Myoclonus, treatment

Lower respiratory tract infections treatment of Macrolide antibiotics Manic symptoms drug-induced Migraine headaches treatment of Monoamine oxidase inhibitors contemporary treatment of depression Multiple sclerosis treatment of Myasthenia gravis treatment of Mycoses treatment of deep-seated organisms Myoclonus treatment of Narcolepsy treatment of Neurotransmitters and their receptor subtypes Newborns undeveloped pharmacokinetic profile Nitrate products... 

Oruvail is a proprietary preparation of ketoprofen and Feldene is a proprietary preparation of piroxicam, both of which are non-steroidal antiinflammatory drugs Nootropil is a proprietary preparation of piracetam, which is not a non-steroidal anti-inflammatory drug. Nootropil is indicated as adjunctival treatment in cortical myoclonus. 

Carbamazepine overdose first leads to neuromuscular disturbances, such as nystagmus, myoclonus, and hyperreflexia, with later progression to seizures and coma. Cardiac conduction changes are possible. Nausea, vomiting, and urinary retention also may occur. Treatment should include induction of vomiting, gastric lavage, and supportive care. After a serious overdose, blood pressure and respiratory and kidney function should be monitored for several days. 

Staedt J, Hunerjager H, Ruther E, Stoppe G (1998) Pergolide treatment of choice in restless legs syndrome (RLS) and nocturnal myoclonus syndrome (NMS). Long term follow up on pergolide. J Neural Transm 105 265-268... 

Side effects. Piracetam is well tolerated and there is a low incidence of reported side effects. Those that do occur, at a frequency of less than 10%, include dizziness, insomnia, nausea, gastrointestinal discomfort, weight gain, drowsiness and agitation. Piracetam is indicated only for the treatment of myoclonus, particularly cortical myoclonus. It is used as a second-line drug for patients who are resistant to valproate or the benzodiazepines. 

Valproate is now the most commonly used antiepileptic drug worldwide. It is the drug of choice in primary generalized epilepsy, particularly in the treatment of generalized absence, myoclonus and tonic-clonic seizures. Valproate is the drug of first choice in atypical absence and atonic seizures, for Lennox-Gastaut syndrome and myoclonic epilepsy. 

Instances of distress in the newborn have been reported after treatment of their mothers with tricyclic antidepressants in the period before delivery (134). In one case, a neonate had signs of congestive heart failure without cardiac abnormality another had tachycardia and myoclonus a third had respiratory distress and neuromuscular spasms. These effects were thought to have resulted from both the adrenergic and anticholinergic effects of the tricyclic antidepressants, which readily pass the placenta and should be avoided during the perinatal period. 

A 23-year-old Japanese woman with major depression took a single dose of paroxetine (20 mg) and 1 hour later had agitation, myoclonus, mild hyperthermia (37.5°C), sweating, and diarrhea, symptoms that meet the criteria for the serotonin syndrome she recovered with supportive treatment over 3 days (2). 

Carbamazepine can precipitate or aggravate myoclonic, atonic, and absence seizures, especially in children and adolescents with a history of bilaterally synchronous spike-and-wave discharges in the electroencephalogram both generalized and partial seizures can be worsened (10). In children, the new appearance of generalized paroxysmal discharges after treatment may be predictive of seizure exacerbation or suboptimal control (11). Tonic seizures are occasionally aggravated by carbamazepine (SEDA-22, 85). Non-epileptic myoclonus occurs rarely. 

Marinella MA. Myoclonus and generalized seizures associated with gatifloxacin treatment. Arch Intern Med 2001 161(18) 2261-2. 

Potter JM, Reid DB, Shaw RJ, Hackett P, Hickman PE. Myoclonus associated with treatment with high doses of morphine the role of supplemental drugs. BMJ 1989 299(6692) 150-3. 

Although seizures are uncommon, several cases have been reported, including when pethidine was used in PCA. The metabolite norpethidine is considered to be of significant importance in provoking seizures. Risk factors are renal insufficiency, sickle-cell anemia, high doses of pethidine, and concurrent administration of phenothia-zines or drugs that induce hepatic enzymes (SEDA-16, 85) (SEDA-18, 82) (SEDA-19, 85). Myoclonus can occur (7). Norpethidine is twice as likely as pethidine to cause convulsions. The seizures occur at a norpethidine concentration range of 0.38-9.9 pg/ml, and only few reports have described convulsions within the first 24 hours of pethidine treatment. 

Anticonvulsant Agents — Clonazepam (2f) was clinically useful in the treatment of akinetic and myoclonic seizures,22 intention myoclonus,23 tic douloureux24 and has been recorded as the drug of choice for status epilepticus.25... 

Many reports have linked childhood hyperactivity to impaired central serotonin functions.89 In animals, the occurrence of a behavioral syndrome consisting of hyperactivity, stereotyped movements, and increase of temperature has been induced by L-tryptophan, as a serotonin precursor, by serotonin reuptake inhibitors, and by MAOIs.90 Most of these manifestations can be blocked specifically by pretreatment with an inhibitor of serotonin synthesis. In humans, the association of myoclonus, diarrhea, confusion, hypomania, agitation, hyperreflexia, shivering, incoordination, fever, and diaphoresis, when patients are treated with serotoninergic agents, could constitute a "serotonin syndrome." Such cases of serotonin syndrome were reported after treatments with L-tryptophan, MAOIs, serotonin reuptake inhibitors, and tricyclics, alone or in association. 

Treatments of first choice for cortical myoclonus are valproic acid (sodium valproate) and clonazepam. Primidone and phenobarbital may also be useful. Piracetam has advantages in these circumstances, as its addition to existing treatments is rarely accompanied by sedation. 

In patients with brain-stem reticular-reflex myoclonus, valproic acid and clonazepam are the most useful agents. In hyperreflexia, treatment is directed against the disabling tonic spasms, rather than jerks. Carbamazepine, phenytoin, and clonazepam are useful agents in this respect. Ballistic overflow myoclonus may improve with anticholinergic drugs such as benztropine or trihexyphenidyl. 

Treatment of palatal myoclonus is often unsuccessful, but phenytoin, carbamazepine, clonazepam, trihexyphenidyl, and baclofen have been effective in some patients. Clonazepam is effective in over half of patients with propriospinal myoclonus, but other anticonvulsants are usually not helpful. Segmental spinal myoclonus is often resistant to drug treatment, but diazepam, carbamazepine, tetrabenazine and, particularly, clonazepam are sometimes effective. 

C. Serotonin syndrome (see p 21) is characterized by confusion, hypomania, restlessness, myoclonus, hyperreflexia, diaphoresis, shivering, tremor, incoordination, and hyperthermia. This reaction may be seen when a patient taking an MAO inhibitor (p 269) ingests a serotonin uptake blocker. Because of the long duration of effects of MAO inhibitors and most of the serotonin uptake blookers, this reaotion can occur up to several days to weeks after either treatment regimen has been discontinued. The syndrome has also been described in patients taking an overdose of an SSRI or combinations of various SSRIs without concomitant MAO inhibitor use. 

Obeso JA, Artieda J, Quinn N, Rothwell JC, LuquinMR, Vaamonde J, MarsdenCD. Piracetam in the treatment of different types of myoclonus. Clin Neuro armacol ( 9BZ) 11, 529-36. 

Raychev I. Piracetam (pyramem) in the treatment of ccrtical myoclonus. 5" European Congress of Epileptology, Madrid 2002. P382. 

Lemus CZ, Lieberman JA, Johns CA. Myoclonus during treatment with clozapine and lithium the role of serotonin. Hillside J Clin Psychiatry (1989) 11, 127-30. 

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