Myoclonus Induced by the Use of Gabapentin

  • Cho, Keun-Tae (Department of Neurosurgery Dongguk University International Hospital) ;
  • Hong, Seung-Koan (Department of Neurosurgery Dongguk University International Hospital)
  • Published : 2008.05.31

Abstract

Myoclonus is a rare side effect of gabapentin (GBP) and has been reported in patients with preexisting myoclonus, mental retardation, chronic static encephalopathy, diffuse brain damage, impaired renal function, or end stage renal disease. We report a case of myoclonus in a patient with normal renal function and no previous disorders. A 69-year-old female underwent diskectomy and foraminotomy at the left L4-L5 level. Post-operatively, she complained of paresthesia in her left leg, which was thought to be due to root manipulation during surgery. To relieve the paresthesia, she was given tramadol, an oral opioid agonist, and GBP. One week after GBP was increased to 900 mg per day, myoclonus developed, which severely impaired her normal activity. Her symptoms resolved 2 days after discontinuation of GBP. The coadministration of tramadol and GBP may mutually enhance the myoclonic potential of each drug. The causal relationship between GBP and myoclonus was suggested by cessation of myoclonus after GBP discontinuation despite continued therapy with tramadol.

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References

  1. Asconape J, Diedrich A, DellaBadia J : Myoclonus associated with the use of gabapentin. Epilepsia 41 : 479-481, 2000 https://doi.org/10.1111/j.1528-1157.2000.tb00192.x
  2. Backonja MM : Anticonvulsants (antineuropathics) for neuropathic pain syndromes. Clin J Pain 16 (2 Suppl) : S67-72, 2000 https://doi.org/10.1097/00002508-200006001-00012
  3. Braverman DL, Slipman CW, Lenrow DA : Using gabapentin to treat failed back surgery syndrome caused by epidural fibrosis: A report of 2 cases. Arch Phys Med Rehabil 82 : 691-693, 2001 https://doi.org/10.1053/apmr.2001.21867
  4. Carter GT, Galer BS : Advances in the management of neuropathic pain. Phys Med Rehabil Clin N Am 12 : 447-459, 2001
  5. Eckhardt K, Ammon S, Hofmann U, Riebe A, Gugeler N, Mikus G : Gabapentin enhances the analgesic effect of morphine in healthy volunteers. Anesth Analg 91 : 185-191, 2000 https://doi.org/10.1097/00000539-200007000-00035
  6. Holtkamp M, Halle A, Meierkord H, Masuhr F : Gabapentin-induced severe myoclonus in a patient with impaired renal function. J Neurol 253 : 382-383, 2006 https://doi.org/10.1007/s00415-005-0970-1
  7. Laird MA, Gidal BE : Use of gabapentin in the treatment of neuro-pathic pain. Ann Pharmacother 34 : 802-807, 2000 https://doi.org/10.1345/aph.19303
  8. Pandey CK, Navkar DV, Giri PJ, Raza M, Behari S, Singh RB, et al : Evaluation of the optimal preemptive dose of gabapentin for postoperative pain relief after lumbar diskectomy : a randomized, double-blind, placebo-controlled study. J Neurosurg Anesthesiol 17 : 65-68, 2005 https://doi.org/10.1097/01.ana.0000151407.62650.51
  9. Pranzatelli MR : Serotonin and human myoclonus. Rationale for the use of serotonin receptor agonists and antagonists. Arch Neurol 51 : 605-617, 1994 https://doi.org/10.1001/archneur.1994.00540180083018
  10. Rao ML, Clarenbach P, Vahlensieck M, Kratzschmar S : Gabapentin augments whole blood serotonin in healthy young men. J Neural Transm 73 : 129-134, 1988 https://doi.org/10.1007/BF01243384
  11. Reeves AL, So EL, Sharbrough FW, Krahn LE : Movement disorders associated with the use of gabapentin. Epilepsia 37 : 988-990, 1996 https://doi.org/10.1111/j.1528-1157.1996.tb00537.x
  12. Scullin P, Sheahan P, Sheila K : Myoclonic jerks associated with gabapentin. Palliat Med 17 : 717-718, 2003
  13. Taylor CP : Mechanisms of action of new anti-epileptic drugs. London : Royal Society of Medicine services, 1993, pp13-40
  14. Turan A, Karamanlioglu B, Memis D, Hamamcioglu MK, Tukenmez B, Pamukcu Z, et al : Analgesic effects of gabapentin after spinal surgery. Anesthesiology 100 : 935-938, 2004 https://doi.org/10.1097/00000542-200404000-00025
  15. Wiffen PJ, McQuay HJ, Edwards JE, Moore RA : Gabapentin for acute and chronic pain. Cochrane Database Syst Rev 20 : CD005452, 2005
  16. Yaksi A, Ozgonenel L, Ozgonenel B : The efficiency of gabapentin therapy in patients with lumbar spinal stenosis. Spine 32 : 939-942, 2007 https://doi.org/10.1097/01.brs.0000261029.29170.e6
  17. Zhang C, Glenn DG, Bell WL, O'Donovan CA : Gabapentininduced myoclonus in end-stage renal disease. Epilepsia 46 : 156-158, 2005 https://doi.org/10.1111/j.0013-9580.2005.20804.x