Materiały źródłowe

• #1 Myoclonus: Causes, Types, and Treatment

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

  While its not always possible to prevent myoclonus, you can take precautions to reduce your risk of being vulnerable to known causes. You may reduce your risk of myoclonus if you: […] Protect yourself against brain injury by wearing a helmet or headgear during activities such as riding a bicycle or motorcycle. […] Contact your doctor if you experience twitching after starting a new medication so that changes can be made.

• #2 What Is Myoclonus? Types, Symptoms, Causes, and Treatment

  https://resources.healthgrades.com/right-care/brain-and-nerves/myoclonus

  There is no sure way to prevent myoclonus, as doctors are still trying to understand what causes it. […] If doctors have prescribed treatment for myoclonus or its cause, the best way to prevent and manage symptoms is to follow your treatment plan. […] Avoiding seizure triggers may also help you reduce the risk of myoclonic seizures due to epilepsy.

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

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

  Myoclonus can be physiologic (eg, hiccuping, sleep-related muscle contractions) or secondary to various brain disorders, systemic disorders, or medications. […] If a metabolic disturbance is the cause, correct it, and when necessary, give medications (eg, clonazepam, valproate, levetiracetam) 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.

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

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

  Seizures can happen to anyone under the right circumstances, so its impossible to prevent them completely. However, there are things you can do that will reduce your risk of seizures or the conditions that cause them, including: […] Manage your health conditions. Managing chronic conditions can help you avoid seizures, especially those that happen because of your blood sugar with either Type 1 diabetes or Type 2 diabetes. Treating hypertension, controlling your cholesterol level and avoiding smoking can decrease your risks for strokes and heart attacks. These conditions can damage your brain and lead to various forms of myoclonus, including myoclonic seizures. […] Dont ignore infections. Eye and ear infections are especially important to treat. If these infections spread to your brain, they can cause seizures. Infections can also cause high fevers, which can lead to seizures.

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

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

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

• #6 Opioid Drug Use and Myoclonus | Michael’s House

  https://michaelshouse.com/blog/opioid-drug-use-and-myoclonus/

  Myoclonus is involuntary twitching in a muscle or group of muscles. It is not a disease, but it can be a symptom of a nervous system disorder or other physical health issue. […] Myoclonus that isn’t a symptom of a preexisting disease or disorder may result from a reaction to a medication or to drug poisoning. […] Myoclonus isn’t an uncommon or unexpected side effect of opioid use or abuse. Treating this opioid-related form of myoclonus begins, and can often end, with ceasing opioid drug use. […] When a person is using opioids to manage a chronic pain issue or pain related to cancer, he or she will have to explore alternative pain management options. […] If a person is struggling with opioid addiction, he or she will have to pursue an addiction treatment program.

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

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

  Wear safety equipment. Head injuries are a major cause of seizures. Using safety equipment (helmets, safety belts and restraints, etc.) can help you avoid an injury that leads to a seizure. […] Avoid possible seizure triggers. People with a history of seizures from flashing lights should use caution and avoid similar triggers whenever possible. You should also be careful drinking alcohol (or avoid it altogether if your healthcare provider advises that).

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

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

  Myoclonus Injury Prevention […] Theres no way to prevent myoclonus. But you can try to reduce your chances of getting hurt when a severe spasm happens. To do that: […] Get specialized support. For instance, a neuropsychiatrist can help you spot triggers and learn to manage movement issues. Working with a physical therapist can improve your balance, strength, and coordination. […] Protect yourself. Wear protective gear so you don’t risk further damage to your nervous system or brain. For instance, always wear a seat belt when you’re in a car. And wear a helmet to protect your head when you’re riding a bike or playing contact sports. […] Follow your doctor’s advice. If you live with another health issue, do your best to manage it. Take any medication as prescribed and see your doctor regularly.

• #9 Reducing etomidate-induced myoclonus | JBI

  https://jbi.global/news/article/reducing-etomidate-induced-myoclonus

  A recently published umbrella review provides an important analysis of the relative effectiveness of various pharmacologic agents to reduce the incidence and severity of etomidate-induced myoclonus. […] Methods to reduce the impact of myoclonus in patients given etomidate have been proposed. These include pre-treatment with opioids (such as butorphanol, dezocine, remifentanil), lidocaine, dexmedetomidine, and benzodiazepines. […] With so many prophylactic options available, each with their own set of potential side effects and varying degrees of effectiveness, anaesthesia providers would benefit from a determination of which pharmacologic treatment offers the most reliable prevention of myoclonus when etomidate administration is necessary. […] Multiple randomised controlled trials, and systematic reviews and meta-analyses have been conducted to determine the most effective method of pre-treatment to prevent or reduce etomidate-induced myoclonus.

• #10 A Comparative Study of Different Doses of Lignocaine on Prevention of Etomidate Induced Myoclonus during Induction of Anesthesia – International Journal of Recent Surgical and Medical Sciences

  https://ijrsms.com/a-comparative-study-of-different-doses-of-lignocaine-on-prevention-of-etomidate-induced-myoclonus-during-induction-of-anesthesia/

  Etomidate, an intravenous (IV) induction agent known for its stable myocardial action, can produce myoclonus which can be detrimental for the cardiac patients. […] Though lignocaine has proven its efficacy in attenuating the etomidate-induced myoclonus, the ideal dose of lignocaine is not known. […] The aim of our trial was to analyze two different doses of lignocaine on the occurrence and intensity of etomidate induced myoclonus. […] Pretreatment with IV lignocaine 0.5mg/kg and 1 mg/kg IV remarkably decreased the occurrence and severity of myoclonus induced by etomidate up to same extent. […] Current study has shown that both doses of IV lignocaine when injected prior to etomidate decreased the occurrence and intensity of etomidate induced myoclonus. […] Literature have shown that lignocaine can be an ideal pretreatment for prevention of myoclonus as it has a short, rapid onset of action, and least effect on cardiorespiratory system.

• #11 Medical Science Monitor | Prevention of etomidate-induced myoclonus: Which is superior: Fentanyl, midazolam, or a combination? A Retrospective comparative study – Article abstract #889833

  https://medscimonit.com/abstract/index/idArt/889833

  BACKGROUND: In this retrospective comparative study, we aimed to compare the effectiveness of fentanyl, midazolam, and a combination of fentanyl and midazolam to prevent etomidate-induced myoclonus. […] RESULTS: Study results showed that myoclonus incidence was 85%, 40%, 70%, and 25% in Group NP, Group F, Group M, and Group FM, respectively, and were significantly lower in Group F and Group FM. […] CONCLUSIONS: We conclude that pretreatment with fentanyl or combination of fentanyl and midazolam was effective in preventing etomidate-induced myoclonus.

• #12 Using dezocine to prevent etomidate-induced myoclonus: a meta-analysis | DDDT

  https://www.dovepress.com/using-dezocine-to-prevent-etomidate-induced-myoclonus-a-meta-analysis–peer-reviewed-fulltext-article-DDDT

  This study was designed to evaluate the efficacy and safety of preinjection of dezocine in preventing etomidate-induced myoclonus. […] The meta-analysis showed that 1) the preinjection of dezocine can reduce the incidence of etomidate-induced myoclonus (relative risk [RR] =0.25, 95% CI [0.13, 0.50], P0.0001), which is consistent with the result of subgroup analysis; 2) the preinjection of dezocine can reduce the incidence of mild, moderate, and severe myoclonus; […] The preinjection of dezocine has the effect of both lowering the incidence of etomidate-induced myoclonus and easing the severity of myoclonus, but without increasing dizziness and nausea or affecting the heart rate. […] This study showed that the preinjection of dezocine can reduce the incidence of etomidate-induced myoclonus and can mitigate the severity of myoclonus without adverse reactions.

• #13 SciELO Brazil – Prevention of etomidate-induced myoclonus during anesthetic induction by pretreatment with dexmedetomidine Prevention of etomidate-induced myoclonus during anesthetic induction by pretreatment with dexmedetomidine

  https://www.scielo.br/j/bjmbr/a/RWkkBsbtCc9TZgHSrJbWPhj/

  Myoclonus induced by etomidate during induction of general anesthesia is undesirable. This study evaluated the effect of dexmedetomidine (DEX) pretreatment on the incidence and severity of etomidate-induced myoclonus. […] Pretreatment with 0.5 and 1.0 g/kg DEX significantly reduced the incidence of etomidate-induced myoclonus during anesthetic induction; however, 0.5 g/kg DEX is recommended because it had fewer side effects. […] Our study demonstrated that DEX pretreatment significantly reduced the incidence of etomidate-induced myoclonus in a dose-dependent manner but had no effect on the severity of myoclonus. […] In conclusion, this study showed that pretreatment with DEX at 0.5 and 1.0 g/kg before etomidate administration during anesthetic induction could significantly reduce the incidence of myoclonus. DEX at 0.5 g/kg is recommended because it is associated with fewer side effects.

• #14 Prevention of etomidate-induced myoclonus during anesthetic induction by pretreatment with dexmedetomidine – Brazilian Journal of Medical and Biological Research

  https://www.bjournal.org/article/prevention-of-etomidate-induced-myoclonus-during-anesthetic-induction-by-pretreatment-with-dexmedetomidine/

  Myoclonus induced by etomidate during induction of general anesthesia is undesirable. This study evaluated the effect of dexmedetomidine (DEX) pretreatment on the incidence and severity of etomidate-induced myoclonus. […] Pretreatment with 0.5 and 1.0 µg/kg DEX significantly reduced the incidence of etomidate-induced myoclonus during anesthetic induction; however, 0.5 µg/kg DEX is recommended because it had fewer side effects.

• #15 A comparison of pretreatment with lignocaine versus dexmedetomidine in prevention of etomidate induced myoclonus- A randomised comparative trial – Indian J Clin Anaesth

  https://www.ijca.in/article-details/16372

  Etomidate might cause side effects during anaesthetic induction, such as injection discomfort, phlebitis, hemolysis, and myoclonus. This study was, therefore, conducted in order to compare the pre-treatment with lignocaine versus dexmedetomidine in deterrence of myoclonus resulting from Etomidate. […] We conclude that the prevalence of Etomidate-induced myoclonus was significantly decreased in patients who were pre-treated with dexmedetomidine in comparison with lignocaine.

• #16 A Comparative Study of Different Doses of Lignocaine on Prevention of Etomidate Induced Myoclonus during Induction of Anesthesia – International Journal of Recent Surgical and Medical Sciences

  https://ijrsms.com/a-comparative-study-of-different-doses-of-lignocaine-on-prevention-of-etomidate-induced-myoclonus-during-induction-of-anesthesia/

  All the studies in literature have used only low doses of IV lignocaine (0.5 mg/kg) which has shown to remarkably reduce the occurrence of myoclonus due to etomidate. […] Both doses of lignocaine reduced the incidence and severity of myoclonus up to same extent and are equally effective in controlling etomidate induced myoclonus.

• #17 Reducing etomidate-induced myoclonus | JBI

  https://jbi.global/news/article/reducing-etomidate-induced-myoclonus

  An umbrella review has just been published in JBI Evidence Synthesis on pharmacological interventions for reducing the incidence of myoclonus in patients receiving etomidate for induction of general anaesthesia. […] All pharmacologic interventions identified in the umbrella review demonstrated a statistically significant reduction in the incidence of myoclonus when administered prophylactically ahead of an induction dose of etomidate. […] The absolute risk reduction indicating the effectiveness of the prophylactic medications ranged from 47% to 81% for mild, 52% to 92% for moderate, and 61% to 96% for severe myoclonus. […] Opioids demonstrated the most consistent and substantial effect on reducing the incidence and severity in myoclonus compared with non-opioids.

• #18 Video Case Report: Action Myoclonus After CAR-T Cell Therapy

  https://practicalneurology.com/articles/2021-feb/video-case-report-action-myoclonus-after-car-t-cell-therapy

  ICANS can be treated with corticosteroids and seizure prophylaxis with levetiracetam.4 […] In the case of Mr. H, presented here, levetiracetam had the added benefit of being a first-line choice for the symptomatic treatment of cortical myoclonus.5

• #19 An effective drug for myoclonus-dystonia, a rare disease of the nervous system – Inserm Newsroom

  https://presse.inserm.fr/en/an-effective-drug-for-myoclonus-dystonia-a-rare-disease-of-the-nervous-system/56651/

  Myoclonus-dystonia is a rare disease that results from poor control of movements by the brain, leading to abnormal muscle contractions. […] There is presently no effective drug for this disease. […] The results of this trial show that zonisamide brings about a highly significant reduction in the myoclonus and associated disability. […] This is the first trial to demonstrate the efficacy of a drug against this disease, explains Prof. Flamand-Roze. Zonisamide may therefore be offered to patients with mild and moderate forms of myoclonus-dystonia, and to all patients who choose not to have, or who cannot have neurosurgical treatment.

• #20 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. […] This report provides further evidence to the small but growing cases of DBS treating rare hyperkinetic movement disorders.

• #21 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

  We conclude that pallidal stimulation is a safe and well-tolerated treatment for PHM and that asleep iMRI guidance is an effective, accurate method for lead placement. Additional clinical trials with more structured protocol for patient selection, systematic programming guidelines, and objective, blinded, assessment of improvement are needed.

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