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Hobson E, McDermott C. Advances in symptom management and in monitoring disease progression in motor neuron disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 176:119-169. [PMID: 38802174 DOI: 10.1016/bs.irn.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
The aim of supportive management of motor neuron disease is to improve survival, promote good quality of life and patient independence and autonomy whilst preparing for future progression and the end of life. Multidisciplinary specialist care aims to address the multifaceted and interacting biopsychosocial problems associated with motor neuron disease that leads to proven benefits in both survival and quality of life. This chapter will explore principles, structure and details of treatment options, and make recommendations for practice and for future research.
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Affiliation(s)
- Esther Hobson
- Sheffield Institute for Translational Neuroscience, Division of Neuroscience, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| | - Christopher McDermott
- Sheffield Institute for Translational Neuroscience, Division of Neuroscience, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom.
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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] [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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S.Al-Otaibi J, Mary Y, Mary Y, Armaković SJ, Armaković S, Van Alsenoy C, Yathirajan H. Insights into the reactivity properties, docking, DFT and MD simulations of orphenadrinium dihydrogen citrate in different solvents. J Mol Liq 2022. [DOI: 10.1016/j.molliq.2022.120583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abd-Elsalam S, Ebrahim S, Soliman S, Alkhalawany W, Elfert A, Hawash N, Elkadeem M, Badawi R. Orphenadrine in treatment of muscle cramps in cirrhotic patients: a randomized study. Eur J Gastroenterol Hepatol 2020; 32:1042-1045. [PMID: 31834056 DOI: 10.1097/meg.0000000000001622] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Many patients of liver cirrhosis are complaining of muscle cramps, which are annoying to them. There is no effective treatment for muscle cramps in cirrhotic patients till now. This study purposed to evaluate efficacy and safety of orphenadrine in the treatment of muscle cramps in cirrhotic patients. METHODS One hundred and twenty four patients who had muscle cramps three or more times weekly were included. They were divided into two arms: 62 patients administrated orphenadrine and 62 administrated placebo. They were followed up till 2 weeks after the end of therapy. Muscle cramps were evaluated using questionnaire as regards severity, duration, and frequency. Also, side effects of orphenadrine were recorded. RESULTS Frequency, duration of muscle cramps, and pain score improved significantly after 1 month of orphenadrine therapy in comparison to placebo. Few side effects were recorded in the form of dry mouth, drowsiness, and nausea. CONCLUSION Orphenadrine is considered as promising safe drug for treatment of muscle cramps associated with liver cirrhosis.
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Affiliation(s)
| | - Shaimaa Ebrahim
- Department of Tropical medicine, Faculty of Medicine, Tanta University
| | | | - Walaa Alkhalawany
- Department of Tropical medicine, Faculty of Medicine, Tanta University
| | - Asem Elfert
- Department of Tropical medicine, Faculty of Medicine, Tanta University
| | - Nehad Hawash
- Department of Tropical medicine, Faculty of Medicine, Tanta University
| | - Mahmoud Elkadeem
- Department of Tropical medicine, Faculty of Medicine, Tanta University
| | - Rehab Badawi
- Department of Tropical medicine, Faculty of Medicine, Tanta University
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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] [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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Imura T, Inoue G, Nakazawa T, Miyagi M, Saito W, Uchida K, Namba T, Shirasawa E, Takahira N, Takaso M. Treatment of nocturnal leg cramps by blockade of the medial branch of the deep peroneal nerve after lumbar spine surgery. Brain Behav 2015; 5:e00370. [PMID: 26445706 PMCID: PMC4589815 DOI: 10.1002/brb3.370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/04/2015] [Accepted: 07/07/2015] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Patients with lumbar spine disease sometimes complain of nocturnal leg cramps. We sought to investigate the effectiveness of blocking the medial branch of the deep peroneal nerve as treatment for nocturnal leg cramps after spinal surgery for lumbar spine disease. METHODS We evaluated 66 postoperative patients in this prospective comparative study of a group of patients with a nerve block (n = 41) and a control group without (n = 25). In the block group, the medial branch of the deep peroneal nerve was blocked at the distal two-thirds of the interspace between the first and second metatarsals using 5.0 mL of 1.0% lidocaine. RESULTS Two weeks after the block, the frequency of nocturnal leg cramps was reduced to less than a quarter of pretreatment baseline frequency in 61.0% of patients (n = 25) and less than half in 80.5% (n = 33). In the control group, the frequency of the leg cramps was reduced from baseline in 32.0% of patients (n = 8), and was unchanged or increased in 68.0% (n = 17) at 2 weeks. Cramp frequency was reduced to less than a quarter or less than half of baseline frequency in a significantly (P < 0.05 and P < 0.01, respectively) larger percentage of patients in the block group. The severity of each cramp was less in about two-thirds of patients (63.4%; n = 26) in the block group and was unchanged in one-third (31.7%; n = 13). CONCLUSIONS Blocking the medial branch of the peroneal nerve can be an effective, long-lasting, and simple treatment with low risk for nocturnal cramps sustained after lumbar spine surgery.
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Affiliation(s)
- Takayuki Imura
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
| | - Toshiyuki Nakazawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
| | - Wataru Saito
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
| | - Kentaro Uchida
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
| | - Takanori Namba
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
| | - Eiki Shirasawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
| | - Naonobu Takahira
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University Sagamihara, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
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Abstract
BACKGROUND Muscle cramps can occur anywhere and for many reasons. Quinine has been used to treat cramps of all causes. However, controversy continues about its efficacy and safety. This review was first published in 2010 and searches were updated in 2014. OBJECTIVES To assess the efficacy and safety of quinine-based agents in treating muscle cramps. SEARCH METHODS On 27 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE and EMBASE. We searched reference lists of articles up to 2014. We also searched for ongoing trials in November 2014. SELECTION CRITERIA Randomised controlled trials of people of all ages with muscle cramps in any location and of any cause, treated with quinine or its derivatives. DATA COLLECTION AND ANALYSIS Three review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We contacted study authors for additional information. For comparisons including more than one trial, we assessed the quality of the evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). MAIN RESULTS We identified 23 trials with a total of 1586 participants. Fifty-eight per cent of these participants were from five unpublished studies. Quinine was compared to placebo (20 trials, n = 1140), vitamin E (four trials, n = 543), a quinine-vitamin E combination (three trials, n = 510), a quinine-theophylline combination (one trial, n = 77), and xylocaine injections into the gastrocnemius muscle (one trial, n = 24). The most commonly used quinine dosage was 300 mg/day (range 200 to 500 mg). We found no new trials for inclusion when searches were updated in 2014.The risk of bias in the trials varied considerably. All 23 trials claimed to be randomised, but only a minority described randomisation and allocation concealment adequately.Compared to placebo, quinine significantly reduced cramp number over two weeks by 28%, cramp intensity by 10%, and cramp days by 20%. Cramp duration was not significantly affected.A significantly greater number of people suffered minor adverse events on quinine than placebo (risk difference (RD) 3%, 95% confidence interval (CI) 0% to 6%), mainly gastrointestinal symptoms. Overdoses of quinine have been reported elsewhere to cause potentially fatal adverse effects, but in the included trials there was no significant difference in major adverse events compared with placebo (RD 0%, 95% CI -1% to 2%). One participant suffered from thrombocytopenia (0.12% risk) on quinine.A quinine-vitamin E combination, vitamin E alone, and xylocaine injections into gastrocnemius were not significantly different to quinine across all outcomes, including adverse effects. Based on a single trial comparison, quinine alone was significantly less effective than a quinine-theophylline combination but with no significant differences in adverse events. AUTHORS' CONCLUSIONS There is low quality evidence that quinine (200 mg to 500 mg daily) significantly reduces cramp number and cramp days and moderate quality evidence that quinine reduces cramp intensity. There is moderate quality evidence that with use up to 60 days, the incidence of serious adverse events is not significantly greater than for placebo in the identified trials, but because serious adverse events can be rarely fatal, in some countries prescription of quinine is severely restricted.Evidence from single trials suggests that theophylline combined with quinine improves cramps more than quinine alone, and the effects of xylocaine injections into gastrocnemius are not significantly different to quinine across all outcomes. Low or moderate quality evidence shows no significant difference between quinine and vitamin E or quinine and quinine-vitamin E mixture. Further research into these alternatives, as well other pharmacological and non-pharmacological treatments, is thus warranted.There is no evidence to judge optimal dosage or duration of quinine treatment. Further studies using different dosages and measurement of serum quinine levels will allow a therapeutic range to be defined for muscle cramp. Because serious adverse events are not common, large population studies are required to more accurately inform incidence. Longer lengths of follow-up in future trials will help determine the duration of action following cessation of quinine as well as long-term adverse events. The search for new therapies, pharmacological and nonpharmacological, should continue and further trials should compare vitamin E, quinine-vitamin E combination, and quinine-theophylline mixture with quinine.
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Affiliation(s)
- Sherif El‐Tawil
- PO Box 114, National Hospital for Neurology and NeurosurgeryCochrane Neuromuscular Disease Group, MRC Centre for Neuromuscular DiseasesQueen SquareLondonUKWC1N 3BG
| | - Tarique Al Musa
- St Georges Hospital NHS TrustDepartment of CardiologyLondonUK
| | - Haseeb Valli
- Homerton University HospitalDepartment of CardiologyHomerton RowLondonUKE9 6SR
| | - Michael PT Lunn
- National Hospital for Neurology and NeurosurgeryDepartment of Neurology and MRC Centre for Neuromuscular DiseasesQueen SquareLondonUKWC1N 3BG
| | - Ruth Brassington
- National Hospital for Neurology and NeurosurgeryMRC Centre for Neuromuscular DiseasesPO Box 114LondonUKWC1N 3BG
| | | | - Markus Weber
- Kantonsspital St. GallenMuskelzentrum/ALS ClinicGreithstrasse 20St. GallenSwitzerland9007
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Rana AQ, Khan F, Mosabbir A, Ondo W. Differentiating nocturnal leg cramps and restless legs syndrome. Expert Rev Neurother 2014; 14:813-8. [DOI: 10.1586/14737175.2014.927734] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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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] [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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Abstract
BACKGROUND Muscle cramps can occur anywhere and for many reasons. Quinine has been used to treat cramps of all causes. However, controversy continues about its efficacy and safety. OBJECTIVES To assess the efficacy and safety of quinine in treating muscle cramps. SEARCH STRATEGY We searched The Cochrane Neuromuscular Disease Group Register, The Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 3, 2010), MEDLINE, EMBASE and reference lists of articles up to July 2010. SELECTION CRITERIA Randomised controlled trials of people of all ages with muscle cramps in any location and of any cause, treated with quinine or its derivatives. DATA COLLECTION AND ANALYSIS Three authors independently selected trials for inclusion, assessed risk of bias and extracted data. We contacted study authors for additional information. MAIN RESULTS We identified 23 trials with a total of 1586 participants. Fifty-eight per cent of these participants were from five unpublished studies. Quinine was compared to placebo (20 trials, n =1140), vitamin E (four trials, n = 543), a quinine-vitamin E combination (three trials, n = 510), a quinine-theophylline combination (one trial, n = 77), and xylocaine injections into the gastrocnemius muscle (one trial, n = 24). The most commonly used quinine dosage was 300 mg/day (range 200 to 500 mg).Compared to placebo, quinine significantly reduced cramp number over two weeks by 28%, cramp intensity by 10%, and cramp days by 20%. Cramp duration was not significantly affected.A significantly greater number of people suffered minor adverse events on quinine than placebo (risk difference +3%, 95% confidence intervals 0% to 6%), mainly gastrointestinal symptoms. Overdoses of quinine have been reported elsewhere to cause potentially fatal adverse effects, but in the included trials there was no significant difference in major adverse events compared with placebo (risk difference 0%, 95% confidence intervals -1% to 2%). One participant suffered from thrombocytopenia (0.12% risk) on quinine.A quinine-vitamin E combination, vitamin E alone, and xylocaine injections into gastrocnemius were not significantly different to quinine across all outcomes, including adverse effects. Based on a single trial comparison, quinine alone was significantly less effective than a quinine-theophylline combination but with no significant differences in adverse events. AUTHORS' CONCLUSIONS There is moderate quality evidence that quinine significantly reduces cramp frequency, intensity and cramp days in dosages between 200 and 500 mg/day. There is moderate quality evidence that with use up to 60 days, the incidence of serious adverse events is not significantly greater than for placebo in the identified trials. Further research is required on the optimal dose and duration of use, and also on alternative treatments.
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Affiliation(s)
- Sherif El-Tawil
- Cochrane Neuromuscular Disease Group, MRC Centre for Neuromuscular Disease, PO Box 114, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK, WC1N 3BG
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Henares García P. Calambres nocturnos: una queja frecuente en atención primaria. Semergen 2010. [DOI: 10.1016/j.semerg.2009.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Finsterer J, Stöllberger C. Quinine-responsive muscle cramps in X-linked bulbospinal muscular atrophy Kennedy. J Neurol 2009; 256:1355-6. [DOI: 10.1007/s00415-009-5101-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Accepted: 03/04/2009] [Indexed: 11/29/2022]
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