Long-term efficacy and safety of piracetam in the treatment of progressive myoclonus epilepsy.
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.
Fedi
M
M
FRCP(C), Montreal Neurological Institute and Hospital, 3801 University St, Room 127, Montreal, Quebec, Canada H3A 2B4. MIDA@MUSICA.MCGILL.CA
Reutens
D
D
Dubeau
F
F
Andermann
E
E
D'Agostino
D
D
Andermann
F
F
D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D004185:Disability Evaluation; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004831:Epilepsies, Myoclonic / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D018697:Nootropic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D010889:Piracetam / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D012449:Safety; D016896:Treatment Outcome
D000927:Anticonvulsants; D018697:Nootropic Agents; D010889:Piracetam