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Long-Term Therapy of Myoclonus and Other Neurologic Disorders with L-5-Hydroxytryptophan and Carbidopa

List of authors.
  • Melvin H. Van Woert, M.D.,
  • David Rosenbaum, M.D.,
  • John Howieson, M.D.,
  • and Malcolm B. Bowers, Jr., M.D.

Abstract

We evaluated the therapeutic effect of L-5-hydroxytryptophan (L-5HTP), the precursor of serotonin (5-hydroxytryptamine), combined with carbidopa, a peripheral decarboxylase inhibitor, in patients with intention myoclonus and examined the serotonin metabolites in spinal fluid, blood and urine before and during therapy. In 18 patients with intention myoclonus due to anoxia or other brain damage, 11 derived more than 50 per cent overall improvement during treatment with L-5HTP and carbidopa. Spinal-fluid 5-hydroxyindoleacetic acid was 35 per cent lower in patients with intention myoclonus than in controls (P<0.05). Therapy with L-5HTP and carbidopa increased the concentration of serotonin metabolites in urine and spinal fluid.

We postulate that a deficiency of brain serotonin is causally related to intention myoclonus and that the therapeutic effect of L-5HTP and carbidopa may be due to the repletion of serotonin in regions of the brain where serotoninergic neurons have degenerated. (N Engl J Med 296:70–75, 1977)

Funding and Disclosures

Presented in part at a meeting of the American Academy of Neurology, Toronto, ON, Canada, April 30, 1976.

Supported by a grant (NS 12341) from the National Institutes of Health and in part by a grant (RR 00071) from the Division of Research Resources, General Clinical Research Center Branch.

We are indebted to Merck Sharp and Dohme Research Laboratories for the carbidopa used in these studies.

Author Affiliations

From the departments of Medicine, Neurology and Pharmacology, Mount Sinai School of Medicine, New York, NY, and the departments of Neurology and Psychiatry, Yale University School of Medicine, New Haven, CT (address reprint requests to Dr. Van Woert at the Department of Neurology, Mount Sinai School of Medicine, Fifth Ave. and 100th St., New York, NY 10029).

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