Long-term Efficacy and Safety of Piracetam in the Treatment of Progressive Myoclonus Epilepsy

Fedi, Marco; Reutens, David C.; Dubeau, François; Andermann, Eva; D’Agostino, Daniela; Andermann, Frédérick

doi:10.1001/archneur.58.5.781

Cited by 68 publications

(39 citation statements)

References 24 publications

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“…These agents have been applied in diverse clinical situations; while piracetam is not widely used in the treatment of epilepsy, it has efficacy against the myoclonus of the progressive myoclonus epilepsies [10, 11] and that seen in idiopathic generalized epilepsy [12]. Both oxiracetam [13] and GVS-111 [14] have reported efficacy in the promotion of cognitive function, but this has not been confirmed in large-scale clinical trials.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of the Efficacy of Piracetam and Piracetam-Like Compounds in Experimental Stroke

2007

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Background/Objective: Piracetam was a candidate neuroprotective drug for acute stroke ineffective in clinical trial. Here we use systematic review and meta-analysis to describe the evidence supporting a protective effect of piracetam and its derivatives in animal models of stroke. Methods: We present a systematic review of reports describing the use of piracetam and its derivatives in animal models of focal ischaemia, where the outcome was measured as an infarct size or neurological score (Der Simonian and Laird random effects meta-analysis). Results: Only 2 studies, published 10 years after the first clinical trial of piracetam had been initiated, described its efficacy in animal models of stroke. A further 4 studies described the efficacy of related compounds. Piracetam and its derivatives improved the outcome by 30.2% (95% CI = 16.1–44.4). The median study quality was 4/10 (inter-quartile range = 4–6). Conclusion: Piracetam and its derivatives demonstrate neuroprotective efficacy in experimental stroke, but our findings raise concerns about the amount of available data, the quality of the studies and publication bias.

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Section: Introductionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of the Efficacy of Piracetam and Piracetam-Like Compounds in Experimental Stroke

2007

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“…Nevertheless, some patients experienced efficacy reduction after some weeks. Fedi et al [28] evaluated long-term (up to 18 months) efficacy and tolerability of add-on PIR in 11 patients with advanced PMEs (ULD in 2, LD in 3, MERFF in 3, sialidosis in 1, undetermined in 2). A statistically significant improvement in myoclonus severity was observed mainly during the first 12 months; side effects were rare, mild, and transitory.…”

Section: Resultsmentioning

confidence: 99%

Update on Pharmacological Treatment of Progressive Myoclonus Epilepsies

Ferlazzo

Trenité²,

Haan

et al. 2018

CPD

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Background Progressive myoclonus epilepsies (PMEs) are a group of rare inherited diseases featuring a combination of myoclonus, seizures and variable degree of cognitive impairment. Despite extensive investigations, a large number of PMEs remain undiagnosed. In this review, we focus on the current pharmacological approach to PMEs. Methods References were mainly identified through PubMed search until February 2017 and backtracking of references in pertinent studies. Results The majority of available data on the efficacy of antiepileptic medications in PMEs are primarily anecdotal or observational, based on individual responses in small series. Valproic acid is the drug of choice, except for PMEs due to mitochondrial diseases. Levetiracetam and clonazepam should be considered as the first add-on treatment. Zonisamide and perampanel represent promising alternatives. Phenobarbital and primidone should be reserved to patients with resistant disabling myoclonus or seizures. Lamotrigine should be used with caution due to its unpredictable effect on myoclonus. Avoidance of drugs known to aggravate myoclonus and seizures, such as carbamazepine and phenytoin, is paramount. Psychiatric (in particular depression) and other comorbidities need to be adequately managed. Although a 3- to 4-drug regimen is often necessary to control seizures and myoclonus, particular care should be paid to avoid excessive pharmacological load and neurotoxic side effects. Target therapy is possible only for a minority of PMEs. Conclusions Overall, the treatment of PMEs remains symptomatic (i.e. pharmacological treatment of seizures and myoclonus). Further dissection of the genetic background of the different PMEs might hopefully help in the future with individualised treatment options.

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“…Diğer yandan, miyoklonileri arttırabilen fenitoin, LM, KBZ ve okskarbazepin, bu hastalarda tercih edilmemelidir. [17,18] Bizim olgumuzda da KBZ tedavisi sonrası miyoklonilerde artış olduğu, hatta bu nedenle ailenin ilaçları kestiği, ani ilaç kesimi sonrasında ise yaklaşık üç gün süren bilinç kaybı olduğu öğrenilmişti. Öykü-deki bu bilgi nonkonvülsif status epileptikus kliniğini düşün-dürse de, o döneme ait elimizde yeterli bilgi olmadığından kesin bir yargıya varmamız mümkün olamamıştır.…”

Section: Discussionunclassified

Lafora Disease: A Case Report

Doğan¹,

İlik²,

Çelik³

et al. 2016

Epilepsi

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Long-term Efficacy and Safety of Piracetam in the Treatment of Progressive Myoclonus Epilepsy

Abstract: Piracetam given as add-on therapy seems to be an effective, sustained, and well-tolerated treatment of myoclonus. In patients with progressive myoclonus epilepsy, the efficacy of the drug increased during the first 12 months of treatment and then stabilized.

Cited by 68 publications

References 24 publications

A Systematic Review and Meta-Analysis of the Efficacy of Piracetam and Piracetam-Like Compounds in Experimental Stroke

A Systematic Review and Meta-Analysis of the Efficacy of Piracetam and Piracetam-Like Compounds in Experimental Stroke

Update on Pharmacological Treatment of Progressive Myoclonus Epilepsies

Lafora Disease: A Case Report

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