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© 2010 American Academy of Neurology Special Article Assessment: Symptomatic treatment for muscle cramps (an evidence-based review)Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of NeurologyFrom the Stanford University School of Medicine, Palo Alto, CA. Address correspondence and reprint requests to American Academy of Neurology, 1080 Montreal Ave., St. Paul, MN 55116guidelines{at}aan.com. Background: A Food and Drug Administration advisory in 2006 warned against the off-label use of quinine sulfate and its derivatives in the treatment of muscle cramps. Physicians are faced with a difficult scenario in choosing a treatment regimen for patients with muscle cramps. This American Academy of Neurology assessment systematically reviews the available evidence on the symptomatic treatment of muscle cramps. Methods: A total of 563 potential articles were reviewed, of which 24 met the inclusion criteria of prospective trials evaluating the efficacy of a particular treatment on muscle cramps as a primary or secondary outcome. Results: There are Class I studies showing the efficacy of quinine derivatives for treatment of muscle cramps. However, the benefit is modest and there are adverse effects from published prospective trials as well as case reports. There is one Class II study each to support the use of Naftidrofuryl, vitamin B complex, lidocaine, and diltiazem in the treatment of muscle cramps. Recommendations: Although likely effective (Level A), quinine derivatives should be avoided for routine use in the management of muscle cramps because of the potential of toxicity, but in select patients they can be considered for an individual therapeutic trial once potential side effects are taken into account. Vitamin B complex, Naftidrofuryl, and calcium channel blockers such as diltiazem are possibly effective and may be considered in the management of muscle cramps (Level C). Further studies are needed to identify agents that are effective and safe for the treatment of muscle cramps.
Abbreviations: ALS = amyotrophic lateral sclerosis; CI = confidence interval; FDA = Food and Drug Administration.
Supplemental data at www.neurology.org Appendices e-1 through e-4 and table e-1 are available on the Neurology® Web site at www.neurology.org. Approved by the Therapeutics and Technology Assessment Subcommittee on April 28, 2009; by the Practice Committee on July 1, 2009; and by the AAN Board of Directors on November 9, 2009. Disclosure: Author disclosures are provided at the end of the article. Received July 23, 2009. Accepted in final form November 9, 2009. This article has been cited by other articles:
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