Long-term Safety and Efficacy of Mexiletine in Myotonic Dystrophy Types 1 and 2

Neurol Clin Pract. 2021 Oct;11(5):e682-e685. doi: 10.1212/CPJ.0000000000001073.

Abstract

Background and objective: Myotonic dystrophy types 1 and 2 are progressive multisystem genetic disorders whose core clinical feature is myotonia. Mexiletine, an antagonist of voltage-gated sodium channels, is a recommended antimyotonic agent in the nondystrophic myotonias, but its use in myotonic dystrophy is limited because of lack of data regarding its long-term efficacy and safety profile.

Methods: To address this issue, this study retrospectively evaluated patients with myotonic dystrophy receiving mexiletine over a mean time period of 32.9 months (range 0.1-216 months).

Results: This study demonstrated that 96% of patients reported some improvement in myotonia symptoms with mexiletine treatment. No clinically relevant cardiac adverse events were associated with the long-term use of mexiletine.

Conclusions: These findings support that mexiletine is both safe and effective when used long-term in myotonic dystrophy.

Classification of evidence: This study provides Class IV evidence that mexiletine is a well-tolerated and effective treatment for myotonic dystrophy types 1 and 2.