Frequency Of Cramps Research Articles

Non-drug therapies for the secondary prevention of lower limb muscle cramps.

Lower limb muscle cramps are common and painful. They can limit exercise participation, and reduce quality of sleep, and quality of life. Many interventions are available for lower limb cramps; some are controversial or could cause harm, and often, people experience no benefit from the interventions used. This is an update of a Cochrane Review first published in 2012. We updated the review to incorporate new evidence. To assess the effects of non-drug, non-invasive therapies for lower limb muscle cramps. In August 2018 and May 2020, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, and reference lists of included studies. We imposed no restrictions by language or publication date. We included all randomised controlled trials (RCTs) of non-drug, non-invasive interventions tested over at least four weeks, for lower limb muscle cramps in any group of people, except pregnant women. The primary outcome was cramp frequency. Secondary outcomes were cramp pain severity, cramp duration, health-related quality of life, quality of sleep, participation in activities of daily living, proportion of participants reporting lower limb muscle cramps, and adverse events. Two review authors independently selected trials, assessed risk of bias, and cross-checked data extraction and analyses according to standard Cochrane procedures. We included three trials, with 201 participants, all 50 years of age and older; none had neurological disease. All trials evaluated a form of stretching for lower limb muscle cramps. A combination of daily calf and hamstring stretching for six weeks may reduce the severity of night-time lower limb muscle cramps (measured on a 10 cm visual analogue scale (VAS) where 0 = no pain and 10 cm = worst pain imaginable) in people aged 55 years and older, compared to no intervention (mean difference (MD) -1.30, 95% confidence interval (CI) -1.74 to -0.86; 1 RCT, 80 participants; low-certainty evidence). The certainty of evidence was very low for cramp frequency (change in number of cramps per night from week zero to week six) comparing the stretching group and the no intervention group (MD -1.2, 95% CI -1.8 to -0.6; 80 participants; very low-certainty evidence). Calf stretching alone for 12 weeks may make little to no difference to the frequency of night-time lower limb muscle cramps in people aged 60 years and older (stretching group median number of cramps in the last four weeks (Md) 4, interquartile range (IQR) 8; N = 48; sham stretching group Md 3, IQR 7.63; N = 46) (U = 973.5, z = -0.995, P = 0.32, r = 0.10; 1 RCT, 94 participants; low-certainty evidence). This trial did not report cramp severity. The evidence is very uncertain about the effects of a combination of daily calf, quadriceps, and hamstring stretching on the frequency and severity of leg cramps in 50- to 60-year-old women with metabolic syndrome (N = 24). It was not possible to fully analyse the frequency data and the scale used to measure cramp severity is not validated. No study reported health-related quality of life, quality of sleep, or participation in activities of daily living. No participant in these three studies reported adverse events. The evidence for adverse events was of moderate certainty as the studies were too small to detect uncommon events. In two of the three studies, outcomes were at risk of recall bias, and tools used to measure outcomes were not validated. Due to limitations in study designs that led to risks of bias, and imprecise findings with wide CIs, we cannot be certain that findings of future studies will be similar to those presented in this review. A combination of daily calf and hamstring stretching for six weeks may reduce the severity of night-time lower limb muscle cramps in people aged 55 years and older, but the effect on cramp frequency is uncertain. Calf stretching alone compared to sham stretchingfor 12 weeks may make little or no difference to the frequency of night-time lower limb muscle cramps in people aged 60 years and older. The evidence is very uncertain about the effects of a combination of daily calf, quadriceps, and hamstring stretching on the frequency and severity of leg cramps in 50- to 60-year-old women with metabolic syndrome. Overall, use of unvalidated outcome measures and inconsistent diagnosticcriteriamake it difficult to compare the studies and apply findings to clinical practice. Given the prevalence and impact of lower limb muscle cramps, there is a pressing need to carefully evaluate many of the commonly recommended and emerging non-drug therapies in well-designed RCTs across all types of lower limb muscle cramps. A specific cramp outcome tool should be developed and validated for use in future research.

Fasciectomy for Recurrent Chronic Exertional Compartment Syndrome of the Anterior Leg.

This study aimed to determine whether a fasciectomy for recurrent chronic exertional compartment syndrome of the anterior leg (ant-CECS) after a minimally invasive fasciotomy is safe and beneficial. Demographics and clinical course of patients undergoing a fasciectomy for ongoing exercise-related leg pain (ERLP) after an earlier minimally invasive fasciotomy for ant-CECS were prospectively obtained using questionnaires. Patient-reported severity and frequency of pain, tightness, weakness, cramping, and paresthesia in rest and during exercise were scored before and after surgery. A successful outcome was defined as a self-reported good or excellent result. Between January 2013 and March 2019, 24 of the 958 patients evaluated for ERLP were included in the study (15 females; median age, 24 yr; range, 14-37 yr). Intracompartmental pressure values before the minimally invasive fasciotomy and before the fasciectomy were not different. Perioperative findings were fibrotic bands, pseudofascias, or complete fusions of fascial edges. Postoperative superficial wound infections requiring oral antibiotics occurred in four legs. After rehabilitation, the total symptom scores during exercise and resting conditions decreased threefold compared with preoperatively (exercise, 55 ± 5 to 17 ± 3, P < 0.001; rest, 30 ± 4 to 10 ± 2, P < 0.001). All cardinal symptoms decreased significantly, but the largest improvements were reported for pain and tightness. At follow-up (median, 12 months; range, 2-65 months), 79% of patients reported a successful outcome, whereas 75% had returned to physical activity. An anterior fasciectomy with associated treatment of correlated pathologies can be safe and beneficial in patients with ongoing ERLP who previously underwent a minimally invasive fasciotomy for ant-CECS.

Interventions for leg cramps in pregnancy.

Interventions for leg cramps in pregnancy.

Chronic exertional compartment syndrome in the differential diagnosis of peripheral artery disease in older patients with exercise-induced lower limb pain

ObjectivePeripheral artery disease (PAD) and chronic exertional compartment syndrome (CECS) both cause exercise-induced lower limb pain. CECS is mostly described in young individuals and may therefore not be considered in older patients with intermittent claudication. The aim of our study was to identify differences in characteristics and symptomatology between patients with CECS and PAD that may help in recognizing CECS in patients ≥50 years with exercise-induced lower limb pain. MethodsIn this case-control study, patients with CECS ≥50 years were selected from a prospectively followed cohort and compared with a sample of newly diagnosed patients with PAD ≥50 years. A questionnaire assessed frequency and severity of lower limb pain, tightness, cramps, muscle weakness, and altered skin sensation at rest and during exercise. ResultsAt rest, patients with CECS (n = 43, 42% female, 57 years; range, 50-76 years) reported significantly more pain, tightness, muscle weakness and altered skin sensation (all P < .01) than patients with PAD (n = 41, 39% female, 72 years; range, 51-93 years). Having CECS was associated with a significantly higher combined symptom score at rest (P = .02). During exercise, patients with CECS experienced more tightness, muscle weakness and altered sensation (P < .01), but not pain and cramps (P = .36; P = .70). Exercise-induced complaints occurred much later in patients with CECS than in patients with PAD (15 minutes vs 4 minutes; P < .01). Persistence of pain over 4.5 minutes proved most discriminative for the presence of CECS (sensitivity, 95%; specificity, 54%; positive predictive value, 65%). Exercise cessation completely alleviated complaints in all patients with PAD (n = 41) but not in 73% (n = 29) of the patients with CECS. Ongoing discomfort strongly predicted the presence of CECS (sensitivity, 73%; specificity, 100%; positive predictive value, 100%). ConclusionsPatients with CECS ≥50 years report a symptom pattern that is different from patients with PAD. These differences may aid vascular surgeons in identifying older patients with CECS.

Magnesium for skeletal muscle cramps.

Magnesium for skeletal muscle cramps.

Efficacy and safety of mexiletine in amyotrophic lateral sclerosis: a systematic review of randomized controlled trials.

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 intakeamong ALS patientsare nausea (n=11, 7.8%) and tremors (n=5, 3.6%).

CERVICAL PRIMING WITH SUBLINGUAL MISOPROSTOL PRIOR TO INSERTION OF AN INTRAUTERINE DEVICE IN WOMEN WITH NO PREVIOUS VAGINAL DELIVERY A RANDOMIZED CONTROLLED TRIAL

Background: The use of misoprostol at a dose of 600 µg administered sublingual 2 hrs prior to IUD insertion increased the ease of insertion and reduced the incidence of failed insertion and pain during the procedure, although the frequency of cramps increased following misoprostol use. Objective: To evaluate the efficacy of sublingual misoprostol 2 hours prior to intrauterine device (IUD) insertion in women with previous cesarean section. Patients and Methods: This randomized, double-blind clinical trial was conducted on women of reproductive age were submitted to IUD insertion between Jan 2019 and July 2019. A total of 120 women were randomly allocated to two equal groups: Group I received 600 µg of misoprostol sublingual 2h prior to IUD insertion, Group II received placebo. Results: Significant differences were found between the groups for all the immediate end points studied, with less difficulty in inserting the IUD with misoprostol group. A positive balance was detected between the benefits and risks of the use of misoprostol. However, it was not feasible to conclude that its use was imperative prior to IUD insertion in previous CS, and IUD insertion should not be canceled when the medication was unavailable. Conclusion: In view of its effect in promoting cervical dilatation, misoprostol may be used prior to IUD insertion in previous CS.

The effects of diuretic use and the presence of ascites on muscle cramps in patients with cirrhosis: a nationwide study.

Administration of diuretics and the presence of ascites in patients with cirrhosis were reported to be associated with muscle cramps; however, the clinical evidence is limited. This study aimed to determine whether muscle cramps are a diuretic-induced complication and whether ascites was a factor related to muscle cramp. A total of 1064 adult patients with cirrhosis were enrolled from 10 hospitals in Japan between June 2017 and December 2018. A questionnaire regarding cramps was completed by all patients. The ratio of extracellular water (ECW) was analyzed using the bioelectrical impedance analysis. Logistic regression analysis was performed to analyze the effects of diuretic administration and the ECW ratio on cramps. Patients using diuretics had a higher incidence rate, higher frequency, stronger pain, and longer duration of cramps than those who did not. In the multivariate analysis, diuretic administration and the ECW ratio values ≥ 0.4 were not significantly associated with the presence, frequency, intensity, or duration of cramps. However, in the case of patients limited to Child-Pugh B or C, diuretic use was significantly correlated with the cramp frequency. These results demonstrated that muscle cramps were not a complication of diuretic use in patients with cirrhosis; however, in those limited to Child-Pugh B or C, diuretic use was a factor that affected the frequency of cramps. Moreover, no association was found between the presence of ascites and cramps.

A Higher Concentration of Dialysate Magnesium to Reduce the Frequency of Muscle Cramps: A Narrative Review.

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.

Isolated Lateral Chronic Exertional Compartment Syndrome of the Leg: A New Entity?

Background:Chronic exertional compartment syndrome (CECS) mostly occurs in the anterior or deep posterior compartments (ant-CECS and dp-CECS, respectively) of the leg. It is generally accepted that CECS of the third or lateral compartment (lat-CECS) always occurs together with ant-CECS. However, whether exertional leg pain (ELP) can be caused by an isolated form of lat-CECS is unknown.Purpose:To determine the existence of isolated lat-CECS and study whether history taking and a physical examination aid in discriminating between different subtypes of CECS.Study Design:Case series; Level of evidence, 4.Methods:Patients were eligible for this single-center study, conducted between January 2013 and February 2018, if they reported anterolateral ELP and completed a questionnaire scoring the frequency and intensity of pain, tightness, cramps, muscle weakness, and paresthesia during rest and exercise. They were asked to mark areas of altered foot skin sensation, if present, on a drawing. All patients underwent a dynamic intracompartmental pressure (ICP) measurement of the anterior and lateral compartments simultaneously. The diagnosis of CECS was confirmed by elevated ICP (Pedowitz criteria). There were 3 patient groups: (1) isolated ant-CECS with elevated ICP in the anterior compartment and normal ICP in the lateral compartment, (2) isolated lat-CECS with elevated ICP in the lateral compartment but normal ICP in the anterior compartment, and (3) ant-/lat-CECS with elevated ICP in both the anterior and lateral compartments.Results:A total of 73 patients with anterolateral ELP fulfilled study criteria (isolated ant-CECS: n = 26; isolated lat-CECS: n = 5; ant-/lat-CECS: n = 42). Group differences were not observed regarding age (isolated ant-CECS: median, 26 years [range, 13-68 years]; isolated lat-CECS: median, 20 years [range, 17-63 years]; ant-/lat-CECS: median, 28 years [range, 17-57 years]; χ2 (2) = 0.466; P = .79), sex (isolated ant-CECS: 50% male; isolated lat-CECS: 40% male; ant-/lat-CECS: 62% male; P = .49), or bilateral symptoms (isolated ant-CECS: 54%; isolated lat-CECS: 80%; ant-/lat-CECS: 69%; P = .40). However, cramps at rest were present in a portion of the patients with isolated ant-CECS (38%) and ant-/lat-CECS (57%) but not in those with isolated lat-CECS (P = .032). Patient drawings of altered foot skin sensation did not contribute to the diagnosis (P = .92). ICP values after provocation were all lower in patients with isolated ant-CECS and isolated lat-CECS compared with those with ant-/lat-CECS (P < .05).Conclusion:Seven percent of patients with CECS and anterolateral ELP who had symptoms due to isolated lat-CECS in the presence of normal muscle pressure in the anterior compartment.

Pilot testing a stretching regimen for prevention of night time nocturnal leg cramps

Nocturnal leg cramps (NLC) are painful, involuntary muscle contractions that affect the quality of sleep. The aim of this study was to examine the feasibility and effectiveness of a stretching regimen in frail older adults aged over 75 years with NLC. The experimental group (n = 15) received an intervention, which they were instructed to perform three daily exercises to stretch the calves and hamstrings. After six weeks, frequency and pain intensity of NLC were both significantly decreased in the experimental group compared to the control group. A paired samples t-test reveals a statistically significant decrease in cramp frequency (t = 2.2, df 28, P = 0.04) and cramp intensity (t = 2.7, df 28, P = 0.01). Therefore, a six-week stretching regimen is likely to reduce the frequency and pain intensity of NLC in frail older adults aged over 75 years.

Can L-carnitine supplementation and exercise improve muscle complications in patients with liver cirrhosis who receive branched-chain amino acid supplementation?

The aim of this study was to elucidate the efficacy of the combination of L-carnitine and exercise, reported to prevent muscle wasting, for muscle complications (function, volume, and cramping) in patients with liver cirrhosis (LC) who received branched-chain amino acid supplementation. From December 2017 to April 2018, 18 patients with LC who had been given branched-chain amino acid granule supplementation (12.45 g/day) were enrolled (mean age 68.4±10.8 years; 10 males and eight females; Child-Pugh A : B=9 : 9). After evaluating the average number of daily steps, oral L-carnitine supplementation (1000 mg/day) and additional exercise (plus 2000 steps/day) were added for 6 months. Every 4 weeks, a pedometer, a hand dynamometer, ergometer, and bioelectrical impedance analysis were used to evaluate daily steps, muscle function and muscle volume, and muscle cramps were recorded using a numerical rating scale. Average steps and serum levels of total and free carnitine were increased from before treatment to the final measurement (1883.5±1211.6 vs. 3165.1±1800.0/day, 62.6±16.5 vs. 110.9±28.6 μmol/l, and 47.7±15.2 vs. 83.2±21.5 μmol/l, respectively; P<0.01), whereas there were no significant changes in the ratios of handgrip strength, leg strength, and muscle volume after 6 months [1.00±0.13 (P=0.991), 1.07±0.13 (P=0.073), and 0.992±0.036 (P=0.390), respectively]. However, the frequency of complaints of muscle cramping was reduced as compared with the start of therapy (baseline, 3 months, and 6 months: 6.3±4.8, 3.1±3.3, and 2.1±2.0, respectively) (P=0.025, Holm's method), whereas numerical rating scale did not show any significant improvement. L-Carnitine may have an important role for prevention of muscle wasting and reducing the frequency of muscle cramping.

Randomized-controlled trial of methocarbamol as a novel treatment for muscle cramps in cirrhotic patients.

Muscle cramps occur in 29-88% of patients with liver cirrhosis. They adversely affect quality of life. This study aimed to evaluate the efficacy and safety of methocarbamol as a novel therapy in controlling muscle cramps in cirrhotic patients. This study was carried on 100 patients with liver cirrhosis in addition to chronic hepatitis C who presented with frequent muscle cramps (≥three cramps per week). Half of these patients received methocarbamol and the other half received placebo. This was done through equal randomization. Questionnaires on muscle cramp were answered. Patients were evaluated before, after 1 month of treatment, and 2 weeks after washout of treatment in terms of severity, duration, and frequency of cramps. Liver, renal functions, and electrolytes were analyzed. Also, any side effect was detected. Patients who were treated with methocarbamol showed a significant decrease in the frequency and duration of cramps. Also, the pain score improved significantly. However, no significant changes were observed in the placebo group. Few side effects of methocarbamol were recorded, including dry mouth and drowsiness. Methocarbamol seems to be a promising safe and well-tolerated medication, and plays a role in the treatment of muscle cramps in patients with liver cirrhosis.

Lifestyle Intervention for Reducing Leg Cramps among Pregnant Women

Background: Leg cramps are a common discomfort during pregnancy account 30-50% of pregnant women. Lifestyle intervention help in reducing symptoms and discomfort associated with leg cramps. Aim: Was to study the effectiveness of lifestyle intervention for reducing leg cramps among pregnant women. Research Design: A quasi-experimental design was used. Setting: This study was conducted in Outpatient Clinic at Obstetric and Gynecological Department affiliated at Benha Teaching Hospital. Sampling: A purposive sample of 212 pregnant women having leg cramps and divided into study and control group. Tools: Three tools were used for collecting data; 1) A structured interviewing questionnaire; it includes four parts personal characteristics of studied women, past and current obstetric history, leg cramps history, and studied women's knowledge. 2) Modified Healthy Life Style Assessment Scale. 3) Visual analogue Scale. Results: showed that the mean age in the studied group and control group were 27.06±6.45 & 26.98±7.43 respectively. And secondary education is the education level of the large proportion of both study and control group 49.1% & 57.5% respectively, there was highly significant differences between two groups in all items related to their knowledge pConclusion: implementation of lifestyle intervention was effective in improving pregnant women's Lifestyle, through improving their knowledge and decreasing the severity and frequency of leg cramps. Recommendation: The nurses should provide all pregnant women at antenatal clinics with a self-care guideline about lifestyle intervention for reducing leg cramps during pregnancy to improve their awareness.

Effect of Isotonic Exercise on the Frequency of Muscle Cramps in Hemodialysis Patients: A Clinical Trial

Background: The long-term complications of hemodialysis deteriorate patients’ quality of life and lead to physical and mental discomfort. Physiologically, sports activities can play an important role in reducing these side effects including muscle cramps. Objectives: The aim of this study was, to determine the impact of isotonic exercise on the frequency of muscle cramps. Methods: This clinical trial was carried out on 60 hemodialysis patients admitted to the dialysis units of Shahrekord and Borujen hospitals in 2014. The intervention included an isotonic exercise program that was implemented during 10 sessions of constant cycling (each lasting 10 minutes) immediately before dialysis. The outcome variable was the number of muscle cramps in patients during the hemodialysis session. The data were analyzed in SPSS-16 using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential tests (independent and paired t-tests). Results: The mean frequency of leg cramps before the intervention was not significantly different between the two groups (P = 0.10). However, it was significantly different between the groups after the intervention (P = 0.001). Moreover, the number of muscle cramps in the experimental group was significantly lower after the intervention than before implementing the program (P = 0.03). Conclusions: The isotonic exercise of constant cycling has a considerable effect on decreasing the number of muscle cramps in hemodialysis patients. Hence, it is suggested that dialysis units provide facilities for constant walking and cycling to accelerate patients’ treatment.

CLINICAL NUTRITION PROGRAM IMPROVES CHRONIC FATIGUE AND INTESTINAL PAIN IN 50 YEAR OLD MAN WITH HASHIMOTO’S

Event Abstract Back to Event CLINICAL NUTRITION PROGRAM IMPROVES CHRONIC FATIGUE AND INTESTINAL PAIN IN 50 YEAR OLD MAN WITH HASHIMOTO’S David J. Clark1* 1 Carrick Institute, United States Background: A 50 year old man presented with a history of chronic fatigue, gastrointestinal pain, cramping and gas. Within one hour after eating he experienced pain and gas, and then 3 to 4 hours later, he suffered severe lower intestinal cramping. He also suffered constipation (only one to two bowel movements per week). Frequently, a few hours after waking , he would be so fatigue that he needed to nap. This also occurred after doing any kind of exercising such as cycling. Eight years prior to presentation he was diagnosed with hypothyroidism and prescribed levothyroxine. Three years later he demonstrated elevated thyroid autoantibodies (Hashimoto’s) and was switched to bioidentical thyroid replacement. He followed various interventions including acupuncture, low FODMAPS diet and Small Intestine Bacterial Overgrowth protocol— but with no positive effects on his symptoms. He followed a gluten-free diet at time of presentation. He was taking Armour daily as well as vitamin D. Methods: Blood chemistry revealed high homocysteine (13.9), potassium (5.4), TSH (13.26), TPO antibodies (144) and thyroglobulin antibodies (2), low HDL (39), T4 (4.2), Reverse T3 (6), free T4 (0.7), normal T3 and Free T3, clinically significantly high BUN (25), clinically significantly low B12 (375), vitamin D (35). Urea Breath Test for H. pylori was negative. Urinary Organic Acids testing revealed high Arabinose (36), 4-Hydroxybenzoic (0.90), oxalic (135), 3-Hydroxyglutaric (6.8), Suberic (4.0), and 2-Hydroxyhippuric (1.2) acids. Dried urine testing for hormones revealed low levels of epitestosterone, clinically significantly low levels of beta-pregnanediol, alpha-pregnanediol, DHEA sulfate, androsterone, testosterone, 5-alpha DHT, He was placed on an anti-inflammatory diet and a supplement protocol utilizing turmeric, resveratrol, sublingual vitamin D, high EPA fish oil, broad-spectrum digestive enzyme formula, pregnenolone, a multi-nutrient formula for lowering homocysteine and a multi-multi-nutrient formula for support of normal tissue glucose levels. Results: At 60 day follow up, the patient reported a 60% increase in his energy. He no longer needed to nap in the mornings, nor after exercise. He reported a 50% improvement in the frequency of gastrointestinal pain and cramping. Frequency of bowel movements had increased to four to five times per week. In addition, blood chemistry showed improved B12 (580), vitamin D (68.4), homocysteine (11.1). Conclusion: The author suggests further investigation into clinical nutrition, diet and supplementation in the treatment of chronic fatigue and gastrointestinal complaints in patients with Hashimoto’s. Keywords: Hashimoto's autoimmune thyroiditis, HPA axis (hypothalamus-pituitary-adrenal), supplementation, Anti-inflammatory diet, Clinical Nutrition Conference: International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019. Presentation Type: Poster Presentation Topic: Clinical Neuroscience Citation: Clark DJ (2019). CLINICAL NUTRITION PROGRAM IMPROVES CHRONIC FATIGUE AND INTESTINAL PAIN IN 50 YEAR OLD MAN WITH HASHIMOTO’S. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience. doi: 10.3389/conf.fneur.2019.62.00025 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Apr 2019; Published Online: 27 Sep 2019. * Correspondence: Mx. David J Clark, Carrick Institute, Cape Canaveral, Florida, 32920, United States, mail@doctordavidclark.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers David J Clark Google David J Clark Google Scholar David J Clark PubMed David J Clark Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Effects of Neuromuscular Electrical Stimulation on the Frequency of Skeletal Muscle Cramps: A Prospective Controlled Clinical Trial

We investigated if neuromuscular electrical stimulation (NMES) of calf muscles prevents spontaneous calf cramps. In 19 individuals affected by more than or equal to one calf cramp per week the gastrocnemius of the predominantly affected leg was stimulated twice a week (intervention leg, IL) over six weeks (3 × 6 stimulation trains at 30 Hz above the individual cramp threshold frequency). The other leg served as control (CL). The participants were advised to record all spontaneous muscle cramps from two weeks before the intervention until two weeks after the last NMES session. The number of spontaneous calf cramps in the two weeks after the intervention was 78% lower (2.1 ± 6.8 cramps) in the stimulated (p < 0.001) and 63% lower (2.0 ± 6.9 cramps) in the unstimulated calves (p < 0.001), when compared to the two weeks prior to the intervention (IL: 9.6 ± 12.4 cramps; CL: 5.5 ± 12.7 cramps). Only in the IL, this improvement was accompanied by an increase in the cramp threshold frequency from 15.5 ± 8.5 Hz before the NMES intervention to 21.7 ± 12.4 Hz after the intervention. The severity of the remaining calf cramps tended to be lower in both legs after the intervention. The applied stimulation protocol seems to provide an effective prevention strategy in individuals affected by regular calf cramps.

Efficacy of Botulinum Toxin A for Treating Cramps in Diabetic Neuropathy.

Muscle cramps occur in >50% of diabetic patients and reduce the quality of life. No effective treatment is available. We evaluated the clinical effectiveness of botulinum toxin A (BTX-A) injections for treating cramps in diabetic patients with neuropathy. This single-center, double-blind, placebo-controlled perspective study investigated the efficacy and safety of BTX-A intramuscular injection for treating calf or foot cramps refractory to common pharmacological drugs. Fifty diabetic patients with peripheral neuropathy and cramps were randomly assigned to 2 matched groups. BTX-A (100 or 30 units) or saline was injected on each side into the gastrocnemius or the small flexor foot muscles. Changes in pain intensity (primary outcome) and cramp frequency were evaluated over the course of 20 weeks after BTX-A administration. Cramp interference in daily life and the electrophysiological cramp threshold frequency were also measured. The treatment was repeated 5 months after first injection in 19 responders. All outcome measures improved significantly after BTX-A compared with placebo. The changes with respect to baseline were already significant after 1 week and persisted up to week 14. Only 5 of 25 (20%) patients were nonresponders (<50% decrease of the primary outcome). The responses to a second BTX-A injection provided results similar to the first administration. Mild pain at the injection site (4/25 cases) was the only adverse event, and it disappeared within 2 to 3 days. Local BTX-A infiltration is an efficacious and safe procedure for obtaining a sustained amelioration of muscle cramps associated with diabetic neuropathy. Ann Neurol 2018;84:682-690.

Investigation of Muscle Cramps in Patients With Cirrhosis Using Electrical Stimulation Cramp Threshold Frequency

Introduction: Electrically stimulated cramp threshold frequency (TF) correlates well with occurrence of muscle cramps; i.e., lower TF represents increased predisposition to cramps. Higher frequency of muscle cramps in cirrhosis is associated with a poor quality of life. However, the etiology of muscle cramps in cirrhotic individuals is not well understood. In the current study, we tested the hypothesis that cirrhotic patients with muscle cramps have lower cramp TF. Methods: 36 participants were recruited: Group A: cirrhotic patients who experienced at least 3 episodes of cramps/week (n=14); Group B: cirrhotic patients without cramps (n=12) and Group C: healthy individuals without cramps (n=10). All groups were matched for age, gender and BMI whereas Groups A and B were matched for liver disease etiology and diuretic usage. Patients recorded cramps in a daily diary for 3 weeks and then underwent blood sampling and testing for cramp TF of tibial and ulnar nerves. Threshold frequency was determined by delivering a series of 8 shocks over 2 seconds. If no cramp occured, the frequency was increased by 2 Hz with a minimum of 60 seconds between the end of each stimulus until a cramp was induced. The shocks were delivered until max TF of 40 Hz was reached or patient requested to stop the test. Results: The study cohort comprised of 53% women, 86% Caucasian, BMI 32 ± 11 kg/m2 with mean age of 55 ± 9 years. Group A experienced an average of 5 ± 1 episodes of cramps per week. Cramps were induced in 43% of Group A, 50% of Group B, and 70% of Group C participants (P>0.05). Of those, 5 (14%) had induced cramps in both the tibial and ulnar nerve stimulation, whereas 10 (28%) patients had cramps induced only in the tibial nerve and 4 (11%) had cramps induced only at the ulnar nerve. The lowest TF required to induce cramps either with tibial or ulnar nerve stimulation was not significantly different among three groups: Group A (16 ± 6 Hz), Group B (15 ± 3 Hz) and Group C ( 17 ± 4 Hz) (P>0.05). Serum levels of magnesium (r= -0.71, P<0.05) and albumin (r=-0.52, P<0.05) had significant negative correlation with cramp TF. Conclusion: The frequency of electrically stimuted muscle cramps, or TF required to induce muscle cramps was not different in cirrhotics with cramps compared to other groups. The negative relationship between serum magnesium and albumin with cramp TF suggests therapeutic potential for magnesium and albumin for muscle cramps in cirrhotics.

Randomised clinical trial: oral taurine supplementation versus placebo reduces muscle cramps in patients with chronic liver disease.

Painful muscle cramps occur in the majority of patients with cirrhosis impacting significantly on quality of life and sleep patterns. They are frequently unrecognised or overlooked. Current management is based on anecdotal evidence or case study reports. To investigate the effect of oral taurine supplementation on frequency, duration, and intensity of muscle cramps in patients with chronic liver disease. Patients with chronic liver disease who experienced three or more muscle cramps/week were enrolled in a double-blinded, randomised control, crossover, taurine dose-variable study. Each participant received either taurine supplementation or placebo for 4weeks then crossed to the alternative arm. Primary outcome data for frequency, duration, and intensity of muscle cramps was recorded by participants. Participants recorded frequency, duration, and location of muscle cramps. Biochemical parameters, including serum taurine and methionine levels, were measured at each time point. Linear mixed models were used to analyse outcomes. Forty-nine patients were enrolled in the study and 30 patients completed the protocol. Participants who were unable to complete the protocol were not included in the final analysis due to the absence of outcome data. The mean age of participants was 54.7years and 70% were males. Oral taurine supplementation increased serum taurine levels (P<0.001). There were no adverse side effects associated with taurine supplementation. Participants receiving 2g taurine/d experienced a reduction in cramp frequency (seven cramps fewer/fortnight, P=0.03), duration (89minutes less/fortnight P=0.03), and severity (1.4 units less on a Likert scale P<0.004) compared to placebo. Oral supplementation with 2g taurine/d results in a clinically significant reduction in the frequency, duration, and intensity of muscle cramps in patients with chronic liver disease. Taurine should be considered as a safe and effective intervention in the management of muscle cramps in individuals with chronic liver disease. This study was registered with the Australian New Zealand Clinical Trials Register: ACTRN12612000289819.