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Journal of Neurology

, Volume 264, Issue 8, pp 1559–1566 | Cite as

The clinical heterogeneity of drug-induced myoclonus: an illustrated review

  • Sabine Janssen
  • Bastiaan R. Bloem
  • Bart P. van de WarrenburgEmail author
Open Access
Review

Abstract

A wide variety of drugs can cause myoclonus. To illustrate this, we first discuss two personally observed cases, one presenting with generalized, but facial-predominant, myoclonus that was induced by amantadine; and the other presenting with propriospinal myoclonus triggered by an antibiotic. We then review the literature on drugs that may cause myoclonus, extracting the corresponding clinical phenotype and suggested underlying pathophysiology. The most frequently reported classes of drugs causing myoclonus include opiates, antidepressants, antipsychotics, and antibiotics. The distribution of myoclonus ranges from focal to generalized, even amongst patients using the same drug, which suggests various neuro-anatomical generators. Possible underlying pathophysiological alterations involve serotonin, dopamine, GABA, and glutamate-related processes at various levels of the neuraxis. The high number of cases of drug-induced myoclonus, together with their reported heterogeneous clinical characteristics, underscores the importance of considering drugs as a possible cause of myoclonus, regardless of its clinical characteristics.

Keywords

Drug-induced myoclonus Myoclonus/phenotype Myoclonus/physiopathology 

Introduction

Myoclonus are involuntary sudden, brief, shock-like ‘jerky’ movements due to muscular contractions (‘positive myoclonus’) or sudden lapses of muscle contraction in active muscles (‘negative myoclonus’ or ‘asterixis’) [40, 44]. Myoclonus can be classified by distribution (focal, segmental, multifocal, and generalized) [75], by localization of the ‘pulse generator’ (cortical, subcortical, brainstem, spinal, or peripheral) [44], and by aetiology (physiological, essential, epileptic, symptomatic, and psychogenic) [44, 52]. In this paper, we review the phenomenon of drug-induced myoclonus, a subgroup of symptomatic myoclonus, with an emphasis on the clinical and pathophysiological heterogeneity of this phenomenon, which could mislead clinicians and result in insufficient consideration of drugs as the cause of myoclonus.

We first describe two personally observed cases of drug-induced myoclonus. Next, we present the results of our literature search on those drugs reported to cause myoclonus, including details of the corresponding clinical phenotype and, whenever available, data on the neuro-anatomical origins and pathophysiological processes.

Case description

Case A

Patient A was a 79-year-old woman who developed her first ever epileptic seizure 2 days after the start of intravenous penicillin and ciprofloxacin prescribed for pneumonia. On neurological examination after the seizure she was alert but showed jerky movements of trunk, abdomen, and arms (particularly the right shoulder) more than of her legs that she could not suppress (video 1). The spread and temporal gradient of these jerks were particularly indicative of propriospinal myoclonus. EEG showed no epileptic phenomena, not even at the time when the movements occurred during recording. Antibiotic therapy was switched to claritromycin and ceftazidim, after which the myoclonus disappeared. The final diagnosis was that of ciprofloxacin and/or penicillin-induced propriospinal myoclonus.

Case B

Patient B was a 66-year-old man who had been diagnosed 12 years previously with Parkinson’s disease for which he took levodopa/benserazide 125 mg t.i.d. plus 125 mg b.i.d. as dispersible tablets, and ropinirole 6 mg b.i.d. His medical history reported a left-sided stereotactic thalamotomy because of a troublesome tremor of his right hand and a cervical disc herniation. Because of peak-dose dyskinesias and marked off periods during the night, amantadine was started and augmented to 100 mg t.i.d. Slow-release levodopa/benserazide ante noctum was added to the treatment regimen. One month after these treatment adjustments, the patient developed involuntary jerks through his whole body but predominantly in his face and neck, also severely affecting his speech. These jerks were not sensitive to stimuli and occurred mainly during action (both positive and negative) but were also present at rest. During walking, axial action myoclonus was apparent (video 2). The remaining examination showed an asymmetric hypokinetic-rigid syndrome, the severity of which was similar to prior examination. Suspecting drug-induced generalized myoclonus, amantadine was tapered off, and the myoclonus disappeared within 2 weeks.

Methods

Search strategy

We searched PubMed using the MeSH terms “Myoclonus/chemically induced”, “Myoclonus/etiology”, “Myoclonus/pharmacology”, “Myoclonus/physiology”, “Myoclonus/physiopathology”, “Drug-Related Side Effects and Adverse Reactions”, and “Dyskinesia, Drug-Induced”. Only articles in English, published before September 2016, were reviewed for relevance.

Results

Our literature search on drug-induced myoclonus mainly identified case reports and (mostly small) case series (the largest involving 32 patients). Table 1 summarizes the number of cases reported per subclass of drugs associated with myoclonus, the distribution of myoclonus, and one or two relevant references per category. The full table with all references considered (Table 2) is available as supplementary material. Almost all classes of drugs have been linked to myoclonus. The clinical phenotype covered the whole spectrum, from a focal to a generalized distribution. The presumed anatomic structures and neurotransmitters involved are suggested to differ per causative agent. Drug-induced myoclonus was usually reversible following withdrawal of the offending drug [10, 44], and only a single case of persistent myoclonus has been reported [75]. We here describe the characteristics of myoclonus caused by the four classes of drugs most often reported in relation to myoclonus (opiates, antidepressants, antipsychotics, and antibiotics) and by the group of drugs involved in our case B (NMDA antagonists).
Table 1

Case reports and illustrative references upon medication-induced myoclonus

Pharmacological class

Pharmacological subclass

Number of cases reported Illustrative reference(s)

All distributions

Focal

Segmental

Multifocal

Generalized

Distribution not described

Opiates

Full agonists

105

1 [47]

18 [32]

13 [19]

73 [7, 83 78 ]

Partial agonist–antagonist

7

7 [7]

Antidepressants

Selective serotonin-reuptake inhibitors (SSRIs)

44

2 [30]

6 [86]

36 [74]

Tricyclic antidepressants (TCAs)

55

5 [54]

2 [20]

4 [68]

44 [7, 8]

Lithium

10

6 [11, 20]

2 [14]

2 [7]

Monoamine oxidase (MAO) inhibitors

4

1 [5]

3 [7]

Serotonin-norepinephrine reuptake inhibitor (SNRI)

1

1 [18]

Noradrenalin and dopamine reuptake inhibitors

1

1 [31]

Antipsychotics

Typical

65

56 [93]

1 [16]

8 [7]

Atypical

15

5 [6]

3 [92]

7 [7]

Antibiotics

β-lactams

40

3 [80]

3 [87]

34 [7, 79]

Quinolones

34

2 [81]

2 [21]

30 [7]

Sulfonamides

3

2 [41]

1 [58]

Aminoglycosides

6

1 [75]

5 [7]

Anxiolytics

Benzodiazepines

66

7 [51]

59 [7]

Anti-epileptics

Gabapentin

27

3 [4]

17 [4, 101]

3 [77, 101]

4 [7]

Pregabalin

9

1 [35]

8 [63]

Valproic acid

10

1 [98]

9 [1, 7]

Lamotrigine

7

3 [23]

1 [13]

3 [74]

Carbamazepine

5

1 [50]

4 [7, 27]

Phenytoine

4

2 [17]

2 [7]

Topiramate

4

2 [45]

1 [3]

1 [64]

Phenobarbital

2

2 [7]

Vigabatrin

2

2 [62]

Clobazam

1

1 [27]

Anti-parkinsonians

L-dopa

28

28 [7, 43, 90]

Dopamine agonists

8

8 [7, 90]

Non-competitive (NMDA)-glutamatereceptor-antagonist (amantadine) (also see ‘anti-dementia’)

10

2 [31]

 

1 [96]

7 [55]

COMT inhibitors

1

1 [7]

MAO-inhibitors

1

1 [7]

Anesthetics

General anesthetics

42

1 [89]

15 [97]

8 [97]

7 [97, 46]

11 [7]

Local anesthetics

4

4 [2]

Anti-dementia

Cholinesterase inhibitors

18

18 [7]

Non-competitive (NMDA)-glutamatereceptor-antagonist (memantine) (also see anti-parkinsonians)

9

1 [69]

3 [60]

5 [7, 66]

Cytostatics

Ifosfamide

5

1 [56]

4 [76]

Prednimustine

4

3 [53, 59]

1 [53]

Chlorambucil

2

1 [95]

1 [95]

Others

Anti-emetics

23

1 [36]

1 [61]

2 [12]

19 [7]

Anti-arrhythmics

5

3 [91]

1 [84]

1 [7]

Vitamins

5

4 [99]

1 [65]

Anti-hypertensives

2

2 [88]

Contrast agents

3

1 [24]

2 [9]

Immunomodulating drugs

2

1 [22]

1 [7]

Anti-fibrinolytic agents

1

1 [34]

Anti-histamines

1

1 [37]

Anti-hypotensives

1

1 [94]

Anti-tussives

1

1 [82]

Adrenergic bronchodilators

3

3 [57]

NSAID

1

1 [7]

Anti-viral agents

1

1 [28]

Anti-malaria prophylaxis

1

1 [39]

Classes and subclasses of drugs described to cause drug-induced myoclonus. References were sorted to distribution of myoclonus. The numbers of reported cases of drug-induced myoclonus are listed. One or two illustrative reference(s) per distribution is/are listed in superscript

– No studies describing myoclonus with this distribution, for this class of drugs. The references used to count the number of cases reported are listed in Table 2 available as ‘supplementary material’

Opiates

Myoclonus may occur as a result of initial administration, change, or withdrawal of opiates [19, 32, 47]. Mainly generalized, but also multifocal and a single case of focal myoclonus have been described (Table 1, and supplementary Table 2). Opiate-related myoclonus occurs more frequently in patients concurrently treated with antidepressant, antipsychotic, antiemetic, or nonsteroidal anti-inflammatory drugs [47]. The precise pathophysiology remains poorly understood. A neuro-excitatory effect of opioid compounds and metabolites has been attributed to glutamate activation of N-methyl-D-aspartate (NMDA) receptors, glycine-mediated disinhibition of neural pathways at the cortical or spinal level, antagonism of gamma-amino-butyric acid (GABA) activity in the spinal cord, serotonergic and GABAergic pathways in the brainstem, and dopaminergic pathways in the basal ganglia [32].

Antidepressants

Various classes of antidepressants have been associated with myoclonus (Table 1, and supplementary Table 2). Selective serotonin-reuptake inhibitors (SSRIs) can cause multifocal [30, 67] or generalized myoclonus [48, 64, 86]. Tricyclic antidepressants (TCAs) can cause either focal (especially jaw) [26, 54], multifocal [20, 42], and generalized [14, 49, 68, 98] myoclonus. Lithium has been observed to cause multifocal [11, 20] and generalized [14] myoclonus. An EEG transient over the contralateral sensorimotor region preceding the myoclonus suggested a cortical origin of myoclonus in patients treated with a TCA [20] or lithium [11]. Serotoninergic mechanisms are probably involved in the generation of antidepressant-induced myoclonus [30]. While SSRIs increase serotonin levels in the synaptic cleft, TCAs increase serotonin activity, and lithium facilitates the presynaptic release of serotonin [20]. A combination of two serotonergic active drugs, such as a TCA and lithium, appears more likely to cause myoclonus than a single drug [14, 20].

Antipsychotics

Classic antipsychotics, including haloperidol, have been reported to cause multifocal myoclonus of both arms, sensitive to posture [25, 85]; of limbs and of the face [16]; and of the trunk and limbs [93]. Atypical antipsychotics, including quetiapine and olanzapine, can cause both multifocal [33, 72] and generalized [29, 73, 92] myoclonus. The exact pathogenesis of antipsychotic-induced myoclonus has not yet been unraveled, but involvement of serotonergic [16, 72], dopaminergic [93], and GABA-ergic [92] mechanisms have all been suggested.

Antibiotics

Antibiotic-induced myoclonus mainly occurs in association with high or toxic doses of antibiotics and/or underlying renal disease [75]. It is commonly accompanied by other symptoms, such as altered mental state, seizures (similar to our case A), aphasia, chorea, and skin rash [75]. Myoclonus due to β-lactam antibiotics clinically varies from subtle peri-ocular twitching to generalized myoclonus [75]. Myoclonus due to quinolones can be generalized [21, 38] or multifocal [81]. It is hypothesized that β-lactam antibiotics selectively antagonize [75] and quinolones completely inhibit [71] gamma aminobutyric acid (GABA) receptors, decreasing their inhibitory activity at nerve terminals, thus inducing a hyperexcitable neuronal state of the central nervous system that triggers myoclonus. Sulfonamides have been associated with multifocal and generalized myoclonus. A causative role of altered dopamine metabolism due to inhibition of dihydrofolate reductase [15] as well as increased phenylalanine levels due to the inhibition of phenylalanine metabolism have been proposed [41]. Multifocal myoclonus that is due to aminoglycosides has been attributed to NMDA receptor activation and subsequent excitotoxicity.

NMDA antagonists

Myoclonus due to N-methyl-D-aspartate (NMDA) receptor antagonists has rarely been reported. Amantadine has been shown to reduce levodopa-induced dyskinesias [100] but paradoxically has also been reported to induce jaw myoclonus in two patients [31, 70] and generalized myoclonus in four patients [55, 96]. In addition, memantine gave rise to myoclonus in patients with dementia [58, 60, 66]. The mechanism underlying amantadine and memantine induced myoclonus remains unclear, but might involve altered levels of dopamine, serotonin, and/or glutamate release [55, 96].

Conclusion

A French pharmacovigilance database study [7], registering all compulsorily reported adverse drug reactions in France, reported an incidence of drug-induced myoclonus of 0.2% (423/185.634 reported adverse events over a 20-year period), which might be an underestimation due to underreporting [7]. Our literature survey is not suitable to extract epidemiological data, but the large number of case reports that we identified does suggest that drug-induced myoclonus is not an uncommon phenomenon in movement disorder consultations. Of course, we cannot offer certainty about causality for the observed associations between drugs and myoclonus, which is inherent to a literature review of case reports and case series. However, in many cases, myoclonus appeared shortly after the prescription of a new (and presumably causally involved) drug, and disappeared again readily after this same drug was stopped, suggesting a causal relationship.

Our survey—as well as the French pharmacovigilance database study—found that the most important groups of drugs with links to myoclonus are: opiates, antidepressants, antipsychotic drugs, and antibiotics. However, drug-induced myoclonus may also be caused by a wide variety of other drugs. Drug-induced myoclonus is usually reversible upon discontinuation of the offending drug, and this stresses the importance of making the correct diagnosis of drug-induced myoclonus. Importantly, the phenomenology of the myoclonus can vary within a group of drugs and even for one particular drug, suggesting that the neuro-anatomical generator varies. From a clinical perspective, this also means that drugs as a cause cannot be discarded based solely on clinical myoclonus characteristics. The precise cellular and neurochemical alterations that make a certain drug cause myoclonus remain largely unclear and therefore need further study.

Notes

Acknowledgments

S Janssen: is supported by a research Grant from the Netherlands Organization for Scientific Research. BP van de Warrenburg: receives research support from the Radboud University Medical Center, the Netherlands Brain Foundation, and ZonMW. BR Bloem: receives research funding from the National Parkinson Foundation, the Netherlands organization for scientific research, International Parkinson Fonds, Hersenstichting Nederland, UCB, Abbvie and the Michael J Fox Foundation. He received honoraria from Adamas, Abbvie, Danone, Zambon. We are very grateful to J.P. Bulstra and J.H.M. Janssen for their help with editing the video material.

Compliance with ethical standards

Conflicts of interest

S Janssen: no conflicts of interest to declare. BP van de Warrenburg: no conflicts of interest to declare. BR Bloem: no conflicts of interest to declare.

Supplementary material

415_2016_8357_MOESM1_ESM.docx (215 kb)
Supplementary material 1 (DOCX 215 kb)
415_2016_8357_MOESM2_ESM.docx (11 kb)
Supplementary material 2 (DOCX 11 kb)

Supplementary material 3 (MP4 18275 kb)

415_2016_8357_MOESM4_ESM.mp4 (11.6 mb)
Supplementary material 4 (MP4 11868 kb)

References

  1. 1.
    Aguglia U, Gambardella A, Zappia M, Valentino P, Quattrone A (1995) Negative myoclonus during valproate-related stupor. Neurophysiological evidence of a cortical non-epileptic origin. Electroencephalogr Clin Neurophysiol 94:103–108PubMedCrossRefGoogle Scholar
  2. 2.
    Alfa JA, Bamgbade OA (2008) Acute myoclonus following spinal anaesthesia. Eur J Anaesthesiol 25:256–257PubMedCrossRefGoogle Scholar
  3. 3.
    Alonso-Navarro H, Jimenez-Jimenez FJ (2006) Reversible tremor, myoclonus, and fasciculations associated with topiramate use for migraine. Clin Neuropharmacol 29:157–159PubMedCrossRefGoogle Scholar
  4. 4.
    Asconape J, Diedrich A, DellaBadia J (2000) Myoclonus associated with the use of gabapentin. Epilepsia 41:479–481PubMedCrossRefGoogle Scholar
  5. 5.
    Askenasy JJ, Yahr MD (1988) Is monoamine oxidase inhibitor induced myoclonus serotoninergically mediated? J Neural Transm 72:67–76PubMedCrossRefGoogle Scholar
  6. 6.
    Barak Y, Levine J, Weisz R (1996) Clozapine-induced myoclonus: two case reports. J Clin Psychopharmacol 16:339–340PubMedCrossRefGoogle Scholar
  7. 7.
    Brefel-Courbon C, Gardette V, Ory F, Montastruc JL (2006) Drug-induced myoclonus: a French pharmacovigilance database study. Neurophysiol Clin 36:333–336PubMedCrossRefGoogle Scholar
  8. 8.
    Casas M, Garcia-Ribera C, Alvarez E, Udina C, Queralto JM, Grau JM (1987) Myoclonic movements as a side-effect of treatment with therapeutic doses of clomipramine. Int Clin Psychopharmacol 2:333–336PubMedCrossRefGoogle Scholar
  9. 9.
    Casazza M, Bracchi M, Girotti F (1985) Spinal myoclonus and clinical worsening after intravenous contrast medium in a patient with spinal arteriovenous malformation. AJNR Am J Neuroradiol 6:965–966PubMedGoogle Scholar
  10. 10.
    Caviness JN, Brown P (2004) Myoclonus: current concepts and recent advances. Lancet Neurol 3:598–607PubMedCrossRefGoogle Scholar
  11. 11.
    Caviness JN, Evidente VG (2003) Cortical myoclonus during lithium exposure. Arch Neurol 60:401–404PubMedCrossRefGoogle Scholar
  12. 12.
    Chaw SH, Chan L, Lee PK, Bakar JA, Rasiah R, Foo LL (2016) Prolonged drug-induced myoclonus: is it related to palonosetron? J Anesth 30(6):1063–1066PubMedCrossRefGoogle Scholar
  13. 13.
    Crespel A, Genton P, Berramdane M, Coubes P, Monicard C, Baldy-Moulinier M, Gelisse P (2005) Lamotrigine associated with exacerbation or de novo myoclonus in idiopathic generalized epilepsies. Neurology 65:762–764PubMedCrossRefGoogle Scholar
  14. 14.
    Devanand DP, Sackeim HA, Brown RP (1988) Myoclonus during combined tricyclic antidepressant and lithium treatment. J Clin Psychopharmacol 8:446–447PubMedCrossRefGoogle Scholar
  15. 15.
    Dib EG, Bernstein S, Benesch C (2004) Multifocal myoclonus induced by trimethoprim-sulfamethoxazole therapy in a patient with nocardia infection. N Engl J Med 350:88–89PubMedCrossRefGoogle Scholar
  16. 16.
    Dominguez C, Benito-Leon J, Bermejo-Pareja F (2009) Multifocal myoclonus induced by haloperidol. Neurol Sci 30:385–386PubMedCrossRefGoogle Scholar
  17. 17.
    Duarte J, Sempere AP, Cabezas MC, Marcos J, Claveria LE (1996) Postural myoclonus induced by phenytoin. Clin Neuropharmacol 19:536–538PubMedCrossRefGoogle Scholar
  18. 18.
    Dutra LA, Pedroso JL, Felix EP, Barsottini OG (2008) Venlafaxine induced-myoclonus in a patient with mixed dementia. Arq Neuropsiquiatr 66:894–895PubMedCrossRefGoogle Scholar
  19. 19.
    Essandoh S, Sakae M, Miller J, Glare PA (2010) A cautionary tale from critical care: resolution of myoclonus after fentanyl rotation to hydromorphone. J Pain Symptom Manage 40:e4–6PubMedCrossRefGoogle Scholar
  20. 20.
    Evidente VG, Caviness JN (1999) Focal cortical transient preceding myoclonus during lithium and tricyclic antidepressant therapy. Neurology 52:211–213PubMedCrossRefGoogle Scholar
  21. 21.
    Farrington J, Stoudemire A, Tierney J (1995) The role of ciprofloxacin in a patient with delirium due to multiple etiologies. Gen Hosp Psychiatry 17:47–53PubMedCrossRefGoogle Scholar
  22. 22.
    Ferbert A, Biniek R, Kindler J, Maurin N (1993) Myoclonus and tremor induced acutely by administration of tumor necrosis factor in a patient with Ehlers-Danlos syndrome. Mov Disord 8:232–233PubMedCrossRefGoogle Scholar
  23. 23.
    Fernandez Corcuera P, Pomarol E, Amann B, McKenna P (2008) Myoclonus provoked by lamotrigine in a bipolar patient. J Clin Psychopharmacol 28:248–249PubMedCrossRefGoogle Scholar
  24. 24.
    Finsterer J, Lubec D, Verlicchi A, Samec P (1998) Facial myocloni and stroke as late sequelae of metrizamide myelography. J Neuropsychiatry Clin Neurosci 10:472–473PubMedCrossRefGoogle Scholar
  25. 25.
    Fukuzako H, Tominaga H, Izumi K, Koja T, Nomoto M, Hokazono Y, Kamei K, Fujii H, Fukuda T, Matsumoto K (1990) Postural myoclonus associated with long-term administration of neuroleptics in schizophrenic patients. Biol Psychiatry 27:1116–1126PubMedCrossRefGoogle Scholar
  26. 26.
    Garvey MJ, Tollefson GD (1987) Occurrence of myoclonus in patients treated with cyclic antidepressants. Arch Gen Psychiatry 44:269–272PubMedCrossRefGoogle Scholar
  27. 27.
    Genton P, Nguyen VH, Mesdjian E (1998) Carbamazepine intoxication with negative myoclonus after the addition of clobazam. Epilepsia 39:1115–1118PubMedCrossRefGoogle Scholar
  28. 28.
    Gentry JL 3rd, Peterson C (2015) Death delusions and myoclonus: acyclovir toxicity. Am J Med 128:692–694PubMedCrossRefGoogle Scholar
  29. 29.
    George M, Haasz M, Coronado A, Salhanick S, Korbel L, Kitzmiller JP (2013) Acute dyskinesia, myoclonus, and akathisa in an adolescent male abusing quetiapine via nasal insufflation: a case study. BMC Pediatr 13:187PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Ghaziuddin N, Iqbal A, Khetarpal S (2001) Myoclonus during prolonged treatment with sertraline in an adolescent patient. J Child Adolesc Psychopharmacol 11:199–202PubMedCrossRefGoogle Scholar
  31. 31.
    Gupta A, Lang AE (2010) Drug-induced cranial myoclonus. Mov Disord 25:2264–2265PubMedCrossRefGoogle Scholar
  32. 32.
    Han PK, Arnold R, Bond G, Janson D, Abu-Elmagd K (2002) Myoclonus secondary to withdrawal from transdermal fentanyl: case report and literature review. J Pain Symptom Manage 23:66–72PubMedCrossRefGoogle Scholar
  33. 33.
    Horga G, Horga A, Baeza I, Castro-Fornieles J, Lazaro L, Pons A (2010) Drug-induced speech dysfluency and myoclonus preceding generalized tonic-clonic seizures in an adolescent male with schizophrenia. J Child Adolesc Psychopharmacol 20:233–234PubMedCrossRefGoogle Scholar
  34. 34.
    Hui AC, Wong TY, Chow KM, Szeto CC (2003) Multifocal myoclonus secondary to tranexamic acid. J Neurol Neurosurg Psychiatry 74:547PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Huppertz HJ, Feuerstein TJ, Schulze-Bonhage A (2001) Myoclonus in epilepsy patients with anticonvulsive add-on therapy with pregabalin. Epilepsia 42:790–792PubMedCrossRefGoogle Scholar
  36. 36.
    Immovilli P, Rota E, Morelli N, Iafelice I, Magnacavallo A, Guidetti D (2015) Metoclopramide-induced facial and palatopharyngeal myoclonus. Neurology 84:1284PubMedCrossRefGoogle Scholar
  37. 37.
    Irioka T, Machida A, Yokota T, Mizusawa H (2008) Antihistamine-associated myoclonus: a case report. Mov Disord 23:1615–1616PubMedCrossRefGoogle Scholar
  38. 38.
    Jayathissa S, Woolley M, Ganasegaram M, Holden J, Cu E (2010) Myoclonus and delirium associated with ciprofloxacin. Age Ageing 39:762PubMedCrossRefGoogle Scholar
  39. 39.
    Jimenez-Huete A, Gil-Nagel A, Franch O (2002) Multifocal myoclonus associated with mefloquine chemoprophylaxis. Clin Neuropharmacol 25:243PubMedCrossRefGoogle Scholar
  40. 40.
    Jimenez-Jimenez FJ, Puertas I, de Toledo-Heras M (2004) Drug-induced myoclonus: frequency, mechanisms and management. CNS Drugs 18:93–104PubMedCrossRefGoogle Scholar
  41. 41.
    Jundt F, Lempert T, Dorken B, Pezzutto A (2004) Trimethoprim-sulfamethoxazole exacerbates posthypoxic action myoclonus in a patient with suspicion of Pneumocystis jiroveci infection. Infection 32:176–178PubMedCrossRefGoogle Scholar
  42. 42.
    Kettl P, DePaulo JR Jr (1983) Maprotiline-induced myoclonus. J Clin Psychopharmacol 3:264–265PubMedCrossRefGoogle Scholar
  43. 43.
    Klawans HL, D’Amico DJ, Patel BC (1975) Behavioral supersensitivity to 5-hydroxytryptophan induced by chronic methysergide pretreatment. Psychopharmacologia 44:297–300PubMedCrossRefGoogle Scholar
  44. 44.
    Kojovic M, Cordivari C, Bhatia K (2011) Myoclonic disorders: a practical approach for diagnosis and treatment. Ther Adv Neurol Disord 4:47–62PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Kutluay E, Pakoz B, Beydoun A (2007) Reversible facial myoclonus with topiramate therapy for epilepsy. Epilepsia 48:2001–2002PubMedCrossRefGoogle Scholar
  46. 46.
    Laughlin TP, Newberg LA (1985) Prolonged myoclonus after etomidate anesthesia. Anesth Analg 64:80–82PubMedCrossRefGoogle Scholar
  47. 47.
    Lauterbach EC (1999) Hiccup and apparent myoclonus after hydrocodone: review of the opiate-related hiccup and myoclonus literature. Clin Neuropharmacol 22:87–92PubMedCrossRefGoogle Scholar
  48. 48.
    Lauterbach EC (1994) Reversible intermittent rhythmic myoclonus with fluoxetine in presumed Pick’s disease. Mov Disord 9:343–346PubMedCrossRefGoogle Scholar
  49. 49.
    Lippmann S, Moskovitz R, O’Tuama L (1977) Tricyclic-induced myoclonus. Am J Psychiatry 134:90–91PubMedCrossRefGoogle Scholar
  50. 50.
    Magaudda A, Di Rosa G (2012) Carbamazepine-induced non-epileptic myoclonus and tic-like movements. Epileptic Disord 14:172–173PubMedGoogle Scholar
  51. 51.
    Magny JF, d’Allest AM, Nedelcoux H, Zupan V, Dehan M (1994) Midazolam and myoclonus in neonate. Eur J Pediatr 153:389–390PubMedCrossRefGoogle Scholar
  52. 52.
    Marsden CD, Hallett M, Fahn S (1982) The nosology and pathophysiology of myoclonus. Movement Disorders. Butterworths, London, pp 196–248Google Scholar
  53. 53.
    Martin M, Diaz-Rubio E, Casado A, Valverde JJ, Garcia Urra D, Lopez-Martin JA, Rodriguez-Lescure A (1994) Prednimustine-induced myoclonus–a report of three cases. Acta Oncol 33:81–82PubMedCrossRefGoogle Scholar
  54. 54.
    Masand P (1992) Desipramine-induced oral-pharyngeal disturbances: stuttering and jaw myoclonus. J Clin Psychopharmacol 12:444–445PubMedCrossRefGoogle Scholar
  55. 55.
    Matsunaga K, Uozumi T, Qingrui L, Hashimoto T, Tsuji S (2001) Amantadine-induced cortical myoclonus. Neurology 56:279–280PubMedCrossRefGoogle Scholar
  56. 56.
    Meyer T, Ludolph AC, Munch C (2002) Ifosfamide encephalopathy presenting with asterixis. J Neurol Sci 199:85–88PubMedCrossRefGoogle Scholar
  57. 57.
    Micheli F, Cersosimo MG, Scorticati MC, Velez M, Gonzalez S (2000) Myoclonus secondary to albuterol (salbutamol) instillation. Neurology 54:2022–2023PubMedCrossRefGoogle Scholar
  58. 58.
    Moellentin D, Picone C, Leadbetter E (2008) Memantine-induced myoclonus and delirium exacerbated by trimethoprim. Ann Pharmacother 42:443–447PubMedCrossRefGoogle Scholar
  59. 59.
    Monnerat C, Gander M, Leyvraz S (1997) A rare case of prednimustine-induced myoclonus. J Natl Cancer Inst 89:173–174PubMedCrossRefGoogle Scholar
  60. 60.
    Murgai AA, LeDoux MS (2015) Memantine-induced Myoclonus in a Patient with Alzheimer Disease. Tremor and other hyperkinetic movements 5:337PubMedPubMedCentralGoogle Scholar
  61. 61.
    Nampiaparampil D, Oruc NE (2006) Metodopramide-induced palatopharyngeal myoclonus. Mov Disord 21:2028–2029PubMedCrossRefGoogle Scholar
  62. 62.
    Neufeld MY, Vishnevska S (1995) Vigabatrin and multifocal myoclonus in adults with partial seizures. Clin Neuropharmacol 18:280–283PubMedCrossRefGoogle Scholar
  63. 63.
    Olszewska DA, Chalissery AJ, Williams J, Lynch T, Smyth S (2015) Speech myoclonus due to probable pregabalin adverse drug-reaction. Parkinsonism Relat Disord 21:823–824PubMedCrossRefGoogle Scholar
  64. 64.
    Oulis P, Potagas C, Masdrakis VG, Thomopoulos Y, Kouzoupis AV, Soldatos CR (2008) Reversible tremor and myoclonus associated with topiramate-fluvoxamine coadministration. Clin Neuropharmacol 31:366–367PubMedCrossRefGoogle Scholar
  65. 65.
    Ozer EA, Turker M, Bakiler AR, Yaprak I, Ozturk C (2001) Involuntary movements in infantile cobalamin deficiency appearing after treatment. Pediatr Neurol 25:81–83PubMedCrossRefGoogle Scholar
  66. 66.
    Papageorgiou SG, Kontaxis T, Antelli A, Kalfakis N (2007) Exacerbation of myoclonus by memantine in a patient with Alzheimer disease. J Clin Psychopharmacol 27:407–408PubMedCrossRefGoogle Scholar
  67. 67.
    Patel HC, Bruza D, Yeragani V (1988) Myoclonus with trazodone. J Clin Psychopharmacol 8:152PubMedCrossRefGoogle Scholar
  68. 68.
    Patterson JF (1990) Myoclonus caused by a tricyclic antidepressant. South Med J 83:463–465PubMedCrossRefGoogle Scholar
  69. 69.
    Pei LJ, Tianzhi IL, Lim WS (2015) Memantine-induced myoclonus precipitated by renal impairment and drug interactions. J Am Geriatr Soc 63:2643–2644PubMedCrossRefGoogle Scholar
  70. 70.
    Pfeiffer RF (1996) Amantadine-induced “vocal” myoclonus. Mov Disord 11:104–106PubMedCrossRefGoogle Scholar
  71. 71.
    Post B, Koelman JH, Tijssen MA (2004) Propriospinal myoclonus after treatment with ciprofloxacin. Mov Disord 19:595–597PubMedCrossRefGoogle Scholar
  72. 72.
    Praharaj SK, Venkatesh BG, Sarkhel S, Zia-ul-Haq M, Sinha VK (2010) Clozapine-induced myoclonus: a case study and brief review. Prog Neuropsychopharmacol Biol Psychiatry 34:242–243PubMedCrossRefGoogle Scholar
  73. 73.
    Rosen JB, Milstein MJ, Haut SR (2012) Olanzapine-associated myoclonus. Epilepsy Res 98:247–250PubMedCrossRefGoogle Scholar
  74. 74.
    Rosenhagen MC, Schmidt U, Weber F, Steiger A (2006) Combination therapy of lamotrigine and escitalopram may cause myoclonus. J Clin Psychopharmacol 26:346–347PubMedCrossRefGoogle Scholar
  75. 75.
    Sarva H, Panichpisal K (2012) Gentamicin-induced myoclonus: a case report and literature review of antibiotics-induced myoclonus. Neurologist 18:385–388PubMedCrossRefGoogle Scholar
  76. 76.
    Savica R, Rabinstein AA, Josephs KA (2011) Ifosfamide associated myoclonus-encephalopathy syndrome. J Neurol 258:1729–1731PubMedCrossRefGoogle Scholar
  77. 77.
    Shea YF, Mok MM, Chang RS (2014) Gabapentin-induced myoclonus in an elderly with end-stage renal failure. Journal of the Formosan Medical Association =. Taiwan yi zhi 113:660–661PubMedCrossRefGoogle Scholar
  78. 78.
    Sjogren P, Thunedborg LP, Christrup L, Hansen SH, Franks J (1998) Is development of hyperalgesia, allodynia and myoclonus related to morphine metabolism during long-term administration? Six case histories. Acta Anaesthesiol Scand 42:1070–1075PubMedCrossRefGoogle Scholar
  79. 79.
    Sonck J, Laureys G, Verbeelen D (2008) The neurotoxicity and safety of treatment with cefepime in patients with renal failure. Nephrol Dial Transplant 23:966–970PubMedCrossRefGoogle Scholar
  80. 80.
    Spina Silva T, Dal-Pra Ducci R, Zorzetto FP, Braatz VL, de Paola L, Kowacs PA (2014) Meropenem-induced myoclonus: a case report. Seizure 23:912–914PubMedCrossRefGoogle Scholar
  81. 81.
    Striano P, Zara F, Coppola A, Ciampa C, Pezzella M, Striano S (2007) Epileptic myoclonus as ciprofloxacin-associated adverse effect. Mov Disord 22:1675–1676PubMedCrossRefGoogle Scholar
  82. 82.
    Tanaka A, Nagamatsu T, Yamaguchi M, Nomura A, Nagura F, Maeda K, Tomino T, Watanabe T, Shimizu H, Fujita Y, Ito Y (2011) Myoclonus after dextromethorphan administration in peritoneal dialysis. Ann Pharmacother 45:e1PubMedCrossRefGoogle Scholar
  83. 83.
    Thwaites D, McCann S, Broderick P (2004) Hydromorphone neuroexcitation. J Palliat Med 7:545–550PubMedCrossRefGoogle Scholar
  84. 84.
    Ting SM, Lee D, Maclean D, Sheerin NS (2008) Paranoid psychosis and myoclonus: flecainide toxicity in renal failure. Cardiology 111:83–86PubMedCrossRefGoogle Scholar
  85. 85.
    Tominaga H, Fukuzako H, Izumi K, Koja T, Fukuda T, Fujii H, Matsumoto K, Sonoda H, Imamura K (1987) Tardive myoclonus. Lancet 1:322PubMedCrossRefGoogle Scholar
  86. 86.
    Tremolizzo L, Fermi S, Fusco ML, Susani E, Frigo M, Piolti R, Ferrarese C, Appollonio I (2011) Generalized action myoclonus associated with escitalopram in a patient with mixed dementia. J Clin Psychopharmacol 31:394–395PubMedCrossRefGoogle Scholar
  87. 87.
    Uchihara T, Tsukagoshi H (1988) Myoclonic activity associated with cefmetazole, with a review of neurotoxicity of cephalosporins. Clin Neurol Neurosurg 90:369–371PubMedCrossRefGoogle Scholar
  88. 88.
    Vadlamudi L, Wijdicks EF (2002) Multifocal myoclonus due to verapamil overdose. Neurology 58:984PubMedCrossRefGoogle Scholar
  89. 89.
    Van Keulen SG, Burton JH (2003) Myoclonus associated with etomidate for ED procedural sedation and analgesia. Am J Emerg Med 21:556–558PubMedCrossRefGoogle Scholar
  90. 90.
    Vardi J, Glaubman H, Rabey JM, Streifler M (1978) Myoclonic attacks induced by L-dopa and bromocryptin in Parkinson patients: a sleep EEG study. J Neurol 218:35–42PubMedCrossRefGoogle Scholar
  91. 91.
    Velasco SL, Sierra-Hidalgo F, Rodriguez RM, Guerreo AJ, Morales JR (2014) Flecainide-induced myoclonus. Clin Neuropharmacol 37:65–66PubMedCrossRefGoogle Scholar
  92. 92.
    Velayudhan L, Kirchner V (2005) Quetiapine-induced myoclonus. Int Clin Psychopharmacol 20:119–120PubMedCrossRefGoogle Scholar
  93. 93.
    Vural A, Tezer FI (2012) Myoclonus induced by haloperidol in the intensive care unit. J Neuropsychiatry Clin Neurosci 24:E41PubMedCrossRefGoogle Scholar
  94. 94.
    Wierre L, Decaudin B, Barsumau J, Vairon MX, Horrent S, Odou P, Azar R (2004) Dobutamine-induced myoclonia in severe renal failure. Nephrol Dial Transplant 19:1336–1337PubMedCrossRefGoogle Scholar
  95. 95.
    Wyllie AR, Bayliff CD, Kovacs MJ (1997) Myoclonus due to chlorambucil in two adults with lymphoma. Ann Pharmacother 31:171–174PubMedCrossRefGoogle Scholar
  96. 96.
    Yarnall AJ, Burn DJ (2012) Amantadine-induced myoclonus in a patient with progressive supranuclear palsy. Age Ageing 41:695–696PubMedCrossRefGoogle Scholar
  97. 97.
    Yates AM, Wolfson AB, Shum L, Kehrl T (2013) A descriptive study of myoclonus associated with etomidate procedural sedation in the ED. Am J Emerg Med 31:852–854PubMedCrossRefGoogle Scholar
  98. 98.
    Yoon JH, Lee PH, Yong SW, Park HY, Lim TS, Choi JY (2008) Movement disorders at a university hospital emergency room. An analysis of clinical pattern and etiology. J Neurol 255:745–749PubMedCrossRefGoogle Scholar
  99. 99.
    Zanus C, Alberini E, Costa P, Colonna F, Zennaro F, Carrozzi M (2012) Involuntary movements after correction of vitamin B12 deficiency: a video-case report. Epileptic Disord 14:174–180PubMedGoogle Scholar
  100. 100.
    Zesiewicz TA, Sullivan KL, Hauser RA (2007) Levodopa-induced dyskinesia in Parkinson’s disease: epidemiology, etiology, and treatment. Curr Neurol Neurosci Rep 7:302–310PubMedCrossRefGoogle Scholar
  101. 101.
    Zhang C, Glenn DG, Bell WL, O’Donovan CA (2005) Gabapentin-induced myoclonus in end-stage renal disease. Epilepsia 46:156–158PubMedCrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Department of Neurology 935Radboud University Medical Center, Donders Institute of Brain, Cognition and BehaviourNijmegenThe Netherlands
  2. 2.Biomedical Signal and Systems GroupMIRA Institute for Biomedical Technology and Technical Medicine, University of TwenteEnschedeThe Netherlands

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