Makindo Medical Notes

What Are Cramps?

• Cramps are involuntary, painful contractions of a muscle or portion of a muscle.
• They are thought to originate distally in the motor neuron and are often accompanied by palpable knot-like hardening of the muscle.
• Cramps are typically relieved by passive stretching of the affected muscle.
• They are common at night, during exercise, or immediately after physical activity.

Common Causes of Cramps

• Benign Causes: Nighttime cramps or exercise-related cramps often occur without any underlying pathology.
• Neurological Conditions: May indicate motor neuron disease or polyneuropathy.
• Metabolic Disturbances: Common in pregnancy, uremia, hypothyroidism, and adrenal insufficiency.
• Fluid or Electrolyte Disorders: Dehydration, hemodialysis, or imbalances in electrolytes such as potassium, magnesium, or calcium.

Management and Treatment

• Stretching: Passive stretching of the affected muscle often provides immediate relief.
• Identifying Reversible Causes: Address underlying issues such as dehydration, electrolyte imbalance, or metabolic disorders.
• Pharmacological Options:
  • Daytime cramps may respond to:
    • Phenytoin: 300-400 mg daily orally.
    • Carbamazepine: 200-400 mg orally three times a day.
    • Baclofen or oxcarbazepine (used occasionally, though evidence is limited).
  • Nocturnal cramps may respond to:
    • Quinine sulfate: 325 mg orally at bedtime (use cautiously due to potential side effects).
    • Phenytoin: 100-300 mg at bedtime.
    • Carbamazepine: 200-400 mg at bedtime.
    • Diazepam: 5-10 mg at bedtime.
  • Levetiracetam and gabapentin have been suggested as occasionally helpful in open-label studies.

Risks and Cautions

• Quinine Sulfate: While effective, it carries risks of serious hematologic abnormalities such as:
  • Haemolytic uremic syndrome–thrombotic thrombocytopenia purpura.
  • Disseminated intravascular coagulation.
  • Bleeding diathesis.
  Quinine should only be prescribed if cramps are disabling and unresponsive to other treatments.
• Always consult a healthcare provider before starting medications for cramps.

Conclusion

• Cramps are often a benign condition and best managed with stretching and addressing underlying causes.
• Pharmacological treatments should be used cautiously, especially in the case of quinine sulfate.

Note: While medications like phenytoin, carbamazepine, and quinine are sometimes prescribed, their efficacy for cramps is not well-supported by robust clinical evidence. Use these treatments under medical supervision.