific types of myoclonus, such as segmental or peripheral myoclonus 2, 3, 5
Treatment Approaches
The treatment approach for myoclonus depends on the underlying physiology and etiology of the condition. A thorough evaluation, including clinical characterization, electrophysiological tests, and imaging studies, is essential to determine the best treatment strategy 2, 3, 5. In some cases, a combination of medications may be necessary to control myoclonus, and polytherapy with large dosages may be required 5. Additionally, avoidance of medications that may aggravate myoclonic seizures, such as carbamazepine and phenytoin, is crucial 4.
Specific Types of Myoclonus
Different types of myoclonus may require specific treatment approaches:
- Cortical myoclonus: treated with sodium valproic acid, clonazepam, levetiracetam, and piracetam 2, 3, 5
- Cortical-subcortical myoclonus: treated with valproic acid, lamotrigine, and other medications 2, 3
- Subcortical-nonsegmental myoclonus: treated with clonazepam and deep-brain stimulation 2
- Segmental myoclonus: treated with clonazepam and botulinum toxin 3, 5
- Peripheral myoclonus: treated with botulinum toxin 3, 5