Quinine: not a safe drug for treating nocturnal leg cramps

Hogan, David B.

doi:10.1503/cmaj.150044

Cited by 13 publications

(8 citation statements)

References 6 publications

(11 reference statements)

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“…Stretching of affected muscle groups is often recommended for prevention of muscle cramps, but the respective evidence is scarce even for otherwise healthy subjects101 and no ALS-specific studies have been published. For pharmacological treatment, mexiletine 150 mg twice daily may be considered since it has recently been shown to improve symptoms in a randomized controlled trial.102 Numerous other compounds including baclofen, memantine, vitamin E, and L-threonine have failed to show significant effects on muscle cramps in patients with ALS.103 The effects of quinidine (usually 200–300 mg at night) have been extensively evaluated in various non-ALS conditions, with moderate evidence that cramp intensity, and possibly frequency, are reduced.104 However, long-term quinidine is not recommended because of possible side effects and significant safety concerns 105…”

Section: Sleep-related Leg Muscle Cramps and Fasciculationsmentioning

confidence: 99%

<p>Sleep disturbances in patients with amyotrophic lateral sclerosis: current perspectives</p>

Boentert

2019

NSS

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Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease inevitably leading to generalized muscle weakness and premature death. Sleep disturbances are extremely common in patients with ALS and substantially add to the burden of disease for both patients and caregivers. Disruption of sleep can be caused by physical symptoms, such as muscle cramps, pain, reduced mobility, spasticity, mucus retention, and restless legs syndrome. In addition, depression and anxiety may lead to significant insomnia. In a small subset of patients, rapid eye movement (REM) sleep behavioral disorder may be present, reflecting neurodegeneration of central nervous system pathways which are involved in REM sleep regulation. With regard to overall prognosis, sleep-disordered breathing (SDB) and nocturnal hypoventilation (NH) are of utmost importance, particularly because NH precedes respiratory failure. Timely mechanical ventilation is one of the most significant therapeutic measures to prolong life span in ALS, and transcutaneous capnometry is superior to pulse oxymetry to detect NH early. In addition, it has been shown that in patients on home ventilatory support, survival time depends on whether normocapnia, normoxia, and elimination of apneic events during sleep can be reliably achieved. Several studies have investigated sleep patterns and clinical determinants of sleep disruption in ALS, but exact prevalence numbers are unknown. Thus, constant awareness for sleep-related symptoms is appropriate. Since no curative treatment can be offered to affected patients, sleep complaints should be thoroughly investigated in order to identify any treatable etiology and improve or stabilize quality of life as much as possible. The use of hypnotics should be confined to palliation during the terminal phase and refractory insomnia in earlier stages of the disease, taking into account that most compounds potentially aggravate SDB.

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Section: Sleep-related Leg Muscle Cramps and Fasciculationsmentioning

confidence: 99%

<p>Sleep disturbances in patients with amyotrophic lateral sclerosis: current perspectives</p>

Boentert

2019

NSS

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“…Baclofen and other compounds such as Vitamin-E, memantine and L-threonine have not shown any beneficial effects for management of cramps in ALS patients (28). Quinidine has been reported to decrease cramp intensity and frequency, however, given broad side effect profile (cinchonism, thrombocytopenia and myocardial toxicity), extended usage should be considered cautiously (2,29).…”

Section: Sleep and Motor Symptoms Of Alsmentioning

confidence: 99%

Sleep disorders in Amyotrophic Lateral Sclerosis

Murala

Katyal

Narula³

et al. 2021

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Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder affecting both the central and peripheral nervous system. The median survival rate for ALS patients after symptom onset is 2.5 to 3.5 years and after diagnosis of ALS is about 1.5 to 2.5 years. Patients with ALS can have a wide spectrum of sleep disorders including but not limited to insomnia, sleep related breathing disorders, parasomnias, obstructive sleep apnea (OSA) and nocturnal hypoventilation (NH). Sleep-related breathing disorders substantially increase both morbidity and mortality in ALS patients. In this review, we have discussed the ALS motor symptoms, sleep-related breathing disorders, behavioral abnormalities and sleep disturbing factors which impair the health-related quality of life.

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“…Baclofen and other compounds did not show significant effects on muscle cramps in patients with ALS [36]. Quinidine (200-300 mg once to twice daily) has been evaluated in numerous other neurological conditions, showing reduction of both cramp frequency and intensity [37] but long-term use may be associated with severe thrombocytopenia, cinchonism, and myocardial toxicity [38].…”

Section: Motor Symptoms Of Als and Sleepmentioning

confidence: 99%

Sleep and Sleep Disruption in Amyotrophic Lateral Sclerosis

Boentert

2020

Curr Neurol Neurosci Rep

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Purpose of Review In amyotrophic lateral sclerosis (ALS), sleep disruption is frequently present and substantially adds to disease burden. This review aims to summarize current knowledge on causes, pathophysiology, and treatment of sleep disturbances in ALS.Recent Findings Motor neuron degeneration and muscle weakness may lead to muscle cramps, pain, spasticity, immobilization, restless legs, sleep-disordered breathing, and difficulties to clear secretions. Furthermore, existential fears and depression may promote insomnia. Sleep-disordered breathing, and nocturnal hypoventilation in particular, requires ventilatory support which meaningfully prolongs survival and improves health-related quality of life albeit respiratory failure is inevitable. Early indication for non-invasive ventilation can be achieved by inclusion of capnometry in diagnostic sleep studies. Summary Sleep disruption is extremely common in ALS and may arise from different etiologies. The absence of causative therapeutic options for ALS underlines the importance of symptomatic and palliative treatment strategies that acknowledge sleeprelated complaints.

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Quinine: not a safe drug for treating nocturnal leg cramps

Cited by 13 publications

References 6 publications

<p>Sleep disturbances in patients with amyotrophic lateral sclerosis: current perspectives</p>

<p>Sleep disturbances in patients with amyotrophic lateral sclerosis: current perspectives</p>

Sleep disorders in Amyotrophic Lateral Sclerosis

Sleep and Sleep Disruption in Amyotrophic Lateral Sclerosis

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