Nocturnal leg cramps
- John W Winkelman, MD, PhD
John W Winkelman, MD, PhD
- Chief, Sleep Disorders Clinical Research Program
- Departments of Psychiatry and Neurology
- Massachusetts General Hospital
- Associate Professor of Psychiatry
- Harvard Medical School
- Section Editors
- Ira N Targoff, MD
Ira N Targoff, MD
- Section Editor — Muscle Disease
- Professor of Medicine, Section of Rheumatology
- University of Oklahoma Health Sciences Center
- Jeremy M Shefner, MD, PhD
Jeremy M Shefner, MD, PhD
- Section Editor — Neuromuscular Disease
- Professor and Chair of Neurology, Barrow Neurological Institute
- Professor of Neurology, University of Arizona, Phoenix
- Clinical Professor of Neurology, Creighton University
Nocturnal leg cramps, also termed sleep-related leg cramps, are a common lower-extremity condition that produces pain and can disrupt sleep. Symptoms result from involuntary muscle contractions, which are sudden in onset, usually affecting the calf or foot.
Nocturnal leg cramps are reviewed here. Other nighttime disorders of leg discomfort or movement, including restless legs syndrome (RLS) and periodic limb movements of sleep (PLMS), are discussed separately. (See "Clinical features and diagnosis of restless legs syndrome/Willis-Ekbom disease and periodic limb movement disorder in adults".)
Nocturnal leg cramps are common and frequently unreported to clinicians [1,2]. In the general population, they are present in nearly 50 percent of those over the age of 50, have an increased prevalence and frequency with age, and show no gender preference.
Nocturnal leg cramps have been reported in about 7 percent of children and adolescents . Peak occurrence in this population was at 16 to 18 years of age, with no cases reported less than eight years of age. Pediatric nocturnal leg cramps are typically benign, self-limited, and infrequent [3,4].
CAUSES AND PATHOGENESIS
Leg cramps can be idiopathic, which is most common, or secondary to other medical conditions. Secondary causes include structural disorders or leg positioning; neurologic disorders; metabolic disorders, including extracellular fluid volume depletion and electrolyte disturbances; and medications [5-16]. Patients with the most common form of leg cramps have no fluid or electrolyte imbalance.
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- CAUSES AND PATHOGENESIS
- CLINICAL MANIFESTATIONS
- Diagnostic evaluation
- Diagnostic criteria
- DIFFERENTIAL DIAGNOSIS
- Treatment of acute leg cramps
- Prevention of recurrent leg cramps
- - Initial preventive therapies
- - Resistant to initial preventive therapies
- Initial drug therapies
- Resistant to initial drug therapies
- When to refer
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS