Myoclonus medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Saumya Easaw, M.B.B.S.[3]

Medical Therapy

Treatment of myoclonus focuses on medications that may help reduce symptoms.

1. Clonazepam:
   • The drug of first choice to treat myoclonus, especially certain types of action myoclonus, is clonazepam, a benzodiazepine.
   • Dosages of clonazepam usually are increased gradually until the patient improves or side effects become harmful.
   • Common side effects:Drowsiness and loss of coordination.
   • The beneficial effects of clonazepam may diminish over time if the patient develops a tolerance for the drug.
2. Other Drugs:
   • Many of the drugs used for myoclonus, such as barbiturates, phenytoin and primidone, are also used to treat epilepsy.
   • Barbiturates slow down the central nervous system and cause tranquilizing or antiseizure effects.
   • Phenytoin and primidone are effective antiepileptics drugs, although phenytoin can cause liver failure or have other harmful long-term effects in patients with PME.
   • Sodium valproate is an alternative therapy for myoclonus and can be used either alone or in combination with clonazepam. Although clonazepam and/or sodium valproate are effective in the majority of patients with myoclonus, some people have adverse reactions to these drugs.
   • 5-hydroxytryptophan: Some studies have shown that doses of 5-hydroxytryptophan (5-HT) leads to improvement in patients with some types of action myoclonus and PME. However, other studies indicate that 5-HT therapy is not effective in all people with myoclonus, and, in fact, may worsen the condition in some patients. These differences in the effect of 5-HT on patients with myoclonus have not yet been explained, but they may offer important clues to underlying abnormalities in serotonin receptors.

The complex origins of myoclonus may require the use of multiple drugs for effective treatment. Although some drugs have a limited effect when used individually, they may have a greater effect when used with drugs that act on different pathways or mechanisms in the brain. By combining several of these drugs, scientists hope to achieve greater control of myoclonic symptoms. Some drugs currently being studied in different combinations include clonazepam, sodium valproate, piracetam, and primidone. Hormonal therapy also may improve responses to antimyoclonic drugs in some people.