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Long-term Efficacy and Safety of Piracetam in the Treatment of Progressive Myoclonus Epilepsy
Marco Fedi, MD;
David Reutens, MD, FRACP;
François Dubeau, MD, FRCPC;
Eva Andermann, MD, PhD, FCCMG;
Daniela D'Agostino, MD;
Frederick Andermann, MD, FRCPC
Arch Neurol. 2001;58:781-786.
Background Piracetam has been proven to be effective and well tolerated in the
treatment of myoclonus in short-term studies.
Objective To assess its long-term clinical efficacy, 11 patients with disabling
myoclonus due to progressive myoclonus epilepsy were treated with piracetam
in an open-label study.
Methods Neurologic outcome (at the 1st, 6th, 12th, and 18th month of treatment)
was assessed by an adjusted sum score of the following 3 indices: motor impairment,
functional disability, and global assessment of disability due to myoclonus.
Severity of other neurologic symptoms (seizure frequency and severity, dysarthria,
and gait ataxia) also was assessed. Treatment with piracetam was initiated
at a dose of 3.2 g/d that was gradually increased until stable benefit was
noted (maximal dose in the trial was 20 g/d). Concomitant antiepileptic drugs
were maintained at their previous dose.
Results Statistically significant improvement in the total rating score was
observed after introduction of piracetam at the 1st, 6th, and 12th month of
treatment. Severity of other neurologic symptom scores did not improve significantly.
Two patients reported drowsiness during the first 2 weeks of treatment.
Conclusions Piracetam given as add-on therapy seems to be an effective, sustained,
and well-tolerated treatment of myoclonus. In patients with progressive myoclonus
epilepsy, the efficacy of the drug increased during the first 12 months of
treatment and then stabilized.
From the Department of Neurology and Neurosurgery, Montreal Neurological
Institute and Hospital, McGill University, Montreal, Quebec. Dr Reutens is
now with the Department of Neurology, Austin and Repatriation Medical Centre,
University of Melbourne, Melbourne, Australia.
Corresponding author: Frederick Andermann, MD, FRCP(C), Montreal
Neurological Institute and Hospital, 3801 University St, Room 127, Montreal,
Quebec, Canada H3A 2B4 (e-mail: MIDA{at}MUSICA.MCGILL.CA).
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