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Journal of Neurology
J Neurol. 2017; 264(8): 1559–1566.
Published online 2016 December 16. doi:  10.1007/s00415-016-8357-z
PMCID: PMC5533847

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


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.

Electronic supplementary material

The online version of this article (doi:10.1007/s00415-016-8357-z) contains supplementary material, which is available to authorized users.

Keywords: Drug-induced myoclonus, Myoclonus/phenotype, Myoclonus/physiopathology


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.


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.


Our literature search on drug-induced myoclonus mainly identified case reports and (mostly small) case series (the largest involving 32 patients). Table Table11 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


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 (Table1,1, 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].


Various classes of antidepressants have been associated with myoclonus (Table (Table1,1, 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].


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.


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].


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.

Electronic supplementary material

Below is the link to the electronic supplementary material.


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

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.


Electronic supplementary material

The online version of this article (doi:10.1007/s00415-016-8357-z) contains supplementary material, which is available to authorized users.

Contributor Information

Sabine Janssen, ln.cmuduobdar@nessnaj.oruenenibas.

Bastiaan R. Bloem, ln.cmuduobdar@meolb.sab.

Bart P. van de Warrenburg, Phone: 0031-243613396, ln.cmuduobdar@grubnerrawednav.traB.


1. Aguglia U, Gambardella A, Zappia M, Valentino P, Quattrone A. Negative myoclonus during valproate-related stupor. Neurophysiological evidence of a cortical non-epileptic origin. Electroencephalogr Clin Neurophysiol. 1995;94:103–108. doi: 10.1016/0013-4694(94)00268-P. [PubMed] [Cross Ref]
2. Alfa JA, Bamgbade OA. Acute myoclonus following spinal anaesthesia. Eur J Anaesthesiol. 2008;25:256–257. doi: 10.1017/S0265021507002578. [PubMed] [Cross Ref]
3. Alonso-Navarro H, Jimenez-Jimenez FJ. Reversible tremor, myoclonus, and fasciculations associated with topiramate use for migraine. Clin Neuropharmacol. 2006;29:157–159. doi: 10.1097/01.WNF.0000220825.65393.93. [PubMed] [Cross Ref]
4. Asconape J, Diedrich A, DellaBadia J. Myoclonus associated with the use of gabapentin. Epilepsia. 2000;41:479–481. doi: 10.1111/j.1528-1157.2000.tb00192.x. [PubMed] [Cross Ref]
5. Askenasy JJ, Yahr MD. Is monoamine oxidase inhibitor induced myoclonus serotoninergically mediated? J Neural Transm. 1988;72:67–76. doi: 10.1007/BF01244633. [PubMed] [Cross Ref]
6. Barak Y, Levine J, Weisz R. Clozapine-induced myoclonus: two case reports. J Clin Psychopharmacol. 1996;16:339–340. doi: 10.1097/00004714-199608000-00016. [PubMed] [Cross Ref]
7. Brefel-Courbon C, Gardette V, Ory F, Montastruc JL. Drug-induced myoclonus: a French pharmacovigilance database study. Neurophysiol Clin. 2006;36:333–336. doi: 10.1016/j.neucli.2006.12.003. [PubMed] [Cross Ref]
8. Casas M, Garcia-Ribera C, Alvarez E, Udina C, Queralto JM, Grau JM. Myoclonic movements as a side-effect of treatment with therapeutic doses of clomipramine. Int Clin Psychopharmacol. 1987;2:333–336. doi: 10.1097/00004850-198710000-00006. [PubMed] [Cross Ref]
9. Casazza M, Bracchi M, Girotti F. Spinal myoclonus and clinical worsening after intravenous contrast medium in a patient with spinal arteriovenous malformation. AJNR Am J Neuroradiol. 1985;6:965–966. [PubMed]
10. Caviness JN, Brown P. Myoclonus: current concepts and recent advances. Lancet Neurol. 2004;3:598–607. doi: 10.1016/S1474-4422(04)00880-4. [PubMed] [Cross Ref]
11. Caviness JN, Evidente VG. Cortical myoclonus during lithium exposure. Arch Neurol. 2003;60:401–404. doi: 10.1001/archneur.60.3.401. [PubMed] [Cross Ref]
12. Chaw SH, Chan L, Lee PK, Bakar JA, Rasiah R, Foo LL. Prolonged drug-induced myoclonus: is it related to palonosetron? J Anesth. 2016;30(6):1063–1066. doi: 10.1007/s00540-016-2228-8. [PubMed] [Cross Ref]
13. Crespel A, Genton P, Berramdane M, Coubes P, Monicard C, Baldy-Moulinier M, Gelisse P. Lamotrigine associated with exacerbation or de novo myoclonus in idiopathic generalized epilepsies. Neurology. 2005;65:762–764. doi: 10.1212/01.wnl.0000174517.21383.36. [PubMed] [Cross Ref]
14. Devanand DP, Sackeim HA, Brown RP. Myoclonus during combined tricyclic antidepressant and lithium treatment. J Clin Psychopharmacol. 1988;8:446–447. doi: 10.1097/00004714-198812000-00024. [PubMed] [Cross Ref]
15. Dib EG, Bernstein S, Benesch C. Multifocal myoclonus induced by trimethoprim-sulfamethoxazole therapy in a patient with nocardia infection. N Engl J Med. 2004;350:88–89. doi: 10.1056/NEJM200401013500121. [PubMed] [Cross Ref]
16. Dominguez C, Benito-Leon J, Bermejo-Pareja F. Multifocal myoclonus induced by haloperidol. Neurol Sci. 2009;30:385–386. doi: 10.1007/s10072-009-0104-0. [PubMed] [Cross Ref]
17. Duarte J, Sempere AP, Cabezas MC, Marcos J, Claveria LE. Postural myoclonus induced by phenytoin. Clin Neuropharmacol. 1996;19:536–538. doi: 10.1097/00002826-199619060-00009. [PubMed] [Cross Ref]
18. Dutra LA, Pedroso JL, Felix EP, Barsottini OG. Venlafaxine induced-myoclonus in a patient with mixed dementia. Arq Neuropsiquiatr. 2008;66:894–895. doi: 10.1590/S0004-282X2008000600025. [PubMed] [Cross Ref]
19. Essandoh S, Sakae M, Miller J, Glare PA. A cautionary tale from critical care: resolution of myoclonus after fentanyl rotation to hydromorphone. J Pain Symptom Manage. 2010;40:e4–6. doi: 10.1016/j.jpainsymman.2010.08.005. [PubMed] [Cross Ref]
20. Evidente VG, Caviness JN. Focal cortical transient preceding myoclonus during lithium and tricyclic antidepressant therapy. Neurology. 1999;52:211–213. doi: 10.1212/WNL.52.1.211. [PubMed] [Cross Ref]
21. Farrington J, Stoudemire A, Tierney J. The role of ciprofloxacin in a patient with delirium due to multiple etiologies. Gen Hosp Psychiatry. 1995;17:47–53. doi: 10.1016/0163-8343(94)00065-L. [PubMed] [Cross Ref]
22. Ferbert A, Biniek R, Kindler J, Maurin N. Myoclonus and tremor induced acutely by administration of tumor necrosis factor in a patient with Ehlers-Danlos syndrome. Mov Disord. 1993;8:232–233. doi: 10.1002/mds.870080225. [PubMed] [Cross Ref]
23. Fernandez Corcuera P, Pomarol E, Amann B, McKenna P. Myoclonus provoked by lamotrigine in a bipolar patient. J Clin Psychopharmacol. 2008;28:248–249. doi: 10.1097/JCP.0b013e318167465f. [PubMed] [Cross Ref]
24. Finsterer J, Lubec D, Verlicchi A, Samec P. Facial myocloni and stroke as late sequelae of metrizamide myelography. J Neuropsychiatry Clin Neurosci. 1998;10:472–473. doi: 10.1176/jnp.10.4.472a. [PubMed] [Cross Ref]
25. Fukuzako H, Tominaga H, Izumi K, Koja T, Nomoto M, Hokazono Y, Kamei K, Fujii H, Fukuda T, Matsumoto K. Postural myoclonus associated with long-term administration of neuroleptics in schizophrenic patients. Biol Psychiatry. 1990;27:1116–1126. doi: 10.1016/0006-3223(90)90048-7. [PubMed] [Cross Ref]
26. Garvey MJ, Tollefson GD. Occurrence of myoclonus in patients treated with cyclic antidepressants. Arch Gen Psychiatry. 1987;44:269–272. doi: 10.1001/archpsyc.1987.01800150081010. [PubMed] [Cross Ref]
27. Genton P, Nguyen VH, Mesdjian E. Carbamazepine intoxication with negative myoclonus after the addition of clobazam. Epilepsia. 1998;39:1115–1118. doi: 10.1111/j.1528-1157.1998.tb01299.x. [PubMed] [Cross Ref]
28. Gentry JL, 3rd, Peterson C. Death delusions and myoclonus: acyclovir toxicity. Am J Med. 2015;128:692–694. doi: 10.1016/j.amjmed.2015.03.001. [PubMed] [Cross Ref]
29. George M, Haasz M, Coronado A, Salhanick S, Korbel L, Kitzmiller JP. Acute dyskinesia, myoclonus, and akathisa in an adolescent male abusing quetiapine via nasal insufflation: a case study. BMC Pediatr. 2013;13:187. doi: 10.1186/1471-2431-13-187. [PMC free article] [PubMed] [Cross Ref]
30. Ghaziuddin N, Iqbal A, Khetarpal S. Myoclonus during prolonged treatment with sertraline in an adolescent patient. J Child Adolesc Psychopharmacol. 2001;11:199–202. doi: 10.1089/104454601750284126. [PubMed] [Cross Ref]
31. Gupta A, Lang AE. Drug-induced cranial myoclonus. Mov Disord. 2010;25:2264–2265. doi: 10.1002/mds.23140. [PubMed] [Cross Ref]
32. Han PK, Arnold R, Bond G, Janson D, Abu-Elmagd K. Myoclonus secondary to withdrawal from transdermal fentanyl: case report and literature review. J Pain Symptom Manage. 2002;23:66–72. doi: 10.1016/S0885-3924(01)00370-0. [PubMed] [Cross Ref]
33. Horga G, Horga A, Baeza I, Castro-Fornieles J, Lazaro L, Pons A. Drug-induced speech dysfluency and myoclonus preceding generalized tonic-clonic seizures in an adolescent male with schizophrenia. J Child Adolesc Psychopharmacol. 2010;20:233–234. doi: 10.1089/cap.2009.0010. [PubMed] [Cross Ref]
34. Hui AC, Wong TY, Chow KM, Szeto CC. Multifocal myoclonus secondary to tranexamic acid. J Neurol Neurosurg Psychiatry. 2003;74:547. doi: 10.1136/jnnp.74.4.547. [PMC free article] [PubMed] [Cross Ref]
35. Huppertz HJ, Feuerstein TJ, Schulze-Bonhage A. Myoclonus in epilepsy patients with anticonvulsive add-on therapy with pregabalin. Epilepsia. 2001;42:790–792. doi: 10.1046/j.1528-1157.2001.44000.x. [PubMed] [Cross Ref]
36. Immovilli P, Rota E, Morelli N, Iafelice I, Magnacavallo A, Guidetti D. Metoclopramide-induced facial and palatopharyngeal myoclonus. Neurology. 2015;84:1284. doi: 10.1212/WNL.0000000000001393. [PubMed] [Cross Ref]
37. Irioka T, Machida A, Yokota T, Mizusawa H. Antihistamine-associated myoclonus: a case report. Mov Disord. 2008;23:1615–1616. doi: 10.1002/mds.22076. [PubMed] [Cross Ref]
38. Jayathissa S, Woolley M, Ganasegaram M, Holden J, Cu E. Myoclonus and delirium associated with ciprofloxacin. Age Ageing. 2010;39:762. doi: 10.1093/ageing/afq107. [PubMed] [Cross Ref]
39. Jimenez-Huete A, Gil-Nagel A, Franch O. Multifocal myoclonus associated with mefloquine chemoprophylaxis. Clin Neuropharmacol. 2002;25:243. doi: 10.1097/00002826-200209000-00002. [PubMed] [Cross Ref]
40. Jimenez-Jimenez FJ, Puertas I, de Toledo-Heras M. Drug-induced myoclonus: frequency, mechanisms and management. CNS Drugs. 2004;18:93–104. doi: 10.2165/00023210-200418020-00003. [PubMed] [Cross Ref]
41. Jundt F, Lempert T, Dorken B, Pezzutto A. Trimethoprim-sulfamethoxazole exacerbates posthypoxic action myoclonus in a patient with suspicion of Pneumocystis jiroveci infection. Infection. 2004;32:176–178. doi: 10.1007/s15010-004-3011-6. [PubMed] [Cross Ref]
42. Kettl P, DePaulo JR., Jr Maprotiline-induced myoclonus. J Clin Psychopharmacol. 1983;3:264–265. doi: 10.1097/00004714-198308000-00034. [PubMed] [Cross Ref]
43. Klawans HL, D’Amico DJ, Patel BC. Behavioral supersensitivity to 5-hydroxytryptophan induced by chronic methysergide pretreatment. Psychopharmacologia. 1975;44:297–300. doi: 10.1007/BF00428910. [PubMed] [Cross Ref]
44. Kojovic M, Cordivari C, Bhatia K. Myoclonic disorders: a practical approach for diagnosis and treatment. Ther Adv Neurol Disord. 2011;4:47–62. doi: 10.1177/1756285610395653. [PMC free article] [PubMed] [Cross Ref]
45. Kutluay E, Pakoz B, Beydoun A. Reversible facial myoclonus with topiramate therapy for epilepsy. Epilepsia. 2007;48:2001–2002. doi: 10.1111/j.1528-1167.2007.01165_3.x. [PubMed] [Cross Ref]
46. Laughlin TP, Newberg LA. Prolonged myoclonus after etomidate anesthesia. Anesth Analg. 1985;64:80–82. doi: 10.1213/00000539-198501000-00017. [PubMed] [Cross Ref]
47. Lauterbach EC. Hiccup and apparent myoclonus after hydrocodone: review of the opiate-related hiccup and myoclonus literature. Clin Neuropharmacol. 1999;22:87–92. doi: 10.1097/00002826-199903000-00004. [PubMed] [Cross Ref]
48. Lauterbach EC. Reversible intermittent rhythmic myoclonus with fluoxetine in presumed Pick’s disease. Mov Disord. 1994;9:343–346. doi: 10.1002/mds.870090314. [PubMed] [Cross Ref]
49. Lippmann S, Moskovitz R, O’Tuama L. Tricyclic-induced myoclonus. Am J Psychiatry. 1977;134:90–91. doi: 10.1176/ajp.134.1.90. [PubMed] [Cross Ref]
50. Magaudda A, Di Rosa G. Carbamazepine-induced non-epileptic myoclonus and tic-like movements. Epileptic Disord. 2012;14:172–173. [PubMed]
51. Magny JF, d’Allest AM, Nedelcoux H, Zupan V, Dehan M. Midazolam and myoclonus in neonate. Eur J Pediatr. 1994;153:389–390. doi: 10.1007/BF01956430. [PubMed] [Cross Ref]
52. Marsden CD, Hallett M, Fahn S. Movement Disorders. London: Butterworths; 1982. The nosology and pathophysiology of myoclonus; pp. 196–248.
53. Martin M, Diaz-Rubio E, Casado A, Valverde JJ, Garcia Urra D, Lopez-Martin JA, Rodriguez-Lescure A. Prednimustine-induced myoclonus–a report of three cases. Acta Oncol. 1994;33:81–82. doi: 10.3109/02841869409098387. [PubMed] [Cross Ref]
54. Masand P. Desipramine-induced oral-pharyngeal disturbances: stuttering and jaw myoclonus. J Clin Psychopharmacol. 1992;12:444–445. doi: 10.1097/00004714-199212000-00014. [PubMed] [Cross Ref]
55. Matsunaga K, Uozumi T, Qingrui L, Hashimoto T, Tsuji S. Amantadine-induced cortical myoclonus. Neurology. 2001;56:279–280. doi: 10.1212/WNL.56.2.279. [PubMed] [Cross Ref]
56. Meyer T, Ludolph AC, Munch C. Ifosfamide encephalopathy presenting with asterixis. J Neurol Sci. 2002;199:85–88. doi: 10.1016/S0022-510X(02)00077-1. [PubMed] [Cross Ref]
57. Micheli F, Cersosimo MG, Scorticati MC, Velez M, Gonzalez S. Myoclonus secondary to albuterol (salbutamol) instillation. Neurology. 2000;54:2022–2023. doi: 10.1212/WNL.54.10.2022. [PubMed] [Cross Ref]
58. Moellentin D, Picone C, Leadbetter E. Memantine-induced myoclonus and delirium exacerbated by trimethoprim. Ann Pharmacother. 2008;42:443–447. doi: 10.1345/aph.1K619. [PubMed] [Cross Ref]
59. Monnerat C, Gander M, Leyvraz S. A rare case of prednimustine-induced myoclonus. J Natl Cancer Inst. 1997;89:173–174. doi: 10.1093/jnci/89.2.173. [PubMed] [Cross Ref]
60. Murgai AA, LeDoux MS. Memantine-induced Myoclonus in a Patient with Alzheimer Disease. Tremor and other hyperkinetic movements. 2015;5:337. [PMC free article] [PubMed]
61. Nampiaparampil D, Oruc NE. Metodopramide-induced palatopharyngeal myoclonus. Mov Disord. 2006;21:2028–2029. doi: 10.1002/mds.21074. [PubMed] [Cross Ref]
62. Neufeld MY, Vishnevska S. Vigabatrin and multifocal myoclonus in adults with partial seizures. Clin Neuropharmacol. 1995;18:280–283. doi: 10.1097/00002826-199506000-00010. [PubMed] [Cross Ref]
63. Olszewska DA, Chalissery AJ, Williams J, Lynch T, Smyth S. Speech myoclonus due to probable pregabalin adverse drug-reaction. Parkinsonism Relat Disord. 2015;21:823–824. doi: 10.1016/j.parkreldis.2015.04.026. [PubMed] [Cross Ref]
64. Oulis P, Potagas C, Masdrakis VG, Thomopoulos Y, Kouzoupis AV, Soldatos CR. Reversible tremor and myoclonus associated with topiramate-fluvoxamine coadministration. Clin Neuropharmacol. 2008;31:366–367. doi: 10.1097/WNF.0b013e31815ce4c2. [PubMed] [Cross Ref]
65. Ozer EA, Turker M, Bakiler AR, Yaprak I, Ozturk C. Involuntary movements in infantile cobalamin deficiency appearing after treatment. Pediatr Neurol. 2001;25:81–83. doi: 10.1016/S0887-8994(01)00289-2. [PubMed] [Cross Ref]
66. Papageorgiou SG, Kontaxis T, Antelli A, Kalfakis N. Exacerbation of myoclonus by memantine in a patient with Alzheimer disease. J Clin Psychopharmacol. 2007;27:407–408. doi: 10.1097/ [PubMed] [Cross Ref]
67. Patel HC, Bruza D, Yeragani V. Myoclonus with trazodone. J Clin Psychopharmacol. 1988;8:152. doi: 10.1097/00004714-198804000-00026. [PubMed] [Cross Ref]
68. Patterson JF. Myoclonus caused by a tricyclic antidepressant. South Med J. 1990;83:463–465. doi: 10.1097/00007611-199004000-00026. [PubMed] [Cross Ref]
69. Pei LJ, Tianzhi IL, Lim WS. Memantine-induced myoclonus precipitated by renal impairment and drug interactions. J Am Geriatr Soc. 2015;63:2643–2644. doi: 10.1111/jgs.13847. [PubMed] [Cross Ref]
70. Pfeiffer RF. Amantadine-induced “vocal” myoclonus. Mov Disord. 1996;11:104–106. doi: 10.1002/mds.870110123. [PubMed] [Cross Ref]
71. Post B, Koelman JH, Tijssen MA. Propriospinal myoclonus after treatment with ciprofloxacin. Mov Disord. 2004;19:595–597. doi: 10.1002/mds.10717. [PubMed] [Cross Ref]
72. Praharaj SK, Venkatesh BG, Sarkhel S, Zia-ul-Haq M, Sinha VK. Clozapine-induced myoclonus: a case study and brief review. Prog Neuropsychopharmacol Biol Psychiatry. 2010;34:242–243. doi: 10.1016/j.pnpbp.2009.10.006. [PubMed] [Cross Ref]
73. Rosen JB, Milstein MJ, Haut SR. Olanzapine-associated myoclonus. Epilepsy Res. 2012;98:247–250. doi: 10.1016/j.eplepsyres.2011.07.020. [PubMed] [Cross Ref]
74. Rosenhagen MC, Schmidt U, Weber F, Steiger A. Combination therapy of lamotrigine and escitalopram may cause myoclonus. J Clin Psychopharmacol. 2006;26:346–347. doi: 10.1097/ [PubMed] [Cross Ref]
75. Sarva H, Panichpisal K. Gentamicin-induced myoclonus: a case report and literature review of antibiotics-induced myoclonus. Neurologist. 2012;18:385–388. doi: 10.1097/NRL.0b013e3182704d78. [PubMed] [Cross Ref]
76. Savica R, Rabinstein AA, Josephs KA. Ifosfamide associated myoclonus-encephalopathy syndrome. J Neurol. 2011;258:1729–1731. doi: 10.1007/s00415-011-5990-4. [PubMed] [Cross Ref]
77. Shea YF, Mok MM, Chang RS. Gabapentin-induced myoclonus in an elderly with end-stage renal failure. Journal of the Formosan Medical Association = Taiwan yi zhi. 2014;113:660–661. doi: 10.1016/j.jfma.2012.06.001. [PubMed] [Cross Ref]
78. Sjogren P, Thunedborg LP, Christrup L, Hansen SH, Franks J. Is development of hyperalgesia, allodynia and myoclonus related to morphine metabolism during long-term administration? Six case histories. Acta Anaesthesiol Scand. 1998;42:1070–1075. doi: 10.1111/j.1399-6576.1998.tb05378.x. [PubMed] [Cross Ref]
79. Sonck J, Laureys G, Verbeelen D. The neurotoxicity and safety of treatment with cefepime in patients with renal failure. Nephrol Dial Transplant. 2008;23:966–970. doi: 10.1093/ndt/gfm713. [PubMed] [Cross Ref]
80. Spina Silva T, Dal-Pra Ducci R, Zorzetto FP, Braatz VL, de Paola L, Kowacs PA. Meropenem-induced myoclonus: a case report. Seizure. 2014;23:912–914. doi: 10.1016/j.seizure.2014.06.017. [PubMed] [Cross Ref]
81. Striano P, Zara F, Coppola A, Ciampa C, Pezzella M, Striano S. Epileptic myoclonus as ciprofloxacin-associated adverse effect. Mov Disord. 2007;22:1675–1676. doi: 10.1002/mds.21456. [PubMed] [Cross Ref]
82. Tanaka A, Nagamatsu T, Yamaguchi M, Nomura A, Nagura F, Maeda K, Tomino T, Watanabe T, Shimizu H, Fujita Y, Ito Y. Myoclonus after dextromethorphan administration in peritoneal dialysis. Ann Pharmacother. 2011;45:e1. doi: 10.1345/aph.1P301. [PubMed] [Cross Ref]
83. Thwaites D, McCann S, Broderick P. Hydromorphone neuroexcitation. J Palliat Med. 2004;7:545–550. doi: 10.1089/jpm.2004.7.545. [PubMed] [Cross Ref]
84. Ting SM, Lee D, Maclean D, Sheerin NS. Paranoid psychosis and myoclonus: flecainide toxicity in renal failure. Cardiology. 2008;111:83–86. doi: 10.1159/000119694. [PubMed] [Cross Ref]
85. Tominaga H, Fukuzako H, Izumi K, Koja T, Fukuda T, Fujii H, Matsumoto K, Sonoda H, Imamura K. Tardive myoclonus. Lancet. 1987;1:322. doi: 10.1016/S0140-6736(87)92042-3. [PubMed] [Cross Ref]
86. Tremolizzo L, Fermi S, Fusco ML, Susani E, Frigo M, Piolti R, Ferrarese C, Appollonio I. Generalized action myoclonus associated with escitalopram in a patient with mixed dementia. J Clin Psychopharmacol. 2011;31:394–395. doi: 10.1097/JCP.0b013e318218f4d5. [PubMed] [Cross Ref]
87. Uchihara T, Tsukagoshi H. Myoclonic activity associated with cefmetazole, with a review of neurotoxicity of cephalosporins. Clin Neurol Neurosurg. 1988;90:369–371. doi: 10.1016/0303-8467(88)90013-3. [PubMed] [Cross Ref]
88. Vadlamudi L, Wijdicks EF. Multifocal myoclonus due to verapamil overdose. Neurology. 2002;58:984. doi: 10.1212/WNL.58.6.984. [PubMed] [Cross Ref]
89. Van Keulen SG, Burton JH. Myoclonus associated with etomidate for ED procedural sedation and analgesia. Am J Emerg Med. 2003;21:556–558. doi: 10.1016/j.ajem.2003.08.004. [PubMed] [Cross Ref]
90. Vardi J, Glaubman H, Rabey JM, Streifler M. Myoclonic attacks induced by L-dopa and bromocryptin in Parkinson patients: a sleep EEG study. J Neurol. 1978;218:35–42. doi: 10.1007/BF00314716. [PubMed] [Cross Ref]
91. Velasco SL, Sierra-Hidalgo F, Rodriguez RM, Guerreo AJ, Morales JR. Flecainide-induced myoclonus. Clin Neuropharmacol. 2014;37:65–66. doi: 10.1097/WNF.0000000000000025. [PubMed] [Cross Ref]
92. Velayudhan L, Kirchner V. Quetiapine-induced myoclonus. Int Clin Psychopharmacol. 2005;20:119–120. doi: 10.1097/00004850-200503000-00011. [PubMed] [Cross Ref]
93. Vural A, Tezer FI. Myoclonus induced by haloperidol in the intensive care unit. J Neuropsychiatry Clin Neurosci. 2012;24:E41. doi: 10.1176/appi.neuropsych.11080179. [PubMed] [Cross Ref]
94. Wierre L, Decaudin B, Barsumau J, Vairon MX, Horrent S, Odou P, Azar R. Dobutamine-induced myoclonia in severe renal failure. Nephrol Dial Transplant. 2004;19:1336–1337. doi: 10.1093/ndt/gfh132. [PubMed] [Cross Ref]
95. Wyllie AR, Bayliff CD, Kovacs MJ. Myoclonus due to chlorambucil in two adults with lymphoma. Ann Pharmacother. 1997;31:171–174. doi: 10.1177/106002809703100207. [PubMed] [Cross Ref]
96. Yarnall AJ, Burn DJ. Amantadine-induced myoclonus in a patient with progressive supranuclear palsy. Age Ageing. 2012;41:695–696. doi: 10.1093/ageing/afs043. [PubMed] [Cross Ref]
97. Yates AM, Wolfson AB, Shum L, Kehrl T. A descriptive study of myoclonus associated with etomidate procedural sedation in the ED. Am J Emerg Med. 2013;31:852–854. doi: 10.1016/j.ajem.2013.02.042. [PubMed] [Cross Ref]
98. Yoon JH, Lee PH, Yong SW, Park HY, Lim TS, Choi JY. Movement disorders at a university hospital emergency room. An analysis of clinical pattern and etiology. J Neurol. 2008;255:745–749. doi: 10.1007/s00415-008-0789-7. [PubMed] [Cross Ref]
99. Zanus C, Alberini E, Costa P, Colonna F, Zennaro F, Carrozzi M. Involuntary movements after correction of vitamin B12 deficiency: a video-case report. Epileptic Disord. 2012;14:174–180. [PubMed]
100. Zesiewicz TA, Sullivan KL, Hauser RA. Levodopa-induced dyskinesia in Parkinson’s disease: epidemiology, etiology, and treatment. Curr Neurol Neurosci Rep. 2007;7:302–310. doi: 10.1007/s11910-007-0046-y. [PubMed] [Cross Ref]
101. Zhang C, Glenn DG, Bell WL, O’Donovan CA. Gabapentin-induced myoclonus in end-stage renal disease. Epilepsia. 2005;46:156–158. doi: 10.1111/j.0013-9580.2005.20804.x. [PubMed] [Cross Ref]

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