myoclonus treatment

 Q: Which of the following is preferred treatment for myoclonus? (select one)

A) Levetiracetam 

 B) Phenytoin

Answer: A

Although historically phenytoin has been used for cortical myoclonus but it can paradoxically exacerbate myoclonus. Special care should be taken on patients who have myoclonus with Unverricht-Lundborg disease, which is progressive myoclonic epilepsy disorder. Also phenytoin can make symptoms worse in palatal myoclonus and cortical-subcortical myoclonus. Levetiracetam is the preffered drug of choice. 

There is a long list of medications which have been tried with various successes including piracetam, brivaracetam, clonazepam, and valproic acid.

#neurology

#pharmacology

References:

1. Lim LL, Ahmed A. Limited efficacy of levetiracetam on myoclonus of different etiologies. Parkinsonism Relat Disord 2005; 11:135.

2. Eldridge R, Iivanainen M, Stern R, et al. "Baltic" myoclonus epilepsy: hereditary disorder of childhood made worse by phenytoin. Lancet 1983; 2:838.