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Treatment of Pediatric Movement Disorders

Medication: Anti-epileptics

Anti-epileptic medications are designed for the prevention of seizures. Nevertheless, this class of medications has also shown benefit in psychiatric disorders and movement disorders. Examples of anti-epileptic medications used for movement disorders include (US trade names are in parentheses):

  • Carbamazepine (Tegretol®). This medicine is often remarkably effective for paroxysmal kinesogenic choreoathetosis (PKC). Very low doses are often sufficient to treat the disorder completely. Carbamazepine may worsen myoclonus and myoclonic epilepsy. While the dose is being increased, side effects include nausea and mild sedation. Carbamazepine may cause a decrease in the white blood cell count (WBC) and increases in markers for liver disease.

  • Valproate (Depakote®). Valproic acid enhances activity at the inhibitory GABA receptors in the brain's basal ganglia. This may be the reason that valproate is helpful for movement disorders. It is often used for myoclonus or chorea. Valproate has a very low rate of side effects in children over 2 years; however, it may cause liver problems, particularly in children with metabolic disorders, or a drop in the white blood cell or platelet counts. Valproate may lower carnitine levels; this usually does not cause problems unless there is an underlying deficiency of carnitine.

  • Lamotrigine (Lamictal®). There have been anecdotal reports of improvement in myoclonus with this medicine. Lamotrigine must be increased slowly, and when combined with valproate, there have been reports of life-threatening skin rashes.

  • Levetiracetam (Keppra®). This medicine, is closely related to piracetam (which is not available in the US). Piracetam has been reported to be an effective treatment for myoclonus.

  • Primidone (Mysoline®). Primidone is metabolized to several intermediate drugs, including phenobarbital. It acts similarly to phenobarbital by potentiating activity at the inhibitory GABA synapses. Primidone is useful for certain types of tremor. Side effects include drowsiness.

  • Benzodiazepines. This is a large class of drugs that act on the central nervous system. These drugs include clonazepam (Klonopin®), diazepam (Valium®), lorazepam (Ativan®), and clobazam (Frisium®, not available in the US). All these medications stimulate inhibitory GABA activity; they may be active in the cortex, basal ganglia, and spinal cord. The differences between the different drugs relate to the duration of action and the relative effect on spinal cord receptors. Diazepam is often used for spasticity, while clonazepam is often used for chorea or myoclonus. Side effects include drowsiness and increased oral secretions (particularly evident with clonazepam).