University of Genoa, G. Gaslini Institute, Maternal and Child Health, Department of Neurosciences, Pediatric Neurology and Muscular Diseases Unit, Rehabilitation, Ophtalmology, Genetics, Genova, Italy.
Expert Opin Pharmacother. 2013 Jul;14(10):1355-61. doi: 10.1517/14656566.2013.800045. Epub 2013 May 14.
Myoclonic seizures can be observed in various clinical settings and different epileptic conditions, including some forms of both diopathic and symptomatic epilepsies. Relatively little has been written on treatment of myoclonic seizures. Some old antiepileptic drugs, such as valproate and some benzodiazepines, are widely used but more treatment options exist today for some newer antiepileptic drugs. Nevertheless, patients can be refractory to drug treatment and some drugs may exacerbate or even induce myoclonus.
Key safety, tolerability, and efficacy data are presented for different antiepileptic drugs with antimyoclonic effect, alone and/or in combination.
Treatment of myoclonic seizures in children is mainly based on prospective and retrospective studies, with little evidence from randomized clinical trials. Valproate is commonly the first choice alone or in combination with some benzodiazepines or levetiracetam. There is still insufficient evidence for the use of topiramate and zonisamide as monotherapy. Of major importance remains avoidance of medication that may aggravate the seizures. Better understanding of pathophysiologic mechanisms of myoclonic seizures and myoclonic epilepsies could yield great improvement in the treatment and quality of life of patients.
肌阵挛性发作可见于多种临床情况和不同的癫痫状态，包括一些特发性和症状性癫痫的形式。关于肌阵挛性发作的治疗，相关文献报道较少。一些传统的抗癫痫药物，如丙戊酸钠和一些苯二氮䓬类药物，应用广泛，但如今针对一些新型抗癫痫药物，有更多的治疗选择。然而，患者可能对抗癫痫药物治疗无反应，且一些药物可能会加重甚至诱发肌阵挛。
本文呈现了具有抗肌阵挛作用的不同抗癫痫药物的关键安全性、耐受性和疗效数据，包括单独使用和联合使用的情况。
儿童肌阵挛性发作的治疗主要基于前瞻性和回顾性研究，随机临床试验的证据较少。丙戊酸钠通常是单独使用或与一些苯二氮䓬类药物或左乙拉西坦联合使用的首选药物。托吡酯和唑尼沙胺作为单药治疗的证据仍然不足。避免使用可能加重发作的药物仍然很重要。更好地了解肌阵挛性发作和肌阵挛性癫痫的病理生理机制，可以极大地改善患者的治疗效果和生活质量。
