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Treatment of myoclonus with l‐5‐hydroxytryptophan and carbidopa: Clinical, electrophusiological, and biochemical observations
Author(s) -
Thal Leon J.,
Sharpless Nansie S.,
Wolfson Leslie,
Katzman Robert
Publication year - 1980
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.410070611
Subject(s) - myoclonus , carbidopa , 5 hydroxytryptophan , probenecid , 5 hydroxyindoleacetic acid , medicine , serotonergic , serotonin , anesthesia , cerebrospinal fluid , gastroenterology , levodopa , receptor , disease , parkinson's disease
Six patients with myoclonus of varying cause were treated with L‐5‐hydroxytryptophan (L‐5‐HTP) and carbidopa. While spontaneous myoclonus decreased in three of the patients and action myoclonus in four, only two patients had marked functional improvement. Side effects included gastrointestinal and affective disturbances. L‐5‐HTP therapy caused a diminished frequency of paroxysmal discharges in the electroencephalograms of three patients which did not always correlate with clinical improvement. Lumbar cerebrospinal fluid 5‐hydroxyindoleacetic acid (5‐HIAA) concentration after probenecid was decreased in all patients prior to therapy, but this reduction did not predict treatment response. Urinary excretion patterns for 5‐HTP, serotonin, and 5‐HIAA during treatment were similar in responders and nonresponders. It is concluded that while some patients with myoclonus do benefit from L‐5‐HTP therapy, biochemical and electrophysilogical tests are not useful predictors of treatment response, and the high incidence of side effects limits the usefulness of this therapy.