ABSTRACT
Fasciculations and cramps originate in the motor unit, a functional unit that includes the lower motor neuron and their innervated muscle fibres. Both are common complaints in outpatient practice. These symptoms can be secondary to neurological or medical pathology, presenting a broad differential diagnosis and a complex approach. Recent neurophysiological studies have increased the knowledge of their origin mainly in amyotrophic lateral sclerosis. The symptomatic management of fasciculations and cramps depends on their etiology and includes pharmacological and non-pharmacological treatments. This article aims to present an updated review of the most relevant aspects of physiopathology, clinical approach, and differential diagnosis of both phenomena.
Subject(s)
Humans , Fasciculation/diagnosis , Fasciculation/etiology , Fasciculation/therapy , Amyotrophic Lateral Sclerosis/complications , Amyotrophic Lateral Sclerosis/diagnosis , Amyotrophic Lateral Sclerosis/therapy , Electromyography/adverse effects , Motor Neurons/physiology , Muscle Cramp/diagnosis , Muscle Cramp/etiology , Muscle Cramp/therapyABSTRACT
Objective We tried to observe the effects of Chinese herb fumigation and washing combined with electromyographic biofeedback on stroke patients with muscle cramp on limbs.Methods 84 patients who had muscle cramp on limbs were selected and divided into two groups randomly,namely the intervention group and the control group and both groups had 42 stroke patients.The intervention group was treated with routine treatment,Chinese herbal fumigation and washing and electromyographic biofeedback treatment.The control group received only routine treatment and electromyographic biofeedback treatment.We had compared and analyzed the Ashworth Spasticity Scale and the Daily Life Abihty Score (Barthel index) of the two groups at the time of the pre therapy,two weeks after the treatment and at the end of the treatment(after four weeks),respectively.Results There were no significant differences between the two groups in Barthel index,however,there were significant differences in Ashworth Spasticity Scale scores between the two groups four weeks after treatment,t=-3.84,P ＜ 0.05.Conclusions The effect of Chinese herb fumigation and washing combining with the electromyo-graphic biofeedback treatment is better than usage of the electromyographic biofeedback treatment alone on stroke patients with muscle cramp on limbs.
ABSTRACT
The effectiveness of the Kampo medicine shakuyakukanzoto extract for patients with muscle cramp is well known, but recently side effects related to pseudoaldosteronism have also been reported. To avoid this issue, Kampo medicines without <i>Glycyrrhizae Radix </i>are needed for treatment of muscle cramp. We investigated the therapeutic effect of shimotsuto extract, which has traditionally been used to treat anemia, in 26 patients (mean age : 70.7 ± 12.1 years) with muscle cramp. Improvement of the symptom was noted in 18 patients (69%), with no change in 8 patients (31%). The abdominal muscle tension of the former patients was significantly lower than the latter. Here, the cases of four representative patients in whom muscle cramp was improved by shimotsuto are described. The response rate to shimotsuto was similar to that of shakuyakukanzoto. Our results suggest that shimotsuto extract is a suitable alternative to shakuyakukanzoto for treatment of muscle cramp in older non-robust type patients not in need of emergency care.
ABSTRACT
We treated 5 patients with painful muscle cramp due to heat injury using Shakuyakukanzoto. According to their severities, 4 patients were classified with 1 st degree and 1 patient with 3rd degree heat injury. Painful muscle cramps in 4 patients with 1st degree were cured through a single dose of Shakuyakukanzoto. On the other hand, painful muscle cramps in 1 patient with 3rd degree was managed for 4 days after administration of Shakuyakukanzoto. No Shakuyakukanzoto complications were observed in any patient, nor contribution to rhabdomyolysis in 3 patients. Shakuyakukanzoto may be useful to prevent acute kidney injury due to rhabdomyolysis by controlling painful muscle cramps in heat injury.
ABSTRACT
BACKGROUND: Muscle cramps in cirrhotic patients are not serious symptoms but have frequently bad effect on their quality of life. We have evaluated the effectiveness of treatment with eperisone hydrochloride, an antispastic agent, on muscle cramps in cirrhotic patients. METHODS: Sixty five cirrhotic patients (cramps 35, no cramps 30) were included in our study. Thirty five patients with muscle cramps were questioned about the frequency and localization of muscle cramps. All patients were evaluated a physical findings and blood chemistry at the beginning of the study and after one month. Eperisone hydrochloride 50 mg per day were given orally to the patients with muscle cramps. RESULTS: There were significant differences for the number of diuretics use (p=0.019), hemoglobin (p=0.005), platelet (p=0.007), total bilirubin (p=0.003), albumin (p=0.000), total calcium (p=0.0001) and Na+ (p=0.001) between with and without muscle cramps. Muscle cramps were found to occur in calf muscles (60%) and hands (54%), to occur several times a week (76%), mainly during sleep (73%) and to last for several minutes (53%). After a month, muscle cramps completely disappeared in 7 patients (20%), decreased in frequency in 18 patients (51%) and were unaltered in 10 patients (29%). Side effects were observed in 7 patients (epigastric discomfort in five, fatigue in two) but any patients were not stopped. CONCLUSIONS: Eperisone hydrochloride was significantly effective in treatment for the muscle cramps of the patients with liver cirrhosis. In addition, this agents was well tolerated without any serious adverse effects in the majority of the patients.
Subject(s)
Humans , Bilirubin , Blood Platelets , Calcium , Chemistry , Diuretics , Fatigue , Hand , Liver Cirrhosis , Liver , Muscle Cramp , Muscles , Quality of LifeABSTRACT
The purposes of this study were to 1) develop“cramp screening tests”to investigate susceptibility to exercise induced muscle cramp (EIMC) and 2) examine the effect of muscle fatigue and dehydra. tion-rehydration on EIMC using the tests. Twenty healthy male subjects were placed into three groups based on their experience of EIMC ; high (n=4, frequent cramps in daily life), low-medium (n=12, cramps with special conditions such as strenuous exercise), and no cramps (n=4), and performed two cramp screening tests for the toe flexors and hamstrings. The results indicated that the higher the frequency of muscle cramps in daily life, the higher the cramp induction rates in the tests. To investigate the effect of muscle fatigue on EIMC, 15 out of the 20 subjects performed 100 rhythmic isometric (knee joint angle of 90°) or isokinetic contractions (range of motion : 60-120°, flexion : 60°/s, extension ; 300°/s) of the knee flexors in separate days. Susceptibility to EIMC decreased in the exercised muscle after the fatiguing exercises, but significantly increased in the toe of the exercised limb. To verify the effect of dehydration on EIMC, nine out of the 20 subjects were dehydrated to reduce 3 % of body weight by an intermittent sauna exposure and rehydrated by giving the dehydrated amount of plain water. Dehydration significantly increased the susceptibility to EIMC, and rehydration did not contribute to decrease the susceptibility. These results suggest that the susceptibility to EIMC would be estimated by using the tests, and dehydration is associated with EIMC, but muscle fatigue does not seem to be a direct factor for EIMC.
ABSTRACT
Type 2 fiber predominance or a decrease of the type 1/type 2 ratio was rarely reported as the only abnormal pathologic finding in patients suffering from muscle cramp and myalgia. Here, we describe the clinicopathologic findings of three cases of type 2 fiber predominance, presented with muscle cramp and myalgia in otherwise healthy patients. All of them were young men (18, 19 and 22 years). Light microscopic and neurologic examinations, and laboratory data showed mere nonspecific findings that were not concordant with their subjective symptoms. However, enzyme histochemistry performed on muscle biopsy revealed an increased fraction of type 2 fibers; 73%, 80%, and 75%, in each case. The pathogenesis of this entity remains unclear, but the recognition of this unusual clinicopathologic entity is important for both pathologists and neurologists so they can avoid misdiagnoses or unnecessarily tiresome studies. We emphasize that type 2 fiber predominance should be included in the underlying causes of unexplained muscle cramps and exertional myalgia, especially among young adults, although it remains unclear whether the fiber type predominance is a separate entity or a part of other underlying neurologic or systemic disorders.
Subject(s)
Humans , Male , Young Adult , Biopsy , Diagnostic Errors , Muscle Cramp , Myalgia , Neurologic ExaminationABSTRACT
Leg cramps are frequently seen in patients who are undergoing hemodialysis. Syakuyaku-kanzo-to is usually effective against leg cramps, but not for all patients. On the other hand, Yokuinin, coix seed, has been known to restrain spasms of the frame muscle. This paper reports on the effectiveness of Yokuinin in controlling leg cramps during hemodialysis-especially when Shakuyaku-kanzo-to is not effective. Tests were performed on nine patients who have had maintenance hemodialysis in our hospital, and whose leg cramps were not responsive to Syakuyaku-kanzo-to. The patients were provided with three to six tablets of Yokuinin (Yokuinin extract tablet “Kotaro”) a day, and the effect on their leg cramps was measured after three weeks. Yokuinin was effective on five patients, whose leg cramps disappeared (an efficacy rate of 55.6%). Side effects were not observed. These results suggest that Yokuinin is a useful medicine (as part of a treatment regimen of traditional medicine) for leg cramps that result from hemodialysis-especially with patients for whom Shakuyaku-kanzo-to is not effective.
ABSTRACT
A painful muscle cramp caused by diabetic neuropathy is one of most bothersome symptoms of patients with diabetes mellitus. It happens during night time and causes sleep disturbance. In this communication we report on the clinical usefulness of Shakuyaku-kanzo-to on nocturnal leg cramp. Twelve diabetic patients were treated with 2.5 to 7.5g/day of Shakuyaku-kanzo-to for 4 weeks. Eight patients were cured of muscle cramp and clinical usefulness was recognized in all patients. In conclusion, Shakuyaku-kanzo-to is very useful in the treatment of patients with muscle cramp caused by diabetic neuropathy.
ABSTRACT
A 48% incidence of muscle cramps was found in 150 patients with liver cirrhosis. A 76.7% incidence of muscle cramps was found in patients with decompensated liver cirrhosis, which was statistically higher than a 36.4% incidence in patients with compensated liver cirrhosis.<br>In order to evaluate the effect of Hachimi-jio-gan on the treatment of muscle cramps in cirrhotic patients, 5g or 7.5g of Hachimi-jio-gan was administered orally to 31 cirrhotic patients (15 patients in the compensated stage and 16 patients in the decompensated stage), who had suffered from muscle cramps at a frequency of more than once a week. The frequency of muscle cramps was found to have decreased in all patients and to have completely disappeared in 19 patients (61.3% of 31 patients) following administration of Hachimi-jio-gan orally for 4 weeks.<br>The vibration perception threshold (VPT) was examined in 5 cirrhotic patients. The VPT improved in all patients in proportion to the decrease in the frequency of muscle cramps following administration of Hachimi-jio-gan orally.<br>The effect of Hachimi-jio-gan was compared to the effect of Gorei-san ane Shakuyaku-Kanzo-to on muscle cramps in 11 cirrhotic patients. The effective rates were 100%, 36.4% and 54.5% respectively. Judging from these results, Hachimi-jio-gan can be considered more effective in giving relief from muscle cramps. Hachimi-jio-gan was also effective in giving relief from muscle cramps in 6 cirrhotic patients in which Mecobalamin had no effect.<br>These results suggest that Hachimi-jio-gan is a useful drug for the treatment of muscle cramps in patients with liver cirrhosis.