CHLORMETHIAZOLE IN THE MANAGEMENT OF THE OPSOCLONUS-MYOCLONUS SYNDROME

Two instances of successful treatment of the rare ocular dyskinesia, o psoclonus, with chlormethiazole are reported. A 65-year-old woman had the opsoclonus-myoclonus syndrome associated with carcinoma of the bre ast; her myoclonia and opsoclonus did not respond to intravenous diaze pam or phenytoin. Treatment with intravenous chlormethiazole resulted in rapid control of her myoclonic attacks, followed by slower but comp lete resolution of the opsoclonus. Following control of the acute symp toms the patient was transferred to an oral chlormethiazole dose which was further reduced maintenance subsequently discontinued after 5 pat ient's overall clinical status had improved. A 53-year-old man with op soclonia, myoclonia, ataxia and encephalopathy, not associated with ne oplasia, was given immunosuppressor drugs to establish basal control, and oral chlormethiazole for symptomatic treatment. Almost immediately after the initial dose of chlormethiazole the patient became more ori entated; he was sedated and the agitation and myoclonic fits were brou ght under control quite quickly. The opsoclonus responded progressivel y and was completely resolved after a few days. The initial oral dose of chlormethiazole was gradually reduced and was discontinued after 5 - 6 months. Chlormethiazole was well tolerated; it may have an importa nt role in the management of the rare opsoclonus-myoclonus syndrome.