Muscle cramps in chronic liver diseases and treatment with antispastic agent (eperisone hydrochloride)

Kobayashi, Yoshimasa; Kawasaki, Tsunehisa; Takai, Yoshimi; Nakajima, Tomomi; Kanai, Koichi

doi:10.1007/bf01300302

Cited by 23 publications

(24 citation statements)

References 5 publications

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“…1,3,4,16,19,20 Previous reports on cirrhotic patients suggested that the prevalence of muscle cramp changed between 22% and 88%. 3,4 Kornikoff and Theodor 4 were the first to report that in a series of 33 patients with cirrhosis, 88% had painful muscle 19 reported that the prevalence of muscle cramp was 49% if the cirrhotic patients had muscle cramps more than 3 times in a month.…”

Section: Discussionmentioning

confidence: 99%

The Role of Serum Zinc And Other Factors on the Prevalence of Muscle Cramps in Non-alcoholic Cirrhotic Patients

Başkol¹,

Özbakır²,

Coşkun³

et al. 2004

Journal of Clinical Gastroenterology

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Section: Discussionmentioning

confidence: 99%

The Role of Serum Zinc And Other Factors on the Prevalence of Muscle Cramps in Non-alcoholic Cirrhotic Patients

Başkol¹,

Özbakır²,

Coşkun³

et al. 2004

Journal of Clinical Gastroenterology

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“…5,6 The prevalence is varied and ranges from 29% to 88% depending on the inclusion criteria used by the investigators. 2,3,[7][8][9] The exact mechanism behind the occurrence of muscle cramps remains elusive. 10 Potential primary hypotheses include neurologic, muscular, endocrine, or electrolyte imbalance.…”

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confidence: 99%

Prevalence and Morbidity Associated With Muscle Cramps in Patients With Cirrhosis

Chatrath¹,

Ghabril²,

Tandra³

et al. 2011

Gastroenterology

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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. KeywordsChronic liver disease questionnaire; Cirrhosis; Muscle crampsThe association of muscle cramps with cirrhosis was first reported by Konikoff and Theodor 1 in 1986 when they made their observation of repeated painful muscle cramps by patients with cirrhosis. They proposed that the strikingly high incidence and uniformity of the phenomenon may justify the inclusion of painful muscle cramps among the recognized symptoms of cirrhosis. 1 Subsequently, several studies have confirmed that muscle cramps are a common symptom of cirrhosis. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript them as sudden, uncomfortable squeezing or contraction of a muscle, lasting seconds to minutes. An electromyogram of a cramping muscle reveals involuntary repetitive firing of motor unit action potentials at high rates (up to 150 per second) producing a sustained muscle contraction. 5,6 These cramps are not associated with any progressive motor neuron disease or chronic neuromuscular disability and are different from muscle contracture, dystonia, and tetany. 5,6 The prevalence is varied and ranges from 29% to 88% depending on the inclusion criteria used by the investigators. 2,3,[7][8][9] The exact mechanism behind the occurrence of muscle cramps remains elusive. 10 Potential primary hypotheses include neurologic, muscular, endocrine, or electrolyte imbalance. 2,4,[9][10][11] Diuretic use in cirrhotic patients also has been implicated as a cause of muscle cramps thro...

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“…Although our study was not controlled with placebo or active reference drug, the results we obtained in a relatively large series of patients are consistent with those reported from previous studies. [22][23][24][26][27] A randomized, double-blind, clinical trial in patients with cervical spondylosis showed that eperisone had a beneficial activity on pain in arms and shoulders, stiffness, and other symptoms related to cervical spondylosis. 26 In addition, eperisone was found to be comparable to physiotherapy in reducing the spasticity in patients with cerebral stroke, 27 and the cramps secondary to chronic liver diseases.…”

Section: Discussionmentioning

confidence: 99%

“…26 In addition, eperisone was found to be comparable to physiotherapy in reducing the spasticity in patients with cerebral stroke, 27 and the cramps secondary to chronic liver diseases. 24 A trial involving patients with myelopathy or tropical spastic paraparesis, showed that motor disability was significantly improved in 50% of patients treated with eperisone hydrochloride alone and, to a lesser extent, in those patients treated with other muscle relaxants or antiinflammatory drugs. 22 It is worth noting that the analgesic and muscle relaxant effects of eperisone were achieved with a single drug, while it is common practice in rheumatology to combine a pain killer (eg, paracetamol or NSAID) with a muscle relaxant (eg, tramadol, thiocholchicoside, or dantrolene), even using fixed-dose combinations, 14 in order to achieve a satisfactory reduction of both pain and muscle contracture.…”

Section: Discussionmentioning

confidence: 99%

“…21 More importantly, eperisone appears to be devoid of clinically relevant sedative effects on the CNS, as reported in trials involving patients with myelopathy or tropical spastic paraparesis, 22 patients with neurogenic bladder, 23 and patients with muscle cramps secondary to liver diseases. 24 The lack of sedative effects, together with a lack of GI adverse effects typical of NSAIDs, represent the most important advantages of eperisone. This is especially true in patients with LBP as they are usually older and, therefore, are at high risk of NSAID-induced GI toxicity.…”

Section: Introductionmentioning

confidence: 99%

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Open experience with a new myorelaxant agent for low back pain

Sartini

Guerra²

2008

Adv Therapy

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Eperisone had an analgesic and muscle relaxant effect in patients with LBP. It should be noted that while it is common practice in rheumatology to combine a pain killer with a muscle relaxant in order to achieve a satisfactory result on both symptoms, the present results with eperisone were achieved with a single drug. With an improved tolerability profile compared with nonsteroidal anti-inflammatory drugs, and a lack of significant adverse effects on the CNS, eperisone hydrochloride represents a valuable alternative to traditional analgesics and muscle relaxants for the treatment of LBP.

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Muscle cramps in chronic liver diseases and treatment with antispastic agent (eperisone hydrochloride)

Cited by 23 publications

References 5 publications

The Role of Serum Zinc And Other Factors on the Prevalence of Muscle Cramps in Non-alcoholic Cirrhotic Patients

The Role of Serum Zinc And Other Factors on the Prevalence of Muscle Cramps in Non-alcoholic Cirrhotic Patients

Prevalence and Morbidity Associated With Muscle Cramps in Patients With Cirrhosis

Open experience with a new myorelaxant agent for low back pain

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