Donepezil-Associated Myoclonus Case Improved Briefly With Diazepam Before Further Management

Symptom suppression and removal of a suspected precipitating drug are separate parts of a case timeline.

What the publication shows

The patient developed multifocal jerks after starting donepezil. EEG did not show epileptic activity. Intravenous diazepam produced improvement, but symptoms returned the next day. Donepezil was then discontinued and clonazepam started, followed by complete reported recovery.

Limits of the evidence

The single case cannot isolate withdrawal of donepezil from clonazepam’s contribution. A transient benzodiazepine response does not prove epilepsy or identify the cause of myoclonus. The literature review contained only a small number of related reports.

Application to expert review

For an expert opinion, distinguish the initial response, recurrence and later combined changes. Record the suspected causative medicine and the symptomatic treatment separately. Do not interpret improvement after diazepam as proof that a persistent underlying trigger had been removed.

Source and related reading

Source: Publication PMC10619993. The case-review applications above are interpretive analysis.