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Six days after resuscitation from a cardiorespiratory arrest, a 61-year-old man is experiencing frequent action-induced myoclonic jerks that impair his ability to fully participate in physical therapy. Which of the following medications should be prescribed as a first-line agent to reduce the myoclonus?
Explanation
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Myoclonus can be treated symptomatically if the symptoms are bothersome or interfere with normal functioning. In this case, the postanoxic myoclonus is interfering with physical therapy. First-line agents in the treatment of myoclonus include valproate, clonazepam, and levetiracetam. Clonazepam is not recommended for long-term use because of the development of sedation and tolerance. Topiramate and zonisamide are used as second-line agents. Carbamazepine and lamotrigine have no role in the treatment of myoclonus and actually may exacerbate myoclonus in some cases.
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Reference
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Espay AJ, Chen R. Myoclonus. Continuum (Minneap Minn). 2013 Oct19(5 Movement Disorders)1264-86. doi 10.121201.CON.0000436156.54532.1a. PMID 24092290.
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Option 1
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Is Correct (Option 1):
Carbamazepine
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Option 2
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Is Correct (Option 2):
Lamotrigine
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Option 3
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Is Correct (Option 3):
Levetiracetam
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Option 4
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Is Correct (Option 4):
Zonisamide
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