Postsurgical cortical myoclonus responsive to perampanel

Bianchini, Simonetta; Bellantoni, G.; Albergati, Andrea; Magrassi, Lorenzo

doi:10.1212/cpj.0000000000000440

Cited by 5 publications

(3 citation statements)

References 6 publications

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“…In addition to improvement myoclonus scales and measures of activities of daily living, treatment with perampanel resulted in increased latency and reduced amplitude of giant SEPs, suggesting that perampanel may reduce cortical hyperexcitability and hypersynchronization [3,36]. There are multiple additional case reports of perampanel at dosages ranging from 4 to 10 mg improving cortical myoclonus of varying etiologies including myoclonic epilepsy, postsurgical, and posthypoxic myoclonus [36][37][38][39][40].…”

Section: Treatmentmentioning

confidence: 99%

Physiology-Based Treatment of Myoclonus

Pena

Caviness

2020

Neurotherapeutics

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Myoclonus can cause significant disability for patients. Myoclonus has a strikingly diverse array of underlying etiologies, clinical presentations, and pathophysiological mechanisms. 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. Electrophysiological testing including EEG (electroencephalogram) and EMG (electromyogram) data is helpful in determining the neurophysiological classification of myoclonus. The neurophysiological subtypes of myoclonus include cortical, cortical-subcortical, subcortical-nonsegmental, segmental, and peripheral. Levetiracetam, valproic acid, and clonazepam are often used to treat cortical myoclonus. In cortical-subcortical myoclonus, treatment of myoclonic seizures is prioritized, valproic acid being the mainstay of therapy. Subcortical-nonsegmental 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.

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Section: Treatmentmentioning

confidence: 99%

Physiology-Based Treatment of Myoclonus

Pena

Caviness

2020

Neurotherapeutics

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“…Low doses of PER (2–6 mg/day) are effective against intractable myoclonus in patients with Lance-Adams syndrome, Unverricht-Lundborg disease (ULD), postsurgical cortical myoclonus and Lafora disease [[2], [3], [4], [5], [6], [7], [8]]. Oi et al [8] reported decreased of giant SEP amplitude and prolonged latencies (P25 and N33), and the correlation with the degree of ADL improvement and PER concentration for patients with refractory cortical myoclonus after PEM administration.…”

Section: Discussionmentioning

confidence: 99%

“…Perampanel (PER) is a specific antagonist of the α-amino-3-hydroxy-5-methyl-4- isoxazolepropionic acid (AMPA) receptor, used to treat epilepsy [1], and its efficacy has been demonstrated in drug-resistant cortical myoclonus [[2], [3], [4], [5], [6], [7], [8]]. We describe two patients with myoclonus epilepsy whose intractable myoclonus was improved by low dose PER.…”

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confidence: 99%