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A randomized, controlled, double-blind, crossover trial of zonisamide in myoclonus-dystonia

Elodie Hainque 1 Marie Vidailhet 1 Nathalie Cozic 2 Fanny Charbonnier-Beaupel 2 Stephane Thobois 3 Christine Tranchant 4 Vanessa Brochard 1 Gérald Glibert Sophie Drapier 5, 6 Eugénie Mutez 7 Anne Doe de Maindreville Thibaud Lebouvier Cécile Hubsch 2, 1 Bertrand Degos 2 Cécilia Bonnet 2 David Grabli 2 André-Pierre Legrand Aurélie Méneret 1 Jean-Philippe Azulay 8 Anne Bissery Noel Zahr 2 Fabienne Clot 9, 10 Alain Mallet Sophie Dupont 11, 1 Emmanuelle Apartis 12, 1 Jean-Christophe Corvol 1, 13 Emmanuel Roze 1, 14
Abstract : Objective: To evaluate the efficacy and safety of zonisamide in patients with myoclonus-dystonia. Methods: We conducted a randomized, double-blind, placebo-controlled crossover trial of zonisamide (300 mg/d) in 24 patients with myoclonus-dystonia. Each treatment period consisted of a 6-week titration phase followed by a 3-week fixed-dose phase. The periods were separated by a 5-week washout period. The co–primary outcomes were action myoclonus severity (section 4 of the Unified Myoclonus Rating Scale [UMRS 4]) and myoclonus-related functional disability (UMRS 5). Secondary outcomes included dystonia severity, assessed with the movement and disability subscales of the Burke-Fahn-Marsden-Dystonia Rating Scale (BFM), the Clinical Global Impression–Improvement scale (CGI), and safety measures. Wilcoxon signed-rank tests for paired data were used to analyze treatment effects. Results: Twenty-three patients (11 men, 12 women) were analyzed in the intention-to-treat analysis. Zonisamide significantly improved both action myoclonus (median improvement [95% confidence limits] −5 [−9.25 to −1.44], p = 0.003) and myoclonus-related functional disability (median improvement [95% confidence limits] −2 [−2.58 to −2.46], p = 0.007) compared to placebo. Zonisamide also significantly improved dystonia (BFM movement) compared to placebo (median improvement [95% confidence limits] −3 [−8.46 to 0.03], p = 0.009). No difference was found between zonisamide and placebo with respect to the CGI (median improvement [95% confidence limits] −1 [−1.31 to 0.09], p = 0.1). Zonisamide was well-tolerated. Conclusions: Zonisamide is well-tolerated and effective on the motor symptoms of myoclonus-dystonia. Classification of evidence: This study provides Class I evidence that zonisamide improves myoclonus and related disability in patients with myoclonus-dystonia
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Submitted on : Thursday, April 14, 2016 - 11:21:47 AM
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Elodie Hainque, Marie Vidailhet, Nathalie Cozic, Fanny Charbonnier-Beaupel, Stephane Thobois, et al.. A randomized, controlled, double-blind, crossover trial of zonisamide in myoclonus-dystonia. Neurology, American Academy of Neurology, 2016, 86 (18), pp.1729-35. ⟨10.1212/WNL.0000000000002631⟩. ⟨hal-01302410⟩



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