Fasciculaciones y calambres: bases fisiológicas y enfrentamiento clínico de un fenómeno complejo / Fasciculations and cramps: physiological bases and clinical approach of a complex phenomenon

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.

Calambres nocturnos en embarazadas / Nocturnal leg cramps in pregnant women

Se evalúa la evidencia acerca de los posibles tratamientos para los calambres en embarazadas de más de 20 semanas de edad gestacional. La mejor evidencia de eficacia disponible se relaciona a la suplementación de magnesio, ya sea en forma de lactato o citrato, a una dosis de 5 mmoles a la mañana y 10 mmoles a la tarde. La evidencia sobre la suplementación de calcio, cloruro de sodio y multivitamínicos es débil por lo que no son recomendables. Los expertos recomiendan ejercicios y masajes en las piernas, aunque carecemos de evidencia para demostrar su eficacia.

Effect of Isotonic and Isometric Exercise Box on muscular Cramping pain During Hemodialysis

Muscle cramp is one of the common complications of hemodialysis. Muscular contractions, called cramps, typically occurs in the lower extremities. The three most important predisposing factors are [a] hypotension, [b] low dry weight, and [c] use of low sodium dialysis solution. The aim of this study was to assess the effects of isotonic and isometric exercises on the frequency and intensity of hemodialysis induced cramps. This was a clinical trial study and included 35 patients who had experienced, at least one episode of muscle cramp during hemodialysis and at the interval between two dialysis. In a period of 2 weeks severity of pain due to muscular cramp before and after exercise was recorded. Then isometric and isotonic exercises, recommenced by a consultant physiotherapist, was planned and performed by the patients for 2 weeks. The same variables again were assessed for 2 weeks. Data were analyzed by means of paired T- test, wilcoxon and correlate bivariate Pearson using SPSS win soft ware. The severity and frequency of dialysis induced muscular cramps significantly decreased during and between 2 dialyses [p<0.001]. While all the patients had experienced at least one episode of muscular cramp; after the exercise muscular cramps occurred with less severity during dialysis in 48.5% and at the interval between 2 dialyses in 16.1% of the subjects. Isotonic and isometric exercises can prevent and decrease muscular cramping pain in the dialysis patients

Incidência de cäibras em uma populaçäo / Incidence of cramps in a population

Objetivo: Estudar a prevalência de cäibras em uma populaçäo. Material e métodos: Foram entrevistadas 600 pessoas escolhidas aleatoriamente no Pronto Atendimento do Hospital das Clínicas, as quais responderam a um protocolo sobre cäibras, sendo avaliadas quanto à idade, sexo, profissäo, presença de cäibras, localizaçäo, fatores de desencadeamento, uso de medicamentos, doenças associadas, entre outros. Resultados: Das 600 pessoas entrevistadas, com uma idade média de 38,2 anos (mínima 6 - máxima 85 anos), eram do sexo feminino 61,3 por cento e 38,7 por cento do sexo masculino. A presença de cäibras ocorreu em 57,2 por cento sendo que o local de preferência foram as panturrilhas (61,5 por cento), predominando à noite (61,5 por cento), ao repouso (58,3 por cento) e com duraçäo menor que cinco minutos (62,1 por cento). O uso de diurético esteve associado em 9,6 por cento. Fraqueza muscular ocorreu em 40,2 por cento e HAS foi relatada em 13,1 por cento. Conclusäo: Este trabalho demonstrou que a cäibra teve uma alta incidência na populaçäo-alvo avaliada, devendo ser melhor estudada.

Diagnóstico e tratamento das lesöes musculares parciais e totais / Diagnosis and treatment of partial and total muscular injuries

No período de 15 anos, 18.095 pacientes foram cadastrados na clínica privada, Centro Médico Esportivo Sao Francisco da Penitência e no Serviço Médico do Fluminense Football Clube. Observamos que, entre os 18.095 pacientes tratados, 10.719 (59,23 por cento) foram diagnosticados com lesoes esportivas e 2.670 (24 por cento), portadores de lesoes musculares. Apresentamos os meios de diagnóstico, que sao baseados na observaçao clínica evolutiva de atletas de alto nível, com minucioso registro diário e na escolha de exames complementares para orientaçao do tratamento conservador ou cirúrgico.

Writer's cramp: the experience with botulinum toxin injections in 25 patients.

Twenty-five writer's cramp patients have been attending the Movement Disorder Clinic at the Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok during three years period (between January 1988 - January 1991). There were 17 male subjects and the male to female sex ratio was 2.125:1. The mean age of the patient was 36.80 (SD 10.21) years with the range of 18-60 years. The mean duration of illness of all patients was 5.88 (SD 7.14) years with the range of 1 to 30 years. Eighteen patients (72.0%) were classified as simple writer's cramp and seven patients (28.0%) were dystonic writer's cramp. The mean age of the patients of both groups was not different while the duration of illness in the dystonic group was statistically significantly longer than the simple group, i.e. 12.0 (SD 12.1) versus 3.9 (SD 3.1) years. Fourteen patients (56%) had associated pain during writing and 6 patients (24%) had hand tremor. All patients were right handed and had a history of various pharmacological treatments without any consistent benefit. They included muscle relaxants, tranquillisers, antiepileptic drugs, and betablockers. Fourteen patients from 17 available history records (82.4%) had been spending at least 4-10 hours writing each day. Twenty-one patients (84%) had botulinum toxin injections, 40-80 international mouse units were given in 2-4 divided doses over the overactive forearm muscles observed during writing without the electromyographic glidance. There was no loss to the follow-up. Fourteen of the 21 subjects (66.7%) showed definite improvement in hand writing, 4 patients (19.0%) improved minimally and 3 patients (14.3%) revealed no improvement. Arm pain in all 12 patients associated during writing was abolished after the injections. There were complications in 7 patients (33.3%) presented as transient finger drop (5 patients, 23.8%) and easily fatigued arm (2 patients, 9.5%). These preliminary results confirm that botulinum toxin injections is a successful treatment for many patients with writer's cramp without performing complex electromyographic recordings while the patients are writing. The constraints of this treatment are its high cost (i.e. 1 vial of 100 units costs 300 US dollars) and its benefit lasts for only 4-6 months.