Materiały źródłowe

• #1 Treatment of myoclonus – UpToDate

  https://www.uptodate.com/contents/treatment-of-myoclonus

  Myoclonus is a sudden, involuntary, shock-like movement caused by sudden muscular contraction (positive myoclonus) or inhibition (negative myoclonus). Among movement disorder phenotypes, myoclonus is the most transient: it is essentially the quickest abnormal movement with a given body part. […] Myoclonic movements have many possible etiologies, and treatment is generally guided by the anatomic/physiologic type of myoclonus. Although there are some treatable underlying etiologies, myoclonus management is primarily symptomatic, and medications often have limited benefits. […] Treat the underlying disorder — When the etiology of myoclonus is treatable or reversible, treatment of the underlying condition may partially or completely relieve the myoclonus. Examples include myoclonus caused by an acquired abnormal metabolic state (eg, hepatic failure), a removable medication or toxin (eg, selective serotonin reuptake inhibitors, opioids), an excisable lesion (eg, thoracic meningioma for spinal myoclonus), or functional jerks due to functional neurological symptom disorder (conversion disorder).

• #2 Myoclonus – OCParkinsons.com

  https://ocparkinsons.com/movement-disorders/myoclonus/

  Myoclonus is not a disease but rather a symptom that describes a sudden, involuntary jerking of muscle. […] More persistent instances of myoclonus, however, can become painful and cause movements to distort making it impossible to conduct simple tasks such as walking, talking, and eating. […] Understanding the underlying cause of the symptom is the key to designing a care and treatment program that will help to alleviate symptoms. […] If you are experiencing reoccurring, involuntary muscle contraction, then you should contact a specialist. Our team of neurology and movement disorder experts work with you to first identify the underlying cause and then develop a healing program to help manage your symptoms. […] As such, we work closely with you to understand your unique circumstances and design care programs that fit your individual needs.

• #3 Myoclonus – Jaipur Child Neuro Care (Dr. Vivek Jain)

  https://jaipurchildneuro.com/myoclonus/

  Myoclonus (say: my-oh-KLOH-nus) is the sudden and rapid twitching of a muscle or a group of muscles. The twitching is caused by uncontrolled muscle contraction or relaxation. […] Myoclonus is a sign of a condition affecting the brain and spinal cord. […] In milder cases of myoclonus, children have a single muscle contraction followed by relaxation and a loss of muscle tone. […] In more severe cases of myoclonus, groups of muscles contract involuntarily throughout the body. […] Myoclonus is treated with drugs that slow down the central nervous system.

• #4 FF #114 Myoclonus | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/myoclonus/

  Myoclonus can disrupt sleep, make coordinated movements difficult, and be bothersome to patients or families. Treatment consists of correction of the underlying cause and symptomatic treatment of the myoclonus. […] If the offending agent is a non-essential medication, it should be discontinued. In the case of opioid-induced myoclonus, rotation to a different opioid may help. […] Benzodiazepines are the primary symptomatic treatment at end-of-life. While any benzodiazepine will work, clonazepam and lorazepam are commonly used. […] Sedation is likely when using benzodiazepines. If sedation is to be avoided, anticonvulsants such as levetiracetam (1,000-3,000 mg/day) and valproic acid (1200-2000 mg/day) may be helpful. The muscle relaxant dantrolene in doses of 50-100 mg/day has been reported as effective.

• #5

  https://www.cookchildrens.org/services/neurosciences/conditions/myoclonus/

  Most of us have experienced those little twitches or jerky movements as we’re falling asleep, or we’ve seen other people have them. […] But sometimes serious forms of myoclonus develop in response to infection, head or spinal cord injury, stroke, brain tumors or other disorders. […] For children, teens and young adults who develop more serious myoclonus disorders, there is a team of renowned neuroscientists at Cook Children’s who are ready to treat them and help them have as active a life as possible. […] Myoclonus refers to a sudden, involuntary jerking of a muscle or group of muscles. […] More severe cases of myoclonus may involve persistent, shock-like contractions in a group of muscles, distort movement and severely limit a person’s ability to eat, talk or walk. […] Myoclonic jerking may develop in children, teens and young adults who have disorders such as multiple sclerosis, juvenile Parkinson’s disease or epilepsy, a disorder in which the electrical activity in the brain becomes disordered and leads to seizures. […] Treatment will begin by caring for any underlying causes, such as tumors or electrolyte imbalances. […] Treatment of myoclonus also focuses on medications that may help reduce symptoms.

• #6 Myoclonus – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/myoclonus/diagnosis-treatment/drc-20350462

  Our caring team of Mayo Clinic experts can help you with your myoclonus-related health concerns […] Treatment of myoclonus works best if you can stop the problem that’s causing it. For example, treatment may focus on another condition, a medicine or a toxin that is causing the myoclonus. […] Most of the time, however, the underlying cause can’t be cured or eliminated. In these cases, treatment is aimed at reducing myoclonus symptoms, especially when they’re disabling. […] There are no drugs specifically designed to treat myoclonus. But treatments for other diseases may help relieve myoclonus symptoms. More than one drug may be needed to control the symptoms. […] Medicines that health care providers commonly prescribe for myoclonus include: […] Clonazepam (Klonopin), a tranquilizer, is the most common drug used to treat myoclonus symptoms.

• #7 Opsoclonus-Myoclonus Syndrome | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/opsoclonus-myoclonus-syndrome

  Opsoclonus-myoclonus syndrome (OMS) is a rare autoimmune condition that usually affects young children. […] Most patients with OMS improve with standard immunotherapy treatment, though the relapse rate in children is 50 to 75 percent. Aggressive, early treatment appears to lower the rate of relapse and improve outcomes. […] Your child’s doctor may recommend immunotherapy as treatment for opsoclonus-myoclonus syndrome. Immunotherapy is a type of treatment that helps keep the body’s immune system from attacking the brain. Standard immunotherapy treatment for OMS is started soon after diagnosis and usually continues for at least one to two years. The goal of treatment is a decrease or disappearance (remission) of symptoms. […] Your child may also need physical therapy, speech therapy, or occupational therapy to improve development and long-term prognosis. […] The Pediatric Neuro-Immunology Program at Boston Children’s Hospital is dedicated to the comprehensive care of children and adolescents who have autoimmune disorders of the brain and spinal cord (neuro-immune disorders).

• #8 Pediatric myoclonus in Infants and Newborns – Children’s Health Neurology

  https://www.childrens.com/specialties-services/conditions/myoclonus

  At Childrens Health, the neurology team has extensive training and experience working with children who have movement disorders. We diagnose and treat all forms of myoclonus as well as the conditions causing them to give your child the care they need. […] Doctors usually diagnose this condition through a physical exam and careful observation. It can be important to diagnose and treat myoclonus in children early to find the cause and, in some cases, prevent it from getting worse. […] In children, myoclonus can be treated by medications or by a type of surgery called deep brain stimulation (DBS). The treatment typically depends on what is causing the myoclonus. […] Our care team includes a broad range of specialists who have the expertise to work with your child to diagnose and treat the symptoms and underlying causes of myoclonus.

• #9 The Importance of Identifying Myoclonus in the Setting of Mental Status Abnormalities: Differential Diagnosis and Treatment

  https://www.psychiatrist.com/pcc/myoclonus-and-mental-status-abnormalities/

  Myoclonus often accompanies changes in mental status that may be useful in guiding the differential diagnosis and workup. […] Clinical information, such as the time course, accompanying cognitive deficits, medical history, and current medications, provides a useful framework for narrowing the differential diagnosis. […] Laboratory work should be tailored to assess for the presence of organ dysfunction that may account for metabolic encephalopathies; intracranial imaging, electroencephalography, and lumbar puncture are adjunctive diagnostics that can also be considered. […] The evaluation and treatment of myoclonus begins with a detailed history and physical examination, targeted diagnostic studies, and, often, empiric therapeutics, which in and of themselves have diagnostic value. […] The key to the initial evaluation is to identify whether the myoclonus is most likely a primary process, epileptic in etiology, or secondary to another medical process.

• #10 Benign Neonatal Sleep Myoclonus Treatment & Management: Medical Care, Consultations, Long-Term Monitoring

  https://emedicine.medscape.com/article/1355567-treatment

  Medical care of benign neonatal sleep myoclonus (BNSM) consists of making a timely diagnosis. Delayed recognition often results in extensive diagnostic testing, including screening for infectious causes of seizures (eg, spinal tap, blood cultures, empiric antibiotics) and neurodiagnostics (eg, electroencephalography, brain imaging, brain monitoring). This process almost invariably results in admission to the hospital and a great deal of family distress. […] Early recognition of BNSM can be facilitated by the use of home-video monitoring by parents, especially if the episodes are frequent. If the child is otherwise clinically well, ask the parents to obtain video footage while their child undergoes medical evaluation. Once a provider is experienced in the clinical manifestations, this can be invaluable in the diagnosis of benign neonatal sleep myoclonus. At that point, parents are reassured regarding the benign nature of the condition and educated regarding the prognosis. If clinical concern for possible seizure remains but the child is otherwise clinically stable (eg, without concerning pregnancy-related risk factors or abnormal findings on examination), admission to the hospital for a short stay to facilitate monitoring and observation by trained professionals is prudent.

• #11

  https://www.aurorahealthcare.org/services/neuroscience/neurology/neurological-conditions/neuromuscular-disorders/myoclonus

  Myoclonus treatment is highly personalized, taking into account your overall health and the specific details gathered about your twitching muscle episodes. […] Initially, the focus will be on addressing any underlying conditions. However, in many cases your treatment will focus on reducing the frequency of your muscle twitching episodes or making them less intense. Myoclonus treatments often involve medications, including: […] Your doctor will carefully tailor your treatment plan to best address your specific needs and enhance your quality of life.

• #12 Myoclonus – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/myoclonus/diagnosis-treatment/drc-20350462

  Drugs used to control epileptic seizures may help reduce myoclonus symptoms. […] OnabotulinumtoxinA (Botox) injections may help treat various forms of myoclonus, particularly if only a single area is affected. […] If myoclonus symptoms are caused by a tumor or lesion in the brain or spinal cord, surgery may be an option. […] Deep brain stimulation has been tried in some people with myoclonus and other movement disorders.

• #13 Myoclonus | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/myoclonus

  Myoclonus refers to a quick jerking movement that you can’t control. […] Treating whatever condition causes myoclonus can help control symptoms. […] If your myoclonus symptoms become frequent and persistent, talk to your health care provider about a diagnosis and treatment options. […] Treatment of myoclonus works best if you can stop the problem that’s causing it. […] Most of the time, however, the underlying cause can’t be cured or eliminated. In these cases, treatment is aimed at reducing myoclonus symptoms, especially when they’re disabling. […] Medicines that health care providers commonly prescribe for myoclonus include: […] OnabotulinumtoxinA (Botox) injections may help treat various forms of myoclonus, particularly if only a single area is affected. […] If myoclonus symptoms are caused by a tumor or lesion in the brain or spinal cord, surgery may be an option. […] Your health care provider is likely to ask you a number of questions. Being ready to answer them may make time to go over any points you want to discuss in-depth.

• #14 Assessment and Treatment of Myoclonus: A Review – touchNEUROLOGY

  https://touchneurology.com/movement-disorders/journal-articles/assessment-and-treatment-of-myoclonus-a-review/

  Myoclonus is defined as sudden, brief, shock-like contractions of muscles, and it can be a challenging diagnosis for the clinician to face. […] Treatment of myoclonus is often symptomatic, unless a clear treatable underlying cause can be found. […] This article aims to help providers navigate the assessment and treatment of myoclonus, focusing on neurophysiological classification as a guide. […] Treatment of myoclonus differs vastly depending on the aetiology. […] Once treatable conditions of myoclonus have been exhausted, then the clinician may consider symptomatic treatment, especially when there is not a treatable cause for the myoclonus and when the myoclonus is functionally disabling for the patient. […] Before selecting a pharmacological treatment for myoclonus it is important to consider the neurophysiological classification of the myoclonus, as different medications can treat different subtypes. […] Treatment should be directed at any underlying cause of myoclonus where possible or feasible. […] When no other treatable cause is found, treatment for myoclonus should be targeted at specific neurophysiological classifications.

• #15 The Importance of Identifying Myoclonus in the Setting of Mental Status Abnormalities: Differential Diagnosis and Treatment

  https://www.psychiatrist.com/pcc/myoclonus-and-mental-status-abnormalities/

  The treatment for myoclonus is predicated on its underlying etiology. […] In instances in which the myoclonus is a primary process or the underlying etiology cannot be easily reversed, treatments are directed toward the underlying mechanism of the myoclonus (ie, cortical, cortical-subcortical, subcortical nonsegmental, segmental, or peripheral myoclonus). […] Accepted therapies for cortical myoclonus include levetiracetam, piracetam, clonazepam, and valproic acid. […] Given their relatively favorable side effect profiles, levetiracetam and piracetam are the preferred initial agents for chronic cortical myoclonus, although multiple agents (in combination) are often needed to achieve the desired effect. […] Clonazepam is often used as a first-line agent, and several alternative antiepileptic agents have also been used with success. […] Systemic medications have shown only limited benefit in this subcategory.

• #16 Neurological symptoms

  https://www.rch.org.au/rch_palliative/for_health_professionals/Neurological_symptoms/

  Myoclonus, the brief and irregular contraction of all or part of a muscle, can occur as a result of immobility, pain, or other sensory stimulation. It is also a recognised side effect of opioid use, particularly pethidine and is more common where the patient has renal impairment. It is postulated that the major cause is accumulation of opioid metabolites, but the dose at which it occurs varies widely. […] Treatment of myoclonus may not be necessary if it is not troubling the patient. If required it may be appropriate to reduce the dose of opioid, change the route of administration or change to another drug. Benzodiazepines are useful in the management of myoclonus with alternatives including Oral diazepam 0.05-0.1mg/kg q4-6h (max 5mg/dose), Oral or sublingual clonazepam (0.01mg/kg q8-12h), Midazolam as a continuous S/c or IV infusion (see seizure management) is usually effective.

• #17 Post-Hypoxic Myoclonus • LITFL • CCC

  https://litfl.com/post-hypoxic-myoclonus/

  Post-hypoxic myoclonus (PHM) refers to myoclonus occurring after hypoxic brain injury resulting from a cardiac arrest, characterised by abrupt, irregular contractions of muscles that may be focal or generalised […] Chronic also known as Lance-Adams syndrome, refers to myoclonus that starts days to weeks after cardiopulmonary resuscitation in patients who regained consciousness (cognitive function may range from normal to absent) […] Myoclonic status epilepticus prognosis is extremely poor […] Regardless of treatment the prognosis is poor due to the severity of underlying brain injury […] aggressive treatment may improve longterm function […] pharmacological control of myoclonus with agents such as sodium valproate, clonazepam, and levetiracetam […] rehabilitation to limit disabilities.

• #18

  https://journals.lww.com/ccmjournal/fulltext/2020/11000/myoclonus_in_patients_with_coronavirus_disease.14.aspx

  In our cohort, outcomes after myoclonus were highly variable, with one deceased patient and five who were successfully extubated cognitively intact without focal neurologic deficits. […] In cases of COVID-19, myoclonus may be multifactorial and represent a combination of hypoxia, medication toxicity, and direct or para-infectious complications of the virus itself.

• #19 Benign Neonatal Sleep Myoclonus Treatment & Management: Medical Care, Consultations, Long-Term Monitoring

  https://emedicine.medscape.com/article/1355567-treatment

  Inpatient care is warranted in patients with BNSM only if other risk factors for neurologic disease are evident, such as developmental concerns, deficits or abnormalities upon examination, or signs of metabolic or infectious disease. However, as mentioned above, inpatient care should be strongly considered if the movements have not been clearly identified as benign in nature by a medical provider. […] No medication is necessary in benign neonatal sleep myoclonus. In fact, treatment with benzodiazepines and other anticonvulsants may worsen the movements because they may cause sedation and sleep. […] If clinical confusion remains, a pediatric neurologist should be consulted to observe video footage and to perform an extended neurologic examination. Further diagnostic testing could be ordered based on their assessment and based on concern regarding possible seizures or other more ominous causes of myoclonus in children. This would be especially pertinent in patients with late-onset manifestations or with other concerning neurologic findings. […] Outpatient care of the child with a clear history of benign neonatal sleep myoclonus is within the purview of a general pediatrician. Monitoring for other neurologic or developmental concerns is included in the standard recommendations for pediatric care in the first year of life.

• #20 Myoclonic Seizure: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23172-myoclonic-seizure

  Your healthcare provider can help determine if myoclonic seizures are a warning sign of bigger seizures and what, if anything, you can do to use this information to your advantage. […] If you have myoclonic seizures or a condition that causes them, your healthcare provider will give you guidance, information and resources that can help you manage this condition. […] It’s important to follow that guidance closely and ask questions if you don’t understand. […] If your treatments aren’t as effective as you’d like or you experience problems from side effects, talk to your healthcare provider about these concerns. […] They can often help you find other treatments that work better or minimize side effects.

• #21 What Is Myoclonus? A Comprehensive Guide

  https://drchandrilchugh.com/myoclonus/what-is-myoclonus-a-comprehensive-guide/

  Myoclonus treatment is based on whats causing it. The first step is usually using medicines. This includes drugs like clonazepam, levetiracetam, valproic acid, and 5-hydroxytryptophan to help with the symptoms. […] Doctors often use a mix of treatments to fight myoclonus. This might include medicine, Botox, or even surgery. By using different therapies together, they aim to make life better for those with myoclonus. […] Myoclonus makes a big difference in how people live. The sudden jerks and twitches can limit what they do physically. They might also feel embarrassed when this happens around others. This can lead to them feeling upset or scared, especially if the spasms are strong or stop them from doing daily tasks like eating or walking. All of this really affects how they feel and live their life.

• #22 Opsoclonus-Myoclonus Syndrome | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/opsoclonus-myoclonus-syndrome

  Opsoclonus-myoclonus syndrome (OMS) is a rare autoimmune condition that usually affects young children. […] Most patients with OMS improve with standard immunotherapy treatment, though the relapse rate in children is 50 to 75 percent. Aggressive, early treatment appears to lower the rate of relapse and improve outcomes. […] Your child’s doctor may recommend immunotherapy as treatment for opsoclonus-myoclonus syndrome. Immunotherapy is a type of treatment that helps keep the body’s immune system from attacking the brain. Standard immunotherapy treatment for OMS is started soon after diagnosis and usually continues for at least one to two years. The goal of treatment is a decrease or disappearance (remission) of symptoms. […] Your child may also need physical therapy, speech therapy, or occupational therapy to improve development and long-term prognosis. […] The Pediatric Neuro-Immunology Program at Boston Children’s Hospital is dedicated to the comprehensive care of children and adolescents who have autoimmune disorders of the brain and spinal cord (neuro-immune disorders).

• #23 What Is Myoclonus? A Comprehensive Guide

  https://drchandrilchugh.com/myoclonus/what-is-myoclonus-a-comprehensive-guide/

  Doctors need to look at the whole picture with myoclonus. They should work closely with the patients, their families, and other experts to come up with plans that help in every way. […] This approach should fix the physical issues, help with daily tasks, and make life better overall. By looking at and treating myoclonus this way, doctors can lessen the hard impact and make life better for those dealing with it.

• #24 Myoclonus – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/myoclonus/symptoms-causes/syc-20350459

  Myoclonus care at Mayo Clinic […] Treating whatever condition causes myoclonus can help control symptoms. Sometimes the cause of myoclonus is unknown or can’t be specifically treated. In these cases, the goal of treatment is to reduce the effects of myoclonus on quality of life. […] If your myoclonus symptoms become frequent and persistent, talk to your health care provider about a diagnosis and treatment options.

Zobacz więcej