Piracetam in the treatment of cortical myoclonus

This paper reviews existing publications on the use of piracetam for the tr eatment of cortical myoclonus of various etiologies and includes the person al experience of the authors in progressive myoclonus epilepsy. Two double- blind comparisons with placebo provided results which allow recommendations for the dosage and usage of piracetam in cortical myoclonus. Wide individu al variation (7-24 g daily) exists in dosage requirements but responses are dose-related so that dosage should be increased until an optimum effect is obtained. Tolerability after long-term use of piracetam in high dosage has been very good and without toxicity or serious adverse effects. Side effec ts have been occasional, mild and transient, The authors present their expe rience of 12 patients with progressive myoclonus epilepsy in whom the admin istration of up to 45 g piracetam daily, when added to existing anti-epilep tic treatment, caused marked and sometimes spectacular improvement and was without significant adverse effects. improvement was maintained for up to 7 years. The use of piracetam for disabling cortical myoclonus of any etiolo gy, either as an addition to existing antimyoclonic drugs or as monotherapy , may bring about profound improvement in disability and quality of life. P iracetam should be considered a first-line drug for the treatment of cortic al myoclonus.