Chronic Cerebellar Stimulation

To the Editor.—  In the recent article "Chronic Cerebellar Stimulation in Epilepsy" (Arch Neurol 33:559, 1976), Cooper et al suggest that one of the criteria for selection of patients must be intractability to all known therapeutic medications.First, it should be pointed out that three patients in Dr Cooper's series who had myoclonus and grand mal seizures did not get a trial of the two most effective therapeutic regimens for this condition, L-5-hydroxytryptophan (L-5HTP) with carbidopa and clonazepam (Clonopin).^1-3 In 18 patients with intention myoclonus either due to anoxia or other brain damage, we observed that 61% derived a greater than 50% overall improvement during treatment with L-5HTP in combination with carbidopa. Sixtyseven percent of these patients had grand mal seizures that became under better control with standard anticonvulsants during L-5HTP and carbidopa therapy. Similar symptomatic improvement in myoclonus and seizures was also noted in patients with hereditary progressive myoclonus epilepsy.