The aim of the study was to define the features, preva-at rest, frequently at night, are asymmetric, and affect lence, and pathophysiology of therapy for muscle most of the gastrocnemius muscle and small muscles cramps in cirrhotic patients. The first protocol study of the foot. In 1985 and later in 1988 Konikoff and included 294 cirrhotic patients and 194 age-and sex-Theodor reported a higher prevalence of true muscle matched controls. Controls were defined as inpatients cramps in 33 patients with cirrhosis as compared with or outpatients without any clinical and laboratory evithat observed in a matched population without cirrhodence of liver disease. Features and prevalence of mussis and suggested the inclusion of muscle cramps cle cramps were defined on the basis of a standard quesamong the recognized symptoms of cirrhosis. The tionnaire. As far as the pathophysiological associations findings and conclusions were supported in larger seof muscle cramps were concerned, the following parameries of patients by Chao et al 5 and by Kobayashi et al. 6 ters were evaluated: mean arterial pressure (MAP), nutritional status, liver function tests, plasma volume (PV), However, these studies did not demonstrate a relationplasma renin activity (PRA), and electrolyte, mineral, ship between prevalence of muscle cramps and the and acid-base status. The prevalence of cramps was stage of cirrhosis evaluated by both clinical and laborahigher in cirrhotic patients than in controls, and it was tory features. Furthermore, even considering the related to the duration of recognized cirrhosis and to poorly understood pathophysiology of muscle cramps, 1,2 the severity of liver function impairment. At a multiple no plausible explanation for the relation between cirregression analysis, the presence of ascites, low values rhosis and muscle cramps was presented. Even Koniof MAP, and high values of PRA were the independent koff et al. suggested, subsequently, that a vitamin E predictive factors for the occurrence of cramps in cirdeficiency may play a role in the pathogenesis of muscle rhosis. In the second protocol study, the effects of a suscramps in these patients, it is still uncertain whether tained expansion of the effective circulating volume induced by intravenous infusion of human albumin were muscle cramps can be considered a symptom of cirrhocompared with those of a placebo in 12 cirrhotic patients sis. A recent review did not report muscle cramps with more than three cramp crises a week. Compared among the musculoskeletal manifestations of liver diswith the placebo, albumin reduced the cramp frequency ease. 8 Furthermore, muscle cramps have also been con-(P Γ΅ .01). In conclusion, an increased prevalence of true sidered as a side effect of diuretics in cirrhotic patients muscle cramps occurs in patients with cirrhosis. Our with ascites. Even if cramps do not appear as a major data indicate that the pathophysiological link between clinical problem in patients with cirrhosis, their frecirrhosis and cramps may be represented by the reducquency and severity may sometimes seriously affect tion of the effective circulating volume. They also inditheir quality of life. Thus, efforts to better understand cate that weekly infusion of human albumin may be an the origin of this symptom appear justified. effective treatment for cramps in cirrhosis. (HEPATOL-OGY 1996;23:264-273.)
The aims of this study were to evaluate the prevalence of cramps in cirrhosis according to cause and severity of the disease. In addition, studies were per-Painful involuntary skeletal muscle contractions may be separated into true cramps, contracture, tet-formed to define its pathophysiology. any, or dystonia on the basis of their signs and symp-
Methods
toms. True cramps are the most common form, occur