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Meta-Analysis
. 2012 Apr 18;2012(4):CD004157.
doi: 10.1002/14651858.CD004157.pub2.

Treatment for cramps in amyotrophic lateral sclerosis/motor neuron disease

Reto Baldinger  1 , Hans Dieter Katzberg, Markus Weber
Affiliations
Meta-Analysis

Treatment for cramps in amyotrophic lateral sclerosis/motor neuron disease

Reto Baldinger et al. Cochrane Database Syst Rev. .

Abstract

Background: Cramps are painful, involuntary muscle contractions. They commonly affect people with amyotrophic lateral sclerosis/motor neuron disease (ALS/MND) at all stages of the disease. To date, the treatment of muscle cramps in ALS has been largely empirical without any evidence from randomised controlled trials.

Objectives: To systematically assess the effect of interventions on muscle cramps as a primary or secondary endpoint or adverse event in people with ALS/MND.

Search methods: We searched the Cochrane Neuromuscular Disease Group Specialized Register (14 February 2011), the Cochrane Central Register of Controlled Trials (Issue 1, 2011 in The Cochrane Library), MEDLINE (January 1966 to January 2011) and EMBASE (January 1980 to January 2011) and reference lists of articles searched using the terms motor neuron disease, motor neurone disease, motoneuron disease or amyotrophic lateral sclerosis. We contacted authors of trials for further information.

Selection criteria: We included all randomised and quasi-randomised trials of oral medications in people with ALS which assessed cramps as a primary or secondary outcome measure or as an adverse event. We also included trials using subcutaneous or intravenous medications or physical therapy.

Data collection and analysis: All authors applied the selection criteria and assessed study quality independently, and all authors performed independent data extraction.

Main results: Twenty studies including 4789 participants were identified. Only one trial, of tetrahydrocannabinol (THC), assessed cramps as the primary endpoint. Thirteen studies assessed cramps as a secondary endpoint. The medications comprised vitamin E, baclofen, riluzole, L-threonine, xaliproden, indinavir, and memantine. Six studies assessed cramps as an adverse event. The medications comprised creatine, gabapentin, dextromethorphan, quinidine, and lithium. In all 20 studies no favourable effect for the treatment of cramps in ALS/MND could be demonstrated, but many studies were underpowered to draw a definite conclusion. A meta-analysis of two small studies showed a statistically nonsignificant result for the amino acid L-threonine for the treatment of cramps in ALS/MND. No study was identified using physical therapy as a therapeutic intervention for cramps.

Authors' conclusions: There is no evidence to support the use of any intervention for muscle cramps in ALS/MND. More and larger randomised controlled trials evaluating treatments for muscle cramps in ALS/MND are needed.

PubMed Disclaimer

Conflict of interest statement

MW designed and conducted the study on THC for the treatment of cramps in ALS. He has not received any financial support or honoraria from the manufacturer. RB and HDK declare no known conflicts of interest.

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
2
2
Forest plot of comparison: 6 L‐threonine, outcome: 6.1 Muscle cramp VAS.
1.1
1.1. Analysis
Comparison 1 L‐threonine 2 g/d versus placebo, Outcome 1 Muscle cramp VAS.
2.1
2.1. Analysis
Comparison 2 Vitamin E 1g/d versus placebo, Outcome 1 Muscle cramp VAS.
3.1
3.1. Analysis
Comparison 3 Tetrahydrocannabinol (THC) versus placebo, Outcome 1 Muscle cramp VAS.
4.1
4.1. Analysis
Comparison 4 Memantine versus placebo, Outcome 1 Muscle cramp VAS.
5.1
5.1. Analysis
Comparison 5 Creatine versus placebo, Outcome 1 Cramps (side effect).
6.1
6.1. Analysis
Comparison 6 Indinavir versus placebo, Outcome 1 Cramps (side effect).
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD004157

References

References to studies included in this review

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Lacomblez 1989a {published data only}
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Miller 2007 {published data only}
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Nefussy 2010 {published data only}
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Panitch 2006 {published data only}
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Pascuzzi 2010 {published data only}
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Piepers 2009 {published data only}
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rHCNTF 1996 {published data only}
    1. ALS CNTF Treatment Study Group. A double‐blind placebo‐controlled clinical trial of subcutaneous recombinant human ciliary neurotrophic factor (rHCNTF) in amyotrophic lateral sclerosis. Neurology 1996;46(5):1244‐9. [PUBMED: 8628466] - PubMed
Rivera 1979 {published data only}
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Rivera 1980 {published data only}
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References to ongoing studies

Strong ongoing {published data only (unpublished sought but not used)}
    1. Randomised crossover design trial of vitamin E vs placebo for treatment of cramps in amyotrophic lateral sclerosis. Ongoing study December 2006.

Additional references

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