Article type: Case Report
Article title: Action myoclonus secondary to donepezil: Case report and literature review
Journal: Rambam Maimonides Medical Journal
Year: 2023
Authors: Jamir Pitton Rissardo, Ana LetÃcia Fornari Caprara
E-mail: jamirrissardo@gmail.com
ABSTRACT
Movement disorders associated with donepezil have been only rarely reported. Herein, we describe an older woman who developed myoclonus secondary to donepezil. A 61-year-old female presented with brief involuntary twitching. The patient reported that she consulted a general practitioner about 1 month before due to memory complaints. A diagnosis of mild cognitive impairment was made. Donepezil was started. After 4 weeks, she presented to our emergency department due to significant twitching. Multifocal myoclonus was observed. These movements occurred during rest and voluntary movement. Laboratory exams and cerebrospinal fluid analysis were normal. A cranial computed tomography and brain magnetic resonance imaging were unremarkable. Electroencephalography did not show epileptic activity. Electromyography revealed burst durations varying between 50 and 100 ms. Diazepam intravenous was started, which improved her abnormal movement within 1 hour. On the next day, she developed the same clinical symptoms of presentation. Donepezil was discontinued, and clonazepam was started. The patient had a complete recovery from her myoclonus. To the authors’ knowledge, there are six reports of myoclonus secondary to donepezil/galantamine. There is no report of rivastigmine-induced myoclonus. The most frequent presentation was multifocal myoclonus. The management was the discontinuation of the acetylcholinesterase inhibitor. All the individuals recovered within 3 weeks.
Keywords: Aricept, donepezil hydrochloride, drug-induced, movement disorder, myoclonus
Full text available at:
DOI
10.5041/RMMJ.10510
Citation
Rissardo JP, Caprara ALF. Action Myoclonus Secondary to Donepezil: Case Report and Literature Review. Rambam Maimonides Med J 2023;14:e0023.
Figure 1. Possible Pathophysiological Hypothesis for Explaining Myoclonus Secondary to Donepezil. The inhibition of AChE by the AChEI leads to the accumulation of ACh in the synaptic cleft. In predisposed brain regions, this increased cholinergic concentration can lead to twitching. A, choline; B, acetate; C, acetylcholine; D, acetylcholine carrier; E, acetylcholinesterase (AChE); F, choline carrier; Ach, acetylcholine; AChEI, acetylcholinesterase inhibitor (donepezil, galantamine, and rivastigmine).
Table 1. Case Reports of Myoclonus Secondary to Acetylcholinesterase Inhibitors.