Treatment for cramps in amyotrophic lateral sclerosis/motor neuron disease

Muskelzentrum/ALS Clinic, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 01/2012; 4(4):CD004157. DOI: 10.1002/14651858.CD004157.pub2
Source: PubMed

ABSTRACT Cramps are painful, involuntary muscle contractions. They commonly affect people with amyotrophic lateral sclerosis/motor neuron disease (ALS/MND) at all stages of the disease. To date, the treatment of muscle cramps in ALS has been largely empirical without any evidence from randomised controlled trials.
To systematically assess the effect of interventions on muscle cramps as a primary or secondary endpoint or adverse event in people with ALS/MND.
We searched the Cochrane Neuromuscular Disease Group Specialized Register (14 February 2011), the Cochrane Central Register of Controlled Trials (Issue 1, 2011 in The Cochrane Library), MEDLINE (January 1966 to January 2011) and EMBASE (January 1980 to January 2011) and reference lists of articles searched using the terms motor neuron disease, motor neurone disease, motoneuron disease or amyotrophic lateral sclerosis. We contacted authors of trials for further information.
We included all randomised and quasi-randomised trials of oral medications in people with ALS which assessed cramps as a primary or secondary outcome measure or as an adverse event. We also included trials using subcutaneous or intravenous medications or physical therapy.
All authors applied the selection criteria and assessed study quality independently, and all authors performed independent data extraction.
Twenty studies including 4789 participants were identified. Only one trial, of tetrahydrocannabinol (THC), assessed cramps as the primary endpoint. Thirteen studies assessed cramps as a secondary endpoint. The medications comprised vitamin E, baclofen, riluzole, L-threonine, xaliproden, indinavir, and memantine. Six studies assessed cramps as an adverse event. The medications comprised creatine, gabapentin, dextromethorphan, quinidine, and lithium. In all 20 studies no favourable effect for the treatment of cramps in ALS/MND could be demonstrated, but many studies were underpowered to draw a definite conclusion. A meta-analysis of two small studies showed a statistically nonsignificant result for the amino acid L-threonine for the treatment of cramps in ALS/MND. No study was identified using physical therapy as a therapeutic intervention for cramps.
There is no evidence to support the use of any intervention for muscle cramps in ALS/MND. More and larger randomised controlled trials evaluating treatments for muscle cramps in ALS/MND are needed.

1 Follower
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Pain is an often underestimated and neglected symptom in amyotrophic lateral sclerosis (ALS).Methods In a cross-sectional survey, 46 patients with ALS, 46 age- and gender matched population-based controls, and 23 diseased controls with myotonic dystrophy type 2 (DM2) were screened for occurrence, type, distribution, and treatment of pain and cramps. Data were collected with the use of the short form brief pain inventory (BPI).ResultsPain was reported in 78% of ALS patients,79% of DM2 patients, and 54% of controls (P < 0.05). More ALS patients than controls reported moderate to severe pain (42% vs. 20%). Pain in ALS patients interfered significantly more with daily activities than in controls (median pain interference score: 3.0 vs. 1.2, P < 0.05), especially enjoyment of life (5.0 vs. 1.0) and mood (3.0 vs. 1.0). There was no correlation between the duration of the disease and the severity of pain. Movement-induced cramps were reported in 63% of ALS patients, mostly in the distal extremities. There was no difference in the duration of ALS disease between patients reporting cramps and those who did not.DiscussionOur study showed that pain was a relatively frequent symptom which had an important impact on the quality of life. Pain that requires treatment can occur at every stage of ALS.
    12/2014; 5(3). DOI:10.1002/brb3.296
  • [Show abstract] [Hide abstract]
    ABSTRACT: With the acceleration in our understanding of ALS and the related motor neuron disease has come even greater challenges in reconciling all of the proposed pathogenic mechanisms and how this will translate into impactful treatments. Fundamental issues such as diagnostic definition(s) of the disease spectrum, relevant biomarkers, the impact of multiple novel genetic mutations and the significant effect of symptomatic treatments on disease progression are all areas of active investigation. In this review, we will focus on these key issues and highlight the challenges that confront both clinicians and basic science researchers.
    Journal of the American Society for Experimental NeuroTherapeutics 01/2015; 12(2). DOI:10.1007/s13311-014-0332-8 · 3.88 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Amyotrophic lateral sclerosis is a neurodegenerative disease with a survival rate up to 5 years of 20%. It is characterized by the damage of the first and second motor neurons in a progressive course. There is no cure for this disease at the moment. Nevertheless, new treatments are being developed with the haunting shadow of not few drugs that were proven to be ineffective in stopping or slowing the disease progression. As a result, the main treatment objective at the moment is to soothe the complications the disease inexorably generates in its course. In this review we describe the signs and symptoms of the disease progression and its therapeutic options, for which we have reviewed national and international publications, as well as shearing the experience in our centre. The main topics developed are: weakness, sialorrhea, bronchial secretions, pseudobulbar affect, cramps, spasticity, respiratory insufficiency, limb edema, depression and dysphagia. We would like to point out that in spite of the general belief that «there is nothing left to do» we are summarizing a few, and only a few, of the therapeutic tools available for aiding the patients affected with ALS.
    04/2014; DOI:10.1016/j.neuarg.2014.02.004