From the Guidelines
Treatment of post-hypoxic myoclonus should prioritize the use of propofol to suppress myoclonus, as it has been shown to be effective in this context 152. When considering treatment options for post-hypoxic myoclonus, it is essential to note that myoclonus can be particularly difficult to treat, with phenytoin often being ineffective [reference_id: 1]. The European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines suggest using intermittent electroencephalography (EEG) to detect epileptic activity in patients with clinical seizure manifestations, including myoclonus [reference_id: 1]. Key points to consider in the treatment of post-hypoxic myoclonus include:
- The use of antimyoclonic drugs such as clonazepam, sodium valproate, and levetiracetam, which may be effective in post-anoxic myoclonus [reference_id: 1]
- The potential for seizures, including myoclonus, to increase the cerebral metabolic rate and exacerbate brain injury caused by cardiac arrest [reference_id: 1]
- The importance of excluding potential precipitating causes, such as intracranial hemorrhage or electrolyte imbalance, before starting maintenance therapy [reference_id: 1]
- The need for prolonged observation after treatment of seizures, as myoclonus and electrographic seizure activity are related to a poor prognosis, but individual patients may survive with a good outcome [reference_id: 1].
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Post-Hypoxic Myoclonus
- Anecdotal treatment with benzodiazepines and anaesthetics has been tried for myoclonic status epilepticus (MSE) 2
- Valproic acid, clonazepam, and levetiracetam have shown to control epilepsy associated with Lance-Adams syndrome (LAS) effectively, either in combination with other drugs or alone 2
- Levetiracetam is especially useful for posthypoxic myoclonus 3
- A combination of medications is often needed to obtain adequate control of symptoms 3
- Botulinum toxin is also being introduced for focal myoclonus with encouraging results 3
- Deep brain stimulation is a novel and promising advance in LAS treatment 2
- Perampanel may be an effective alternative for the treatment of myoclonias in patients with chronic post-hypoxic myoclonus 4
Medications Used for Post-Hypoxic Myoclonus
- Levetiracetam: suggested as first-line treatment for cortical myoclonus 5
- Valproic acid: commonly used for cortical myoclonus and demonstrated efficacy in epileptic syndromes 5
- Clonazepam: used for subcortical-nonsegmental myoclonus and segmental myoclonus 5
- Gamma-hydroxybutyric acid: used for alcohol-sensitive myoclonus 3
- Perampanel: may be an effective alternative for the treatment of myoclonias in patients with chronic post-hypoxic myoclonus 4
Treatment Approach
- A thorough evaluation for the myoclonus etiology is critical for developing a treatment strategy 5
- Clinical neurophysiology, as assessed by electromyography and electroencephalography, can be used to classify the pathophysiology of the myoclonus 5
- The treatment strategy for the myoclonus is best derived from the neurophysiology classification scheme categories 5