Treatment of Positive Myoclonus

Introduction to Myoclonus Treatment

The American Heart Association and European Resuscitation Council recommend that status myoclonus within 72 hours after cardiac arrest is associated with poor neurological outcomes 1, 2
The first-line treatment for positive myoclonus should be levetiracetam, sodium valproate, or clonazepam, with the specific choice depending on the neurophysiological classification of the myoclonus 1

The American Academy of Neurology recommends EEG monitoring in patients with clinical seizure manifestations to detect epileptic activity 1
Continuous EEG should be considered to monitor patients with diagnosed status epilepticus and to assess treatment effects 1
The American Heart Association suggests that in the presence of myoclonic jerks, EEG recording is suggested to detect any associated epileptiform activity 2
Distinguishing between epileptic and non-epileptic myoclonus is crucial, as treatment approaches differ, according to the American Academy of Neurology 5, 6

The American Heart Association recommends treatment options for status myoclonus, including sodium valproate, levetiracetam, clonazepam, propofol, benzodiazepines, and barbiturates 1
Some patients with early-onset and prolonged myoclonus may evolve into Lance-Adams syndrome with chronic action myoclonus, and can have good neurological recovery despite initial presentation with myoclonus, according to the American Heart Association 3, 4

Routine seizure prophylaxis in post-cardiac arrest patients is not recommended due to the risk of adverse effects and poor response to anti-epileptic agents, according to the European Resuscitation Council 1