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Therkildsen ER, Kaster P, Nielsen JB. A scoping review on muscle cramps and spasms in upper motor neuron disorder-two sides of the same coin? Front Neurol 2024; 15:1360521. [PMID: 38497037 PMCID: PMC10940373 DOI: 10.3389/fneur.2024.1360521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/20/2024] [Indexed: 03/19/2024] Open
Abstract
Background Muscle cramps are typically regarded as benign muscle overactivity in healthy individuals, whereas spasms are linked to spasticity resulting from central motor lesions. However, their striking similarities made us hypothesize that cramping is an under-recognized and potentially misidentified aspect of spasticity. Methods A systematic search on spasms and cramps in patients with Upper Motor Neuron Disorder (spinal cord injury, cerebral palsy, traumatic brain injury, and stroke) was carried out in Embase/Medline, aiming to describe the definitions, characteristics, and measures of spasms and cramps that are used in the scientific literature. Results The search identified 4,202 studies, of which 253 were reviewed: 217 studies documented only muscle spasms, 7 studies reported only cramps, and 29 encompassed both. Most studies (n = 216) lacked explicit definitions for either term. One-half omitted any description and when present, the clinical resemblance was significant. Various methods quantified cramp/spasm frequency, with self-reports being the most common approach. Conclusion Muscle cramps and spasms probably represent related symptoms with a shared pathophysiological component. When considering future treatment strategies, it is important to recognize that part of the patient's spasms may be attributed to cramps.
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Affiliation(s)
| | | | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
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Ganea M, Vicaș LG, Gligor O, Sarac I, Onisan E, Nagy C, Moisa C, Ghitea TC. Exploring the Therapeutic Efficacy of Parsley ( Petroselinum crispum Mill.) as a Functional Food: Implications in Immunological Tolerability, Reduction of Muscle Cramps, and Treatment of Dermatitis. Molecules 2024; 29:608. [PMID: 38338356 PMCID: PMC10856782 DOI: 10.3390/molecules29030608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
The status of parsley as a well-known folk medicine noted for its nutritional and medicinal properties prompted the exploration of its potential as a functional food and natural remedy. The paper aims to investigate the potential of parsley to enhance muscle function and alleviate psoriasiform dermatitis, eventually establishing it as a natural, well-tolerated alternative with specific benefits for both muscles and skin. This study examines the tolerability of parsley in a cohort of 937 participants by assessing immunoglobulin G (IgG) reactions. The findings reveal high tolerability, as 96.26% of participants experienced no adverse effects. Among the 902 individuals lacking hypersensitivity, 37.02% reported muscle cramps, with a notable 15.02% reduction observed in the subgroup consuming parsley juice. In the subset of 32 subjects with dermatitis, the application of parsley extract ointment led to a significant decrease in dermatological parameters (redness, thickness, scaling). While the control group exhibited improvements, statistical significance was not observed. Notably, four categories of affected area reduction were identified, with scaling demonstrating the most pronounced impact. The results propose that parsley holds promise for favorable tolerability, contributing to the alleviation of muscle cramps and presenting an effective alternative in dermatitis treatment. Nonetheless, sustained validation through long-term studies is imperative to substantiate these preliminary findings.
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Affiliation(s)
- Mariana Ganea
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 1st Decembrie Street, 410073 Oradea, Romania; (M.G.); (C.M.); (T.C.G.)
| | - Laura Grațiela Vicaș
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 1st Decembrie Street, 410073 Oradea, Romania; (M.G.); (C.M.); (T.C.G.)
| | - Octavia Gligor
- Faculty of Pharmacy, “Iuliu Hatieganu” University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania;
| | - Ioan Sarac
- Department of Genetic Engineering, University of Life Sciences “King Mihai I Timișoara”, 300645 Timișoara, Romania; (I.S.); (E.O.)
| | - Emilian Onisan
- Department of Genetic Engineering, University of Life Sciences “King Mihai I Timișoara”, 300645 Timișoara, Romania; (I.S.); (E.O.)
| | - Csaba Nagy
- Independent Researcher, 417595 Tinca, Romania;
| | - Corina Moisa
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 1st Decembrie Street, 410073 Oradea, Romania; (M.G.); (C.M.); (T.C.G.)
| | - Timea Claudia Ghitea
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 1st Decembrie Street, 410073 Oradea, Romania; (M.G.); (C.M.); (T.C.G.)
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Su HC, Lin CP, Ho WJ, Chou SH, Wu CT, Chiang HY, Chu PH. Factors affecting the intensity of chronic musculoskeletal pain in patients with cardiovascular disease and evaluation of the efficacy of magnesium emulsion cream for muscle cramps. Medicine (Baltimore) 2023; 102:e35532. [PMID: 37904395 PMCID: PMC10615485 DOI: 10.1097/md.0000000000035532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/15/2023] [Indexed: 11/01/2023] Open
Abstract
Chronic musculoskeletal pain (CMP) is associated with an increased risk of cardiovascular disease (CVD). This study aimed to determine the factors associated with the intensity of CMP in patients with underlying CVD and to evaluate the efficacy of Ice Power Magnesium In Strong Cream in patients with muscle cramps. We investigated 396 patients with or without CMP who visited an outpatient cardiology clinic and analyzed the features of CMP and factors associated with pain intensity and specific types of CVD in study 1. We also analyzed 73 patients who had muscle cramps in the lower extremities in study 2 to evaluate the efficacy of Ice Power Magnesium In Strong Cream in reducing pain intensity. In study 1, multivariable linear regression analysis showed that older age (regression coefficient [B] = 0.66, 95% confidence interval [CI], 0.07-1.24), female sex (B = 1.18, 95% CI, 0.59-1.76), presence of hypertension (B = 0.69, 95% CI, 0.05-1.33), and use of calcium supplements (B = 1.27, 95% CI, 0.31-2.24) were significantly associated with a higher intensity of CMP. In study 2, the mean pain scores at baseline, week 2 and week 4 after treatment were 5.99 ± 2.12, 2.92 ± 2.63, and 1.90 ± 2.41, respectively, and the reductions were significant at both week 2 and week 4 after treatment (P < .05). Older age, female sex, hypertension, and use of calcium supplements were associated with an increased intensity of CMP. Ice Power Magnesium In Strong Cream was effective in reducing the pain intensity of muscle cramps in the lower extremities.
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Affiliation(s)
- Hung-Chi Su
- Division of Cardiology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chia-Pin Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wan-Jing Ho
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shing-Hsien Chou
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chia-Tung Wu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hou-Yu Chiang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Anatomy, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pao-Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Tarabishi MM, Almigdad A, Almonaie S, Farr S, Mansfield C. Chronic Exertional Compartment Syndrome in Athletes: An Overview of the Current Literature. Cureus 2023; 15:e47797. [PMID: 38022185 PMCID: PMC10676709 DOI: 10.7759/cureus.47797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Chronic exertional compartment syndrome is an incapacitating condition that primarily affects athletes and individuals with high activity levels. The exact etiology of the condition is unknown to date, but multiple factors play a role in its occurrence. The clinical presentation includes pain, tightness, muscle weakness, paresthesia, and cramps. Common tools utilized during the diagnostic approach include intramuscular compartment pressure measurement, advanced imaging to exclude other disorder entities, near-infrared spectrometry, and shear wave elastography, with the clinical diagnosis being the gold standard. Management includes both conservative and surgical options. Conservative treatment includes gait re-training and botulinum toxin injections. Further, the operative treatment has variable approaches and may be combined with conservative modalities. This article reviews the literature on chronic exertional compartment syndrome and elucidates future recommendations.
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Affiliation(s)
- Mohammed M Tarabishi
- Department of Reconstructive Orthopedic Surgery, King Fahad Medical City, Riyadh, SAU
- Department of Pediatric Orthopedic and Adult Foot and Ankle Surgery, Orthopedic Hospital Speising, Vienna, AUT
| | - Ahmad Almigdad
- Department of Orthopedics, Royal Medical Services, Amman, JOR
| | - Shahd Almonaie
- Department of Orthopedic Surgery, Alfaisal University College of Medicine, Riyadh, SAU
| | - Sebastian Farr
- Department of Pediatric Orthopedics, Orthopaedic Hospital Speising, Vienna, AUT
| | - Clemens Mansfield
- Department of Pediatric Orthopedic and Adult Foot and Ankle Surgery, Orthopedic Hospital Speising, Vienna, AUT
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Sakamoto T, Saito Y, Takekuma Y, Kikuchi E, Sugawara M. Gefitinib-induced Myositis: A Novel Case Report. YAKUGAKU ZASSHI 2023; 143:617-620. [PMID: 37394456 DOI: 10.1248/yakushi.23-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Chemotherapy-induced myositis is a severe adverse event caused by chemotherapeutic agents such as immune checkpoint inhibitors (ICIs) or cytotoxic agents. We experienced a patient with gefitinib-induced myositis with symptoms of muscle cramps and stiffness in the limbs, and reported the treatment process. A 70-year-old woman received four courses of carboplatin (CBDCA)+pemetrexed (PEM)+gefitinib (intravenous CBDCA area under the curve (AUC) 5 and PEM 500 mg/m2, every 3 weeks, and oral gefitinib 250 mg daily), for epidermal growth factor receptor (EGFR) mutation-positive stage IV lung cancer treatment; followed by seven courses of PEM+gefitinib, and continued gefitinib monotherapy thereafter. Myositis occurred 5 months after the initiation of gefitinib monotherapy. She developed strong limb cramps despite regular oral administration of 400 mg acetaminophen three times a day and complained of pain on a numeric rating scale of 10/10. Her creatine kinase (CK) was elevated from the second course of CBDCA+PEM+gefitinib but was stable at grade 1-2 thereafter. However, the muscle symptoms disappeared with CK normalization within a few days of gefitinib discontinuation due to disease progression. The Naranjo Adverse Drug Reaction Scale score was 6, suggesting a probable association. Osimertinib (an EGFR tyrosine kinase inhibitor)-induced myositis has been reported, but similar events were first observed with gefitinib in this case. Consequently, when treating with gefitinib, myositis, including the CK variation, should be monitored and appropriately managed with multidirectional treatment.
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Affiliation(s)
| | | | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital
| | - Eiki Kikuchi
- Department of Respiratory Medicine, Hokkaido University Hospital
| | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital
- Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University
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Li Y, Zhu R, Wang L, Tan J. Effect of vitamin K2 in the treatment of nocturnal leg cramps in the older population: Study protocol of a randomized, double-blind, controlled trial. Front Nutr 2023; 10:1119233. [PMID: 36908924 PMCID: PMC9996107 DOI: 10.3389/fnut.2023.1119233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Nocturnal leg cramps (NLCs) are sudden contractions of the leg muscles, usually in the posterior calf muscles at night, affecting sleep quality. Because the precise pathophysiology of NCLs is unclear, different interventions have been proposed. There is conflicting evidence regarding the efficacy of conventional interventions in preventing cramps. Thus, the present study aims to investigate the effects of vitamin K2 for NLCs in a prospective randomized, double-blind, controlled trial. Methods and analysis This multicenter, randomized, double-blind, placebo-controlled clinical study will enroll older age (≥65-year-old) with two or more documented episodes of NLCs during 2 weeks of screening. Participants will be randomized to receive vitamin K2 or a similar-looking placebo for 8 weeks in a 1:1 ratio. Follow-up visits will be scheduled each week at the beginning of 4-week intervention, then participants will be visited semimonthly. The primary outcome is the difference in the mean number of NLCs per week in the vitamin K2 and placebo arms. The secondary outcomes include the severity and duration of NLCs in the vitamin K2 and placebo arms. Two hundred patients will be needed, for this two-treatment parallel design study, to achieve a probability is 90% that the study will detect a treatment difference at a two-sided 0.04 significance level, if the difference between treatments is 3.6 (difference in means between treatment arms) NLC events. Discussion Nocturnal Leg Cramps (NLCs) are a common musculoskeletal disorder in the general population, but effective and safe interventions have not been established. Our previous study has shown vitamin K2 was effective to reduce the frequency, severity, and duration of dialysis-related muscle cramps with a good safety profile. This randomized controlled trial (RCT) of rigorous methodological design will help to establish the effectiveness of vitamin K2 for the management of NLCs in older population. The findings of this RCT will encourage the studies of vitamin K2 in musculoskeletal disorders. Clinical Trial Registration www.ClinicalTrials.gov, identifier, NCT05547750.
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Affiliation(s)
- Ying Li
- Department of Hematology, Chengdu Third People's Hospital, Chengdu, Sichuan, China.,School of Clinical Medicine, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Rui Zhu
- Department of Hematology, Chengdu Third People's Hospital, Chengdu, Sichuan, China.,School of Clinical Medicine, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Li Wang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jing Tan
- Department of Hematology, Chengdu Third People's Hospital, Chengdu, Sichuan, China
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Miwa T, Hanai T, Sakai Y, Kochi T, Katsumura N, Shimizu M. Mac-2-binding protein glycosylation isomer is useful to predict muscle cramps in patients with chronic liver disease. Medicine (Baltimore) 2022; 101:e31145. [PMID: 36254085 PMCID: PMC9575787 DOI: 10.1097/md.0000000000031145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Muscle cramps are frequently overlooked and worsen the quality of life in patients with chronic liver disease (CLD). Therefore, a valuable biomarker for predicting muscle cramps is required in the clinical setting. This study aimed to investigate whether the serum Mac-2-binding protein glycosylation isomer (M2BPGi) levels, a reliable liver fibrosis marker, could predict muscle cramps in patients with CLD. This retrospective study included 80 patients with CLD. Muscle cramps were assessed using a questionnaire regarding their presence, frequency, pain severity, and duration. The associated predictors were analyzed using logistic regression analysis. The diagnostic accuracy and optimal cutoff values were evaluated using receiver operating characteristic curves. Of the 80 patients, 55% had muscle cramps and showed significantly higher serum M2BPGi levels than those without them (4.54 cutoff index [COI] vs 2.20; P = .001). Multivariate analysis revealed that M2BPGi (odds ratio [ORs], 1.19; 95% confidence interval, 1.003-1.42; P = .046) was independently associated with the presence of muscle cramps. The optimal COI value for predicting muscle cramps was 3.95, and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 61.4%, 80.6%, 79.4%, 63.0%, and 70.0%, respectively. Patients with a COI value ≥3.95 had a 2-fold higher incidence of muscle cramps than patients with a COI value <3.95 (79% vs 37%; P < .001). M2BPGi levels were also associated with the duration of muscle cramps. Serum M2BPGi appears useful as a biomarker for predicting muscle cramps in patients with CLD.
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Affiliation(s)
- Takao Miwa
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
- Department of Gastroenterology, Chuno Kosei Hospital, Seki, Japan
- *Correspondence: Takao Miwa, Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan (e-mail: )
| | - Tatsunori Hanai
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu University Hospital, Gifu, Japan
| | - Yuko Sakai
- Department of Nutrition, Chuno Kosei Hospital, Seki, Japan
| | - Takahiro Kochi
- Department of Gastroenterology, Chuno Kosei Hospital, Seki, Japan
| | - Naoki Katsumura
- Department of Gastroenterology, Chuno Kosei Hospital, Seki, Japan
| | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
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Abola MTB, Evans NS, Ratchford EV. Vascular Disease Patient Information Page: Leg cramps. Vasc Med 2022; 27:415-417. [PMID: 35411834 DOI: 10.1177/1358863x221088869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Maria Teresa B Abola
- Clinical Research Department, Philippine Heart Center, University of the Philippines College of Medicine, Quezon City, Metro Manila, Philippines
| | - Natalie S Evans
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Elizabeth V Ratchford
- Johns Hopkins Center for Vascular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hu H, Wang C, Liang K, He Q, Song J, Guo X, Hou X, Chen L, Yan F. Relationship Between Muscle Cramps and Diabetic Retinopathy in Patients with Type 2 Diabetes. Diabetes Metab Syndr Obes 2022; 15:827-837. [PMID: 35313678 PMCID: PMC8934164 DOI: 10.2147/dmso.s352735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/24/2022] [Indexed: 11/25/2022] Open
Abstract
AIM Patients with type 2 diabetes (T2DM) often suffer from muscle cramps of varying severity. Studies have shown that muscle cramp is closely related to local microcirculation perfusion disorders. Diabetic retinopathy can not only reflect the microcirculation perfusion in the eye but also the systemic microcirculation in patients with diabetes. The aims of this study were to investigate the relationship between muscle cramps and diabetic retinopathy in patients with type 2 diabetes. METHODS A total of 150 adult patients with type 2 diabetes were enrolled and administered a questionnaire on muscle cramping, along with a visual analogue scale for pain. Diabetic retinopathy (DR) was determined by using fundus photography and graded as non-proliferative DR (NPDR) and proliferative DR (PDR). To assess whether there was an association between the muscle cramps and diabetic retinopathy, we conducted binomial logistic regression analysis. RESULTS Our study revealed that 48% of patients with T2DM experienced muscle cramps in the past three months. Patients self-reported suffering from muscle cramps exhibited a higher prevalence of DR (61% vs 38%, P < 0.05) and PDR (22% vs 4%, P < 0.05) compared with patients without muscle cramps. Serum 25-(OH) vitamin D, calcium, and magnesium levels were not significantly different between patients with and without muscle cramps. After adjusting for age, duration of diabetes, HbA1c, vitamin D, potassium, calcium, and magnesium, we demonstrated that diabetic retinopathy (OR, 2.18; 95% CI, 1.01-4.69; P< 0.05) and albumin (OR, 0.90; 95% CI, 0.82-1.00; P< 0.05) were highly associated with muscle cramps. Binomial logistic regression analysis also indicated that severity of DR is associated with muscle cramps. In addition, DR and PDR were found to be associated with muscle cramp frequency (P for trend < 0.05), duration (P for trend < 0.05), and pain severity (P for trend < 0.05). CONCLUSION Muscle cramps occur frequently in diabetes and are correlated with diabetic retinopathy and albumin. Patients with PDR exhibited a higher frequency, severity, and longer duration relative to those with NPDR or without DR. Our findings suggested that muscle cramps in individuals with T2DM might be a result of microvascular dysfunction. Modulation of microvascular perfusion might thus provide a therapeutic target for alleviating muscle cramps.
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Affiliation(s)
- Huiqing Hu
- Department of Endocrinology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Chuan Wang
- Department of Endocrinology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, 250012, People’s Republic of China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan, People’s Republic of China
- Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan, People’s Republic of China
| | - Kai Liang
- Department of Endocrinology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, 250012, People’s Republic of China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan, People’s Republic of China
- Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan, People’s Republic of China
| | - Qin He
- Department of Endocrinology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Jia Song
- Department of Endocrinology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Xinghong Guo
- Department of Endocrinology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Xinguo Hou
- Department of Endocrinology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, 250012, People’s Republic of China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan, People’s Republic of China
- Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan, People’s Republic of China
| | - Li Chen
- Department of Endocrinology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, 250012, People’s Republic of China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan, People’s Republic of China
- Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan, People’s Republic of China
- Correspondence: Li Chen; Fei Yan, Department of Endocrinology, Qilu Hospital of Shandong University, No. 107 Wenhua Xi Road, Jinan, 250012, People’s Republic of China, Email ;
| | - Fei Yan
- Department of Endocrinology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, 250012, People’s Republic of China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan, People’s Republic of China
- Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan, People’s Republic of China
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Shimada M, Hirashima N, Iwase H, Saito M, Kondo H, Urata N, Unita S, Kondo T, Tanaka D, Tsunekawa T, Fujishiro M. Evaluation of Muscle Cramp Associated with Liver Cirrhosis with a Focus on the Liver Function and Nutritional Status. Intern Med 2021; 60:1343-1348. [PMID: 33281163 PMCID: PMC8170239 DOI: 10.2169/internalmedicine.6231-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective We investigated the muscle cramp status of patients with liver cirrhosis by focusing on the degree of liver damage, skeletal muscle mass, and nutritional status. Methods All enrolled patients completed a questionnaire about muscle cramps. The degree of liver damage was examined using the Child-Pugh classification and the albumin-bilirubin (ALBI) grade. The nutritional status and skeletal muscle mass were examined using the Controlling Nutritional Status (CONUT) method and the psoas muscle index (PMI). Results Among the respondents, 55.7% of the patients reported experiencing muscle cramps. An analysis of the two patient groups-those who experienced muscle cramps and those who did not-revealed significant differences in Child-Pugh classification (muscle cramp-positive vs. muscle cramp-negative: A/B/C, 54.1%/32.4%/13.5% vs. 90.0%/10.0%/0.0%; p=0.004), ALBI grade (1/2/3, 20.5%/71.8%/7.7% vs. 54.8%/38.7%/6.5%; p=0.011), modified ALBI grade (1/2a/2b/3, 20.5%/20.5%/51.3%/7.7% vs. 54.8%/22.6%/16.1%/6.5%; p=0.008), CONUT score (normal/mild/moderate/severe, 25.6%/28.2%/41.0%/5.1% vs. 22.6%/61.3%/12.9%/3.2%; p=0.024), and PMI (3.85±1.13 cm2/m2 vs. 4.94±1.86 cm2/m2; p=0.012). Conclusion Our findings suggest that muscle cramps occur more frequently in patients with liver cirrhosis due to their decreased liver function and poorer nutritional status.
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Affiliation(s)
- Masaaki Shimada
- Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Japan
| | - Noboru Hirashima
- Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Japan
| | - Hiroaki Iwase
- Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Japan
| | - Masashi Saito
- Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Japan
| | - Hisashi Kondo
- Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Japan
| | - Noboru Urata
- Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Japan
| | - Satoshi Unita
- Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Japan
| | - Takashi Kondo
- Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Japan
| | - Daiki Tanaka
- Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Japan
| | - Takuya Tsunekawa
- Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology & Hepatology, Nagoya University Graduate School of Medicine, Japan
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11
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Gagliardo T, Ruggeri R, Di Paola A, Baroni M, Cherubini GB, Gallucci A, Falzone C, Trimboli S, Albul A, Gandini G. Clinical features of muscle cramp in 14 dogs. J Vet Intern Med 2021; 35:372-377. [PMID: 33247617 PMCID: PMC7848340 DOI: 10.1111/jvim.15965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Muscle cramps (MCs) are prolonged, involuntary, painful muscle contractions characterized by an acute onset and short duration, caused by peripheral nerve hyperactivity. OBJECTIVES To provide a detailed description of the clinical features and diagnostic findings in dogs affected by MCs. ANIMALS Fourteen dogs. METHODS Multicenter retrospective case series. Cases were recruited by a call to veterinary neurologists working in referral practices. Medical records and videotapes were searched for dogs showing MCs. The follow-up was obtained by telephone communication with the owner and the referring veterinarian. RESULTS Three patterns of presentation were identified depending on the number of affected limbs and presence/absence of migration of MCs to other limbs. In 9/14 (64%) of dogs, MCs were triggered by prompting the dogs to move. 8/14 (58%) dogs were overtly painful with 6/14 (42%) showing mild discomfort. The cause of MCs was hypocalcemia in 11/14 (79%) dogs: 9 dogs were affected by primary hypoparathyrodism, 1 dog by intestinal lymphoma and 1 dog by protein losing enteropathy. In 3/14 cases (21%) the cause was not identified, and all 3 dogs were German Shepherds. CONCLUSIONS AND CLINICAL IMPORTANCE Muscle cramps can manifest in 1 of 3 clinical patterns. Muscle cramps are elicited when dogs are encouraged to move and do not always appear as painful events, showing in some cases only discomfort. The main cause of MCs in this study was hypocalcemia consequent to primary hypoparathyroidism. In dogs having MCs of unknown etiology, idiopathic disease or paroxysmal dyskinesia could not be ruled out.
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Affiliation(s)
- Teresa Gagliardo
- Department of Veterinary Medical SciencesUniversity of BolognaBolognaItaly
| | - Roberta Ruggeri
- Department of Veterinary Medical SciencesUniversity of BolognaBolognaItaly
| | - Andrea Di Paola
- Department of Veterinary Medical SciencesUniversity of BolognaBolognaItaly
| | - Massimo Baroni
- Clinica Veterinaria Valdinievole Monsummano TermePistoiaItaly
| | - Giunio B. Cherubini
- Department of Neurology and NeurosurgeryDick White ReferralsSix Mile BottomUnited Kingdom
| | | | | | | | - Andrey Albul
- Veterinary Hospital of Neurology, Traumatology and Intensive CareSaint‐PetersburgRussia
| | - Gualtiero Gandini
- Department of Veterinary Medical SciencesUniversity of BolognaBolognaItaly
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12
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Varghese A, Lacson E, Sontrop JM, Acedillo RR, Al-Jaishi AA, Anderson S, Bagga A, Bain KL, Bennett LL, Bohm C, Brown PA, Chan CT, Cote B, Dev V, Field B, Harris C, Kalatharan S, Kiaii M, Molnar AO, Oliver MJ, Parmar MS, Schorr M, Shah N, Silver SA, Smith DM, Sood MM, St Louis I, Tennankore KK, Thompson S, Tonelli M, Vorster H, Waldvogel B, Zacharias J, Garg AX. A Higher Concentration of Dialysate Magnesium to Reduce the Frequency of Muscle Cramps: A Narrative Review. Can J Kidney Health Dis 2020; 7:2054358120964078. [PMID: 33149925 PMCID: PMC7585892 DOI: 10.1177/2054358120964078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/28/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose of review: Strategies to mitigate muscle cramps are a top research priority for patients receiving hemodialysis. As hypomagnesemia is a possible risk factor for cramping, we reviewed the literature to better understand the physiology of cramping as well as the epidemiology of hypomagnesemia and muscle cramps. We also sought to review the evidence from interventional studies on the effect of oral and dialysate magnesium-based therapies on muscle cramps. Sources of information: Peer-reviewed articles. Methods: We searched for relevant articles in major bibliographic databases including MEDLINE and EMBASE. The methodological quality of interventional studies was assessed using a modified version of the Downs and Blacks criteria checklist. Key findings: The etiology of muscle cramps in patients receiving hemodialysis is poorly understood and there are no clear evidence-based prevention or treatment strategies. Several factors may play a role including a low concentration of serum magnesium. The prevalence of hypomagnesemia (concentration of <0.7 mmol/L) in patients receiving hemodialysis ranges from 10% to 20%. Causes of hypomagnesemia include a low dietary intake of magnesium, use of medications that inhibit magnesium absorption (eg, proton pump inhibitors), increased magnesium excretion (eg, high-dose loop diuretics), and a low concentration of dialysate magnesium. Dialysate magnesium concentrations of ≤0.5 mmol/L may be associated with a decrease in serum magnesium concentration over time. Preliminary evidence from observational and interventional studies suggests a higher dialysate magnesium concentration will raise serum magnesium concentrations and may reduce the frequency and severity of muscle cramps. However, the quality of evidence supporting this benefit is limited, and larger, multicenter clinical trials are needed to further determine if magnesium-based therapy can reduce muscle cramps in patients receiving hemodialysis. In studies conducted to date, increasing the concentration of dialysate magnesium appears to be well-tolerated and is associated with a low risk of symptomatic hypermagnesemia. Limitations: Few interventional studies have examined the effect of magnesium-based therapy on muscle cramps in patients receiving hemodialysis and most were nonrandomized, pre-post study designs.
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Affiliation(s)
- Akshay Varghese
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - Eduardo Lacson
- Division of Nephrology, Tufts University School of Medicine, Boston, MA, USA
| | - Jessica M Sontrop
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - Rey R Acedillo
- Department of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Ahmed A Al-Jaishi
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - Sierra Anderson
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - Amit Bagga
- Division of Nephrology, Department of Medicine, Windsor Regional Hospital, ON, Canada
| | - Katie L Bain
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | | | - Clara Bohm
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Pierre A Brown
- Department of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Christopher T Chan
- Division of Nephrology, University Health Network, University of Toronto, ON, Canada
| | - Brenden Cote
- Patient Partner, London Health Sciences Centre, London, ON, Canada
| | - Varun Dev
- Department of Nephrology, Humber River Hospital, Toronto, ON, Canada
| | - Bonnie Field
- Patient Partner, Patient and Family Advisory Council, London Health Sciences Centre, London, ON, Canada
| | - Claire Harris
- Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | - Mercedeh Kiaii
- Division of Nephrology, Department of Medicine, St Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Amber O Molnar
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Matthew J Oliver
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Malvinder S Parmar
- Department of Medicine, Timmins & District Hospital, Timmins, ON, Canada
| | - Melissa Schorr
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - Nikhil Shah
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Samuel A Silver
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - D Michael Smith
- Patient Partner, Patient and Family Advisory Council, London Health Sciences Centre, London, ON, Canada
| | - Manish M Sood
- Department of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Irina St Louis
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - Karthik K Tennankore
- Division of Nephrology, Department of Medicine, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Stephanie Thompson
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Marcello Tonelli
- Division of Nephrology, Department of Medicine, Health Sciences Centre, University of Calgary, Calgary, AB, Canada
| | | | - Blair Waldvogel
- Patient Partner, Home Hemodialysis Department, Health Sciences Centre, Winnipeg, MB, Canada
| | - James Zacharias
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada.,ICES Western, London, ON, Canada
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13
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Adiao KJ, Espiritu A, Bagnas MA. Efficacy and safety of mexiletine in amyotrophic lateral sclerosis: a systematic review of randomized controlled trials. Neurodegener Dis Manag 2020; 10:397-407. [PMID: 32867586 DOI: 10.2217/nmt-2020-0026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Mexiletine is a potential drug in amyotrophic lateral sclerosis (ALS) that has been tested in clinical trials. The objective of this study was to determine the efficacy and safety of mexiletine in ALS via systematic review of existing evidences. Materials & methods: Relevant records were searched using major healthcare electronic databases. Data on functional disability, impairment, survival, muscle cramp frequency and severity, and adverse events were obtained. Results & conclusion: Three relevant randomized controlled trials with 141 patients were included in this review. Mexiletine has no effect on the functional disability, impairment and survival in ALS. However, significant improvement in reducing muscle cramp severity and frequency was shown. The most common adverse effect associated with mexiletine intake among ALS patients are nausea (n = 11, 7.8%) and tremors (n = 5, 3.6%).
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Affiliation(s)
- Karen Joy Adiao
- Division of Adult Neurology, Department of Neurosciences, College of Medicine & Philippine General Hospital, University of the Philippines Manila, Manila 1300, Philippines
| | - Adrian Espiritu
- Division of Adult Neurology, Department of Neurosciences, College of Medicine & Philippine General Hospital, University of the Philippines Manila, Manila 1300, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila 1300, Philippines
| | - Marjorie Anne Bagnas
- Electromyography-Nerve Conduction Velocity (EMG-NCV) Unit, Division of Adult Neurology, Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila 1300, Philippines
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14
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Hanai T, Shiraki M, Imai K, Suetugu A, Takai K, Shimizu M. Usefulness of Carnitine Supplementation for the Complications of Liver Cirrhosis. Nutrients 2020; 12:nu12071915. [PMID: 32610446 PMCID: PMC7401279 DOI: 10.3390/nu12071915] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023] Open
Abstract
Carnitine is a vitamin-like substance that regulates lipid metabolism and energy production. Carnitine homeostasis is mainly regulated by dietary intake and biosynthesis in the organs, including the skeletal muscle and the liver. Therefore, liver cirrhotic patients with reduced food intake, malnutrition, biosynthetic disorder, and poor storage capacity of carnitine in the skeletal muscle and liver are more likely to experience carnitine deficiency. In particular, liver cirrhotic patients with sarcopenia are at a high risk for developing carnitine deficiency. Carnitine deficiency impairs the important metabolic processes of the liver, such as gluconeogenesis, fatty acid metabolism, albumin biosynthesis, and ammonia detoxification by the urea cycle, and causes hypoalbuminemia and hyperammonemia. Carnitine deficiency should be suspected in liver cirrhotic patients with severe malaise, hepatic encephalopathy, sarcopenia, muscle cramps, and so on. Importantly, the blood carnitine level does not always decrease in patients with liver cirrhosis, and it sometimes exceeds the normal level. Therefore, patients with liver cirrhosis should be treated as if they are in a state of relative carnitine deficiency at the liver, skeletal muscle, and mitochondrial levels, even if the blood carnitine level is not decreased. Recent clinical trials have revealed the effectiveness of carnitine supplementation for the complications of liver cirrhosis, such as hepatic encephalopathy, sarcopenia, and muscle cramps. In conclusion, carnitine deficiency is not always rare in liver cirrhosis, and it requires constant attention in the daily medical care of this disease. Carnitine supplementation might be an important strategy for improving the quality of life of patients with liver cirrhosis.
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Affiliation(s)
- Tatsunori Hanai
- Correspondence: ; Tel.: +81-(58)-230-6308; Fax: +81-(58)-230-6310
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15
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Ota K, Fukui K, Nakamura E, Oka M, Ota K, Sakaue M, Sano Y, Takasu A. Effect of Shakuyaku-kanzo-to in patients with muscle cramps: A systematic literature review. J Gen Fam Med 2020; 21:56-62. [PMID: 32489757 PMCID: PMC7260166 DOI: 10.1002/jgf2.302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/15/2020] [Accepted: 01/27/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Previous clinical studies have reported that Shakuyaku-kanzo-to (SKT) has a therapeutic effect on muscle cramps, but few studies have clarified how SKT acts to treat muscle cramps. The aim of this study was to perform an updated systematic review of clinical trials for SKT in patients with muscle cramps. METHODS The literature was systematically reviewed to assess the effects of SKT in patients with muscle cramps. PubMed, Web of Science, Cochrane Library, Google Scholar, and Ichushi-Web were searched using the terms "Shakuyaku-kanzo-to" ("shakuyakukanzoto", etc), "clinical trials" and "muscle cramps". Two quality assessments were conducted independently by three authors. Data were extracted using a standardized extraction tool, and a qualitative synthesis of evidence was performed. RESULTS Three randomized controlled articles were identified and enrolled in this study. A systematic review, but not a meta-analysis, was performed because of the high heterogeneity and limited number of studies. In patients with liver cirrhosis, the odds ratio (OR) for improvement with SKT compared to placebo was 1.27 (95% confidence interval [CI], 0.445-2.086) and compared to Goshajinkigan was 0.81 (95%CI, -1.734-0.114). The OR for improvement with SKT compared with eperisone hydrochloride in patients with lumbar spinal stenosis was 2.86 (95%CI, 0.980-4.744). CONCLUSIONS Current evidence appears insufficient to allow a meta-analysis of the effects of SKT, but SKT might show efficacy in treating muscle cramps in patients with cirrhosis or lumbar spinal stenosis.
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Affiliation(s)
- Koshi Ota
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Keisuke Fukui
- Research and Development CenterOsaka Medical CollegeTakatsukiJapan
| | - Eriko Nakamura
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Masahiro Oka
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Kanna Ota
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Masahide Sakaue
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Yohei Sano
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Akira Takasu
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
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16
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Sawada Y, Kawaratani H, Kubo T, Fujinaga Y, Furukawa M, Saikawa S, Sato S, Takaya H, Kaji K, Shimozato N, Moriya K, Namisaki T, Akahane T, Mitoro A, Yoshiji H. Effect of furosemide on muscle cramps in patients with liver cirrhosis. J Gastroenterol Hepatol 2020; 35:76-81. [PMID: 31385352 DOI: 10.1111/jgh.14820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/04/2019] [Accepted: 07/21/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Patients with cirrhosis usually experience muscle cramps of varying severity. Although diuretics have been reported to cause muscle cramps, clinical evidence is limited. Also, it has been pointed out that the use of diuretics is associated with the progression of sarcopenia in patients with cirrhosis. We conducted a questionnaire survey to clarify the effects of diuretics and skeletal muscle loss on muscle cramps. METHODS Overall, we enrolled 152 adults with cirrhosis in this study. Cramp questionnaires were obtained after informed consent. Study variables (demographics, physical findings, serum metabolic panel, and drugs taken that affect muscle cramps) were extracted from medical records. Body composition, including muscle volume, was analyzed using a bioelectrical impedance analysis method, and muscle strength (handgrip) was evaluated at enrollment. Cross-sectional skeletal muscle area was evaluated on computed tomography imaging at the L3 vertebral level to investigate the relationship between muscle cramps and sarcopenia. RESULTS The proportion of furosemide administration was higher in patients with cramping compared with those without. On a multivariate logistic regression analysis, furosemide use was a significant factor in the presence of muscle cramps. Furthermore, regarding factors contributing to muscle cramp severity, furosemide use was extracted by multivariate logistic regression analysis. In the presence or severity of muscle cramps, skeletal muscles did not show any significant difference. CONCLUSIONS Furosemide use for patients with cirrhosis was considered a risk factor for occurrence and severity of muscle cramps. On the other hand, skeletal muscle mass loss was not associated with muscle cramps.
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Affiliation(s)
- Yasuhiko Sawada
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Hideto Kawaratani
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Takuya Kubo
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Yukihisa Fujinaga
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Masanori Furukawa
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Soichiro Saikawa
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Shinya Sato
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Hiroaki Takaya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Kosuke Kaji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Naotaka Shimozato
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Kei Moriya
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Tadashi Namisaki
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Takemi Akahane
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Akira Mitoro
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Hitoshi Yoshiji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
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17
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Hoffman MD, White MD. Belief in the need for sodium supplementation during ultramarathons remains strong: findings from the Ultrarunners Longitudinal TRAcking (ULTRA) study. Appl Physiol Nutr Metab 2019; 45:118-122. [PMID: 31163112 DOI: 10.1139/apnm-2019-0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the past, ultramarathon runners have commonly believed that consuming sodium supplements, as capsules or tablets, will prevent exercise-associated hyponatremia (EAH), dehydration, muscle cramping, and nausea, but accumulating evidence indicates that sodium supplementation during ultramarathons is not necessary and may be potentially dangerous. In this work, beliefs about whether sodium supplements should be made available at ultramarathons were assessed during 2018 among 1152 participants of the Ultrarunners Longitudinal TRAcking (ULTRA) study, of which 85.2% had completed an ultramarathon during 2014-2018. Two-thirds (66.4%) of study participants indicated that sodium supplements should be made available at ultramarathons, supported by beliefs that they prevent EAH (65.5%) and muscle cramping (59.1%). Of those indicating that sodium supplements should not be made available, 85.0% indicated it is because runners can provide their own, 27.9% indicated it is because they are not necessary, and 12.1% indicated they could increase thirst drive and cause overhydration. In general, there was a tendency for those who were older, less active in running ultramarathons in recent years, and with a longer history of ultramarathon running to be less likely to know that sodium supplements do not help prevent EAH, muscle cramping, and nausea. Novelty Ultramarathon runners continue to have misunderstandings about the need for sodium supplementation during ultramarathons. Few ultramarathon runners recognize that supplementing sodium intake beyond that in food and drink is generally not necessary during ultramarathons or that it could result in overhydration. Continued educational efforts are warranted to help ensure safe participation in the sport.
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Affiliation(s)
- Martin D Hoffman
- Physical Medicine and Rehabilitation Service, Department of Veterans Affairs, Northern California Health Care System, Sacramento, CA 95655, USA.,Department of Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, CA, USA
| | - Matthew D White
- Laboratory for Exercise and Environmental Physiology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
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18
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Shibuya K, Misawa S, Sekiguchi Y, Beppu M, Amino H, Suichi T, Suzuki YI, Tsuneyama A, Kuwabara S. Prodromal muscle cramps predict rapid motor functional decline in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2019; 90:242-243. [PMID: 29777012 DOI: 10.1136/jnnp-2018-318446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/27/2018] [Accepted: 04/29/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Kazumoto Shibuya
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sonoko Misawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yukari Sekiguchi
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Minako Beppu
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Amino
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoki Suichi
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yo-Ichi Suzuki
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Atsuko Tsuneyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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19
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Abstract
BACKGROUND Approximately one out of two individuals over the age of 60 suffers from nocturnal leg cramps. These often have an important impact on the person's quality of life. Different drug and non-drug treatments are proposed to treat these cramps, but none to date have been shown to be both safe and effective. The objective of this study was to describe the drug and non-drug treatments used by primary care patients suffering from cramps. METHODS We used data collected as part of two cross-sectional surveys of patients aged 60 years and older attending general practices in the French region of Alsace. We asked the participants suffering from cramps if they were currently using a treatment for their cramps. We distinguished potentially harmful from unharmful treatments. RESULTS Overall, 632 patients suffering from cramps were included in our study. Only 133 patients (19.5%) were taking a treatment for cramps. 82 patients used one or several of 17 different drug treatments. 58 patients used one or several of 13 different types of non-drug treatments. Potentially harmful treatments, mostly Quinine made up 16,7% (n = 25) of all treatments used for cramps. CONCLUSIONS This study sheds light on the great diversity of therapeutic practices for cramps in outpatient care. Many of the treatments reported by patients have not previously been described in the medical literature. We recommend GPs to ask their patients about the treatments they take for cramps in order to make sure that they are safe.
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Affiliation(s)
- Mathieu Lorenzo
- Department of General Practice, Faculty of Medicine, University of Strasbourg, Strasbourg, France - Clinical Investigation Unit INSERM - CIC 1434, Strasbourg, France
| | - Mickaël Schaeffer
- Public Health Department, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Dagmar M Haller
- Primary care unit, University of Geneva, Geneva, Switzerland
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20
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Kuzel AR, Lodhi MU, Syed IA, Rahim M. Atypical Initial Presentation of Painful Muscle Cramps in a Patient with Amyotrophic Lateral Sclerosis: A Case Report and Brief Review of the Literature. Cureus 2017; 9:e1837. [PMID: 29340258 PMCID: PMC5762189 DOI: 10.7759/cureus.1837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized clinically by progressive muscle weakness that can occur proximally or distally in either the upper or lower extremities. It includes both upper motor neuron signs (spasticity, hyperreflexia, clonus, and Babinski sign) and lower motor neuron signs (atrophy, weakness, and muscle fasciculation). Initial presentation of progressively painful muscle cramps should lead the physician to screen for other signs of amyotrophic lateral sclerosis. We report the case of a 51-year-old male, who presented with dull muscle cramps in the right upper shoulder and arm. After a careful history and physical exam, it was found that patient had both upper and lower motor neuron signs; therefore, a diagnosis of amyotrophic lateral sclerosis was made. Amyotrophic lateral sclerosis should strongly be considered in the differential diagnosis of patients presenting with an atypical initial presentation of progressively painful muscle cramps.
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Affiliation(s)
- Aaron R Kuzel
- Department of Emergency Medicine, Lincoln Memorial University-Debusk College of Osteopathic Medicine
| | | | - Intekhab Askari Syed
- Medical Student, Department of Medicine, Beckley Appalachian Regional Healthcare
| | - Mustafa Rahim
- Assistant Clinical Professor of Internal Medicine, West Virginia University School of Medicine
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21
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Affiliation(s)
- Joyce T Yuan
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Tiffany L Tello
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Carter Hultman
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sarah T Arron
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Sue S Yom
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
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22
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Abd-Elsalam S, El-Kalla F, Ali LA, Mosaad S, Alkhalawany W, Elemary B, Badawi R, Elzeftawy A, Hanafy A, Elfert A. Pilot study of orphenadrine as a novel treatment for muscle cramps in patients with liver cirrhosis. United European Gastroenterol J 2017; 6:422-427. [PMID: 29774156 DOI: 10.1177/2050640617731261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/16/2017] [Indexed: 01/11/2023] Open
Abstract
Background and aims Muscle cramps markedly affect the quality of life in cirrhotic patients with no available highly effective treatment. The aim of this study was to assess the safety and efficacy of orphenadrine in the treatment of muscle cramps in cirrhotic patients. Methods The study enrolled 30 liver cirrhosis patients complaining of frequent muscle cramps (≥3 per week), who were randomized to receive either orphenadrine 100 mg or calcium carbonate 500 mg twice daily as a control for one month. Severity, frequency, and duration of the muscle cramps were assessed before and after treatment as well as recurrence after washout of the drug for two weeks. Side effects were recorded. Results One month after treatment with orphenadrine; the frequency of muscle cramps decreased significantly to 0.6 ± 0.74 per week compared to 12.53 ± 6.01 at baseline (p < 0.001), the duration of muscle cramps decreased from 1 min to 0.1 min after treatment (p < 0.001). The pain score improved significantly from a score of 8/10 to 0/10 (p < 0.001). The side effects were few, such as dry mouth, drowsiness, and nausea, with no significant difference between their occurrences in the two groups. Conclusion Orphenadrine is safe and effective in treatment of muscle cramps in patients with liver cirrhosis.
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Affiliation(s)
- Sherief Abd-Elsalam
- Department of Tropical Medicine and Infectious Diseases, Tanta University, Tanta, Egypt
| | - Ferial El-Kalla
- Department of Tropical Medicine and Infectious Diseases, Tanta University, Tanta, Egypt
| | - Lobna A Ali
- Department of Tropical Medicine and Infectious Diseases, Tanta University, Tanta, Egypt
| | - Samah Mosaad
- Department of Tropical Medicine and Infectious Diseases, Tanta University, Tanta, Egypt
| | - Walaa Alkhalawany
- Department of Tropical Medicine and Infectious Diseases, Tanta University, Tanta, Egypt
| | - Berihan Elemary
- Business Department, Canadian International College, Cairo, Egypt
| | - Rehab Badawi
- Department of Tropical Medicine and Infectious Diseases, Tanta University, Tanta, Egypt
| | - Asmaa Elzeftawy
- Department of Tropical Medicine and Infectious Diseases, Tanta University, Tanta, Egypt
| | - Amr Hanafy
- Internal Medicine Department, Zagazig University, Zagazig, Egypt
| | - Asem Elfert
- Department of Tropical Medicine and Infectious Diseases, Tanta University, Tanta, Egypt
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Abstract
Nocturnal leg cramps are common and troublesome, especially in later life, and have a significant impact on quality of life, particularly sleep quality. This article reviews the current state of knowledge regarding the diagnosis, frequency, pathophysiology and management of cramps. Recent evidence suggests that diuretic and long-acting beta-agonist therapy predispose to leg cramps. There is conflicting evidence regarding the efficacy of prophylactic stretching exercises in preventing cramps. Quinine remains the only medication proven to reduce the frequency and intensity of leg cramps. However, the degree of benefit from quinine is modest and the risks include rare but serious immune-mediated reactions and, especially in older people, dose-related side effects. Quinine treatment should be restricted to those with severe symptoms, should be subject to regular review and requires discussion of the risks and benefits with patients.
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Affiliation(s)
- Louise Rabbitt
- Geriatric Medicine, Galway University Hospitals , Galway, Ireland
| | | | - Shaun T O'Keeffe
- Unit 4, Geriatric Medicine, Merlin Park Regional Hospital, Merlin Park Hospital, Galway, Ireland
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Mohmadi K, Shahgholian N, Valiani M, Mardanparvar H. The effect of acupressure on muscle cramps in patients undergoing hemodialysis. Iran J Nurs Midwifery Res 2016; 21:557-561. [PMID: 28194192 PMCID: PMC5301059 DOI: 10.4103/1735-9066.197684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 04/05/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pain resulting from muscle cramps is one of the most common outcomes of hemodialysis. One of the mechanisms associated with muscle cramps is unnatural muscle metabolism. Because acupressure improves muscle metabolism through the releasing of energy, this study was performed with the purpose of determining the impact of acupressure on muscle cramps. MATERIALS AND METHODS This study was a single-blind clinical trial. Accordingly, 64 patients were selected and intensity and frequency of muscle cramps were determined by randomly categorizing them into two groups. The intervention group received 9 sessions of acupressure and the control group received 9 sessions of placebo intervention. The intervention was performed 15 min before hemodialysis in both groups. In both the groups, average intensity of pain and the frequency pain was compared before, after, and 1 month after completion of the intervention. RESULTS Data analysis revealed that there were no significant statistical differences between the two groups in terms of mean value of intensity (P = 0.586) and frequency (P = 0.780) of muscle cramps before the intervention. We observed a significant difference after completion of intervention sessions (P < 0.001). Moreover, there were no significant differences between mean value of intensity (P < 0.001) and frequency (P = 0.030) of muscle cramps in the control group before, after, and 1 month after the completion of 9 sessions of placebo intervention. CONCLUSIONS Employing acupressure may result in decrease of muscle cramps in patients undergoing hemodialysis.
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Affiliation(s)
- Kolsoom Mohmadi
- Student Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahid Shahgholian
- Department of Critical Care Nursing, Kidney Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahboubeh Valiani
- Department of Midwifery, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Mardanparvar
- Student Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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25
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Zhang YM, Zhuo L, Hu J, Cui G, Zhang L, Zhang XL, Li WG. Clinical significance of different carnitine levels for improving the prognosis of patients undergoing hemodialysis. Ren Fail 2016; 38:1654-1658. [PMID: 27758157 DOI: 10.1080/0886022x.2016.1229967] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To investigate plasma-free carnitine (Fc), acylcarnitine (Ac), and total carnitine (Tc) levels in patients undergoing hemodialysis (HD), and to explore their clinical significance. METHODS A total of 20 subjects were in the normal control group and 133 patients undergoing HD were divided into medicated (received carnitine treatment) and non-medicated groups. The medicated group was further divided into three subgroups according to Fc level: Fc = 80-199, 200-299, and ≥ 300 μmol/L. We used non-derivative tandem mass spectrometry to determine carnitine levels, and clinical symptoms such as weakness, hypotension, and muscle cramps were recorded during dialysis. RESULTS Fc and Tc levels were significantly lower in the non-medicated group than in the control group, whereas Fc, Ac, and Tc levels were higher in the medicated than non-medicated group (p< .05). The medicated group had fewer symptoms during dialysis than the non-medicated group such as weakness, hypotension, and muscle cramps (p< .05). An additional comparison showed that the incidence rates of hypotension and muscle cramps in the Fc < 80-199 μmol/L group were significantly lower than those in the Fc ≥ 300 μmol/L medicated and non-medicated groups. CONCLUSIONS Patients undergoing HD have low carnitine levels. l-Carnitine can effectively increase Fc concentration and improve clinical symptoms; however, only the proper Fc range can reduce complications caused by dialysis. Thus, this range needs to be determined.
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Affiliation(s)
- Yu-Mei Zhang
- a Department of Nephrology , China-Japan Friendship Hospital , Beijing , China
| | - Li Zhuo
- a Department of Nephrology , China-Japan Friendship Hospital , Beijing , China
| | - Jing Hu
- a Department of Nephrology , China-Japan Friendship Hospital , Beijing , China
| | - Gang Cui
- b Department of Pharmacy , China-Japan Friendship Hospital , Beijing , China
| | - Ling Zhang
- a Department of Nephrology , China-Japan Friendship Hospital , Beijing , China
| | - Xiang-Lin Zhang
- b Department of Pharmacy , China-Japan Friendship Hospital , Beijing , China
| | - Wen-Ge Li
- a Department of Nephrology , China-Japan Friendship Hospital , Beijing , China
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26
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Behringer M, Moser M, Montag J, McCourt M, Tenner D, Mester J. Electrically induced muscle cramps induce hypertrophy of calf muscles in healthy adults. J Musculoskelet Neuronal Interact 2015; 15:227-36. [PMID: 26032216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Skeletal muscles usually cramp at short lengths, where the tension that can be exerted by muscle fibers is low. Since high tension is an important anabolic stimulus, it is questionable if cramps can induce hypertrophy and strength gains. In the present study we investigated if electrically induced cramps (EIMCs) can elicit these adaptations. METHODS 15 healthy male adults were randomly assigned to an intervention (IG; n=10) and a control group (CG; n=5). The cramp protocol (CP) applied twice a week to one leg of the IG, consisted of 3x6 EIMCs, of 5 s each. Calf muscles of the opposite leg were stimulated equally, but were hindered from cramping by fixating the ankle at 0° plantar flexion (nCP). RESULTS After six weeks, the cross sectional area of the triceps surae was similarly increased in both the CP (+9.0±3.4%) and the nCP (+6.8±3.7%). By contrast, force of maximal voluntary contractions, measured at 0° and 30° plantar flexion, increased significantly only in nCP (0°: +8.5±8.8%; 30°: 11.7±13.7%). CONCLUSION The present data indicate that muscle cramps can induce hypertrophy in calf muscles, though lacking high tension as an important anabolic stimulus.
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27
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Johnson NE, Sowden J, Dilek N, Eichinger K, Burns J, Mcdermott MP, Shy ME, Herrmann DN. Prospective study of muscle cramps in Charcot-Marie-tooth disease. Muscle Nerve 2015; 51:485-8. [PMID: 25042364 DOI: 10.1002/mus.24333] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 05/06/2014] [Accepted: 07/02/2014] [Indexed: 11/09/2022]
Abstract
INTRODUCTION This study aims to assess the frequency, location, severity, duration, and fluctuation over time of muscle cramps in Charcot-Marie-Tooth disease (CMT). METHODS Inherited Neuropathies Consortium Contact Registry participants recorded the occurrence and characteristics of muscle cramps using an 11-question survey administered 3 times over 8 weeks. RESULTS A total of 110 adult patients with CMT completed the survey. Weekly cramp frequency was 9.3 (SD 12.3), and 23% had daily muscle cramps. Twenty-two percent reported a significant impact on quality of life. Over 8 weeks, the daily frequency and severity of muscle cramps did not change significantly. CONCLUSIONS Patients with CMT have muscle cramps that vary little over an 8-week period, and they may interfere with quality of life. These data may be useful in the planning of clinical trials of agents to treat adults with CMT-associated muscle cramps.
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Affiliation(s)
- Nicholas E Johnson
- The University of Rochester Medical Center, Department of Neurology, Rochester, New York, USA
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28
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Abstract
Exertional heat-related illness (EHRI) is comprised of several states that afflict physically active persons when exercising during conditions of high environmental heat stress. Certain forms of EHRI may become life threatening if not treated. Exertional heat stroke (EHS), characterized by a core body temperature of >40 ° C and mental status changes, is the most severe form of EHRI. EHS must be treated immediately with rapid body cooling to reduce morbidity and mortality. Many EHRI cases are preventable by following heat acclimatization guidelines, modifying sports and exercise sessions during conditions of high environmental heat stress, maintaining adequate hydration, avoiding exertion in the heat when ill, and by educating sports medicine personnel, coaches, parents, and athletes on the early recognition and prevention of EHRI. Heat exhaustion, exercise-associated collapse, exercise-associated muscle cramps, exercise-associated hyponatremia, and exertional rhabdomyolysis are also described.
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Affiliation(s)
- Andrew W Nichols
- Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii at Mānoa, University Health Services Mānoa, 1710 East-West Road, Honolulu, HI, 96822, USA,
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Abstract
We report 10 years' follow-up of the previously described family with a novel mutation of the KCNA1 gene. The family consisted of 3 affected boys (first seen at ages 3, 11, and 12) and their affected mother and asymptomatic father and sister. They clinically presented with diffuse myokymia, muscle cramps, and lower limb spasticity without ataxia, but episodic ataxia developed later during adolescence and early adulthood. Long-term follow-ups of families with known KCNA1 gene mutation are rarely mentioned in the literature. Treatment with carbamazepine, 600 to 800 mg daily resulted in cessation of muscle cramps and marked improvement of lower leg symptoms. In the youngest child, after 2 years carbamazepine had to be changed to oxcarbazepine because of side effects. Carbamazepine and oxcarbazepine are both effective in treatment of symptoms related to KCNA1 gene mutation. Symptoms will reoccur if treatment is stopped and there is variability of symptom severity between family members.
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Affiliation(s)
- Narges Moghimi
- 1Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
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Chatrath H, Liangpunsakul S, Ghabril M, Otte J, Chalasani N, Vuppalanchi R. Prevalence and morbidity associated with muscle cramps in patients with cirrhosis. Am J Med 2012; 125:1019-25. [PMID: 22835465 PMCID: PMC3932181 DOI: 10.1016/j.amjmed.2012.03.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 03/19/2012] [Accepted: 03/19/2012] [Indexed: 12/21/2022]
Abstract
PURPOSE Patients with cirrhosis often experience muscle cramps with varying severity. We investigated the factors associated with the prevalence and morbidity associated with muscle cramps. METHODS A total of 150 adult patients with cirrhosis were enrolled consecutively. Cramp questionnaire with visual analogue scale for pain, Chronic Liver Disease Questionnaire (CLDQ), and blood for measurement of 25-(OH) vitamin D levels were obtained after informed consent. RESULTS A total of 101 patients (67%) reported muscle cramps in the preceding 3 months. Patients with cramps had significantly lower serum albumin (3.1±0.6 g/dL vs 3.3±0.7 g/dL, P=.04) and CLDQ scores (107±37 vs 137±34, P<.0001) compared with those without cramps. The median composite symptom score, defined as product of frequency and severity of cramps, in the study cohort was 12 with a range of 0.3 to 200. There were no clinical or biochemical predictors for occurrence of any cramps or severe cramps (composite symptom score>12). Muscle cramps (P<.001) and hepatic encephalopathy (P=.009) were associated independently with decreased CLDQ scores. Vitamin D deficiency was seen in 66% of the study cohort, but the serum 25-(OH) vitamin D levels were not significantly different between patients with and without cramps (18.0±8.9 ng/mL vs 19.6±9.5 ng/mL, P=.49). CONCLUSIONS Muscle cramps are associated with significantly diminished quality of life in patients with cirrhosis. More research is needed to better understand their mechanism to develop effective treatment.
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Affiliation(s)
- Hemant Chatrath
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind
| | - Suthat Liangpunsakul
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind
| | - Marwan Ghabril
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind
| | - Julie Otte
- Indiana University School of Nursing, Indianapolis
| | - Naga Chalasani
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind
| | - Raj Vuppalanchi
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind
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Dale RB, Leaver-Dunn D, Bishop P. A Compositional Analysis of a Common Acetic Acid Solution With Practical Implications for Ingestion. J Athl Train 2003; 38:57-61. [PMID: 12937473 PMCID: PMC155512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE: Acetic acid solutions, such as pickle juice (PJ), have gained anecdotal popularity among certified athletic trainers and other sports medicine professionals as remedies for exercise-associated muscle cramps. The aims of this study were 2-fold: (1) to report compositional analyses of 2 common types of PJ and (2) to discuss implications for ingestion following current National Athletic Trainers' Association (NATA) fluid-replacement guidelines. DESIGN AND SETTING: Biochemical laboratory analyses of 2 PJ sample types. MEASUREMENTS: Compositional analyses were performed in triplicate and compared with a 1-way analysis of variance. RESULTS: Mean values for PJ with 220 mg of sodium per serving were carbohydrate, 4 +/- 0.2%; osmolality, 713 +/- 6 mOsm.kg H(2)O(-1); pH, 3.8 +/- 0.2; calcium, 0.5 +/- 0.02 g/L; potassium, 1.4 +/- 0.02 g/L; magnesium, 0.1 +/- 0.01 g/L; and sodium, 7.4 +/- 0.1 g/L. Mean values for PJ with 390 mg of sodium per serving were carbohydrate, 3 +/- 0.1%; osmolality, 1446 +/- 9 mOsm.kg H(2)O(-1); pH, 3.5 +/- 0.1 g/L; calcium, 0.1 +/- 0.01 g/L; potassium, 1.2 +/- 0.02 g/L; magnesium, 0.1 +/- 0.01 g/L; and sodium, 17.1 +/- 0.1 g/L. Differences between the 220 and 390 PJ were significant (P <.05) for osmolality, calcium, and sodium. CONCLUSIONS: Both types of PJ exceeded sodium concentration levels set by the current NATA guidelines for fluid replacement. Hypothetical dilution references are presented to assist the athletic trainer with fluid volumes necessary to dilute PJ. Ingestion of PJ or other hypertonic fluids should be followed by ingestion of hypotonic or isotonic fluids to ensure that ingested amounts of sodium fall within the current NATA guidelines. Volumes for proper dilution may be substantial.
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