Table 3.
Characteristics of the included studies
| Randomized clinical trials | Study objective Number of participants Age Male |
Diagnostic criteria | Comorbidities associated with NLC and medication use |
|---|---|---|---|
| Connolly 1993 [29] 6/9 |
Efficacy of quinine N = 27 59 yrs. Male 100% |
Nocturnal leg cramps. Aged > 50. Foot, lower part of leg, sometimes thigh. Sleep interruption. | Coronary artery disease, Peripheral vascular disease, Hypertension, Diabetes Mellitus Medication: diuretics |
| Coppin 2005 [5] 8/9 |
Effect of calf stretching N = 181 75 yrs. Male 46% |
Nocturnal leg cramps, aged > 60, painful and involuntary. Muscle spasms. Disrupt sleep. Disruption. Most commonly in the leg, relief by stretching. | Renal dialysis, asthma and hypertension. Medication: diuretics, nifedipine, salbutamol and terbutaline |
| Garrison 2011 [17] 9/9 |
The effect of magnesium in individuals with leg cramps N = 46 69 yrs. Male 30% |
Leg cramps, aged > 50, at rest (bed or night). Legs and feet. Painful muscle contractions. | Participants with comorbidities excluded |
| Hallegraeff 2012 [9] 9/9 |
Effect of pre sleep stretching N = 80 70 yrs. Male 50% |
Nocturnal leg cramps, aged > 55, Suddenly, episodic. Involuntary. At rest or sleep. Calf, hamstrings or foot. Muscles are tender and hard. Intense painful. From seconds to minutes. Distress. Sleep disruption. Maximum ten minutes. | Varicose veins and arthritis. Physical inactivity and inadequate stretching and reduced muscle and tendon length. Medication: diuretics, lithium, steroids, morphine |
| Jansen 1997 [18] 9/9 |
Efficacy of hydro quinine in muscle cramps N = 102 54 yrs. Male 37% |
Involuntary muscle contraction. Painful Sudden onset. Muscle hardening, maximum duration 10 minutes. | Not stated |
| Roffe 2002 [19] 8/9 |
The effect of magnesium in chronic non-pregnant individuals N = 36 63 yrs. Male 58% |
Leg cramps. Painful contractions of any muscle group in the leg. Sudden onset. Successive improvement. Palpable hardening of the muscle. Distress. | Arthritis, peripheral vascular disease, varicose veins, ankle oedema |
| Serrao 2001 [14] 3/9 |
To evaluate the efficacy and safety of gabapentin in the treatment of muscle Cramps N = 30 54 yrs. 33% |
Sudden, involuntary, painful contractions. Maximum of 10 minutes. Sleep disturbance. | Neuropathy, radiculopathy, Isaac’s syndrome, multiple sclerosis, Parkinson’s disease, vascular disease |
| Young 1993 [15] 1/9 |
The effect of naftidrofuryl in individuals with rest cramps N = 14 61 yrs. Male 64% |
Rest cramps. Night-time cramps. Foot, calf muscles. Distress. | Not stated |
| Observational studies | |||
| Angeli 1996 [20] | To define the features, prevalence, and pathophysiology of therapy for muscle and small muscles cramps in cirrhotic patients. N = 192 56 yrs. Male 65% |
A-symmetric involuntary contractions or stiffness in calves and feet. At rest or at night | Cirrhosis, vascular occlusive disease, peripheral neuropathy, diabetes mellitus, severe renal failure and postphlebitic syndrome |
| Baskol 2004 [21] 6/9 |
The prevalence of muscle cramps in non-alcoholic cirrhosis patients. N = 65 52 yrs. Male 57% |
Muscle cramps. Aged > 50. Involuntary. Painful, visible contraction. Sudden onset. At rest or sleep. From seconds to minutes. Affects quality of life. At least once per week. Sleep disruption. | Liver cirrhosis, diuretic, alcohol use, volume depletion, hyponatremia, haemodialysis, hypothyroidism, uraemia. |
| Garrison 2015 [22] | Seasonally variation of symptom burden of leg cramps in the general population. N = 31.339 69 yrs. Male 38% |
Painful involuntary muscle cramps in the legs or feet during rest. It interrupts sleep. | Motor neuron disease, radiculopathy or hereditary cramp syndromes |
| Garrison 2012 [16] 6/9 |
Evaluating the association between diuretics, statins and long-acting β2 agonist’s use. N = 3492 69 yrs. Male 39% |
Nocturnal leg cramps. Painful legs or feet. During rest or sleep | Medication: diuretics and long-acting β2 agonists |
| Hawke 2013 [4] 9/9 |
Impact of NLC on health related quality of life. N = 160 71 yrs. Male 41% |
Nocturnal leg cramps. Pain afterwards. Sleep disruption. Aged >60 with sleep disruption. Reduced quality of life. Gradually lessens. Sudden, involuntary painful contraction. At night and rest. Relief by stretching. |
Participants with comorbidities known to cause cramp excluded |
| Hawke 2013 [23] 9/9 |
Factors associated with night-time calf muscle cramps N = 160 71 yrs. Male 41% |
Reduced strength dorsiflexion foot. Distress. Lesser quality of life. Interference of activities of daily living. | Hamstring tightness. Foot or leg coldness Participants with comorbidities known to cause cramp were excluded |
| Hirai 2000 [24] 4/9 |
NLC in general population and in patients with varicose veins N = 333 Age not stated Male 26% |
Muscle cramps. Aged >50. Intense painful with sudden onset in calf, foot or thigh. Maximum duration 10 minutes. At least once per week. | Varicose veins |
| Naylor 1994 [25] 5/9 |
Prevalence, severity and correlation with vascular diseases N = 86 73 yrs. Male 44% |
Rest cramps. Aged > 50. Distress. Less quality of life. | Peripheral vascular disease |
| Nishant 2014 [26] 5/9 |
Prevalence of nocturnal leg cramps in LSCS patients and in general population. N = 70 56 yrs. Male 53% |
Nocturnal cramps. Painful. Acute and involuntary. At sleep or rest. Knee flexion test might be indicative for NLC. | Amyotrophic lateral sclerosis, poliomyelitis, peripheral neuropathy, lumbar spinal radiculopathy; metabolic disorders including diabetes, pregnancy, uremia, liver cirrhosis, and hyper- and hypothyroidism; acute extracellular volume depletion including excessive perspiration, hemodialysis, diarrhea, and diuretic therapy; hereditary disorder. Hypertension, hypocalcaemia, hypokalaemia, vascular diseases. Medications: diuretics, antidepressants, calcium blockers, statins, and steroid, nifedipine-blockers. |
| Oboler 1991 [27] 4/9 |
Prevalence and treatment regimens of NLC N = 262 60 yrs. Male 95% |
Painful and involuntary in the calf with a visible palpable knot. At rest or sleep. | Arthritis, Peripheral vascular disease, Hypokalaemia, Coronary artery disease, Hypertension, Kidney disease, Stroke, Diabetes Mellitus, Hypocalcaemia. |
In total 18 studies are included for analysing NLC characteristics: eight randomized clinical trials and ten observational studies