Materiały źródłowe

• #1 Myoclonus – Diagnosis and treatment – Mayo Clinic

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

  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: […] Tranquilizers. Clonazepam (Klonopin), a tranquilizer, is the most common drug used to treat myoclonus symptoms. Clonazepam may cause side effects such as loss of coordination and drowsiness.

• #2 Treatment of myoclonus – UpToDate

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

  Treatment of myoclonus […] 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).

• #3 Treatment of Myoclonus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3899494/

  Myoclonus creates significant disability for patients. A thorough evaluation for the myoclonus etiology is critical for developing a treatment strategy. If the etiology of the myoclonus cannot be reversed or treated, then symptomatic treatment of the myoclonus itself may be warranted. Unfortunately, there are few controlled studies for myoclonus treatments. The treatment strategy for the myoclonus is best derived from the neurophysiology classification scheme categories: 1) cortical, 2) corticalsubcortical, 3) subcorticalnonsegmental, 4) segmental, and 5) peripheral. Levetiracetam is suggested as first-line treatment for cortical myoclonus, but valproic acid and clonazepam are commonly used. Clonazepam is used for subcorticalnonsegmental myoclonus, but other treatments, depending on the syndrome, have been used for this physiological type of myoclonus. Segmental myoclonus is difficult to treat, but clonazepam and botulinum toxin are used. Myoclonus treatment is commonly not effective and/or limited by side effects. At this time, there is little evidence-based data available for myoclonus treatment. The first consideration should be given to reversing the underlying etiology of the myoclonus. For the majority of myoclonus cases, treatment of the underlying disorder is usually not possible or effective, and symptomatic treatment is justified if the myoclonus is disabling enough. The best strategy for symptomatic treatment is derived from using physiological classification. Suppression of myoclonus may come from lowering the excitatory drive and/or increasing inhibition of the responsible neurons that drive the excitatory output. Levetiracetam and piracetam are related drugs and have had limited controlled study for myoclonus treatment. Sodium valproate is the major drug of choice for corticalsubcortical myoclonus overall. Clonazepam is the first line of symptomatic therapy for propriospinal myoclonus. The myoclonic movements of hemifacial spasm will often respond to botulinum toxin therapy along with the more tonic or sustained contractions.

• #4 Myoclonic disorders: a practical approach for diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3036960/

  Myoclonus is a sudden, brief, involuntary muscle jerk. […] A single pharmacological agent rarely control myoclonus and therefore polytherapy with a combination of drugs, often in large dosages, is usually needed. Generally, antiepileptic drugs such as valproate, levetiracetam and piracetam are effective in cortical myoclonus, but less effective in other forms of myoclonus. Clonazepam may be helpful with all types of myoclonus. […] The treatment of myoclonus depends on the underlying disorder. […] A useful approach to the treatment is to first establish the physiology of myoclonus (cortical versus subcortical or spinal), because different drugs will work in different types of myoclonus. […] In general, antiepileptic drugs such as valproate, levetiracetam and piracetam are effective in cortical myoclonus, but ineffective in other forms of myoclonus. Clonazepam is useful in hyperekplexia and partially in reticular reflex myoclonus. […] Segmental myoclonus, irrespective of its origin (palatal tremor, spinal segmental myoclonus) may be treated with botulinum toxin injections, with variable success. […] Psychogenic myoclonus may improve as a result of placebo or psychotherapy.

• #5 Treatment of myoclonus – UpToDate

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

  Treatment of myoclonus […] 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).

• #6 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. In cases that are secondary to medication/drug exposure or toxic/metabolic abnormalities, removal of the offending drug(s) and/or correction of the metabolic abnormalities is the first step in treatment. […] 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.

• #7 Myoclonus – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/movement-and-cerebellar-disorders/myoclonus

  Myoclonus is a brief, shocklike contraction of a muscle or group of muscles. […] Treatment includes correction of reversible causes and, when necessary, oral medications to relieve symptoms. […] Treatment of myoclonus begins with correction of underlying metabolic disturbances or other causes if correctable. If a medication is the cause, the medication is stopped, or the dose is reduced. […] Site of origin for myoclonus helps guide symptomatic treatment. For example, valproate, levetiracetam, and piracetam tend to be effective in cortical myoclonus but ineffective in other types of myoclonus. Clonazepam may be effective in all types of myoclonus. Doses of clonazepam or valproate may need to be lower in older adults. In some cases, a combination of medications is necessary. […] If a metabolic disturbance is the cause, correct it, and when necessary, give medications (eg, clonazepam, valproate, levetiracetam) to relieve symptoms.

• #8 Myoclonus – Diagnosis and treatment – Mayo Clinic

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

  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: […] Tranquilizers. Clonazepam (Klonopin), a tranquilizer, is the most common drug used to treat myoclonus symptoms. Clonazepam may cause side effects such as loss of coordination and drowsiness.

• #9 Myoclonus | Baylor Medicine

  https://www.bcm.edu/healthcare/specialties/neurology/parkinsons-disease-and-movement-disorders/myoclonus

  If possible, the underlying cause of myoclonus should be corrected, but this is not always possible. If the myoclonus is due to a medication side effect, then the myoclonus usually resolves with discontinuation of that medication. If myoclonus persists despite eliminating treatable causes, then the treatment of myoclonus otherwise focuses on medications help reduce symptoms. […] The drugs used to treat myoclonus usually possess anti-seizure properties. Epileptic myoclonus and cortical (arising from the brains cerebral hemispheres) myoclonus respond best to clonazepam and sodium valproate, which may be used alone or in combination. Clonazepam is a tranquilizer and is commonly used to treat myoclonus. Dosages of clonazepam are usually increased gradually until the patient improves or side effects become bothersome. Drowsiness and loss of coordination are common side effects. The beneficial effects of clonazepam may diminish over time if the patient develops a tolerance to the medication. If disability from the myoclonus is not adequately improved on either or both of these medications, then medications such as levetiracetam (Keppra) can be added, which is also very effective in treating myoclonus. Levetiracetam has also been shown to be effective in posthypoxic myoclonus. Primidone may also be of value was an additional drug, as well as clobazam and acetazolamide in severely affected patients. More recently, another antiepileptic agent (Perampanel) has been used to treat patients with various types of myoclonus, including post-hypoxic myoclonus, with good response.

• #10 Myoclonic disorders: a practical approach for diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3036960/

  Myoclonus is a sudden, brief, involuntary muscle jerk. […] A single pharmacological agent rarely control myoclonus and therefore polytherapy with a combination of drugs, often in large dosages, is usually needed. Generally, antiepileptic drugs such as valproate, levetiracetam and piracetam are effective in cortical myoclonus, but less effective in other forms of myoclonus. Clonazepam may be helpful with all types of myoclonus. […] The treatment of myoclonus depends on the underlying disorder. […] A useful approach to the treatment is to first establish the physiology of myoclonus (cortical versus subcortical or spinal), because different drugs will work in different types of myoclonus. […] In general, antiepileptic drugs such as valproate, levetiracetam and piracetam are effective in cortical myoclonus, but ineffective in other forms of myoclonus. Clonazepam is useful in hyperekplexia and partially in reticular reflex myoclonus. […] Segmental myoclonus, irrespective of its origin (palatal tremor, spinal segmental myoclonus) may be treated with botulinum toxin injections, with variable success. […] Psychogenic myoclonus may improve as a result of placebo or psychotherapy.

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

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

  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. […] Cortical myoclonus may be effectively treated with medications that bind to synaptic vesicle protein 2a and are more commonly used to treat various types of epilepsy. […] Valproic acid is another option for the treatment of cortical myoclonus and generally requires dosages ranging from 1200 to 2000 mg/day, but this medication typically works best in combination with other agents. […] For the treatment of cortical-subcortical myoclonus, especially that related to juvenile myoclonic epilepsy, valproic acid is considered to be the first-line therapy. […] Subcortical-nonsegmental myoclonus is more challenging to treat owing to the large number of different underlying causative mechanisms.

• #12 Myoclonus – Diagnosis and treatment – Mayo Clinic

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

  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: […] Tranquilizers. Clonazepam (Klonopin), a tranquilizer, is the most common drug used to treat myoclonus symptoms. Clonazepam may cause side effects such as loss of coordination and drowsiness.

• #13

  https://link.springer.com/article/10.1007/s13311-020-00922-6

  Piracetam and related compounds including levetiracetam and brivaracetam have demonstrated efficacy in treating cortical myoclonus. […] The possible mechanism of action in the case of clonazepam is facilitation of GABAergic transmission by affecting the benzodiazepine receptor and a decrease in 5-hydroxytryptophan utilization in the brain. […] Other pharmacological treatments for cortical myoclonus have included other various anti-epileptic medications. […] Deep brain stimulation surgery has been performed in refractory cases of posthypoxic myoclonus with two cases demonstrating significant improvement in myoclonus severity scales after bilateral globus pallidus interna implantation. […] Transcranial magnetic stimulation (TMS) may present a noninvasive and nonpharmacological method of treating cortical myoclonus, but further study is needed to address long-term efficacy.

• #14 Myoclonus – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/movement-and-cerebellar-disorders/myoclonus

  Myoclonus is a brief, shocklike contraction of a muscle or group of muscles. […] Treatment includes correction of reversible causes and, when necessary, oral medications to relieve symptoms. […] Treatment of myoclonus begins with correction of underlying metabolic disturbances or other causes if correctable. If a medication is the cause, the medication is stopped, or the dose is reduced. […] Site of origin for myoclonus helps guide symptomatic treatment. For example, valproate, levetiracetam, and piracetam tend to be effective in cortical myoclonus but ineffective in other types of myoclonus. Clonazepam may be effective in all types of myoclonus. Doses of clonazepam or valproate may need to be lower in older adults. In some cases, a combination of medications is necessary. […] If a metabolic disturbance is the cause, correct it, and when necessary, give medications (eg, clonazepam, valproate, levetiracetam) to relieve symptoms.

• #15 Myoclonus | Baylor Medicine

  https://www.bcm.edu/healthcare/specialties/neurology/parkinsons-disease-and-movement-disorders/myoclonus

  If possible, the underlying cause of myoclonus should be corrected, but this is not always possible. If the myoclonus is due to a medication side effect, then the myoclonus usually resolves with discontinuation of that medication. If myoclonus persists despite eliminating treatable causes, then the treatment of myoclonus otherwise focuses on medications help reduce symptoms. […] The drugs used to treat myoclonus usually possess anti-seizure properties. Epileptic myoclonus and cortical (arising from the brains cerebral hemispheres) myoclonus respond best to clonazepam and sodium valproate, which may be used alone or in combination. Clonazepam is a tranquilizer and is commonly used to treat myoclonus. Dosages of clonazepam are usually increased gradually until the patient improves or side effects become bothersome. Drowsiness and loss of coordination are common side effects. The beneficial effects of clonazepam may diminish over time if the patient develops a tolerance to the medication. If disability from the myoclonus is not adequately improved on either or both of these medications, then medications such as levetiracetam (Keppra) can be added, which is also very effective in treating myoclonus. Levetiracetam has also been shown to be effective in posthypoxic myoclonus. Primidone may also be of value was an additional drug, as well as clobazam and acetazolamide in severely affected patients. More recently, another antiepileptic agent (Perampanel) has been used to treat patients with various types of myoclonus, including post-hypoxic myoclonus, with good response.

• #16 Myoclonus – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/movement-and-cerebellar-disorders/myoclonus

  Myoclonus is a brief, shocklike contraction of a muscle or group of muscles. […] Treatment includes correction of reversible causes and, when necessary, oral medications to relieve symptoms. […] Treatment of myoclonus begins with correction of underlying metabolic disturbances or other causes if correctable. If a medication is the cause, the medication is stopped, or the dose is reduced. […] Site of origin for myoclonus helps guide symptomatic treatment. For example, valproate, levetiracetam, and piracetam tend to be effective in cortical myoclonus but ineffective in other types of myoclonus. Clonazepam may be effective in all types of myoclonus. Doses of clonazepam or valproate may need to be lower in older adults. In some cases, a combination of medications is necessary. […] If a metabolic disturbance is the cause, correct it, and when necessary, give medications (eg, clonazepam, valproate, levetiracetam) to relieve symptoms.

• #17 Myoclonus – Diagnosis and treatment – Mayo Clinic

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

  Anticonvulsants. Drugs used to control epileptic seizures may help reduce myoclonus symptoms. The most common anticonvulsants used for myoclonus are levetiracetam (Keppra, Elepsia XR, Spritam), valproic acid, zonisamide (Zonegran, Zonisade) and primidone (Mysoline). Piracetam is another anticonvulsant that’s been found to be effective, but it’s not available in the United States. Valproic acid may cause side effects such as nausea. Levetiracetam may cause side effects such as fatigue and dizziness. Side effects from primidone may include sedation and nausea. […] OnabotulinumtoxinA (Botox) injections may help treat various forms of myoclonus, particularly if only a single area is affected. This treatment blocks the release of a chemical messenger that triggers muscle contractions. […] If myoclonus symptoms are caused by a tumor or lesion in the brain or spinal cord, surgery may be an option. People with myoclonus affecting parts of the face or ear also may benefit from surgery.

• #18

  https://journals.lww.com/annalsofian/fulltext/2021/24030/myoclonus__a_review.5.aspx

  Drugs used for cortical myoclonus act by facilitating inhibitory GABAergic transmission and/or reducing the hyperexcitability in the sensorimotor cortex. […] The four most effective agents are levetiracetam, piracetam, valproic acid, and clonazepam. […] Clonazepam is also useful in cortical myoclonus. […] Standard antiepileptic drugs used in cortical myoclonus are not helpful in most types of subcortical-nonsegmental myoclonus. […] For propriospinal myoclonus, other effective agents are zonisamide and levetiracetam. […] Treatment of palatal tremor is difficult. […] The drug of choice in this subtype is usually clonazepam (up to 6 mg/day), but complete suppression is uncommon. […] Both clonic movements and tonic spasms of hemifacial spasm respond excellently to botulinum toxin injection.

• #19 Myoclonus – Diagnosis and treatment – Mayo Clinic

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

  Anticonvulsants. Drugs used to control epileptic seizures may help reduce myoclonus symptoms. The most common anticonvulsants used for myoclonus are levetiracetam (Keppra, Elepsia XR, Spritam), valproic acid, zonisamide (Zonegran, Zonisade) and primidone (Mysoline). Piracetam is another anticonvulsant that’s been found to be effective, but it’s not available in the United States. Valproic acid may cause side effects such as nausea. Levetiracetam may cause side effects such as fatigue and dizziness. Side effects from primidone may include sedation and nausea. […] OnabotulinumtoxinA (Botox) injections may help treat various forms of myoclonus, particularly if only a single area is affected. This treatment blocks the release of a chemical messenger that triggers muscle contractions. […] If myoclonus symptoms are caused by a tumor or lesion in the brain or spinal cord, surgery may be an option. People with myoclonus affecting parts of the face or ear also may benefit from surgery.

• #20 Treatment of Myoclonus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3899494/

  Myoclonus creates significant disability for patients. A thorough evaluation for the myoclonus etiology is critical for developing a treatment strategy. If the etiology of the myoclonus cannot be reversed or treated, then symptomatic treatment of the myoclonus itself may be warranted. Unfortunately, there are few controlled studies for myoclonus treatments. The treatment strategy for the myoclonus is best derived from the neurophysiology classification scheme categories: 1) cortical, 2) corticalsubcortical, 3) subcorticalnonsegmental, 4) segmental, and 5) peripheral. Levetiracetam is suggested as first-line treatment for cortical myoclonus, but valproic acid and clonazepam are commonly used. Clonazepam is used for subcorticalnonsegmental myoclonus, but other treatments, depending on the syndrome, have been used for this physiological type of myoclonus. Segmental myoclonus is difficult to treat, but clonazepam and botulinum toxin are used. Myoclonus treatment is commonly not effective and/or limited by side effects. At this time, there is little evidence-based data available for myoclonus treatment. The first consideration should be given to reversing the underlying etiology of the myoclonus. For the majority of myoclonus cases, treatment of the underlying disorder is usually not possible or effective, and symptomatic treatment is justified if the myoclonus is disabling enough. The best strategy for symptomatic treatment is derived from using physiological classification. Suppression of myoclonus may come from lowering the excitatory drive and/or increasing inhibition of the responsible neurons that drive the excitatory output. Levetiracetam and piracetam are related drugs and have had limited controlled study for myoclonus treatment. Sodium valproate is the major drug of choice for corticalsubcortical myoclonus overall. Clonazepam is the first line of symptomatic therapy for propriospinal myoclonus. The myoclonic movements of hemifacial spasm will often respond to botulinum toxin therapy along with the more tonic or sustained contractions.

• #21 Myoclonus – Diagnosis and treatment – Mayo Clinic

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

  Anticonvulsants. Drugs used to control epileptic seizures may help reduce myoclonus symptoms. The most common anticonvulsants used for myoclonus are levetiracetam (Keppra, Elepsia XR, Spritam), valproic acid, zonisamide (Zonegran, Zonisade) and primidone (Mysoline). Piracetam is another anticonvulsant that’s been found to be effective, but it’s not available in the United States. Valproic acid may cause side effects such as nausea. Levetiracetam may cause side effects such as fatigue and dizziness. Side effects from primidone may include sedation and nausea. […] OnabotulinumtoxinA (Botox) injections may help treat various forms of myoclonus, particularly if only a single area is affected. This treatment blocks the release of a chemical messenger that triggers muscle contractions. […] If myoclonus symptoms are caused by a tumor or lesion in the brain or spinal cord, surgery may be an option. People with myoclonus affecting parts of the face or ear also may benefit from surgery.

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

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

  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. […] Cortical myoclonus may be effectively treated with medications that bind to synaptic vesicle protein 2a and are more commonly used to treat various types of epilepsy. […] Valproic acid is another option for the treatment of cortical myoclonus and generally requires dosages ranging from 1200 to 2000 mg/day, but this medication typically works best in combination with other agents. […] For the treatment of cortical-subcortical myoclonus, especially that related to juvenile myoclonic epilepsy, valproic acid is considered to be the first-line therapy. […] Subcortical-nonsegmental myoclonus is more challenging to treat owing to the large number of different underlying causative mechanisms.

• #23 Myoclonus – Diagnosis and treatment – Mayo Clinic

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

  Anticonvulsants. Drugs used to control epileptic seizures may help reduce myoclonus symptoms. The most common anticonvulsants used for myoclonus are levetiracetam (Keppra, Elepsia XR, Spritam), valproic acid, zonisamide (Zonegran, Zonisade) and primidone (Mysoline). Piracetam is another anticonvulsant that’s been found to be effective, but it’s not available in the United States. Valproic acid may cause side effects such as nausea. Levetiracetam may cause side effects such as fatigue and dizziness. Side effects from primidone may include sedation and nausea. […] OnabotulinumtoxinA (Botox) injections may help treat various forms of myoclonus, particularly if only a single area is affected. This treatment blocks the release of a chemical messenger that triggers muscle contractions. […] If myoclonus symptoms are caused by a tumor or lesion in the brain or spinal cord, surgery may be an option. People with myoclonus affecting parts of the face or ear also may benefit from surgery.

• #24

  https://journals.lww.com/annalsofian/fulltext/2021/24030/myoclonus__a_review.5.aspx

  Drugs used for cortical myoclonus act by facilitating inhibitory GABAergic transmission and/or reducing the hyperexcitability in the sensorimotor cortex. […] The four most effective agents are levetiracetam, piracetam, valproic acid, and clonazepam. […] Clonazepam is also useful in cortical myoclonus. […] Standard antiepileptic drugs used in cortical myoclonus are not helpful in most types of subcortical-nonsegmental myoclonus. […] For propriospinal myoclonus, other effective agents are zonisamide and levetiracetam. […] Treatment of palatal tremor is difficult. […] The drug of choice in this subtype is usually clonazepam (up to 6 mg/day), but complete suppression is uncommon. […] Both clonic movements and tonic spasms of hemifacial spasm respond excellently to botulinum toxin injection.

• #25 Myoclonus – Diagnosis and treatment – Mayo Clinic

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

  Anticonvulsants. Drugs used to control epileptic seizures may help reduce myoclonus symptoms. The most common anticonvulsants used for myoclonus are levetiracetam (Keppra, Elepsia XR, Spritam), valproic acid, zonisamide (Zonegran, Zonisade) and primidone (Mysoline). Piracetam is another anticonvulsant that’s been found to be effective, but it’s not available in the United States. Valproic acid may cause side effects such as nausea. Levetiracetam may cause side effects such as fatigue and dizziness. Side effects from primidone may include sedation and nausea. […] OnabotulinumtoxinA (Botox) injections may help treat various forms of myoclonus, particularly if only a single area is affected. This treatment blocks the release of a chemical messenger that triggers muscle contractions. […] If myoclonus symptoms are caused by a tumor or lesion in the brain or spinal cord, surgery may be an option. People with myoclonus affecting parts of the face or ear also may benefit from surgery.

• #26 Myoclonus – Diagnosis and treatment – Mayo Clinic

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

  Anticonvulsants. Drugs used to control epileptic seizures may help reduce myoclonus symptoms. The most common anticonvulsants used for myoclonus are levetiracetam (Keppra, Elepsia XR, Spritam), valproic acid, zonisamide (Zonegran, Zonisade) and primidone (Mysoline). Piracetam is another anticonvulsant that’s been found to be effective, but it’s not available in the United States. Valproic acid may cause side effects such as nausea. Levetiracetam may cause side effects such as fatigue and dizziness. Side effects from primidone may include sedation and nausea. […] OnabotulinumtoxinA (Botox) injections may help treat various forms of myoclonus, particularly if only a single area is affected. This treatment blocks the release of a chemical messenger that triggers muscle contractions. […] If myoclonus symptoms are caused by a tumor or lesion in the brain or spinal cord, surgery may be an option. People with myoclonus affecting parts of the face or ear also may benefit from surgery.

• #27 Myoclonus | Baylor Medicine

  https://www.bcm.edu/healthcare/specialties/neurology/parkinsons-disease-and-movement-disorders/myoclonus

  If possible, the underlying cause of myoclonus should be corrected, but this is not always possible. If the myoclonus is due to a medication side effect, then the myoclonus usually resolves with discontinuation of that medication. If myoclonus persists despite eliminating treatable causes, then the treatment of myoclonus otherwise focuses on medications help reduce symptoms. […] The drugs used to treat myoclonus usually possess anti-seizure properties. Epileptic myoclonus and cortical (arising from the brains cerebral hemispheres) myoclonus respond best to clonazepam and sodium valproate, which may be used alone or in combination. Clonazepam is a tranquilizer and is commonly used to treat myoclonus. Dosages of clonazepam are usually increased gradually until the patient improves or side effects become bothersome. Drowsiness and loss of coordination are common side effects. The beneficial effects of clonazepam may diminish over time if the patient develops a tolerance to the medication. If disability from the myoclonus is not adequately improved on either or both of these medications, then medications such as levetiracetam (Keppra) can be added, which is also very effective in treating myoclonus. Levetiracetam has also been shown to be effective in posthypoxic myoclonus. Primidone may also be of value was an additional drug, as well as clobazam and acetazolamide in severely affected patients. More recently, another antiepileptic agent (Perampanel) has been used to treat patients with various types of myoclonus, including post-hypoxic myoclonus, with good response.

• #28 Myoclonus | Handouts | MedLink Neurology

  https://www.medlink.com/handouts/myoclonus

  Some studies have shown that doses of 5-hydroxytryptophan (5-HTP), a building block of serotonin (a chemical made in the body that transmits nerve impulses), leads to improvement in individuals with some types of action myoclonus and progressive myoclonus epilepsy. However, other studies indicate that 5-HTP therapy is not effective in all people with myoclonus, and may even worsen the condition in some individuals. These differences in the effect of 5-HTP on people 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 medications for effective treatment. Although some medications have a limited effect when used individually, they may have a greater effect when used with others that act on different pathways or mechanisms in the brain. By combining several drugs, physicians often can achieve greater control of myoclonic symptoms. Hormonal therapy also may improve responses to antimyoclonic drugs in some people.

• #29 Myoclonus: Types, Causes, Symptoms, and Treatment

  https://www.webmd.com/multiple-sclerosis/myoclonus-muscle-twitching

  Anti-seizure drugs. Medicines like levetiracetam (Keppra), primidone (Mysoline), and valproic acid (Valproic) help prevent seizures in people with epilepsy. But they can also help with myoclonus. Side effects include nausea, fatigue, and feeling dizzy. […] 5-hydroxytryptophan (5-HTP). This is a building block of serotonin, an important neurotransmitter. Some studies have found that 5-HTP helps people with certain forms of myoclonus. […] Botox shots. Botulinum toxin „freezes” your muscles and keeps them from twitching. These shots can be helpful if you have frequent spasms on one side of your face. […] Surgery. If a brain or spinal cord lesion is causing your symptoms, your doctor may suggest a procedure to remove it. […] Deep brain stimulation (DBS). In this surgery, your doctor puts electrodes into your brain and uses wire to connect them with a device implanted in your chest. The device sends out signals that block the ones causing your myoclonus. DBS can lower the number of muscle twitches, but as with all surgeries, there are risks. Doctors are researching its use for multiple sclerosis. Right now, its mostly used as a treatment for Parkinsons disease. […] Experts continue to look for new ways to treat myoclonus. Clinical trials are large research studies that rely on volunteers to understand if new treatments work well enough to be available to the general public. If you’re interested in being part of one, talk to your doctor about how to apply.

• #30 Myoclonus | MedLink Neurology

  https://www.medlink.com/articles/myoclonus

  The initial step in addressing myoclonus involves classifying its type and identifying the underlying disease process, which should be treated or reversed whenever possible. […] For cortical myoclonus, several medications have been explored for symptomatic relief. Levetiracetam has shown promise in alleviating cortical myoclonus, although other similar drugs like brivaracetam have not demonstrated confirmed efficacy. […] Sodium oxybate has shown promise in improving post-hypoxic myoclonus of cortical origin, and intrathecal baclofen has been reported to be beneficial in selected cases of post-hypoxic myoclonus. […] In cases where essential myoclonus is part of the myoclonus-dystonia syndrome, there is increasing evidence that deep brain stimulation surgery can provide significant therapeutic benefits.

• #31 Myoclonus | MedLink Neurology

  https://www.medlink.com/articles/myoclonus

  The initial step in addressing myoclonus involves classifying its type and identifying the underlying disease process, which should be treated or reversed whenever possible. […] For cortical myoclonus, several medications have been explored for symptomatic relief. Levetiracetam has shown promise in alleviating cortical myoclonus, although other similar drugs like brivaracetam have not demonstrated confirmed efficacy. […] Sodium oxybate has shown promise in improving post-hypoxic myoclonus of cortical origin, and intrathecal baclofen has been reported to be beneficial in selected cases of post-hypoxic myoclonus. […] In cases where essential myoclonus is part of the myoclonus-dystonia syndrome, there is increasing evidence that deep brain stimulation surgery can provide significant therapeutic benefits.

• #32 Myoclonus Dystonia | Dystonia Medical Research Foundation

  https://dystonia-foundation.org/what-is-dystonia/types-dystonia/myoclonus-dystonia/

  Myoclonus-dystonia (M-D) is a rare and complex neurological movement disorder that affects individuals and families around the world. Treatments are available and researchers are actively pursuing improved therapies and ultimately a cure. […] At this time, there is not yet a cure for myoclonus-dystonia (M-D), but treatments are available to help minimize symptoms. Treatment must be highly customized to the individual. Each component of the M-D—the myoclonus, the dystonia, and the mood component—requires attention for complete care and the most positive results. […] Therapies typically include oral medications and botulinum neurotoxin injections. Complementary therapies such as physical or occupational therapy may support medical treatments. Oral medications that may be helpful for the treatment of myoclonus dystonia include benztropine, clonazepam, neuroleptics, dopamine agonists, and perhaps gamma-hydroxybutyrate (GHB).

• #33 Myoclonus: Causes, Types, and Treatment

  https://www.healthline.com/health/myoclonus

  If myoclonus is caused by an underlying condition, a doctor will attempt to treat that condition first. If the disorder cant be cured, treatment is designed to reduce the severity and frequency of symptoms. […] A doctor may prescribe a sedative (tranquilizer) or anticonvulsant medication to help reduce spasms. […] A doctor may recommend surgery if myoclonus is related to an operable tumor or lesion in the brain or spinal cord. Surgery also may be helpful for certain cases of myoclonus that target the face or ears. […] Injections of onabotulinumtoxinA (Botox) may be effective in treating cases of myoclonus that affect a specific area. It can work to block the release of the chemical messenger that causes the muscle spasms. […] Theres some evidence that 5-hydroxytryptophan (5-HTP), a neurotransmitter that occurs naturally in your body, may help reduce symptoms for some patients. But other studies show the chemical may instead worsen symptoms, and this treatment isnt being commonly used anymore. […] For some people, hormone therapy with adrenocorticotropic hormone (ACTH), may be effective in improving responses to some medications.

• #34 Myoclonus – Diagnosis and treatment – Mayo Clinic

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

  Anticonvulsants. Drugs used to control epileptic seizures may help reduce myoclonus symptoms. The most common anticonvulsants used for myoclonus are levetiracetam (Keppra, Elepsia XR, Spritam), valproic acid, zonisamide (Zonegran, Zonisade) and primidone (Mysoline). Piracetam is another anticonvulsant that’s been found to be effective, but it’s not available in the United States. Valproic acid may cause side effects such as nausea. Levetiracetam may cause side effects such as fatigue and dizziness. Side effects from primidone may include sedation and nausea. […] OnabotulinumtoxinA (Botox) injections may help treat various forms of myoclonus, particularly if only a single area is affected. This treatment blocks the release of a chemical messenger that triggers muscle contractions. […] If myoclonus symptoms are caused by a tumor or lesion in the brain or spinal cord, surgery may be an option. People with myoclonus affecting parts of the face or ear also may benefit from surgery.

• #35 Myoclonus | Handouts | MedLink Neurology

  https://www.medlink.com/handouts/myoclonus

  Botulinum toxin injections can reduce excess muscle activity by blocking the activity of a chemical that makes muscles contract at the cellular level. Botulinum toxin injection is the first line therapy for hemifacial spasm, and has also shown to effectively treat some individuals with palatal myoclonus.

• #36 Myoclonus – Wikipedia

  https://en.wikipedia.org/wiki/Myoclonus

  When patients are taking multiple medications, the discontinuation of drugs suspected of causing myoclonus and treatment of metabolic derangements may resolve some cases of myoclonus. When pharmacological treatment is indicated anticonvulsants are the main line of treatment. Paradoxical reactions to treatment are notable. Drugs which most people respond to may in other individuals worsen their symptoms. Sometimes this leads to the mistake of increasing the dose, rather than decreasing or stopping the drug. […] In forms of myoclonus where only a single area is affected, and even in a few other various forms, Botox injections (OnabotulinumtoxinA) may be helpful. The chemical messenger responsible for triggering the involuntary muscle contractions is blocked by the Botulinum toxins of the Botox.

• #37 Myoclonus – Diagnosis and treatment – Mayo Clinic

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

  Deep brain stimulation has been tried in some people with myoclonus and other movement disorders. Electrodes are implanted within certain areas of the brain. The electrodes produce electrical signals to block the irregular impulses that can cause myoclonus. Researchers continue to study deep brain stimulation for myoclonus.

• #38 Myoclonus Dystonia | Dystonia Medical Research Foundation

  https://dystonia-foundation.org/what-is-dystonia/types-dystonia/myoclonus-dystonia/

  Deep brain stimulation surgery is emerging as a promising option. Complementary therapies may be explored, especially physical therapy, occupational therapy, and regular relaxation practices. […] If obsessive compulsive disorder, depression, anxiety, personality disorders, alcohol abuse, and/or panic attacks are present, these symptoms must also be addressed. Although sometimes difficult to talk about, individuals with M-D who experience signs of these complications are encouraged to bring them to the attention of their treating physician.

• #39 Treatment of Post-Hypoxic Myoclonus using Pallidal Deep Brain Stimulation Placed Using Interventional MRI Methods | Tremor and Other Hyperkinetic Movements

  https://tremorjournal.org/articles/10.5334/tohm.544

  Post-hypoxic myoclonus (PHM) is characterized by generalized myoclonus after hypoxic brain injury. Myoclonus is often functionally impairing and refractory to medical therapies. Deep brain stimulation (DBS) has been used to treat myoclonus-dystonia, but few cases of PHM have been described. […] Our case contributes to growing evidence for DBS for PHM. Interventional MRI guided DBS technique can be used for safe and accurate lead placement. […] We present the first reported case of a patient with PHM who underwent interventional MRI-guided (iMRI) implantation of bilateral pallidal DBS. Our patient had significant improvement in her action myoclonus after DBS, similar to the two other reported cases of patients with PHM treated with bilateral pallidal DBS. […] Given significant functional impairment and complications from myoclonus, our multidisciplinary movement disorder team offered DBS implantation as a palliative treatment for medication-refractory myoclonus.

• #40

  https://link.springer.com/article/10.1007/s13311-020-00922-6

  Piracetam and related compounds including levetiracetam and brivaracetam have demonstrated efficacy in treating cortical myoclonus. […] The possible mechanism of action in the case of clonazepam is facilitation of GABAergic transmission by affecting the benzodiazepine receptor and a decrease in 5-hydroxytryptophan utilization in the brain. […] Other pharmacological treatments for cortical myoclonus have included other various anti-epileptic medications. […] Deep brain stimulation surgery has been performed in refractory cases of posthypoxic myoclonus with two cases demonstrating significant improvement in myoclonus severity scales after bilateral globus pallidus interna implantation. […] Transcranial magnetic stimulation (TMS) may present a noninvasive and nonpharmacological method of treating cortical myoclonus, but further study is needed to address long-term efficacy.

• #41 Myoclonus – Diagnosis and treatment – Mayo Clinic

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

  Deep brain stimulation has been tried in some people with myoclonus and other movement disorders. Electrodes are implanted within certain areas of the brain. The electrodes produce electrical signals to block the irregular impulses that can cause myoclonus. Researchers continue to study deep brain stimulation for myoclonus.

• #42 Myoclonus – Diagnosis and treatment – Mayo Clinic

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

  Anticonvulsants. Drugs used to control epileptic seizures may help reduce myoclonus symptoms. The most common anticonvulsants used for myoclonus are levetiracetam (Keppra, Elepsia XR, Spritam), valproic acid, zonisamide (Zonegran, Zonisade) and primidone (Mysoline). Piracetam is another anticonvulsant that’s been found to be effective, but it’s not available in the United States. Valproic acid may cause side effects such as nausea. Levetiracetam may cause side effects such as fatigue and dizziness. Side effects from primidone may include sedation and nausea. […] OnabotulinumtoxinA (Botox) injections may help treat various forms of myoclonus, particularly if only a single area is affected. This treatment blocks the release of a chemical messenger that triggers muscle contractions. […] If myoclonus symptoms are caused by a tumor or lesion in the brain or spinal cord, surgery may be an option. People with myoclonus affecting parts of the face or ear also may benefit from surgery.

• #43 Myoclonus: Causes, Types, and Treatment

  https://www.healthline.com/health/myoclonus

  If myoclonus is caused by an underlying condition, a doctor will attempt to treat that condition first. If the disorder cant be cured, treatment is designed to reduce the severity and frequency of symptoms. […] A doctor may prescribe a sedative (tranquilizer) or anticonvulsant medication to help reduce spasms. […] A doctor may recommend surgery if myoclonus is related to an operable tumor or lesion in the brain or spinal cord. Surgery also may be helpful for certain cases of myoclonus that target the face or ears. […] Injections of onabotulinumtoxinA (Botox) may be effective in treating cases of myoclonus that affect a specific area. It can work to block the release of the chemical messenger that causes the muscle spasms. […] Theres some evidence that 5-hydroxytryptophan (5-HTP), a neurotransmitter that occurs naturally in your body, may help reduce symptoms for some patients. But other studies show the chemical may instead worsen symptoms, and this treatment isnt being commonly used anymore. […] For some people, hormone therapy with adrenocorticotropic hormone (ACTH), may be effective in improving responses to some medications.

• #44

  https://link.springer.com/article/10.1007/s13311-020-00922-6

  When approaching treatment of myoclonus, the first consideration is whether a reversible or treatable cause exists. This article is devoted to mostly symptomatic treatment. However, progress in defining new myoclonus etiologies is being made, which may in turn lead to advances in treatment. For the rest of the article, treatment will refer to symptomatic treatment of myoclonus. […] Due to the diverse etiologies and characteristics of myoclonus, the treatment of myoclonus is often challenging, and disability may remain after optimal symptomatic treatment occurs. Effective treatments across and even within different subtypes and etiologies may vary tremendously. […] Cortical myoclonus is often responsive to anti-epileptic treatment because these medications address the abnormal intrinsic cortical hyperexcitability that gives rise to cortical myoclonus. Valproic acid has been found to be beneficial in cortical myoclonus.

• #45

  https://link.springer.com/article/10.1007/s11940-016-0404-7

  Treatment of myoclonus requires an understanding of the physiopathology of the condition. The first step in treatment is to determine if there is an epileptic component to the myoclonus and treat accordingly. Secondly, a review of medications (e.g., opiates) and comorbidities (e.g., hepatic or renal failure) is required to establish the possibility of iatrogenic and reversible conditions. Once those are eliminated, delineation between cortical, cortico-subcortical, subcortical, brainstem, and spinal generators can determine the first-line treatment. Cortical myoclonus can be treated with levetiracetam, valproic acid, and clonazepam as first-line agents. Phenytoin and carbamazepine may paradoxically worsen myoclonus. Subcortical and brainstem myoclonus can be treated with clonazepam as a first-line agent, but levetiracetam and valproic acid can be tried as well. l-5-Hydroxytryptophan and sodium oxybate are agents used for refractory cases. Spinal myoclonus does not respond to anti-epileptic drugs, and clonazepam is a first-line agent. Botulinum toxin treatment can be useful for focal cases of spinal myoclonus. The etiology of propriospinal myoclonus is controversial, and a functional etiology is suspected in most cases. Treatment can include clonazepam, levetiracetam, baclofen, valproate, carbamazepine, and zonisamide. Functional myoclonus requires multimodal and multidisciplinary treatment that may include psychotropic drugs and physical and occupational therapy. Close collaboration between neurologists and psychiatrists is required for effective treatment. Finally, deep brain stimulation targeting the globus pallidus pars-interna bilaterally has been used in myoclonus-dystonia when pharmacological treatments have been exhausted.

• #46 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/

  Have you ever been uncertain about whether or how to treat focal or diffuse myoclonus? […] 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.

• #47

  https://link.springer.com/article/10.1007/s11940-016-0404-7

  Treatment of myoclonus requires an understanding of the physiopathology of the condition. The first step in treatment is to determine if there is an epileptic component to the myoclonus and treat accordingly. Secondly, a review of medications (e.g., opiates) and comorbidities (e.g., hepatic or renal failure) is required to establish the possibility of iatrogenic and reversible conditions. Once those are eliminated, delineation between cortical, cortico-subcortical, subcortical, brainstem, and spinal generators can determine the first-line treatment. Cortical myoclonus can be treated with levetiracetam, valproic acid, and clonazepam as first-line agents. Phenytoin and carbamazepine may paradoxically worsen myoclonus. Subcortical and brainstem myoclonus can be treated with clonazepam as a first-line agent, but levetiracetam and valproic acid can be tried as well. l-5-Hydroxytryptophan and sodium oxybate are agents used for refractory cases. Spinal myoclonus does not respond to anti-epileptic drugs, and clonazepam is a first-line agent. Botulinum toxin treatment can be useful for focal cases of spinal myoclonus. The etiology of propriospinal myoclonus is controversial, and a functional etiology is suspected in most cases. Treatment can include clonazepam, levetiracetam, baclofen, valproate, carbamazepine, and zonisamide. Functional myoclonus requires multimodal and multidisciplinary treatment that may include psychotropic drugs and physical and occupational therapy. Close collaboration between neurologists and psychiatrists is required for effective treatment. Finally, deep brain stimulation targeting the globus pallidus pars-interna bilaterally has been used in myoclonus-dystonia when pharmacological treatments have been exhausted.

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

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

  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. […] Cortical myoclonus may be effectively treated with medications that bind to synaptic vesicle protein 2a and are more commonly used to treat various types of epilepsy. […] Valproic acid is another option for the treatment of cortical myoclonus and generally requires dosages ranging from 1200 to 2000 mg/day, but this medication typically works best in combination with other agents. […] For the treatment of cortical-subcortical myoclonus, especially that related to juvenile myoclonic epilepsy, valproic acid is considered to be the first-line therapy. […] Subcortical-nonsegmental myoclonus is more challenging to treat owing to the large number of different underlying causative mechanisms.

• #49

  https://link.springer.com/article/10.1007/s13311-020-00922-6

  Myoclonus can cause significant disability for patients. Treatment of myoclonus is vital to improving the quality of life of patients with these disorders. The optimal treatment strategy for myoclonus is best determined based upon careful evaluation and consideration of the underlying etiology and neurophysiological classification. Levetiracetam, valproic acid, and clonazepam are often used to treat cortical myoclonus. In corticalsubcortical myoclonus, treatment of myoclonic seizures is prioritized, valproic acid being the mainstay of therapy. Subcorticalnonsegmental myoclonus may be treated with clonazepam, though numerous agents have been used depending on the etiology. Segmental and peripheral myoclonus are often resistant to treatment, but anticonvulsants and botulinum toxin injections may be of utility depending upon the case. Pharmacological treatments are often hampered by scarce evidence-based knowledge, adverse effects, and variable efficacy of medications.

• #50

  https://link.springer.com/article/10.1007/s11940-016-0404-7

  Treatment of myoclonus requires an understanding of the physiopathology of the condition. The first step in treatment is to determine if there is an epileptic component to the myoclonus and treat accordingly. Secondly, a review of medications (e.g., opiates) and comorbidities (e.g., hepatic or renal failure) is required to establish the possibility of iatrogenic and reversible conditions. Once those are eliminated, delineation between cortical, cortico-subcortical, subcortical, brainstem, and spinal generators can determine the first-line treatment. Cortical myoclonus can be treated with levetiracetam, valproic acid, and clonazepam as first-line agents. Phenytoin and carbamazepine may paradoxically worsen myoclonus. Subcortical and brainstem myoclonus can be treated with clonazepam as a first-line agent, but levetiracetam and valproic acid can be tried as well. l-5-Hydroxytryptophan and sodium oxybate are agents used for refractory cases. Spinal myoclonus does not respond to anti-epileptic drugs, and clonazepam is a first-line agent. Botulinum toxin treatment can be useful for focal cases of spinal myoclonus. The etiology of propriospinal myoclonus is controversial, and a functional etiology is suspected in most cases. Treatment can include clonazepam, levetiracetam, baclofen, valproate, carbamazepine, and zonisamide. Functional myoclonus requires multimodal and multidisciplinary treatment that may include psychotropic drugs and physical and occupational therapy. Close collaboration between neurologists and psychiatrists is required for effective treatment. Finally, deep brain stimulation targeting the globus pallidus pars-interna bilaterally has been used in myoclonus-dystonia when pharmacological treatments have been exhausted.

• #51

  https://journals.lww.com/annalsofian/fulltext/2021/24030/myoclonus__a_review.5.aspx

  Drugs used for cortical myoclonus act by facilitating inhibitory GABAergic transmission and/or reducing the hyperexcitability in the sensorimotor cortex. […] The four most effective agents are levetiracetam, piracetam, valproic acid, and clonazepam. […] Clonazepam is also useful in cortical myoclonus. […] Standard antiepileptic drugs used in cortical myoclonus are not helpful in most types of subcortical-nonsegmental myoclonus. […] For propriospinal myoclonus, other effective agents are zonisamide and levetiracetam. […] Treatment of palatal tremor is difficult. […] The drug of choice in this subtype is usually clonazepam (up to 6 mg/day), but complete suppression is uncommon. […] Both clonic movements and tonic spasms of hemifacial spasm respond excellently to botulinum toxin injection.

• #52 Treatment of Myoclonus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3899494/

  Myoclonus creates significant disability for patients. A thorough evaluation for the myoclonus etiology is critical for developing a treatment strategy. If the etiology of the myoclonus cannot be reversed or treated, then symptomatic treatment of the myoclonus itself may be warranted. Unfortunately, there are few controlled studies for myoclonus treatments. The treatment strategy for the myoclonus is best derived from the neurophysiology classification scheme categories: 1) cortical, 2) corticalsubcortical, 3) subcorticalnonsegmental, 4) segmental, and 5) peripheral. Levetiracetam is suggested as first-line treatment for cortical myoclonus, but valproic acid and clonazepam are commonly used. Clonazepam is used for subcorticalnonsegmental myoclonus, but other treatments, depending on the syndrome, have been used for this physiological type of myoclonus. Segmental myoclonus is difficult to treat, but clonazepam and botulinum toxin are used. Myoclonus treatment is commonly not effective and/or limited by side effects. At this time, there is little evidence-based data available for myoclonus treatment. The first consideration should be given to reversing the underlying etiology of the myoclonus. For the majority of myoclonus cases, treatment of the underlying disorder is usually not possible or effective, and symptomatic treatment is justified if the myoclonus is disabling enough. The best strategy for symptomatic treatment is derived from using physiological classification. Suppression of myoclonus may come from lowering the excitatory drive and/or increasing inhibition of the responsible neurons that drive the excitatory output. Levetiracetam and piracetam are related drugs and have had limited controlled study for myoclonus treatment. Sodium valproate is the major drug of choice for corticalsubcortical myoclonus overall. Clonazepam is the first line of symptomatic therapy for propriospinal myoclonus. The myoclonic movements of hemifacial spasm will often respond to botulinum toxin therapy along with the more tonic or sustained contractions.

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

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

  Similarly to subcortical-nonsegmental myoclonus, segmental and peripheral myoclonus may have a broad differential, and focal lesions should be ruled out as part of treatment. […] For palatal myoclonus and hemifacial spasm, botulinum toxin injections can be beneficial. […] In cases of spinal segmental myoclonus that are not due to a structural lesion or where the structural lesion cannot be safely removed, levetiracetam and clonazepam may be beneficial.

• #54

  https://journals.lww.com/annalsofian/fulltext/2021/24030/myoclonus__a_review.5.aspx

  Drugs used for cortical myoclonus act by facilitating inhibitory GABAergic transmission and/or reducing the hyperexcitability in the sensorimotor cortex. […] The four most effective agents are levetiracetam, piracetam, valproic acid, and clonazepam. […] Clonazepam is also useful in cortical myoclonus. […] Standard antiepileptic drugs used in cortical myoclonus are not helpful in most types of subcortical-nonsegmental myoclonus. […] For propriospinal myoclonus, other effective agents are zonisamide and levetiracetam. […] Treatment of palatal tremor is difficult. […] The drug of choice in this subtype is usually clonazepam (up to 6 mg/day), but complete suppression is uncommon. […] Both clonic movements and tonic spasms of hemifacial spasm respond excellently to botulinum toxin injection.

• #55

  https://journals.lww.com/annalsofian/fulltext/2021/24030/myoclonus__a_review.5.aspx

  Drugs used for cortical myoclonus act by facilitating inhibitory GABAergic transmission and/or reducing the hyperexcitability in the sensorimotor cortex. […] The four most effective agents are levetiracetam, piracetam, valproic acid, and clonazepam. […] Clonazepam is also useful in cortical myoclonus. […] Standard antiepileptic drugs used in cortical myoclonus are not helpful in most types of subcortical-nonsegmental myoclonus. […] For propriospinal myoclonus, other effective agents are zonisamide and levetiracetam. […] Treatment of palatal tremor is difficult. […] The drug of choice in this subtype is usually clonazepam (up to 6 mg/day), but complete suppression is uncommon. […] Both clonic movements and tonic spasms of hemifacial spasm respond excellently to botulinum toxin injection.

• #56 :: JCN :: Journal of Clinical Neurology

  https://www.thejcn.com/DOIx.php?id=10.3988/jcn.2017.13.3.293

  Propriospinal myoclonus (PSM) is characterized by jerks arising in axial muscles that spread to more caudal and rostral segments along propriospinal pathways. […] Previous case reports have focused on the etiology and mechanism of PSM, but have not evaluated treatment responses objectively. Moreover, most treatments have only employed clonazepam. […] We present a patient with PSM at sleep onset who improved after treatment with clonazepam and add-on levetiracetam. The improvement was confirmed by serial video polysomnography (VPSG). […] Treatment of PSM with clonazepam and levetiracetam significantly reduced the number of myoclonic events and improved sleep efficacy. […] Clonazepam enhances GABAergic neurotransmission by modulating benzodiazepine receptors and is most commonly used in patients with spinal myoclonus.

• #57

  https://link.springer.com/article/10.1007/s11940-016-0404-7

  Treatment of myoclonus requires an understanding of the physiopathology of the condition. The first step in treatment is to determine if there is an epileptic component to the myoclonus and treat accordingly. Secondly, a review of medications (e.g., opiates) and comorbidities (e.g., hepatic or renal failure) is required to establish the possibility of iatrogenic and reversible conditions. Once those are eliminated, delineation between cortical, cortico-subcortical, subcortical, brainstem, and spinal generators can determine the first-line treatment. Cortical myoclonus can be treated with levetiracetam, valproic acid, and clonazepam as first-line agents. Phenytoin and carbamazepine may paradoxically worsen myoclonus. Subcortical and brainstem myoclonus can be treated with clonazepam as a first-line agent, but levetiracetam and valproic acid can be tried as well. l-5-Hydroxytryptophan and sodium oxybate are agents used for refractory cases. Spinal myoclonus does not respond to anti-epileptic drugs, and clonazepam is a first-line agent. Botulinum toxin treatment can be useful for focal cases of spinal myoclonus. The etiology of propriospinal myoclonus is controversial, and a functional etiology is suspected in most cases. Treatment can include clonazepam, levetiracetam, baclofen, valproate, carbamazepine, and zonisamide. Functional myoclonus requires multimodal and multidisciplinary treatment that may include psychotropic drugs and physical and occupational therapy. Close collaboration between neurologists and psychiatrists is required for effective treatment. Finally, deep brain stimulation targeting the globus pallidus pars-interna bilaterally has been used in myoclonus-dystonia when pharmacological treatments have been exhausted.

• #58 :: JCN :: Journal of Clinical Neurology

  https://www.thejcn.com/DOIx.php?id=10.3988/jcn.2017.13.3.293

  Propriospinal myoclonus (PSM) is characterized by jerks arising in axial muscles that spread to more caudal and rostral segments along propriospinal pathways. […] Previous case reports have focused on the etiology and mechanism of PSM, but have not evaluated treatment responses objectively. Moreover, most treatments have only employed clonazepam. […] We present a patient with PSM at sleep onset who improved after treatment with clonazepam and add-on levetiracetam. The improvement was confirmed by serial video polysomnography (VPSG). […] Treatment of PSM with clonazepam and levetiracetam significantly reduced the number of myoclonic events and improved sleep efficacy. […] Clonazepam enhances GABAergic neurotransmission by modulating benzodiazepine receptors and is most commonly used in patients with spinal myoclonus.

• #59 :: JCN :: Journal of Clinical Neurology

  https://www.thejcn.com/DOIx.php?id=10.3988/jcn.2017.13.3.293

  It is considered a first-line therapy for PSM at sleep onset, but it has been found to be effective in only half of the published case reports. […] Our patient also showed only partial improvement after using clonazepam. Levetiracetam is mostly used to control cortical myoclonus, but it has also been reported to be effective in several patients with segmental spinal myoclonus. […] The present case is the first to suggest that a combination of clonazepam and levetiracetam exerts synergistic effects in treating PSM at sleep onset.

• #60 Myoclonus Treatment and Management | UVA Health

  https://uvahealth.com/services/parkinsons-movement-disorders/myoclonus-treatment

  Whether mild or severe, dealing with the sudden twitches and jerks from myoclonus is difficult and impacts your daily life. You can’t control them and you want them to stop. […] At UVA Health, our neurologists are experts in helping people with myoclonus. […] There are several medicines to treat myoclonus. We’ll find the best one for you. […] A physical therapist can teach you exercises to improve muscle control and coordination. They may also suggest relaxation strategies to manage stress, which can sometimes trigger or worsen myoclonus. […] Sometimes it helps to find and avoid things that trigger myoclonus, like caffeine, medicines, and activities. […] We can help you figure out what devices, like a cane or brace, can make your movements more stable. […] Living with myoclonus can be hard mentally as well as physically. We have social workers who can help.

• #61 Response of spinal myoclonus to a combination therapy of autogenic training and biofeedback | BioPsychoSocial Medicine | Full Text

  https://bpsmedicine.biomedcentral.com/articles/10.1186/1751-0759-1-18

  Clinical evidence indicates that certain types of movement disorders are due to psychosomatic factors. Patients with myoclonic movements are usually treated by a variety of therapeutic agents. Autogenic training (AT), a recognized form of psychosomatic therapies, is suitable for certain types of neurological diseases. […] The patient underwent psychosomatic therapy including AT and surface electromyography (EMG)-biofeedback therapy and treatment with clonazepam and carbamazepine. […] AT and EMG-biofeedback resulted in shortening the duration and reducing the amplitude and frequency of the myoclonic discharges. […] Psychosomatic therapy with AT and surface EMG-biofeedback produced excellent improvement of myoclonic movements and allowed the reduction of the dosage of conventional medications.

• #62 Response of spinal myoclonus to a combination therapy of autogenic training and biofeedback | BioPsychoSocial Medicine | Full Text

  https://bpsmedicine.biomedcentral.com/articles/10.1186/1751-0759-1-18

  Clinical evidence indicates that certain types of movement disorders are due to psychosomatic factors. Patients with myoclonic movements are usually treated by a variety of therapeutic agents. Autogenic training (AT), a recognized form of psychosomatic therapies, is suitable for certain types of neurological diseases. […] The patient underwent psychosomatic therapy including AT and surface electromyography (EMG)-biofeedback therapy and treatment with clonazepam and carbamazepine. […] AT and EMG-biofeedback resulted in shortening the duration and reducing the amplitude and frequency of the myoclonic discharges. […] Psychosomatic therapy with AT and surface EMG-biofeedback produced excellent improvement of myoclonic movements and allowed the reduction of the dosage of conventional medications.

• #63 Response of spinal myoclonus to a combination therapy of autogenic training and biofeedback | BioPsychoSocial Medicine | Full Text

  https://bpsmedicine.biomedcentral.com/articles/10.1186/1751-0759-1-18

  We tried psychosomatic therapy; a combination of AT and EMG-biofeedback therapy, to reduce myoclonic movement and drug dosage. […] Our patient with spinal myoclonus responded well to the combination therapy of AT and surface EMG-Biofeedback. Such therapy reduced the duration, amplitude, and frequency of myoclonic jerks and, consequently, we were able to reduce the dosage of clonazepam and carbamazepine.

• #64

  https://link.springer.com/article/10.1007/s11940-016-0404-7

  Treatment of myoclonus requires an understanding of the physiopathology of the condition. The first step in treatment is to determine if there is an epileptic component to the myoclonus and treat accordingly. Secondly, a review of medications (e.g., opiates) and comorbidities (e.g., hepatic or renal failure) is required to establish the possibility of iatrogenic and reversible conditions. Once those are eliminated, delineation between cortical, cortico-subcortical, subcortical, brainstem, and spinal generators can determine the first-line treatment. Cortical myoclonus can be treated with levetiracetam, valproic acid, and clonazepam as first-line agents. Phenytoin and carbamazepine may paradoxically worsen myoclonus. Subcortical and brainstem myoclonus can be treated with clonazepam as a first-line agent, but levetiracetam and valproic acid can be tried as well. l-5-Hydroxytryptophan and sodium oxybate are agents used for refractory cases. Spinal myoclonus does not respond to anti-epileptic drugs, and clonazepam is a first-line agent. Botulinum toxin treatment can be useful for focal cases of spinal myoclonus. The etiology of propriospinal myoclonus is controversial, and a functional etiology is suspected in most cases. Treatment can include clonazepam, levetiracetam, baclofen, valproate, carbamazepine, and zonisamide. Functional myoclonus requires multimodal and multidisciplinary treatment that may include psychotropic drugs and physical and occupational therapy. Close collaboration between neurologists and psychiatrists is required for effective treatment. Finally, deep brain stimulation targeting the globus pallidus pars-interna bilaterally has been used in myoclonus-dystonia when pharmacological treatments have been exhausted.

• #65 Diagnosis and treatment of functional myoclonus | HUANG | Chinese Journal of Contemporary Neurology and Neurosurgery

  http://www.cjcnn.org/index.php/cjcnn/article/view/2787

  Functional myoclonus is a group of paroxysmal abnormal movements, which is one of the common types of functional movement disorder (FMD). […] Placebo or suggestion therapy is effective. […] At present, there is no unified guideline for treatment, which recommends psychotherapy, physical therapy and multidisciplinary cooperation. […] This article reviews the clinical characteristics, diagnosis and differential diagnosis, treatment and prognosis of functional myoclonus, in order to help clinical early accurate diagnosis, timely treatment, and improve patient prognosis.

• #66

  https://link.springer.com/article/10.1007/s11940-016-0404-7

  Treatment of myoclonus requires an understanding of the physiopathology of the condition. The first step in treatment is to determine if there is an epileptic component to the myoclonus and treat accordingly. Secondly, a review of medications (e.g., opiates) and comorbidities (e.g., hepatic or renal failure) is required to establish the possibility of iatrogenic and reversible conditions. Once those are eliminated, delineation between cortical, cortico-subcortical, subcortical, brainstem, and spinal generators can determine the first-line treatment. Cortical myoclonus can be treated with levetiracetam, valproic acid, and clonazepam as first-line agents. Phenytoin and carbamazepine may paradoxically worsen myoclonus. Subcortical and brainstem myoclonus can be treated with clonazepam as a first-line agent, but levetiracetam and valproic acid can be tried as well. l-5-Hydroxytryptophan and sodium oxybate are agents used for refractory cases. Spinal myoclonus does not respond to anti-epileptic drugs, and clonazepam is a first-line agent. Botulinum toxin treatment can be useful for focal cases of spinal myoclonus. The etiology of propriospinal myoclonus is controversial, and a functional etiology is suspected in most cases. Treatment can include clonazepam, levetiracetam, baclofen, valproate, carbamazepine, and zonisamide. Functional myoclonus requires multimodal and multidisciplinary treatment that may include psychotropic drugs and physical and occupational therapy. Close collaboration between neurologists and psychiatrists is required for effective treatment. Finally, deep brain stimulation targeting the globus pallidus pars-interna bilaterally has been used in myoclonus-dystonia when pharmacological treatments have been exhausted.

• #67 Orphanet: Myoclonus-dystonia syndrome

  https://www.orpha.net/en/disease/detail/36899

  Myoclonus-dystonia syndrome (MDS) is a rare movement disorder characterized by mild to moderate dystonia along with 'lightning-like’ myoclonic jerks. […] Treatment plans are individualized to a patient’s presenting symptoms. Benzodiazepines (clonazepam) and antiepileptic drugs (valproate, levetiracetam) are effective in relieving myoclonus and tremor, but patients should be carefully monitored. Similarly, alcohol frequently improves symptoms temporarily, but its long term use is not recommended. Injections of botulinum toxin can relieve focal and cervical dystonia. If these treatments fail or are insufficient, bilateral deep brain stimulation (DBS) of the internal globus pallidum (Gpi) and the central intermediate nucleus (VIM) of the thalamus have shown positive results in providing lasting relief from both myoclonus and dystonia. Gpi stimulation is often sufficient in treating MDS, and may be favored over VIM stimulation, which generally has very little effect on dystonia. In a staged surgical procedure, quadruple stimulation (VIM and Gpi) may also be considered in selected cases.

• #68 Myoclonus Dystonia | Dystonia Medical Research Foundation

  https://dystonia-foundation.org/what-is-dystonia/types-dystonia/myoclonus-dystonia/

  Myoclonus-dystonia (M-D) is a rare and complex neurological movement disorder that affects individuals and families around the world. Treatments are available and researchers are actively pursuing improved therapies and ultimately a cure. […] At this time, there is not yet a cure for myoclonus-dystonia (M-D), but treatments are available to help minimize symptoms. Treatment must be highly customized to the individual. Each component of the M-D—the myoclonus, the dystonia, and the mood component—requires attention for complete care and the most positive results. […] Therapies typically include oral medications and botulinum neurotoxin injections. Complementary therapies such as physical or occupational therapy may support medical treatments. Oral medications that may be helpful for the treatment of myoclonus dystonia include benztropine, clonazepam, neuroleptics, dopamine agonists, and perhaps gamma-hydroxybutyrate (GHB).

• #69 Research Advances on the Treatment of Myoclonus-Dystonia Syndrome

  https://www.iomcworld.org/open-access/research-advances-on-the-treatment-of-myoclonusdystonia-syndrome-46062.html

  Myoclonus-Dystonia Syndrome cant be cured, and the current therapy is mainly aimed to improve the symptoms, which includes medical and surgical treatment. […] The current therapy for MDS is mainly aimed to improve the symptoms, which includes medical and surgical treatment. […] Benzodiazepines could enhance the function of GABA-activated chloride channels. […] Antiepileptic drugs (AEDs) could inhibit neuronal abnormal impulse conduction. […] Anticholinergic Drugs can compete with acetylcholine acting on acetylcholine receptor, thereby antagonizing action of acetylcholine, so the muscle is relaxant. […] Levodopa (L-dopa) replacement therapy is the first choice for the MDS patients with such mechanism. […] Botulinum toxin can inhibit presynaptic release of acetylcholine, resulting in muscle relaxation, and eliminate or mitigate excessive muscle contraction.

• #70 Myoclonus Dystonia – Dystonia Ireland

  https://www.dystonia.ie/forms-of-dystonia/genetic-forms/myoclonus-dystonia/

  Medications that may be helpful for the treatment of myoclonus dystonia include benztropine, clonazepam, neuroleptics, and dopamine agonists. A striking feature in some people with myoclonus is the alleviation of symptoms upon ingestion of alcohol, but response varies greatly even within individual families. Deep brain stimulation surgery is emerging as a promising option. […] Complementary therapies may be explored, especially physical therapy, aquatic physical therapy, and regular relaxation practices.

• #71 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.

• #72 Post-hypoxic Myoclonus: Current Concepts, Neurophysiology, and Treatment | Tremor and Other Hyperkinetic Movements

  https://tremorjournal.org/articles/10.5334/tohm.323

  Myoclonus may occur after hypoxia. […] Treatment options for these two distinct clinical-neurophysiologic post-hypoxic myoclonus syndromes were approached differently. […] More research is needed to clarify mechanisms and treatment of post-hypoxic myoclonus. […] If epileptiform discharges are present, initial treatment should consider antiepileptic drugs such as phenytoin, phenobarbitone, and benzodiazepines. […] Infusion of propofol has been reported to benefit myoclonus arising after acute hypoxia. […] Currently, there is no scoring system to predict the patients who do survive anoxic brain injury and eventually develop LAS. […] The beneficial effect has also been reported when used as a monotherapy for LAS and can also help in controlling seizures, if they are present along with myoclonus.

• #73 Post-hypoxic Myoclonus: Current Concepts, Neurophysiology, and Treatment | Tremor and Other Hyperkinetic Movements

  https://tremorjournal.org/articles/10.5334/tohm.323

  Therapy with diazepam has not been uniformly successful in controlling the myoclonus seen in LAS. […] Clonazepam, another benzodiazepine, was first shown to be effective in the treatment of LAS in 1976. […] The possible mechanism of action in the case of clonazepam is facilitation of GABAergic transmission and a decrease in 5-hydroxytryptophan utilization in the brain. […] For the treatment of refractory cases of LAS, deep brain stimulation surgery has been performed with some initial encouraging results, but only in a few cases and it is still experimental at this time. […] Based on a review in 2000, the following drugs were not found to be helpful in treating myoclonus: amantadine, phenytoin, tetrabenazine, nitrazepam, phenobarbitone, primidone, nortriptyline, and vasopressin. […] The same review mentioned variable benefits with alcohol, levodopa, fluoxetine, baclofen, carbamazepine, and estrogen. […] Some reports have mentioned the usefulness of lacosamide, sodium oxybate, zonisamide, and agomelatine.

• #74 Post-hypoxic Myoclonus: Current Concepts, Neurophysiology, and Treatment | Tremor and Other Hyperkinetic Movements

  https://tremorjournal.org/articles/10.5334/tohm.323

  Therapy with diazepam has not been uniformly successful in controlling the myoclonus seen in LAS. […] Clonazepam, another benzodiazepine, was first shown to be effective in the treatment of LAS in 1976. […] The possible mechanism of action in the case of clonazepam is facilitation of GABAergic transmission and a decrease in 5-hydroxytryptophan utilization in the brain. […] For the treatment of refractory cases of LAS, deep brain stimulation surgery has been performed with some initial encouraging results, but only in a few cases and it is still experimental at this time. […] Based on a review in 2000, the following drugs were not found to be helpful in treating myoclonus: amantadine, phenytoin, tetrabenazine, nitrazepam, phenobarbitone, primidone, nortriptyline, and vasopressin. […] The same review mentioned variable benefits with alcohol, levodopa, fluoxetine, baclofen, carbamazepine, and estrogen. […] Some reports have mentioned the usefulness of lacosamide, sodium oxybate, zonisamide, and agomelatine.

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

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

  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. […] A combination of immunotherapies is typically prescribed and may include a high dose of corticosteroids, intravenous immunoglobulin (IVIg), and rituximab for moderate to severe cases. Your doctor may recommend other immunotherapies for milder cases or if your child experiences a relapse.

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

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

  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. […] A combination of immunotherapies is typically prescribed and may include a high dose of corticosteroids, intravenous immunoglobulin (IVIg), and rituximab for moderate to severe cases. Your doctor may recommend other immunotherapies for milder cases or if your child experiences a relapse.

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

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

  If your child’s OMS is caused by a tumor, your doctor may recommend surgery to remove (resect) it. Tumors in young children usually do not require chemotherapy or radiation therapy. Your child may also need physical therapy, speech therapy, or occupational therapy to improve development and long-term prognosis.

• #78

  https://link.springer.com/article/10.1007/s13311-020-00922-6

  Myoclonus can cause significant disability for patients. Treatment of myoclonus is vital to improving the quality of life of patients with these disorders. The optimal treatment strategy for myoclonus is best determined based upon careful evaluation and consideration of the underlying etiology and neurophysiological classification. Levetiracetam, valproic acid, and clonazepam are often used to treat cortical myoclonus. In corticalsubcortical myoclonus, treatment of myoclonic seizures is prioritized, valproic acid being the mainstay of therapy. Subcorticalnonsegmental myoclonus may be treated with clonazepam, though numerous agents have been used depending on the etiology. Segmental and peripheral myoclonus are often resistant to treatment, but anticonvulsants and botulinum toxin injections may be of utility depending upon the case. Pharmacological treatments are often hampered by scarce evidence-based knowledge, adverse effects, and variable efficacy of medications.

• #79

  https://journals.lww.com/annalsofian/fulltext/2021/24030/myoclonus__a_review.5.aspx

  Myoclonus is a hyperkinetic movement disorder characterized by a sudden, brief, involuntary jerk. […] Though symptomatic treatment is required in the majority of cases, treatment of the underlying etiology should be the primary aim whenever possible. Symptomatic treatment is often not satisfactory, and a combination of different drugs is often required to control the myoclonus. […] The best strategy for symptomatic treatment is to define the physiological classification of myoclonus with the help of neurophysiological test/s because different drugs act in different physiological types of myoclonus. […] If both the etiological diagnosis and physiology of myoclonus are unclear, the drugs that work in cortical myoclonus should be tried first as it is the most common type of myoclonus. […] Recommendations for symptomatic treatment are mostly based on case reports and small case series, and controlled evidence for the same is very sparse.

• #80 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. In cases that are secondary to medication/drug exposure or toxic/metabolic abnormalities, removal of the offending drug(s) and/or correction of the metabolic abnormalities is the first step in treatment. […] 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.

• #81 Treatment of Myoclonus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3899494/

  Myoclonus creates significant disability for patients. A thorough evaluation for the myoclonus etiology is critical for developing a treatment strategy. If the etiology of the myoclonus cannot be reversed or treated, then symptomatic treatment of the myoclonus itself may be warranted. Unfortunately, there are few controlled studies for myoclonus treatments. The treatment strategy for the myoclonus is best derived from the neurophysiology classification scheme categories: 1) cortical, 2) corticalsubcortical, 3) subcorticalnonsegmental, 4) segmental, and 5) peripheral. Levetiracetam is suggested as first-line treatment for cortical myoclonus, but valproic acid and clonazepam are commonly used. Clonazepam is used for subcorticalnonsegmental myoclonus, but other treatments, depending on the syndrome, have been used for this physiological type of myoclonus. Segmental myoclonus is difficult to treat, but clonazepam and botulinum toxin are used. Myoclonus treatment is commonly not effective and/or limited by side effects. At this time, there is little evidence-based data available for myoclonus treatment. The first consideration should be given to reversing the underlying etiology of the myoclonus. For the majority of myoclonus cases, treatment of the underlying disorder is usually not possible or effective, and symptomatic treatment is justified if the myoclonus is disabling enough. The best strategy for symptomatic treatment is derived from using physiological classification. Suppression of myoclonus may come from lowering the excitatory drive and/or increasing inhibition of the responsible neurons that drive the excitatory output. Levetiracetam and piracetam are related drugs and have had limited controlled study for myoclonus treatment. Sodium valproate is the major drug of choice for corticalsubcortical myoclonus overall. Clonazepam is the first line of symptomatic therapy for propriospinal myoclonus. The myoclonic movements of hemifacial spasm will often respond to botulinum toxin therapy along with the more tonic or sustained contractions.

• #82 Myoclonus | MedLink Neurology

  https://www.medlink.com/articles/myoclonus

  Myoclonus, characterized by involuntary, abrupt muscle contractions followed by relaxation, presents a complex clinical landscape. This article offers a comprehensive overview of myoclonus, focusing on differential diagnosis, etiology, and therapeutic strategies. […] Once the diagnosis is established, interventions targeting the underlying cause or providing symptomatic relief become crucial. In this update, we organize the treatment of myoclonus according to its pathophysiology, incorporating recent advancements, including the potential use of deep brain stimulation or botulinum toxin injection for management. […] A symptomatic treatment approach is best strategized based on the physiology classification of the myoclonus. […] There should be a thorough search for myoclonus etiology and consideration for etiology treatment before symptomatic treatment is considered.

• #83 Myoclonus Treatment and Management | UVA Health

  https://uvahealth.com/services/parkinsons-movement-disorders/myoclonus-treatment

  Whether mild or severe, dealing with the sudden twitches and jerks from myoclonus is difficult and impacts your daily life. You can’t control them and you want them to stop. […] At UVA Health, our neurologists are experts in helping people with myoclonus. […] There are several medicines to treat myoclonus. We’ll find the best one for you. […] A physical therapist can teach you exercises to improve muscle control and coordination. They may also suggest relaxation strategies to manage stress, which can sometimes trigger or worsen myoclonus. […] Sometimes it helps to find and avoid things that trigger myoclonus, like caffeine, medicines, and activities. […] We can help you figure out what devices, like a cane or brace, can make your movements more stable. […] Living with myoclonus can be hard mentally as well as physically. We have social workers who can help.

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