Based on small numbers of patients, it is possible to make the following suggestions rather than categorical statements. For
myoclonic seizures and
epilepsies which are not otherwise specified,
valproate seems of proven efficacy.
Ethosuximide may be a useful adjunct. The exact place of
lamotrigine, which controls some myoclonia and makes them worse in other patients, requires further study. The findings are clearer when specific syndromes are considered.
Valproate is the treatment of first choice for benign
myoclonic epilepsy in infants,
myoclonic astatic epilepsy,
epilepsy with myoclonic absences, eyelid myoclonia with absences,
juvenile myoclonic epilepsy and
progressive myoclonus epilepsy. The addition of
ethosuximide to
valproate can be helpful to those with myoclonic absences, where this combination appears more beneficial than either
valproate or
ethosuximide alone and in eyelid myoclonia with absences.
Lamotrigine can be effective
therapy for
juvenile myoclonic epilepsy and eyelid myoclonia with absences when used alone and, in conjunction with other
antiepileptic drugs (AED) (usually
valproate) for
early myoclonic encephalopathy,
myoclonic-astatic epilepsy and particularly,
epilepsy with myoclonic absences. The myoclonia of
infantile neuronal ceroid lipofuscinosis respond to
lamotrigine. Severe
myoclonic epilepsy of infants usually worsens with
lamotrigine, but occasionally, children improve.
Zonisamide added to
clonazepam and
valproate or a
barbiturate, can reduce the cascade of myoclonia in
progressive myoclonus epilepsies for at least 2 years, but relapse may occur thereafter.