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Therapy of intention myoclonus with L-5-hydroxytryptophan and a peripheral decarboxylase inhibitor, MK 486

Departments of Internal Medicine and Pharmacology, Yale University School of Medicine, New Haven, CT.

Three patients with postanoxic intention myoclonus, two patients with intention tremor, and one patient with cerebral palsy were administered L-5-hydroxytryptophan (L-5HTP), the precursor of serotonin, in combination with MK 486, a peripheral amino acid decarboxylase inhibitor. L-5HTP combined with MK 486 were potent long-term therapeutic agents for postanoxic intention myoclonus, but had no effect on intention tremor or cerebral palsy. These drugs were well-tolerated by the patients and more effective than any other known therapy for intention myoclonus. Cerebrospinal fluid concentration of 5-hydroxyindoleacetic acid, the main catabolite of serotonin, appeared low in two patients with intention myoclonus and increased markedly during drug therapy. Postanoxic intention myoclonus may be causally related to a deficiency of brain serotonin.

This study was presented at the twenty-sixth annual meeting of the American Academy of Neurology, San Francisco, April 27, 1974.

Received for publication July 27, 1974.

Dr. Van Woert's address is Department of Pharmacology, Mount Sinai School of Medicine, Fifth Ave. and 100th St., New York, NY 10029.

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