Timothy C. Hain,
MD, Page last modified:
September 24, 2012
Muscle cramps are very common and very disturbing. According to Blyton (2012), about one in every 3 adults have them.
CAUSES OF MUSCLE CRAMPS
For the most part, the cause is unknown. An incomplete list compiled from the literature includes:
- Unknown (of course, this is the most common "cause").
- Electrolyte imbalance (for example, too low potassium, too low calcium or magnesium).
- Pregnancy (magnesium)
- Dialysis (magnesium) (Triger, 1969)
- Nerve damage (for example, radiculopathy or neuropathy)
- Charcot-marie tooth disease (unusual)
- Spinal stenosis with associated radiulopathy
- Peripheral neuropathy such as due to diabetes
- Muscle damage -- myopathy (for example, use of statins or inflammation)
- Inborn errors of metabolism (e.g. McCardles disease -- exceedingly rare)
- Isaac's syndrome (very rare)
DIAGNOSIS OF DROP ATTACKS
Usually electrolytes are checked (e.g. sodium, potassium, calcium, magnesium). In some instances, EMG/NCV is performed looking for neuropathy or myopathy.
TREATMENT OF MUSCLE CRAMPS
While many treatments are proposed for muscle cramps, very little data is available showing that they are helpful (Blyton et al, 2012).
- Botox treatment is very logical and reportedly effective (Bertolasi et al, 1997), but difficult to implement and expensive.
- Anticonvulsants, mainly ones that stabilize sodium channels.
- Carbamazepine and Oxcarbamazine are sometimes effective (Tahmoush et al, 1991).
- Phenytoin (Zisfein et al, 1983).
- Gabapentin and similar medications would also seem logical ones to try.
- Lamotrigine would also seem logical in this situation.
- While quinine sulfate has been suggested in the past, recent literature has suggested that the risks are greater than benefits.
- Stretching exercises appear no better than placebo (Blyton, 2012), although they are routinely advised (e.g. Leung, 1997)
- Mexelitine was reported to be helpful in Machado Joseph disease associated cramps. (Kanai et al, 2003). MJD is rare, but mexilitine might work for other situations.
- Magnesium supplements are reported to be of no effect (Weller et al, 2008), but are very safe and seem worth the attempt.
- Verapamil has been suggested (Eaton, 1989), although the rationale is unclear. Verapamil interacts with statins, increasing their level, so caution is necessary.
- Soma (Eaton, 1989). In our opinion, best avoided.
- Dantrolene is a muscle weakening agent, rarely used. In our opinion, best avoided.
- Minor tranquilizers are rarely used for their muscle relaxant properties.(e.g Tonsa, 1966)
- tizanadine (no reports in literature) and other muscle relaxants
- Bertolasi, L., A. Priori, et al. (1997). "Botulinum toxin treatment of muscle cramps: a clinical and neurophysiological study." Ann Neurol 41(2): 181-186.
- Blyton, F., V. Chuter, et al. (2012). "Non-drug therapies for lower limb muscle cramps." Cochrane Database Syst Rev 1: CD008496.
- Coppin, R. J., D. M. Wicke, et al. (2005). "Managing nocturnal leg cramps--calf-stretching exercises and cessation of quinine treatment: a factorial randomised controlled trial." Br J Gen Pract 55(512): 186-191.
- Eaton, J. M. (1989). "Is this really a muscle cramp?" Postgrad Med 86(3): 227-232.
- Kanai, K., S. Kuwabara, et al. (2003). "Muscle cramp in Machado-Joseph disease: altered motor axonal excitability properties and mexiletine treatment." Brain 126(Pt 4): 965-973.
- Leung, A. K., B. E. Wong, et al. (1997). "Leg cramps in children." Clin Pediatr (Phila) 36(2): 69-73.
- (2000). "Quinine and cramp: uncertainty efficacy, major risks." Prescrire Int 9(49): 154-157.
- Tahmoush, A. J., R. J. Alonso, et al. (1991). "Cramp-fasciculation syndrome: a treatable hyperexcitable peripheral nerve disorder." Neurology 41(7): 1021-1024.
- Tonsa, A. (1966). "[Prevention of succinylcholine-induced muscle cramp with Diazepam]." Anaesthesist 15(11): 363-364.
- Triger, D. R. and A. M. Joekes (1969). "Severe muscle cramp due to acute hypomagnesaemia in haemodialysis." Br Med J 2(5660): 804-805.
- Weller, E., P. Bachert, et al. (1998). "Lack of effect of oral Mg-supplementation on Mg in serum, blood cells, and calf muscle." Med Sci Sports Exerc 30(11): 1584-1591.
- Zisfein, J., M. Sivak, et al. (1983). "Isaacs' syndrome with muscle hypertrophy reversed by phenytoin therapy." Arch Neurol 40(4): 241-242.
April 21, 2015
, Timothy C. Hain, M.D.
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April 21, 2015