Dramatic effect of levetiracetam on epileptic negative myoclonus

OBJECTIVE: To investigate the properties of levetiracetam in a patient with severe epileptic negative myoclonus. Treatment of epileptic negative myoclonus relies on the drugs that are effective in focal epilepsies, but it is usually pharmacoresistant. Levetiracetam is a new antiepileptic drug with a broad-spectrum activity that includes efficacy against positive myoclonus. CASE REPORT: This woman had had epileptic falls since the age of 2 years. In 2000, she was on phenobarbital (100 mg/day) and valproate (2000 mg/day) and had two drop attacks per month. Clinical examination showed negative myoclonus of the arms clearly predominating on the left side, which was confirmed by a polygraphic EEG. Levetiracetam (1000 mg/day in the first week, increased to 2000 mg/day thereafter) was added. During the first 2 months, the patient experienced four minor seizures without fall. A polygraphic EEG confirmed that the patient's epileptic negative myoclonus disappeared during levetiracetam treatment. At 1-year follow-up, this patient had had only one seizure. CONCLUSIONS: The result of levetiracetam treatment in this patient is encouraging, but efficacy should be confirmed in larger series. A long-term follow-up is also necessary to establish that this antimyoclonic effect of levetiracetam is maintained over a period of years.