From the Guidelines
The current treatment for myoclonic jerks typically involves medications that reduce neuronal excitability in the brain, with first-line treatments including valproic acid (Depakote) at doses of 500-2000 mg/day, levetiracetam (Keppra) at 1000-3000 mg/day, or clonazepam (Klonopin) at 0.5-6 mg/day, as recommended by the most recent guidelines 1. These medications work by enhancing inhibitory neurotransmission or reducing excitatory signals in the brain. Treatment should be tailored to the underlying cause of the myoclonus, as jerks can result from epilepsy, metabolic disorders, medication side effects, or neurodegenerative conditions. For epileptic myoclonus, antiseizure medications are most effective, while symptomatic treatment may be appropriate for other causes. Some patients may require combination therapy if single medications are insufficient. Key points to consider in treatment include:
- The use of intermittent electroencephalography (EEG) to detect epileptic activity in patients with clinical seizure manifestations, as recommended by the European Resuscitation Council and European Society of Intensive Care Medicine 1.
- The potential for myoclonus to be particularly difficult to treat, with phenytoin often being ineffective, and propofol being effective in suppressing post-anoxic myoclonus 1.
- The importance of considering the potential for sedatives such as propofol to have antiepileptic effects, and the need for careful consideration of sedation strategies in post-cardiac arrest patients 1. Lifestyle modifications are also important, including avoiding triggers like sleep deprivation, stress, and alcohol consumption. Treatment typically continues long-term for chronic conditions, with periodic assessment of medication effectiveness and side effects. In severe cases unresponsive to medications, deep brain stimulation might be considered as an alternative approach. It is also important to note that there is no direct evidence of undesirable effects of antiepileptic drug therapy in comatose post–cardiac arrest survivors, but treatment with sedatives and conventional antiepileptic drugs in high doses has the potential to cause delayed awakening, prolonged need for mechanical ventilation, and increased critical care days 1. Overall, the treatment of myoclonic jerks should be individualized and based on the underlying cause of the condition, with careful consideration of the potential benefits and risks of different treatment options.
From the FDA Drug Label
Levetiracetam is indicated as adjunctive therapy in the treatment of myoclonic seizures in adults and adolescents 12 years of age and older with juvenile myoclonic epilepsy. The current treatment for myoclonic jerks is levetiracetam as an adjunctive therapy, specifically for patients 12 years of age and older with juvenile myoclonic epilepsy 2.
- Key points:
- Levetiracetam is used as an adjunctive therapy
- For myoclonic seizures in patients with juvenile myoclonic epilepsy
- Effective in patients 12 years of age and older 2
From the Research
Current Treatment for Myoclonic Jerks
The current treatment for myoclonic jerks typically involves the use of antiepileptic drugs. Some of the commonly used medications include:
- Valproate, which is often the first choice for treatment, either alone or in combination with other medications such as benzodiazepines or levetiracetam 3, 4, 5, 6
- Levetiracetam, which has been shown to be effective in treating myoclonic seizures 3, 4, 5, 6
- Benzodiazepines, such as clonazepam, which may be helpful in treating all types of myoclonus 4, 5
- Piracetam, which has been shown to be effective in treating cortical myoclonus 4, 5
- Topiramate and zonisamide, which may be effective in treating myoclonic seizures, although there is limited evidence to support their use as monotherapy 3, 5
Treatment Approach
The treatment approach for myoclonic jerks often involves a combination of medications, as a single pharmacological agent rarely controls myoclonus 4. The choice of medication depends on the underlying cause of the myoclonus, as well as the individual patient's response to treatment. It is also important to avoid medications that may aggravate myoclonic seizures, such as carbamazepine, phenytoin, and oxcarbazepine 3, 5.
Emerging Evidence
There is emerging evidence to support the efficacy of newer antiepileptic drugs in treating myoclonic seizures, although more research is needed to fully understand their potential benefits and limitations 3, 6. Additionally, better understanding of the pathophysiologic mechanisms of myoclonic epilepsies could lead to improved treatment options and quality of life for patients 3, 6.