A Cochrane review [Abstract] 1 included 20 studies with a total of 4789 subjects with amyotrophic lateral sclerosis (ALS). Only one trial, of tetrahydrocannabinol (THC), assessed cramps as the primary endpoint. Thirteen studies assessed cramps as a secondary endpoint. The medications comprised vitamin E, baclofen, riluzole, L-threonine, xaliproden, indinavir, and memantine. Six studies assessed cramps as an adverse event. The medications comprised creatine, gabapentin, dextromethorphan, quinidine, and lithium. In all 20 studies no favourable effect for the treatment of cramps in ALS could be demonstrated, but many studies were underpowered to draw a definite conclusion. A meta-analysis of two small studies showed a statistically nonsignificant result for the amino acid L-threonine for the treatment of cramps in ALS. No study was identified using physical therapy as a therapeutic intervention for cramps.
Comment: The quality of the evidence is downgraded by study quality (measurement and documenting of muscle cramps inadequate), indirectness of evidence (muscle cramps assessed as secondary end point or adverse event) and imprecise results (limited study size for each comparison).
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