Pregabalin-Induced Myoclonus in a Patient Without Kidney Dysfunction

Pregabalin is FDA-approved for the treatment of neuropathic pain associated with diabetes, postherpetic neuralgia, spinal cord injury, and as an adjunctive treatment for partial seizures and thus is a commonly prescribed agent in the primary care, neurological, and pain management settings. Adverse effects of pregabalin include dizziness, somnolence, diplopia, blurry vision, and respiratory depression, as well as delayed dermatological hypersensitivity reactions and weight gain. Pregabalin dosing is influenced by renal function, and dose adjustment should be considered in all patients. A much rarer but serious adverse effect of pregabalin is myoclonus. There have been a few case reports of negative myoclonus in patients treated with both pregabalin and gabapentin; however, these patients tend to have renal dysfunction and typically present with altered mentation. Furthermore, these patients are often treated in the context of refractory epilepsy and are treated with other antiepileptic drugs, some of which can also result in myoclonus. Brief episodes of confusion, diplopia, word-finding difficulty, or other transient neurological deficits, which could be concerning for acute ischemic events in the setting of pregabalin use, have never been described. Here, we present a case report of a patient on long-term pregabalin without renal dysfunction who initially presented as a stroke alert for transient neurological deficits followed by jerking movements consistent with positive myoclonus, which is much less commonly reported than negative myoclonus in the setting of pregabalin usage.