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Effectiveness of piracetam in cortical myoclonus
P Brown1, M J Steiger, P D Thompson
1MRC Human Movement and Balance Unit, Institute of Neurology, London, England.
Abstract:
Twenty-one patients with disabling spontaneous, reflex, or action myoclonus due to various causes, who had shown apparent clinical improvement on introduction of piracetam, entered a placebo-controlled double-blind crossover trial of piracetam (2.4-16.8 g daily). All but one patient had electrophysiological evidence of cortical myoclonus. Patients were randomly allocated to a 14-day course of piracetam followed by identical placebo, or placebo followed by piracetam. Nineteen patients received piracetam/placebo in addition to their routine antimyoclonic treatment (carbamazepine, clonazepam, phenytoin, primidone, sodium valproate, or tryptophan plus isocarboxazid, alone or in combination) and two received piracetam/placebo as monotherapy. All patients were rated at the end of each treatment phase using stimulus sensitivity, motor, writing, functional disability, global assessment, and visual analogue scales. Ten of the 21 patients had to be rescued from the placebo phase of the trial because of a severe and intolerable exacerbation of their myoclonus. No patients required rescue from the piracetam phase of the double-blind trial. When the 21 patients were considered together, there was a significant improvement in motor, writing, functional disability, global assessment, and visual analogue scores during treatment with piracetam compared with placebo. The total rating score also improved significantly with piracetam, by a median of 22%. Piracetam, usually in combination with other antimyoclonic drugs, is a useful treatment for myoclonus of cortical origin.
Insights
Piracetam significantly improved cortical myoclonus symptoms in a placebo-controlled trial. This study found piracetam effective for treating disabling myoclonus, often alongside other medications.
Area of Science:
- Neurology
- Clinical Pharmacology
Background:
- Myoclonus is a neurological disorder characterized by involuntary muscle jerks.
- Cortical myoclonus, often disabling, necessitates effective therapeutic interventions.
Purpose of the Study:
- To evaluate the efficacy of piracetam in patients with disabling myoclonus of cortical origin.
- To compare piracetam treatment against a placebo in a double-blind crossover design.
Main Methods:
- A placebo-controlled, double-blind crossover trial involving 21 patients with cortical myoclonus.
- Patients received piracetam (2.4-16.8 g daily) or placebo for 14 days each, with assessments using various clinical and functional scales.
Main Results:
- Ten patients required rescue from the placebo phase due to severe myoclonus exacerbation, while none needed rescue from the piracetam phase.
- Significant improvements were observed with piracetam compared to placebo across motor, writing, functional disability, global assessment, and visual analogue scales.
- Piracetam treatment resulted in a median 22% improvement in the total rating score.
Conclusions:
- Piracetam demonstrates significant efficacy in treating myoclonus of cortical origin.
- Piracetam is a useful therapeutic option, often as an adjunct to existing antimyoclonic treatments.