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Amelioration of spinal myoclonus with levetiracetam
  1. S C Keswani1,
  2. E H Kossoff1,
  3. G L Krauss1,
  4. C Hagerty2
  1. 1Department of Neurology, The Johns Hopkins University, 600 North Wolfe Street, Baltimore, Maryland 21287, USA
  2. 2Neurology Specialists, Columbia, Maryland, USA
  1. Correspondence to:
 Dr G L Krauss;
 gkrauss{at}jhmi.edu

https://doi.org/10.1136/jnnp.73.4.457

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    Spinal myoclonus has been associated with various spinal cord insults, including mass lesions, ischaemia, infection, and as part of a paraneoplastic syndrome.1 It has been postulated that it occurs as a result of deficient inhibitory glycinergic transmission in the spinal cord and subsequent “release” of synchronous motor neurone oscillations within segments of the cord. Levetiracetam (UCB Pharma, Smyrna, Georgia, USA) is a new antiepileptic drug that has been shown recently to reduce the effect of glycinergic inhibitors. We describe three patients whose spinal myoclonus was markedly ameliorated by levetiracetam.

    CASE REPORTS

    Patient 1: spinal epidural compression

    A 62 year old woman with known diffuse large cell lymphoma presented to her oncologist with progressive back pain accompanied by a band-like sensation around her waist. In the preceding four weeks, she had also been troubled by spontaneous involuntary abdominal contractions, and in the preceding two weeks these were accompanied by involuntary jerks of her legs. The patient could not suppress these spontaneous movements; moreover, as voluntary leg movements often precipitated them, she was unable to walk safely because of numerous falls. She denied any limb weakness and bladder or bowel incontinence.

    On examination, she had a mild spastic paraparesis with 4+/5 MRC grade power in a pyramidal pattern in the lower extremities (quadriceps, hamstrings, and tibialis anterior), 3+ knee and ankle jerks, and extensor plantar responses bilaterally. There were frequent resting myoclonic jerks of her lower extremities, involving both proximal and distal musculature, occurring at a rate of 150–250/min. There were also occasional, infrequent resting myoclonic jerks affecting the trunk. The myoclonic jerks were exacerbated in amplitude during attempts to perform purposeful movements, suggesting the phenomenonology of action myoclonus. The abnormal movements, rather than weakness, made …

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    Footnotes

    • Competing interests: GLK is a paid consultant to UCB Pharma. The terms of this arrangement are being managed by the Johns Hopkins University in accordance with its conflict of interest policies. The other authors declare no competing interests.