What causes extreme "Charlie Horse Spasms" in chins, calves and thighs of people with MS despite using Baclofen and Lyrica?

3/4/2014

Spasms in the legs often do not respond to the same dose of medication used to treat overall spasticity even though they are related phenomenon. If the spasms do not respond to higher doses of Baclofen, tizanidine, gabapentin, Lyrica or a more standard muscle relaxer or if these doses cause too many side effects, we often add a benzodiazepine like diazepam or clonazepam at bedtime. This usually does the job for most people since cramps and spasms are more common at night while lying supine.

Cramps are a slightly different phenomenon causes by muscle irritability and will sometimes respond to magnesium oxide supplements (250 to 500 mg). But beware, higher doses of magnesium oxide can cause loose stools.

4 Comments

Ana

3/4/2014 12:05:19 am

How can I tell if what I am experiencing is a cramp or a spasm?

Dr Kinkel

3/4/2014 11:53:42 pm

The word, "spasm", is not a very specific term and can be applied to any involuntary muscle contraction, not matter what the cause. The spasm may result in visible, involuntary movement of a body part or no visible movement at all. Spasms are common in health and disease and often the reaction of a large group of muscles to pain or nerve root irritation. Spasms are not necessarily painful and, in fact, many of the spasms we observe in people with MS are not painful at all.
Cramps are painful, sustained muscle contractions with visible or palpable tightening of the involved muscle. The area often must be rubbed or stretched to release the cramp and, even then, the cramp often returns repeatedly. Cramps are most common in the small muscle of the feet and calfs. For unclear reasons they tend to be more common at night and can easily awaken you from sleep. Cramps may be caused by a medical problem, especially if they occur frequently, and should be evaluated by your doctor. Common potential causes include dehydration, electrolyte imbalances (especially low sodium or calcium), medications (think statins and steroids), kidney disease, thyroid disease, muscle disease and some neurological conditions like MS. Stretching is the best immediate solution but frequent cramping usually requires evaluation and treatment. The best first line treatment approach is to take magnesium oxide beginning with a dose of 250 mg, usually at bedtime, and then increasing the dose as needed. Beware of diarrhea with higher doses. But if you need treatment like this for your cramps, you should also be telling your doctor about the cramps and making sure you do not need an evaluation.

Susan Sheehan link

3/18/2014 10:33:24 pm

Thanks Dr.K.

Stephen link

10/21/2017 09:58:02 am

I have found that CBD capsules are the only thing that chased these cramps away. Unfortunately, it can only be gotten from a marijuana dispensary, and can be expensive. I can get a package of 30 for $80.

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