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Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
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Myokymia, a muscle twitching, is a newly identified adverse effect of gabapentin toxicity. A medication holiday resolved symptoms, aiding diagnosis when gabapentin levels are unavailable.

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Area of Science:

  • Neurology
  • Pharmacology
  • Clinical Medicine

Background:

  • Gabapentin is widely prescribed for neuropathic pain and epilepsy.
  • Known adverse effects include asterixis and myoclonus, particularly in chronic kidney disease.
  • Myokymia has not been previously reported as a gabapentin-associated adverse effect.

Observation:

  • A 69-year-old male presented with acute muscle spasms, falls, myoclonus, and myokymia.
  • High gabapentin levels (25.8 μg/mL) were detected.
  • Symptoms improved after initiating a gabapentin holiday.

Findings:

  • Myokymia is identified as a novel motor symptom linked to gabapentin toxicity.
  • The patient experienced resolution of myokymia, myoclonus, and tremors after gabapentin withdrawal.
  • Restarting gabapentin at a lower dose led to continued improvement.

Implications:

  • This case highlights myokymia as a potential indicator of gabapentin toxicity.
  • Physicians can utilize this information for earlier diagnosis and treatment, especially when gabapentin levels are not readily accessible.
  • Understanding this adverse effect aids in managing gabapentin therapy and patient safety.