July 27, 2026

@michaelokun

Don't give up on myoclonus. One of my favorite take-home messages from Tony Lang's presentation today at the 36th Annual Aspen Course was that treating myoclonus requires persistence. Too often we stop after one medication fails, but many patients experience meaningful improvement only after careful adjustments and thoughtful combination therapy. Medications such as clonazepam, levetiracetam, valproic acid, zonisamide, and others each have a role, while drugs like phenytoin, carbamazepine, and gabapentin can worsen certain forms of myoclonus and should generally be avoided. Perhaps the most important pearl was this: don't quit. It is not uncommon for patients to require two, three, four, or even more medications working together to achieve the right balance of efficacy and tolerability. As movement disorder specialists, our job is to keep asking questions, refine the diagnosis, and thoughtfully adjust therapy until we find the best path forward. Sometimes the difference between disability and function is simply the willingness to keep trying.