Myoclonus and Convulsions

Question 1

List 5 causes of myoclonus

Answer 1

Cerebral hypoxia
Infection
Drug withdrawal (benzo, EtOH)
Metabolic disorder (renal/liver failure)
Medications (opioid, TCA, neuroleptics)
CNS (trauma, lesion, degeneration, epilepsy)

Question 2

List 2 pharmacological options with good evidence for management of myoclonus:

Answer 2

Keppra

Clonazepam

Valproic acid

Other: benzodiazepines (lorazepam, diazepam, midazolam), phenobarbital, baclofen

Question 3

List 2 criteria for prophylactic anti-convulsants in patient with brain tumor or metastases

Answer 3

1) Previous history of seizure
2) Hemorrhagic brain metastases (particularly melanoma)

• Confirmed in uptodate

Question 4

List 6 non-iatrogenic causes for seizure

Answer 4

Brain tumor / mets
Infection
Stress / lack of sleep / fever
Drug withdrawal (CNS depressant)
Head trauma or CVA
Metabolic disorder

Question 5

List 6 drug classes associated with adverse effect of seizure

Answer 5

Antibiotics
Opioids
Antipsychotics
Anti-depressants
Amphetamines
Anaesthetics

Question 6

List 2 classes of medications used for seizure management at EOL (PO and IV route not available)

Answer 6

Benzodiazepines (Lorazepam, Midazolam, Diazepam)
Barbiturates (Phenobarbital)

Question 7

List top 3 choices for benzodiazepines (and doses) for seizing patient:

Answer 7

1) Lorazepam 2-3mg IV/SC q20min PRN (up to 8mg)

2) Diazepam 0.15-0.25mg/kg (10-20mg) IV/PR
- rpt x 1 after 5 min for IV dose (max 40mg)
- rpt x 1 after 15-30min for PR dose (max 20-30mg)

3) Midazolam 5-10mg q5-15min PRN x 3 doses