Treatment of myoclonic seizures

Epilepsia, 2003

Despite the availability of numerous treatment options, the diagnosis and treatment of myoclonic seizures continue to be challenging. Based on clinical experience, valproate and benzodiazepines have historically been used to treat myoclonic seizures. However, many more treatment options exist today, and the clinician must match the appropriate treatment with the patient's epilepsy syndrome and its underlying etiology. Comorbidities and other medications must also be considered when making decisions regarding treatment. Rarely, some antiepileptic drugs may exacerbate myoclonic seizures. Most epileptic myoclonus can be treated pharmacologically, but some cases respond better to surgery, the ketogenic diet, or vagus nerve stimulation. Because myoclonic seizures can be difficult to treat, clinicians should be flexible in their approach and tailor therapy to each patient.

International Journal of Advances in Medicine, 2016

Background: Incidence of different myoclonic epileptic syndromes is variable in different regions. Here in as there is very few literature available internationally being inclusive of all myoclonic epilepsies together. Very few studies are available which describe all characteristics in a given study population. The aim of the study was to find incidence of different types of myoclonic epilepsies among patients presenting with myoclonic seizures their characteristics and to study all myoclonic epilepsies and juvenile myoclonic epilepsy in the study population. Methods: In this study conducted in neurological unit at Ruby hall clinic, a total of 188 case of epileptic disorder were enrolled irrespective of age and sex, among 136 were new case of epileptic disorder were classified based on seizure pattern, 23 were new cases of myoclonic epilepsy, these 23 new case of myoclonic epilepsy along with 52 old cases of myoclonic epilepsy attending to neurological unit were clubbed, a total of 75 cases myoclonic epilepsy were studied. All cases of myoclonic epilepsy and juvenile myoclonic epilepsy were studied with respect to age of onset different seizures, relation with family history, response to treatment, EEG findings. Results: Out of 136 cases 23 were new cases of myoclonic epilepsy, these 23 newly diagnosed cases of myoclonic epilepsies along with 52 already diagnosed myoclonic epilepsy are clubbed together, total of 75 cases were further studied. Incidence of myoclonic epilepsy among epileptic patients found to be 16.9%. Incidence of JME among myoclonic epilepsies is 75-80%, in all myoclonic epilepsies and JME association with GTCS, family history, EEG abnormalities were common finding, valproate and leviteracetam are good therapeutic options, carbamazepine aggravated myoclonus. Conclusions: For diagnosis of myoclonic epilepsy proper clinical history stress laid to ask history of myoclonic jerk in case of all seizure disorder, diagnosis basically depends on proper knowledge of myoclonic epileptic syndrome, eliciting history, EEG as an ancillary testing when in doubt always expert opinion is required as misdiagnosis of the myoclonus as partial seizure leads to wrong prescription of carbamazepine which exacerbates the myoclonus.

Expert Opinion on Pharmacotherapy, 2013

Epilepsy & Behavior Case Reports, 2013

Myoclonic status epilepticus (MSE) is defined as prolonged period of myoclonic jerks that are correlated with epileptiform discharges on EEG. We here describe clinical features and video-EEG records of six adult patients with MSE who did not have a prior diagnosis of epilepsy. In four out of six patients, MSE was precipitated by drugs. Two out of four patients had chronic renal disease and received beta lactam group antibiotics. Two other patients, who described chronic pain, developed MSE while taking pregabalin. One patient who had dementia and family history of juvenile myoclonic epilepsy (JME) developed MSE one month after quetiapine was introduced. Another patient, who had a recent ischemic stroke, developed MSE due to an unknown reason. In these last two patients, an immediate triggering factor was not evident. Myoclonic status epilepticus ceased in five out of six patients after withdrawal of the drugs and/or intravenous antiepileptic treatment. Myoclonic status epilepticus is a rare event in patients without epilepsy. A correct diagnosis and prompt drug discontinuation may reverse this severe and life-threatening condition.

Epilepsia, 1997

The Commission on Pediatric Epilepsy of the International League against Epilepsy (ILAE) sponsored a workshop on Myoclonus and Epilepsy in Childhood on May 20-23, 1996, in Royaumont, France. The workshop participants and members of the Commission agreed on the following terminology and descriptions. TYPES OF MYOCLONUS There are 4 main types of myoclonus, 3 positive and 1 negative. Cortical myoclonus (CM) CM is due to hyperexcitability of the sensorimotor cortex, and each muscle jerk results from a neuronal discharge in the sensorimotor cortex. Thalamocortical myoclonus In thalamocortical myoclonus, a thalamocortical loop is involved. In both instances, CM and thalamocortical myoclonus, conduction velocity from cortex to muscles is fast:-60 m/s. Timing of muscle innervation after a cortical discharge shows a rostrocaudal lag, with muscles innervated by first cranial nerves contracting initially and those innervated by last cranial nerves contracting later. CM combines a brief (20-75 ms) contraction of both agonist and antagonist muscles. Reticular reflex myoclonus (RRM) RRM results from hyperexcitability of the caudal reticular formation. In contrast to those in CM, electromyographic (EMG) events reflect sequential innervation, with the ninth, seventh and then fifth cranial nerves innervated in that order. Muscle jerks, which last 80-330 ms, precede cortical events. RRM may affect a single muscle or both agonist and antagonist muscles, with proximal muscles often affected, usually bilaterally. Negative myoclonus (NM) NM consists of the inhibition of muscular activity and can be demonstrated as lapses interrupting previously

Treating myoclonic epilepsy in children, 2013

Myoclonic seizures can be observed in various clinical settings and different epileptic conditions, including some forms of both diopathic and symptomatic epilepsies. Relatively little has been written on treatment of myoclonic seizures. Some old antiepileptic drugs, such as valproate and some benzodiazepines, are widely used but more treatment options exist today for some newer antiepileptic drugs. Nevertheless, patients can be refractory to drug treatment and some drugs may exacerbate or even induce myoclonus.

2017

Brain & Development, 1997

The authors report a long-term follow-up of 11 new subjects with benign myoclonic epilepsy. There were some unusual clinical features such as the need for dual therapy in 45.5% of subjects, and the presence of non-epileptic myoclonus in 54.5%, neither of which influenced the prognosis. Neuropsychological and behavioral evolution was less favorable in 45.5% of patients (mental retardation, school learning

Epilepsy Topics, 2014