Drug-Induced Myoclonus: A Systematic Review
<i>Background and Objectives</i>: Myoclonus is already associated with a wide variety of drugs and systemic conditions. As new components are discovered, more drugs are suspected of causing this disabling abnormal involuntary movement. This systematic review aims to assess the medication...
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2025-01-01
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| author | Jamir Pitton Rissardo Ana Letícia Fornari Caprara Nidhi Bhal Rishikulya Repudi Lea Zlatin Ian M. Walker |
| author_facet | Jamir Pitton Rissardo Ana Letícia Fornari Caprara Nidhi Bhal Rishikulya Repudi Lea Zlatin Ian M. Walker |
| author_sort | Jamir Pitton Rissardo |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Myoclonus is already associated with a wide variety of drugs and systemic conditions. As new components are discovered, more drugs are suspected of causing this disabling abnormal involuntary movement. This systematic review aims to assess the medications associated with drug-induced myoclonus (DIM). <i>Materials and Methods</i>: Two reviewers assessed the PubMed database using the search term “myoclonus”, without language restriction, for articles published between 1955 and 2024. The medications found were divided into classes and sub-classes, and the subclasses were graded according to their level of evidence. <i>Results</i>: From 12,097 results, 1115 were found to be DIM. The subclasses of medications with level A evidence were intravenous anesthetics (etomidate), cephalosporins (ceftazidime, cefepime), fluoroquinolones (ciprofloxacin), selective serotonin reuptake inhibitors (citalopram, escitalopram, paroxetine, sertraline), tricyclic antidepressant (amitriptyline), glutamate antagonist (amantadine), atypical antipsychotics (clozapine, quetiapine), antiseizure medications (carbamazepine, oxcarbazepine, phenytoin, gabapentin, pregabalin, valproate), pure opioid agonist (fentanyl, morphine), bismuth salts, and mood stabilizers (lithium). The single medication with the highest number of reports was etomidate. Drug-induced asterixis is associated with a specific list of medications. The neurotransmitters likely involved in DIM are serotonin, dopamine, gamma-aminobutyric acid (GABA), and glutamate. <i>Conclusions</i>: DIM may be reversible with management that can include drug discontinuation, dose adjustment, and the prescription of a medication used to treat idiopathic myoclonus. Based on the main clinical constellation of symptoms and pathophysiological mechanisms found in this study, DIM can be categorized into three types: type 1 (serotonin syndrome), type 2 (non-serotonin syndrome), and type 3 (unknown). |
| format | Article |
| id | doaj-art-0e8ffcdbae7f49b99397c6c668d0ab1a |
| institution | Kabale University |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
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| series | Medicina |
| spelling | doaj-art-0e8ffcdbae7f49b99397c6c668d0ab1a2025-01-24T13:40:46ZengMDPI AGMedicina1010-660X1648-91442025-01-0161113110.3390/medicina61010131Drug-Induced Myoclonus: A Systematic ReviewJamir Pitton Rissardo0Ana Letícia Fornari Caprara1Nidhi Bhal2Rishikulya Repudi3Lea Zlatin4Ian M. Walker5Neurology Department, Cooper University Hospital, Camden, NJ 08103, USANeurology Department, Cooper University Hospital, Camden, NJ 08103, USAMedicine Department, Jehangir Hospital, Pune 411001, IndiaMedicine Department, Apollo Institute of Medical Sciences and Research, Hyderabad 500072, IndiaNeuroscience Department, Ohio State University, Columbus, OH 43210, USANeurology Department, Cooper University Hospital, Camden, NJ 08103, USA<i>Background and Objectives</i>: Myoclonus is already associated with a wide variety of drugs and systemic conditions. As new components are discovered, more drugs are suspected of causing this disabling abnormal involuntary movement. This systematic review aims to assess the medications associated with drug-induced myoclonus (DIM). <i>Materials and Methods</i>: Two reviewers assessed the PubMed database using the search term “myoclonus”, without language restriction, for articles published between 1955 and 2024. The medications found were divided into classes and sub-classes, and the subclasses were graded according to their level of evidence. <i>Results</i>: From 12,097 results, 1115 were found to be DIM. The subclasses of medications with level A evidence were intravenous anesthetics (etomidate), cephalosporins (ceftazidime, cefepime), fluoroquinolones (ciprofloxacin), selective serotonin reuptake inhibitors (citalopram, escitalopram, paroxetine, sertraline), tricyclic antidepressant (amitriptyline), glutamate antagonist (amantadine), atypical antipsychotics (clozapine, quetiapine), antiseizure medications (carbamazepine, oxcarbazepine, phenytoin, gabapentin, pregabalin, valproate), pure opioid agonist (fentanyl, morphine), bismuth salts, and mood stabilizers (lithium). The single medication with the highest number of reports was etomidate. Drug-induced asterixis is associated with a specific list of medications. The neurotransmitters likely involved in DIM are serotonin, dopamine, gamma-aminobutyric acid (GABA), and glutamate. <i>Conclusions</i>: DIM may be reversible with management that can include drug discontinuation, dose adjustment, and the prescription of a medication used to treat idiopathic myoclonus. Based on the main clinical constellation of symptoms and pathophysiological mechanisms found in this study, DIM can be categorized into three types: type 1 (serotonin syndrome), type 2 (non-serotonin syndrome), and type 3 (unknown).https://www.mdpi.com/1648-9144/61/1/131myoclonusneurotoxicityencephalopathydrug-induced myoclonusadverse effectmyoclonus/chemically induced |
| spellingShingle | Jamir Pitton Rissardo Ana Letícia Fornari Caprara Nidhi Bhal Rishikulya Repudi Lea Zlatin Ian M. Walker Drug-Induced Myoclonus: A Systematic Review Medicina myoclonus neurotoxicity encephalopathy drug-induced myoclonus adverse effect myoclonus/chemically induced |
| title | Drug-Induced Myoclonus: A Systematic Review |
| title_full | Drug-Induced Myoclonus: A Systematic Review |
| title_fullStr | Drug-Induced Myoclonus: A Systematic Review |
| title_full_unstemmed | Drug-Induced Myoclonus: A Systematic Review |
| title_short | Drug-Induced Myoclonus: A Systematic Review |
| title_sort | drug induced myoclonus a systematic review |
| topic | myoclonus neurotoxicity encephalopathy drug-induced myoclonus adverse effect myoclonus/chemically induced |
| url | https://www.mdpi.com/1648-9144/61/1/131 |
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