EpistemisMyoclonus
Specialty: Neurology.
Why it occurs
- Physiological myoclonus (during falling asleep or after strenuous exercise)
- Myoclonic epilepsy (juvenile, progressive or symptomatic)
- Post cardiac arrest anoxic encephalopathy (Lance-Adams syndrome or action myoclonus)
- Metabolic encephalopathies (uremia, liver failure, hypercapnia, hypoxia)
- Neurodegenerative diseases (Creutzfeldt-Jakob disease, Lewy body dementia)
- Neuroexcitatory drugs (tricyclic antidepressants, high-dose opioids, lithium)
Initial workup
Continuous electroencephalogram (EEG) or with intermittent light stimulation to record spike-wave paroxysms synchronous with jerks; Brain magnetic resonance imaging (MRI) (DWI and FLAIR diffusion sequences) to look for cortical or basal ganglia hypersignal; general metabolic analysis and determination of drug levels.
red flags
Presence of acute-onset multifocal myoclonus associated with rapidly progressive dementia, ataxia and akinetic mutism (suspected prion disease), or generalized continuous myoclonus associated with coma or marked postanoxia brain obtundation.
Standard management
- Levetiracetam — 500-3000 mg/day, excellent profile for cortical myoclonus
- Sodium valproate — 500-2000 mg/day, broad spectrum, contraindicated in women of childbearing age if alternatives exist
- Clonazepam — 0.5-6 mg/day, very effective in myoclonus of subcortical and spinal origin
- Piracetam (in high doses, as an adjuvant).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 6
- Treatment options
- 4