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Takahashi A. The pathophysiology of leg cramping during dialysis and the use of carnitine in its treatment. Physiol Rep 2021; 9:e15114. [PMID: 34762357 PMCID: PMC8582296 DOI: 10.14814/phy2.15114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/16/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022] Open
Abstract
Leg cramping is a common side effect of hemodialysis, and this is frequently treated by the administration of carnitine, but this is not effective in every patient. Alkalosis is a key component of the etiology of leg cramping during hemodialysis sessions. This is mediated through the binding of calcium ions to serum albumin, which causes hypocalcemia, and an increase in the release of calcium ions from the sarcoplasmic reticulum. Normally the calcium pump on the sarcoplasmic reticulum consumes ATP and quickly reuptakes the released calcium ions, which rapidly stops excessive muscle contractions. Thus, carnitine deficiency results in prolonged muscle contraction because of ATP depletion. However, during ATP production, carnitine is only involved up to the stage of acyl-CoA transport into mitochondria, and for the efficient generation of ATP, the subsequent metabolism of acyl-CoA is also important. For example, β-oxidation and the tricarboxylic acid cycle may be affected by a deficiency of water-soluble vitamins and the electron transport chain requires coenzyme Q10, but statins inhibit its production. The resulting accumulation of excess long-chain acyl-CoA in mitochondria inhibits enzymes involved in energy production. Thus, carnitine administration may be used more effectively if clinicians are aware of its specific physiologic roles.
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Harmsen JF, Latella C, Mesquita R, Fasse A, Schumann M, Behringer M, Taylor J, Nosaka K. H-reflex and M-wave responses after voluntary and electrically evoked muscle cramping. Eur J Appl Physiol 2020; 121:659-672. [PMID: 33245422 DOI: 10.1007/s00421-020-04560-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Despite the widespread occurrence of muscle cramps, their underlying neurophysiological mechanisms remain unknown. To better understand the etiology of muscle cramps, this study investigated acute effects of muscle cramping induced by maximal voluntary isometric contractions (MVIC) and neuromuscular electrical stimulation (NMES) on the amplitude of Hoffmann reflexes (H-reflex) and compound muscle action potentials (M-wave). METHODS Healthy men (n = 14) and women (n = 3) participated in two identical sessions separated by 7 days. Calf muscle cramping was induced by performing MVIC of the plantar flexors in a prone position followed by 2.5-s NMES over the plantar flexors with increasing frequency and intensity. H-reflexes and M-waves evoked by tibial nerve stimulation in gastrocnemius medialis (GM) and soleus were recorded at baseline, and after MVIC-induced cramps and the NMES protocol. RESULTS Six participants cramped after MVIC, and H-reflex amplitude decreased in GM and soleus in Session 1 (- 33 ± 32%, - 34 ± 33%, p = 0.031) with a similar trend in Session 2 (5 cramped, p = 0.063), whereas the maximum M-wave was unchanged. After NMES, 11 (Session 1) and 9 (Session 2) participants cramped. H-reflex and M-wave recruitment curves shifted to the left in both sessions and muscles after NMES independent of cramping (p ≤ 0.001). CONCLUSION Changes in H-reflexes after a muscle cramp induced by MVIC and NMES were inconsistent. While MVIC-induced muscle cramps reduced H-reflex amplitude, muscle stretch to end cramping was a potential contributing factor. By contrast, NMES may potentiate H-reflexes and obscure cramp-related changes. Thus, the challenge for future studies is to separate the neural consequences of cramping from methodology-based effects.
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Affiliation(s)
- Jan-Frieder Harmsen
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany.
- Department of Nutrition and Movement Sciences, School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Christopher Latella
- Center for Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Neurophysiology Research Laboratory, Edith Cowan University, Joondalup, WA, Australia
| | - Ricardo Mesquita
- Center for Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | | | - Moritz Schumann
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Michael Behringer
- Faculty of Sport Sciences, Goethe University Frankfurt, Frankfurt, Germany
| | - Janet Taylor
- Center for Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Neurophysiology Research Laboratory, Edith Cowan University, Joondalup, WA, Australia
| | - Kazunori Nosaka
- Center for Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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Rollnik JD, Däuper J. [The cramp-fasciculation-syndrome (CFS)]. Fortschr Neurol Psychiatr 2020; 88:459-463. [PMID: 32717769 DOI: 10.1055/a-1019-7646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The present review focuses on the cramp-fasciculation syndrome, a benign disorder which is regarded as a hyperexcitability syndrome of the peripheral nervous system. The article presents clinical features, pathophysiology, differential diagnosis, therapy and a case report to illustrate the cramp-fasciculation-syndrome.
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Affiliation(s)
- Jens D Rollnik
- Institut für neurorehabilitative Forschung (InFo), Medizinische Hochschule Hannover, BDH-Klinik Hess. Oldendorf gGmbH
| | - Jan Däuper
- Institut für neurorehabilitative Forschung (InFo), Medizinische Hochschule Hannover, BDH-Klinik Hess. Oldendorf gGmbH
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Abstract
Muscle cramp is a temporary but intense and painful involuntary contraction of skeletal muscle that can occur in many different situations. The causes of, and cures for, the cramps that occur during or soon after exercise remain uncertain, although there is evidence that some cases may be associated with disturbances of water and salt balance, while others appear to involve sustained abnormal spinal reflex activity secondary to fatigue of the affected muscles. Evidence in favour of a role for dyshydration comes largely from medical records obtained in large industrial settings, although it is supported by one large-scale intervention trial and by field trials involving small numbers of athletes. Cramp is notoriously unpredictable, making laboratory studies difficult, but experimental models involving electrical stimulation or intense voluntary contractions of small muscles held in a shortened position can induce cramp in many, although not all, individuals. These studies show that dehydration has no effect on the stimulation frequency required to initiate cramping and confirm a role for spinal pathways, but their relevance to the spontaneous cramps that occur during exercise is questionable. There is a long history of folk remedies for treatment or prevention of cramps; some may reduce the likelihood of some forms of cramping and reduce its intensity and duration, but none are consistently effective. It seems likely that there are different types of cramp that are initiated by different mechanisms; if this is the case, the search for a single strategy for prevention or treatment is unlikely to succeed.
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Affiliation(s)
- Ronald J Maughan
- School of Medicine, St Andrews University, St Andrews, Scotland, UK.
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Huang J, Li H, Zhou R, Huang W, Lin W, Chen T, Long Y. Clinical Heterogeneity in Patients with Glutamate Decarboxylase Antibody. Neuroimmunomodulation 2019; 26:234-238. [PMID: 31661704 DOI: 10.1159/000502695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/08/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To explore the diversity and clinical features of anti-glutamate decarboxylase (GAD) antibody-associated neurological diseases. METHODS Clinical data of a series of 5 patients positive for anti-GAD antibodies were retrospectively analyzed. RESULTS All 5 patients were female, with a median age of 41.5 years (range 19-60 years). Their neurological symptoms included stiff-person syndrome (SPS), encephalitis, myelitis, cramp, visual loss, and paresthesia. Three patients (60%) were diagnosed with tumors, 2 cases of thymic tumor and 1 of breast cancer. On immunohistochemistry for tumor pathology, expression of GAD65 was found only in 1 patient. Four patients (80%) had abnormal brain MRI findings. All patients received immunotherapy and improved significantly after treatment, but 4 (80%) then experienced a relapse. CONCLUSIONS Neurological manifestations in anti-GAD-positive patients are diverse and include SPS, encephalitis, myelitis, cramp, visual loss, and paresthesia.
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Affiliation(s)
- Jiehong Huang
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Guangzhou, China
- Second Clinical College, Guangzhou Medical University, Xinzao, Panyu District, Guangzhou, China
| | - Huilu Li
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Guangzhou, China
- Second Clinical College, Guangzhou Medical University, Xinzao, Panyu District, Guangzhou, China
| | - Ruisi Zhou
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Guangzhou, China
- Second Clinical College, Guangzhou Medical University, Xinzao, Panyu District, Guangzhou, China
| | - Wenyao Huang
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Guangzhou, China
- Second Clinical College, Guangzhou Medical University, Xinzao, Panyu District, Guangzhou, China
| | - Wenhui Lin
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Guangzhou, China
- Second Clinical College, Guangzhou Medical University, Xinzao, Panyu District, Guangzhou, China
| | - Ting Chen
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Guangzhou, China
- Second Clinical College, Guangzhou Medical University, Xinzao, Panyu District, Guangzhou, China
| | - Youming Long
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China,
- Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Guangzhou, China,
- Second Clinical College, Guangzhou Medical University, Xinzao, Panyu District, Guangzhou, China,
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Carris NW, Tsalatsanis A, Tipparaju SM, Cheng F, Magness RR, Kumar A. Metformin's impact on statin-associated muscle symptoms: An analysis of ACCORD study data and research materials from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center. Diabetes Obes Metab 2018; 20:1994-1999. [PMID: 29577553 DOI: 10.1111/dom.13302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/10/2018] [Accepted: 03/20/2018] [Indexed: 12/01/2022]
Abstract
Statins are widely prescribed, yet statin muscle pain limits their use, leading to increased cardiovascular risk. No validated therapy for statin muscle pain exists. The goal of the study was to assess whether metformin was associated with reduced muscle pain. A secondary analysis of data from the ACCORD trial was performed. An ACCORD sub-study assessed patients for muscle cramps and leg/calve pain while walking, typical non-severe statin muscle pain symptoms. We compared muscle pain between patients using a statin (n = 445) or both a statin and metformin (n = 869) at baseline. Overall patient characteristics were balanced between groups. Unadjusted analysis showed fewer reports of muscle cramps (35%) and leg/calve pain while walking (40%) with statins and metformin compared to statin only (muscle cramps, 42%; leg/calve pain while walking, 47%). Multivariable regression demonstrated a 22% odds reduction for muscle cramps (P = 0.049) and a 29% odds reduction for leg/calve pain while walking (P = 0.01). Metformin appears to reduce the risk of non-severe statin muscle pain and additional research is needed to confirm the findings and assess metformin's impact on statin adherence and related cardiovascular outcomes.
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Affiliation(s)
- Nicholas W Carris
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida, College of Pharmacy, Tampa, Florida
- Department of Family Medicine, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Athanasios Tsalatsanis
- Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Srinivas M Tipparaju
- Department of Pharmaceutical Sciences, University of South Florida, College of Pharmacy, Tampa, Florida
| | - Feng Cheng
- Department of Pharmaceutical Sciences, University of South Florida, College of Pharmacy, Tampa, Florida
| | - Ronald R Magness
- Department of Obstetrics and Gynecology, University of South Florida, Perinatal Research Vascular Center Morsani College of Medicine, Tampa, Florida
| | - Ambuj Kumar
- Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Florida
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Bougea A, Kapaki E, Constantinides V, Yapijakis C, Paraskevas GP. An unusual phenocopy of the HANAC syndrome without genetic involvement of COL4A1/COL4A2. Acta Neurol Belg 2018; 118:135-136. [PMID: 29423873 DOI: 10.1007/s13760-018-0890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/29/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Anastasia Bougea
- 1st Department of Neurology, Cognitive and Movement Disorders Clinic, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, 72 Vas. Sophias Ave, 11528, Athens, Greece.
| | - Elisabeth Kapaki
- 1st Department of Neurology, Cognitive and Movement Disorders Clinic, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, 72 Vas. Sophias Ave, 11528, Athens, Greece
| | - Vassilis Constantinides
- 1st Department of Neurology, Cognitive and Movement Disorders Clinic, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, 72 Vas. Sophias Ave, 11528, Athens, Greece
| | - Christos Yapijakis
- 1st Department of Neurology, Cognitive and Movement Disorders Clinic, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, 72 Vas. Sophias Ave, 11528, Athens, Greece
| | - George P Paraskevas
- 1st Department of Neurology, Cognitive and Movement Disorders Clinic, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, 72 Vas. Sophias Ave, 11528, Athens, Greece
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Abstract
Hereditary neuropathy with liability to pressure palsies (HNPP) is a rare autosomal-dominant disorder that most commonly produces recurrent painless focal sensory and motor neuropathies often preceded by minor, mechanical stress, or minor trauma. Herein, we report 2 pediatric cases of HNPP with atypical presentations; isolated muscle cramping and toe walking. Electrophysiologic testing disclosed multifocal sensorimotor polyneuropathy with slowing of sensory conduction velocities in both cases, which prompted PMP 22 gene deletion testing. Multifocal sensorimotor electrophysiologic abnormalities, with slowing of sensory conduction velocities should raise consideration of HNPP in childhood. These case reports emphasize that the diagnosis of HNPP in children requires a high index of suspicion.
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Affiliation(s)
- Yohei Harada
- *Department of Neurology, University of Rochester Medical Center, Rochester, NY; and †Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Quinine, cramps and heart failure: deaths. Quinine has an unfavourable harm-benefit balance in the treatment of cramps. Prescrire Int 2016; 25:243. [PMID: 30688424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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10
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Karatas F, Sahin S, Babacan T, Akin S, Sever AR, Altundag K. Leg cramps associated with tamoxifen use--possible mechanism and treatment recommendations. J BUON 2016; 21:520. [PMID: 27273968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Fatih Karatas
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Caress JB, Ciarlone SL, Sullivan EA, Griffin LP, Cartwright MS. Natural history of muscle cramps in amyotrophic lateral sclerosis. Muscle Nerve 2015; 53:513-7. [PMID: 26332705 DOI: 10.1002/mus.24892] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 06/19/2015] [Accepted: 08/31/2015] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Muscle cramping is a common symptom in amyotrophic lateral sclerosis (ALS) that lacks efficacious treatment. The natural history of this symptom is unknown, which hampers efforts to design optimal clinical trials. METHODS We surveyed early stage ALS patients about their experience with cramps each month by phone for up to 21 months. RESULTS Cramps developed in 95% of patients over the course of their disease. The number of cramps experienced by an individual varied widely from month-to-month and trended lower after the first year of illness (P = 0.26). Those with limb-onset and age >60 years had more cramps than bulbar-onset (P < 0.0001) and younger patients (P < 0.0001). CONCLUSIONS The high variability of the number of cramps experienced suggests that clinical trials will need to use crossover designs or large numbers of participants, even when the treatment effect is substantial.
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Affiliation(s)
- James B Caress
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Stephanie L Ciarlone
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | | | - Leah P Griffin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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de Entrambasaguas M, Ponz A, Sánchez-Monzó P, Peñaranda N. [Fasciculations, cramps, and statins]. Rev Neurol 2015; 60:380-381. [PMID: 25857862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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What can I do to ease the pain of a "charley horse"? Johns Hopkins Med Lett Health After 50 2014; 26:7. [PMID: 25241415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
Although simple characterization of discomfort as cramps, heaviness, shooting pains, and so forth can be misleading, history and examination are key to accurate diagnosis. Absence of both dorsalis pedis and posterior tibial pulses strongly suggests peripheral arterial disease (PAD), and the presence of either pulse makes PAD less likely. Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) are a common cause of lower extremity myalgias. Restless legs syndrome causes nocturnal discomfort but must be distinguished from confounding“mimics." Neurologic causes of leg symptoms include lumbar spinal stenosis, radiculopathy, distal symmetric polyneuropathy, and entrapment neuropathy. Many common causes of leg discomfort can be managed conservatively.
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Affiliation(s)
- Douglas Berger
- General Medicine Service, Department of Medicine, VA Puget Sound, University of Washington, 1660 South Columbian Way, Seattle, WA 98108, USA.
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Abstract
Myofascial trigger points (MTrPs) are hyperirritable points located within a taut band of skeletal muscle or fascia, which cause referred pain, local tenderness and autonomic changes when compressed. There are fundamental differences between the effects produced by the two basic types of MTrPs (active and latent). Active trigger points (ATrPs) usually produce referred pain and tenderness. In contrast, latent trigger points (LTrPs) are foci of hyperirritability in a taut band of muscle, which are clinically associated with a local twitch response, tenderness and/or referred pain upon manual examination. LTrPs may be found in many pain-free skeletal muscles and may be "activated" and converted to ATrPs by continuous detrimental stimuli. ATrPs can be inactivated by different treatment strategies; however, they never fully disappear but rather convert to the latent form. Therefore, the diagnosis and treatment of LTrPs is important. This review highlights the clinical implication of LTrPs.
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Affiliation(s)
- Derya Celik
- Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul University, Istanbul, Turkey.
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Rosenbaum D, Dallongeville J, Sabouret P, Bruckert E. Discontinuation of statin therapy due to muscular side effects: a survey in real life. Nutr Metab Cardiovasc Dis 2013; 23:871-875. [PMID: 22748604 DOI: 10.1016/j.numecd.2012.04.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 04/20/2012] [Accepted: 04/25/2012] [Indexed: 01/14/2023]
Abstract
BACKGROUNDS AND AIMS To assess the burden of statin related muscular symptom in real life. METHODS AND RESULTS We conducted a wide survey on 10,409 French subjects. Among these, 2850 (27%) had hypercholesterolemia and 1074 were treated with statins. Muscular symptoms were reported by 104 (10%) statin treated patients and led to discontinuation in 30% of the symptomatic patients. The main prescribed statins were low doses rosuvastatin, atorvastatin and simvastatin. Pains were the most commonly described symptoms (87%) but many patients also reported stiffness (62%), cramps (67%), weakness or a loss of strength during exertion (55%). Pain was localized in 70% but mostly described as affecting several muscular groups. Approximately 38% of patients reported that their symptoms prevented even moderate exertion during everyday activities, while 42% of patients suffered major disruption to their everyday life. CONCLUSION Muscular symptoms associated with average dosage statin therapy are more frequent than in clinical trials and have a greater impact on patients' life than usually thought.
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Affiliation(s)
- D Rosenbaum
- Unité de Prévention Cardiovasculaire, Service d'Endocrinologie Métabolisme, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France; UPMC Université Paris 06, UMR S 939, F-75013, France.
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Lee KK, Omiya Y, Yuzurihara M, Kase Y, Kobayashi H. Antispasmodic effect of shakuyakukanzoto extract on experimental muscle cramps in vivo: role of the active constituents of Glycyrrhizae radix. J Ethnopharmacol 2013; 145:286-293. [PMID: 23164761 DOI: 10.1016/j.jep.2012.11.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 11/01/2012] [Accepted: 11/04/2012] [Indexed: 06/01/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Shakuyakukanzoto (SKT) composed of Glycyrrhizae radix (G. radix) and Paeoniae radix (P. radix) has been traditionally used in Japan, Korea and China as an antispasmodic drug for the treatment of skeletal muscle cramps and intestinal cramps. AIM OF THIS STUDY To evaluate the antispasmodic activity of SKT and its two components, as well as to identify the key constituents of the components which mediate this effect in skeletal muscles in vivo. MATERIALS AND METHODS An experimental cramp model was constructed to evaluate the effects of peripherally-acting muscle relaxants on electrically-induced cramps under physiological conditions. This was accomplished by surgically isolating the motor supply to the gastrocnemius muscle in an anesthetized rat and delivering electrical stimuli to an isolated tibial nerve to induce tetanic contractions. We first tested dantrolene, a well-known peripherally-acting relaxant, to determine the sensitivity and reliability of our experimental model. We then evaluated the effects of SKT, P. radix, G. radix, and the eight active constituents of G. radix against tetanic contractions. RESULTS We found that dantrolene (10 and 30 mg/kg, i.d.) rapidly and significantly inhibited tetanic contractions (P<0.01) irrespective of dose. SKT (0.5, 1.0, and 2.0 g/kg, i.d.) and G. radix (0.5 and 1.0 g/kg, i.d.) also significantly inhibited tetanic contractions (P<0.01) but in a dose-dependent manner owing to the actions of six of the eight active constituents in G. radix (liquiritin apioside, liquiritigenin, isoliquiritin apioside, isoliquiritigenin, glycycoumarin, and glycyrrhetinic acid, 20 μmol/kg, i.v.). These constituents, which include flavonoids, a triterpenoid, and a courmarin derivative, demonstrated temporal variations in their inhibitory activity. In contrast, P. radix (0.5 and 1.0 g/kg, i.d.) did not show a statistically significant antispasmodic effect in our study; however, we previously found that it had a significant antinociceptive effect. CONCLUSIONS Our findings show that SKT inhibits tetanic contractions in vivo and that G. radix is the main antispasmodic component due to the actions of its active constituents, thus supporting the traditional use of SKT. We further propose that SKT containing the antispasmodic G. radix and antinociceptive P. radix is a pharmaceutically elegant option for muscle cramps as treatment requires a two-pronged approach, i.e., inhibition of hyperexcitable skeletal tissues and modulation of the pain accompanying cramps.
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Affiliation(s)
- Keiko K Lee
- Department of Hospital Administration and Center for Advanced Kampo Medicine and Clinical Research, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
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Braulick KW, Miller KC, Albrecht JM, Tucker JM, Deal JE. Significant and serious dehydration does not affect skeletal muscle cramp threshold frequency. Br J Sports Med 2012; 47:710-4. [PMID: 23222192 DOI: 10.1136/bjsports-2012-091501] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kyle W Braulick
- Departments of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108-6050, USA
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Ochsner F. [The mucisian's cramp. About the illness of Robert Schumann]. Rev Med Suisse 2012; 8:66-69. [PMID: 22303744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The musicians are seen in daily neurological practice facing various problems sometimes simple such as skeletal or tendon pain or even compression of a nerve trunk and sometimes more complicated such as focal dystonia. Dystonia often has a dramatic impact on the career of a musician given the complexity of the clinical and therapeutic approach and the results are often disappointing. The history of the German Romantic composer Robert Schumann illustrates this reality; through his story a discussion of both the different pathophysiological hypotheses responsible for focal dystonia, a disorder of brain plasticity, and of the multimodal therapeutic approaches, revisited in the light of neurophysiological findings will be described.
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Affiliation(s)
- F Ochsner
- Médecin agréé, Département des neurosciences cliniques, CHUV, Av. Léopold-Robert 66, 2301 La Chaux-de-Fonds.
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20
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Raymond CB, Wazny LD. Treatment of leg cramps in patients with chronic kidney disease receiving hemodialysis. CANNT J 2011; 21:19-23. [PMID: 22013661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Colette B Raymond
- Winnipeg Regional Health Authority, Manitoba Renal Program, Winnipeg, MB.
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21
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22
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Schwellnus MP, Allie S, Derman W, Collins M. Increased running speed and pre-race muscle damage as risk factors for exercise-associated muscle cramps in a 56 km ultra-marathon: a prospective cohort study. Br J Sports Med 2011; 45:1132-6. [PMID: 21402566 DOI: 10.1136/bjsm.2010.082677] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Martin P Schwellnus
- Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa.
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23
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Burakgazi AZ, Kelly JJ. A patient with progressive weakness and cramping of right arm and both legs. Diagnosis: persistent, multifocal, partial conduction blocks (CB) of motor axons outside the common sites of nerve entrapment. Rev Neurol Dis 2010; 7:e85-e97. [PMID: 20944528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 44-year-old man presented with a 1-year history of progressive muscle weakness and cramping. Neurophysiology study, along with clinical presentation, was diagnostic. The differential diagnosis, diagnostic testing, treatment, and prognosis of this rare disease are discussed.
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Affiliation(s)
- Ahmet Z Burakgazi
- Department of Neurology, George Washington University Medical Center, Washington, DC, USA
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24
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Abstract
Primary muscle cramps, without known cause, are very frequent especially in the elderly and during the night. They are different from secondary cramps. Likewise they are to be separated from several syndromes erroneously quoted as cramps. The pathophysiological mechanism seems due to result from an initial dysfunction in the distal part of the motoneuron. When the cramps are severe, differential diagnosis with amyotrophic lateral sclerosis may be difficult. Quinine is the best empiric treatment largely used in spite of moderate side effects.
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Affiliation(s)
- G Serratrice
- Service de neurologie et maladies neuromusculaires, Pr J. Pouget, hôpital la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France. georges.@medecine.univ-mrs.fr
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25
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Minetto MA, Botter A, Ravenni R, Merletti R, De Grandis D. Reliability of a novel neurostimulation method to study involuntary muscle phenomena. Muscle Nerve 2008; 37:90-100. [PMID: 17912751 DOI: 10.1002/mus.20903] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Experimental methods involving painful electrical stimulation of a peripheral nerve showed the existence of a minimum stimulation frequency capable of inducing cramp, termed "threshold frequency" (TF). Our aim was to test an alternative method to induce fasciculations and cramps electrically. Two daily sessions of electrical stimulation of the abductor hallucis muscle were performed in 19 volunteers on 3 days: stimulation trains of 150 monophasic square pulses (duration 152 micros) of increasing frequency (current intensity 30% higher than maximal; frequency of the first trial, 4 pps; recovery between trials, 1 min) were delivered to the main muscle motor point until a cramp developed. Once a cramp was induced the protocol was repeated after 30 min. To verify by electromyography that cramp occurred, a surface electrode array was placed between the motor point and the distal tendon. Ambient and skin temperature were kept constant in all sessions. Fasciculations and cramps were elicited in all subjects. We observed the following median (interquartile range) values of TF: day 1 (session 1), 13 (6) pps; day 1 (session 2), 16 (4) pps; day 2 (session 1), 16 (6) pps; day 2 (session 2), 18 (6) pps; day 3 (session 1), 17 (4) pps; day 3 (session 2), 18 (8) pps. TF intersession intraclass correlation coefficients were 0.82, 0.92, and 0.90 for days 1, 2, and 3, respectively. TF interday intraclass correlation coefficient was 0.85. The absence of pain due to the stimulation and the demonstration of TF reliability support the use of our method for the study of involuntary muscle phenomena.
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Affiliation(s)
- Marco Alessandro Minetto
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Turin, Turin, Italy
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26
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Abstract
Hemodialysis patients are susceptible to muscle cramps, both during dialysis sessions as well as in the interdialytic interval. These cramps are often very painful, disruptive to the dialysis treatment, and adversely affect quality of life. There is no well-defined means of preventing or treating these cramps. Quinine sulfate has been used with apparent success in some patients, but the Food and Drug Administration recently ordered the cessation of marketing of unapproved quinine formulations and advised consumers to avoid "off-label" use of quinine for cramps. We review the causes and consequences of hemodialysis-associated cramps, and discuss possible preventive measures and treatments.
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Affiliation(s)
- Sidney M Kobrin
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania School of Medicine and Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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27
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Abstract
Muscle cramp was induced in one head of the gastrocnemius muscle (GA) in eight of thirteen subjects using maximum voluntary contraction when the muscle was in the shortened position. Cramp in GA was painful, involuntary, and localized. Induction of cramp was indicated by the presence of electromyographic (EMG) activity in one head of GA while the other head remained silent. In all cramping subjects, reflex inhibition of cramp electrical activity was observed following Achilles tendon electrical stimulation and they all reported subjective relief of cramp. Thus muscle cramp can be inhibited by stimulation of tendon afferents in the cramped muscle. When the inhibition of cramp-generated EMG and voluntary EMG was compared at similar mean EMG levels, the area and timing of the two phases of inhibition (I(1), I(2)) did not differ significantly. This strongly suggests that the same reflex pathway was the source of the inhibition in both cases. Thus the cramp-generated EMG is also likely to be driven by spinal synaptic input to the motorneurons. We have found that the muscle conditions that appear necessary to facilitate cramp, a near to maximal contraction of the shortened muscle, are also the conditions that render the inhibition generated by tendon afferents ineffective. When the strength of tendon inhibition in cramping subjects was compared with that in subjects that failed to cramp, it was found to be significantly weaker under the same experimental conditions. It is likely that reduced inhibitory feedback from tendon afferents has an important role in generating cramp.
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Affiliation(s)
- Serajul I Khan
- School of Biomedical Sciences, University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia
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28
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Abstract
Muscle cramps are involuntary, painful, spasmodic contractions of the skeletal muscle. Although cramps are a common clinical complaint, their etiology and management have not been well established. Exercise-associated muscle cramps occur during or immediately following exercise, and they are associated with muscular fatigue and shortened muscle contraction. The main challenges for treating physicians are to identify whether the complaint represents a true muscle cramp as well as to rule out the presence of an underlying serious clinical condition. Muscle cramps may be a symptom of any of several conditions, including radiculopathies, Parkinson's disease, hypothyroidism, diabetes mellitus, vascular problems, electrolyte disorders, and metabolic myopathies. Cramps also may occur as a side effect of certain drugs (eg, lipid-lowering agents, antihypertensives, beta-agonists, insulin, oral contraceptives, alcohol). Most athletes who experience exercise-associated muscle cramps are healthy individuals without systemic illness. Therapy should focus on preventing premature fatigue by means of appropriate nutrition and adequate training.
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Affiliation(s)
- Javier Maquirriain
- Orthopaedics and Sports Medicine Research, High Performance National Sports Centre, Buenos Aires, Argentina
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Serrao M, Arendt-Nielsen L, Ge HY, Pierelli F, Sandrini G, Farina D. Experimental muscle pain decreases the frequency threshold of electrically elicited muscle cramps. Exp Brain Res 2007; 182:301-8. [PMID: 17551719 DOI: 10.1007/s00221-007-0985-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 05/05/2007] [Indexed: 11/30/2022]
Abstract
This study in humans tested the hypothesis that nociceptive muscle afferent input facilitates the occurrence of muscle cramps. In 13 healthy adults, muscle cramps were experimentally induced in the foot by stimulating the tibialis posterior nerve at the ankle with 2-s bursts of stimuli separated by 30 s, with stimulation frequency increasing by 2-Hz increments from 10 Hz until the cramp appeared. The minimum stimulation frequency that induced the cramp was defined "cramp frequency threshold". In 2 days, elicitation of the cramp was performed in the two-feet with and without (baseline condition) injection of hypertonic (painful condition) or isotonic (control condition) saline into the deep midportion of the flexor hallucis brevis muscle, from where surface EMG signals were recorded. The cramp frequency threshold was lower for the painful condition with respect to its baseline (mean +/- SE, hypertonic saline: 25.7 +/- 2.1 Hz, corresponding baseline: 31.2 +/- 2.8 Hz; P < 0.01) while there was no difference between the threshold with isotonic injection with respect to baseline. EMG average rectified value and power spectral frequency were higher during the cramp than immediately before the stimulation that elicited the cramp (pre-cramp: 13.9 +/- 1.6 muV and 75.4 +/- 3.8 Hz, respectively; post-cramp: 19.9 +/- 3.2 muV and 101.6 +/- 6.0 Hz; P < 0.05). The results suggest that nociceptive muscle afferent activity induced by injection of hypertonic saline facilitates the generation of electrically elicited muscle cramps.
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Affiliation(s)
- Mariano Serrao
- Rehabilitation Unit, Polo Pontino-ICOT, Latina, University of Rome La Sapienza, Rome, Italy
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30
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31
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Solly S. Clinical lectures on scriveners' palsy, or the paralysis of writers. 1864. Clin Orthop Relat Res 2007; 458:42-6. [PMID: 17473598 DOI: 10.1097/blo.0b013e31803defe9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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32
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McCrory P. A stitch in time. Br J Sports Med 2007; 41:125. [PMID: 17337487 PMCID: PMC2465227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Finsterer J, Fröhlinger W. Tramazoline turns asymptomatic into symptomatic hyper-CK-emia. Eur J Neurol 2007; 14:e7. [PMID: 17355540 DOI: 10.1111/j.1468-1331.2006.01592.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Skeletal muscle cramps are commonly encountered in marathon runners by medical staff. However, the aetiology, and therefore management, of this condition is not well understood. Exercise-associated muscle cramping (EAMC) is defined as an involuntary, painful contraction of skeletal muscle during or immediately after exercise. In early anecdotal reports, cramps were associated with profuse sweating, together with changes in serum electrolyte concentrations. No mechanism explains how such imbalances in serum electrolytes result in localised muscle cramping. The 'muscle fatigue' hypothesis suggests that EAMC is the result of an abnormality of neuromuscular control at the spinal level in response to fatiguing exercise and is based on evidence from epidemiological studies, animal experimental data on spinal reflex activity during fatigue and electromyogram data recorded during bouts of acute cramping after fatiguing exercise. The development of premature muscle fatigue appears to explain the onset of EAMC.
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Affiliation(s)
- Martin P Schwellnus
- UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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35
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Oh SJ, Park KS, Ryan HF, Danon MJ, Lu J, Naini AB, DiMauro S. Exercise-induced cramp, myoglobinuria, and tubular aggregates in phosphoglycerate mutase deficiency. Muscle Nerve 2006; 34:572-6. [PMID: 16881065 DOI: 10.1002/mus.20622] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report two patients in whom phosphoglycerate mutase (PGAM) deficiency was associated with the triad of exercise-induced cramps, recurrent myoglobinuria, and tubular aggregates in the muscle biopsy. Serum creatine kinase (CK) levels were elevated between attacks of myoglobinuria. Forearm ischemic exercise tests produced subnormal increases of venous lactate. Muscle biopsies showed subsarcolemmal tubular aggregates in type 2 fibers. Muscle PGAM activities were markedly decreased (3% of the normal mean) and molecular genetic studies showed that both patients were homozygous for a described missense mutation (W78X). A review of 15 cases with tubular aggregates in the muscle biopsies from our laboratory and 15 cases with PGAM deficiency described in the literature showed that this clinicopathological triad is highly suggestive of PGAM deficiency.
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Affiliation(s)
- Shin J Oh
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
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36
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Richardson M. Muscle physiology--part 4: movement and muscle problems. Nurs Times 2006; 102:26-7. [PMID: 17212293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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37
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Zivkovic SA, Lacomis D, Medsger TA. Muscle cramps associated with localized scleroderma skin lesions: focal dystonia, neuromyotonia, or nerve entrapment? J Rheumatol 2006; 33:2549. [PMID: 17143993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Tamura N, Kuwabara S, Misawa S, Kanai K, Nakata M, Sawai S, Hattori T. Increased nodal persistent Na+ currents in human neuropathy and motor neuron disease estimated by latent addition. Clin Neurophysiol 2006; 117:2451-8. [PMID: 16996798 DOI: 10.1016/j.clinph.2006.07.309] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Revised: 07/22/2006] [Accepted: 07/25/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the changes in nodal persistent Na(+) currents in human neuropathy and motor neuron disease. In human motor axons, approximately 1.0% of total Na(+) channels are active at rest, termed "persistent" Na(+) channels, and the conductance can be non-invasively estimated by the technique of latent addition in vivo. METHODS Latent addition was performed in median motor axons of 93 patients with axonal neuropathy (n=38), lower motor neuron disorder (LMND; n=19) or amyotrophic lateral sclerosis (ALS; n=36) and in 27 age-matched normal subjects. Brief hyperpolarizing conditioning current pulses were delivered, and threshold change at the conditioning-test interval of 0.2 ms was measured as an estimator of the magnitude of persistent Na(+) currents. Threshold electrotonus and supernormality were also measured as indicators of resting membrane potential. RESULTS Threshold changes at 0.2 ms were significantly greater in patients with neuropathy or LMND (p<0.05), and tended to be greater in ALS patients (p=0.075) than in normal controls. Threshold electrotonus and supernormality did not differ in each patient group and normal controls, suggesting that membrane potential is not altered in patients. In the recovery phase of axonal neuropathy, the threshold changes increased in parallel with an increase in amplitudes of compound muscle action potential. CONCLUSIONS Persistent Na(+) currents appear to increase commonly in disorders involving lower motor neurons, possibly associated with axonal regeneration or collateral sprouting or changes in Na(+) channel gating. SIGNIFICANCE The increased axonal excitability could partly be responsible for positive motor symptoms such as muscle cramping frequently seen in lower motor neuron disorders.
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Affiliation(s)
- Noriko Tamura
- Department of Neurology, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
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39
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Ziltener JL, Leal S. [Exercise-associated muscle cramps]. Rev Med Suisse 2006; 2:1787-91. [PMID: 16927557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Exercice-associated muscle cramps are a common sports-medical problem, although often benign, among athletes of endurance-sports above all. They are characterized by a painful, sudden and involuntary contraction of one or more muscular groups. If they become recurrent and/or uncomfortable, they should then be the subject of a thorough etiologic research. Medical history, conventional physical examination and a limited laboratory screen could help to determine the various possible causes of muscle cramp. The "historical" and more recent physiopathological assumptions are systematically reviewed, just as the therapeutic options which are guided as well on empiricism and experience that on medicamentous limited trials.
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Affiliation(s)
- J L Ziltener
- Unité d'orthopédie et traumatologie du sport, Service d'orthopédie, Département de chirurgie, HUG, 1211 Genève 14.
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Abstract
PURPOSE To compare serum electrolyte concentrations of cramping and control Ironman triathletes. METHODS Triathletes suffering from acute exercise-associated muscle cramping (EAMC) after the 2000 South African Ironman Triathlon formed the cramping group (CR, N = 11). Non-cramping triathletes matched for race finishing time and body mass formed the control group (CON, N = 9). All subjects were weighed at race start and immediately post-race. Blood samples were drawn from both groups during recovery for the analysis of serum magnesium, glucose, sodium, potassium and chloride concentrations. Hemoglobin concentration and hematocrit were also measured. Surface electromyography (EMG) (mV) was recorded from a non-cramping control muscle (triceps) and the most severely cramping lower limb muscle of the CR group. EMG was recorded at the beginning of every minute for a 10-min period during recovery. RESULTS There were no significant differences between the groups for body mass or percent body mass loss during the race. Post-race sodium concentration was significantly lower (P = 0.01) in the CR group than the CON group (140 +/- 2 vs 143 +/- 3 mmol.L) but was within the normal clinical range of post-race serum sodium concentrations. There were no significant differences between the two groups for post-race serum electrolytes, glucose, hemoglobin concentrations or hematocrit. Surface EMG (mV) was significantly higher (P < 0.05) in the cramping muscles than the control muscle of the CR group at 0, 3, 4, and 5 min of the 10-min recording period. CONCLUSION Acute EAMC in ironman triathletes is not associated with a greater percent body mass loss or clinically significant differences in serum electrolyte concentrations. The increased EMG activity of cramping muscles may reflect increased neuromuscular activity.
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Affiliation(s)
- Nicole U Sulzer
- UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
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41
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Abstract
A questionnaire was administered to 848 participants (76% runners, 24% walkers) at the conclusion of the 14 km City to Surf community run in order to investigate their experience of exercise-related transient abdominal pain (ETAP). Twenty-seven percent of respondents reported experiencing ETAP during the event, with the condition reported more frequently (p< 0.01) by runners (30%) than walkers (16%). ETAP was mostly described as well-localised (88%) and of an aching (25%), sharp (22%) or cramping (22%) sensation. The most commonly-reported sites of the pain were the right (46%) and left lumbar (23%) regions of the abdomen. Forty-two percent of the respondents who experienced ETAP reported that the pain was detrimental to their performance. Reports of ETAP decreased with age (r= -0.23, p< 0.01) but were unrelated to gender, body mass index or the time taken to complete the event. Among respondents who ran, those who consumed a large mass of food relative to body weight in the time interval 1-2 hr before the event were more likely to develop symptoms of ETAP (p < 0.05). The nutritional content of the pre-event meal did not influence the experience of ETAP. Sufferers of ETAP were more likely to experience nausea (r = 0.12, p< 0.01) and report shoulder tip pain (r= 0.14, p< 0.01). The results indicate that ETAP is a commonly experienced problem and provide insights into the cause of the complaint.
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Affiliation(s)
- D P Morton
- Avondale Centre for Exercise Sciences, Faculty of Lifestyle Education, Avondale College, Cooranbong, New South Wales, Australia
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42
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Schwellnus MP, Nicol J, Laubscher R, Noakes TD. Serum electrolyte concentrations and hydration status are not associated with exercise associated muscle cramping (EAMC) in distance runners. Br J Sports Med 2005; 38:488-92. [PMID: 15273192 PMCID: PMC1724901 DOI: 10.1136/bjsm.2003.007021] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine whether acute exercise associated muscle cramping (EAMC) in distance runners is related to changes in serum electrolyte concentrations and hydration status. METHODS A cohort of 72 runners participating in an ultra-distance road race was followed up for the development of EAMC. All subjects were weighed before and immediately after the race. Blood samples were taken before the race, immediately after the race, and 60 minutes after the race. Blood samples were analysed for glucose, protein, sodium, potassium, calcium, and magnesium concentrations, as well as serum osmolality, haemoglobin, and packed cell volume. Runners who suffered from acute EAMC during the race formed the cramp group (cramp, n = 21), while runners with no history of EAMC during the race formed the control group (control, n = 22). RESULTS There were no significant differences between the two groups for pre-race or post-race body weight, per cent change in body weight, blood volume, plasma volume, or red cell volume. The immediate post-race serum sodium concentration was significantly lower (p = 0.004) in the cramp group (mean (SD), 139.8 (3.1) mmol/l) than in the control group (142.3 (2.1) mmol/l). The immediate post-race serum magnesium concentration was significantly higher (p = 0.03) in the cramp group (0.73 (0.06) mmol/l) than in the control group (0.67 (0.08) mmol/l). CONCLUSIONS There are no clinically significant alterations in serum electrolyte concentrations and there is no alteration in hydration status in runners with EAMC participating in an ultra-distance race.
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Affiliation(s)
- M P Schwellnus
- University of Cape Town, UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Boundary Road, Newlands 7700, South Africa.
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43
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Abstract
Task-specific dystonia significantly impairs the performance of approximately 8% of musicians [Lederman RJ. Muscle Nerve 2003;27:549-561]. We describe hand dystonia in two professional musicians experienced while playing tabla, a percussion instrument.
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Affiliation(s)
- Mona Ragothaman
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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44
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Rosenkranz K, Williamon A, Butler K, Cordivari C, Lees AJ, Rothwell JC. Pathophysiological differences between musician's dystonia and writer's cramp. Brain 2005; 128:918-31. [PMID: 15677703 DOI: 10.1093/brain/awh402] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Focal hand dystonia (FHD) has been suggested to be a maladaptive response of the brain to repetitive performance of stereotyped and attentionally demanding hand movements. However, not all patients with FHD have a strict history of excessive hand use; for example, patients with musician's dystonia (MD) spend many hours per day with their attention focused on instrumental practice, whereas many patients with writer's cramp (WC) have a history of average hand use. The present experiments test whether seven MD and six WC patients have different pathophysiological deficits by examining the spatial pattern of sensorimotor organization in the motor cortex. Two control groups were used, eight healthy non-musicians and eight healthy musicians. The latter served to control for physiological adaptation of the brain to musical training. We used focal vibration of a single hand muscle to produce sensory input whilst the excitability of corticospinal outputs to the vibrated and other hand muscles was evaluated with transcranial magnetic stimulation. In healthy non-musicians, vibration increases the amplitude of motor-evoked potentials and decreases the short-latency intracortical inhibition (SICI) in the vibrated muscle, whilst having the opposite effect on the non-vibrated hand muscles. The pattern of sensorimotor interaction was abnormal in both patient groups. However, the nature of the deficit differed between them. While vibration had little effect on cortical excitability in WC, it strongly reduced SICI in all hand muscles irrespective of spatial organization in MD. In the healthy musicians we found an organization intermediate between that of healthy non-musicians and MD. The data are consistent with a model in which musical practice in healthy musicians leads to beneficial changes in organization of the motor cortex, but in MD these progress too far and begin to interfere with movement rather than assist it. The fact that sensory input had no effect on motor output in patients with WC suggests that sensory information from the hand may play a smaller role in provoking pathological changes in WC than in MD.
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Affiliation(s)
- Karin Rosenkranz
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, UK.
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45
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Kuwabara S, Misawa S, Tamura N, Kanai K, Hiraga A, Ogawara K, Nakata M, Hattori T. The effects of mexiletine on excitability properties of human median motor axons. Clin Neurophysiol 2005; 116:284-9. [PMID: 15661106 DOI: 10.1016/j.clinph.2004.08.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the effects of mexiletine, an analog of lidocaine, on excitability of human axons in vivo. METHODS Threshold tracking was used to measure multiple excitability indices (strength-duration time constant, rheobase, refractoriness, supernormality, and threshold electrotonus) in median motor axons of 20 patients with neuropathic pain or muscle cramping, before and 3 months after treatment with oral 300 mg mexiletine per day. RESULTS After treatment, there was a reduction in pain/muscle cramps, associated with decreased strength-duration time constants (P=0.01), increased rheobasic currents (P=0.06), and lower refractoriness (P=0.02), all of which were consistent with reduced nodal Na+ currents. Supernormality and threshold electrotonus did not change significantly. The changes in strength-duration properties suggest a decrease in persistent Na+ conductance. The lowered refractoriness after treatment might result from reduced transient Na+ currents, but the lack of change in supernormality and threshold electrotonus was not consistent with this hypothesis. CONCLUSIONS Oral mexiletine in a dosage of 300 mg daily suppresses persistent Na+ currents in human motor axons. SIGNIFICANCE Measurements of the excitability indices can be used for non-invasive assessment and monitoring of the effects of mexiletine in patients with neuropathic pain or muscle cramps.
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Affiliation(s)
- Satoshi Kuwabara
- Department of Neurology, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
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Abstract
Muscle cramps are a common problem characterized by a sudden, painful, involuntary contraction of muscle. These true cramps, which originate from peripheral nerves, may be distinguished from other muscle pain or spasm. Medical history, physical examination, and a limited laboratory screen help to determine the various causes of muscle cramps. Despite the "benign" nature of cramps, many patients find the symptom very uncomfortable. Treatment options are guided both by experience and by a limited number of therapeutic trials. Quinine sulfate is an effective medication, but the side-effect profile is worrisome, and other membrane-stabilizing drugs are probably just as effective. Patients will benefit from further studies to better define the pathophysiology of muscle cramps and to find more effective medications with fewer side-effects.
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Affiliation(s)
- Timothy M Miller
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093-0670, USA.
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47
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Benatar M, Chapman KM, Rutkove SB. Repetitive nerve stimulation for the evaluation of peripheral nerve hyperexcitability. J Neurol Sci 2004; 221:47-52. [PMID: 15178213 DOI: 10.1016/j.jns.2004.03.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2003] [Revised: 02/13/2004] [Accepted: 03/14/2004] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine the utility of repetitive nerve stimulation (RNS) in the evaluation of peripheral nerve hyperexcitability (PNH). BACKGROUND PNH describes a group of disorders characterized by muscle cramps, twitching and stiffness. When severe, PNH may be characterized by the presence of continuous muscle fiber activity on routine needle electromyography (EMG). In milder forms of the disease, nerve hyperexcitability may be evidenced by the presence of after-discharges or cramp potentials following RNS. METHODS Fifty-four patients were prospectively recruited and classified into one of three groups-PNH, other neuromuscular disease and controls. We recorded and quantified the after-discharges and cramp potentials following RNS at 1, 5, 10 and 30 Hz. RESULTS The proportion of nerves with after-discharges and/or cramp potentials was significantly greater in the PNH group than the control group at both 5 Hz (p=0.03) and 10 Hz (p=0.01), as well as in the neuromuscular disease group compared to controls at 5 Hz (p=0.02). There was also a significant concordance between complaints of muscle cramps and fasciculations and the finding of after-discharges and/or cramp potentials at both 5 Hz (p=0.005) and 10 Hz (p=0.004). At a stimulation frequency of 10 Hz, the sensitivity of RNS for the diagnosis of PNH (primary or secondary) was 79% and the specificity was 88%. CONCLUSION Our findings suggest that RNS at or below a stimulation frequency of 10 Hz (when positive) is a useful test for the diagnosis of PNH, whether it is primary or secondary.
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Affiliation(s)
- Michael Benatar
- Department of Neurology, Emory University, 1365A Clifton Road N.E., Atlanta, GA 30322, USA.
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48
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Abstract
There is increasing evidence that autoimmunity is implicated in the pathogenesis of peripheral nerve hyperexcitability (neuromyotonia, NMT and Cramp-fasciculation syndrome C-FS ) and in Maladie de Morvan in which CNS features are also present. All three conditions can associate with thymoma, myasthenia gravis and other autoimmune disorders, and can often respond to plasma exchange. In NMT, patient's plasma or IgG can transfer the electrophysiological features to mice, and can reduce voltage-gated potassium channel currents in vitro. Antibodies to voltage-gated potassium channels can be detected in the serum of many patients who have peripheral nerve hyperexcitability, and also in those with Maladie de Morvan. These latter patients have clinical features similar to limbic encephalitis in which VGKC antibodies can also occur. Thus neuromyotonia, cramp-fasciculation syndrome and Maladie de Morvan can occur as antibody-mediated autoimmune ion channelopathies like myasthenia gravis and the Lambert-Eaton myasthenic syndrome. These discoveries should aid diagnosis and offer new approaches to treatment.
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Affiliation(s)
- J Newsom-Davis
- Department of Clinical Neurology, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE, UK.
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Cicarelli G, Della Rocca G, Amboni M, Ciacci C, Mazzacca G, Filla A, Barone P. Clinical and neurological abnormalities in adult celiac disease. Neurol Sci 2004; 24:311-7. [PMID: 14716525 DOI: 10.1007/s10072-003-0181-4] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2003] [Accepted: 09/20/2003] [Indexed: 02/07/2023]
Abstract
We assessed the occurrence of neurological signs and symptoms in adult patients with celiac disease and evaluated the correlation between neurological features and diet. A total of 176 patients and 52 age-matched controls underwent a semistructural interview and a neurologic examination. The effect of gluten-free diet was evaluated by comparing the prevalence of signs and symptoms among patients adhering to a gluten-free diet and patients on an unrestricted diet. The occurrence of headache, dysthymia and signs of peripheral neuropathy was significantly higher in patients with celiac disease than in control subjects. Adherence to a strict gluten-free diet was associated with a significant reduction of headache, dysthymia, cramps and weakness, but did not modify the occurrence of paresthesia or hyporeflexia. Neurological signs and symptoms are associated with celiac disease and can be ameliorated by a gluten-free diet.
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Affiliation(s)
- G Cicarelli
- Department of Neurological Sciences, Federico II University of Naples, Via S. Pansini 5, I-80131 Naples, Italy
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Lönnqvist T, Pihko H. Hereditary neuropathy with liability to pressure palsies (HNPP) in a toddler presenting with toe-walking, pain and stiffness. Neuromuscul Disord 2004; 13:827-9. [PMID: 14678806 DOI: 10.1016/s0960-8966(03)00134-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The typical clinical presentation of hereditary neuropathy with liability to pressure palsies is an adult-onset recurrent, painless monoparesis. Electrophysiological abnormalities--decreased nerve conduction velocities and delayed distal latencies--can be detected even in asymptomatic patients. We describe a toddler, who presented with asymmetric toe walking, painful cramps and stiffness in the legs. He had calf hypertrophy, brisk tendon reflexes and bilateral Babinski signs and the electrophysiological examination was normal. The unlikely diagnosis of hereditary neuropathy with liability to pressure palsies was reached 5 years later, when the boy started to complain of episodic numbness and weakness in the upper extremities. His father, paternal aunt and grandmother had similar symptoms, but they had never been investigated. The typical 1.5 Mb deletion on chromosome 17p11.2-12 was found in our patient and his affected relatives.
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MESH Headings
- Child
- Child, Preschool
- Chromosomes, Human, Pair 17/genetics
- Electromyography
- Gait Disorders, Neurologic/genetics
- Gait Disorders, Neurologic/physiopathology
- Genetic Predisposition to Disease/genetics
- Heredodegenerative Disorders, Nervous System/genetics
- Heredodegenerative Disorders, Nervous System/physiopathology
- Humans
- Male
- Muscle Cramp/genetics
- Muscle Cramp/physiopathology
- Muscle Hypertonia/genetics
- Muscle Hypertonia/physiopathology
- Muscle, Skeletal/innervation
- Muscle, Skeletal/physiopathology
- Myelin Proteins/deficiency
- Myelin Proteins/genetics
- Paralysis/genetics
- Paralysis/physiopathology
- Pedigree
- Peripheral Nerves/metabolism
- Peripheral Nerves/pathology
- Peripheral Nerves/physiopathology
- Peripheral Nervous System Diseases/congenital
- Peripheral Nervous System Diseases/genetics
- Peripheral Nervous System Diseases/physiopathology
- Reflex, Abnormal/genetics
- Reflex, Babinski/genetics
- Reflex, Babinski/physiopathology
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Affiliation(s)
- Tuula Lönnqvist
- Department of Child Neurology, Hospital for Children and Adolescents, University of Helsinki, Helsinki University Central Hospital (HUCH), 00029 Helsinki, Finland.
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