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Sunday, 15 December 2013

Magnesium and Muscles

Magnesium
Magnesium is the eleventh most abundant element by mass in the human body. The adult body content is 25 g distributed in the skeleton and soft tissues. The chemical is essential in manipulating important biological polyphosphate such as ATP, DNA, and RNA and in functionming enzymes(a).
Magnesium and Muscles
1. Magnesium for skeletal muscle cramps
Skeletal muscle cramps are common and often presented to physicians in association with pregnancy, advanced age, exercise or disorders of the motor neuron (such as amyotrophic lateral sclerosis). In a andomized controlled trials (RCTs) of magnesium supplementation (in any form) to prevent skeletal muscle cramps in any patient group (i.e. all clinical presentations of cramp) and to considere comparisons of magnesium with no treatment, placebo control, or other therapy, found that it is unlikely that magnesium supplementation provides clinically meaningful cramp prophylaxis to older adults experiencing skeletal muscle cramps. In contrast, for those experiencing pregnancy-associated rest cramps the literature is conflicting and further research in this patient population is needed. We found no randomized controlled trials evaluating magnesium for exercise-associated muscle cramps or disease state-associated muscle cramps (for example amyotrophic lateral sclerosis/motor neuron disease)(1).

2. Clinical aspects and treatment of calf muscle cramps during pregnancy
According to the study by Riss P, Bartl W, and Jelincic D., muscle cramps were noticed most often in the second half of pregnancy. Gravidae with muscle cramps were on the average older and of higher parity; there was no relationship between muscle cramps and complications during pregnancy or unfavorable fetal outcome. In an uncontrolled therapeutic trial 21 women with muscle cramps received 1,8 g monomagnesium-aspartate twice daily per mouth for 4 weeks. 21 women with muscle cramps had no therapy. 4 weeks after the initiation of magnesium therapy 19/21 women were free of symptoms, compared to only 7/21 patients in the control group. Muscle cramps during pregnancy do not have to be considered a risk factor; they can be significantly improved by the administration of oral magnesium(2).

3. The effect of oral magnesium substitution on pregnancy-induced leg cramps
In the study to  to determine whether women with pregnancy-related leg cramps would benefit from oral magnesium supplementation, indicated that serum magnesium levels in these patients were at or below the lower reference limit, as is also often the case in healthy pregnant patients. Oral magnesium substitution decreased leg cramp distress (p < 0.05 compared with the placebo group, p < 0.001 compared with initial complaints), but did not significantly increase serum magnesium levels, excess magnesium being excreted as measured by an increase in urinary magnesium levels (p < 0.002). Oral magnesium supplementation seems to be a valuable therapeutic tool in the treatment of pregnancy-related leg cramps(3).

4. Pathophysiology and therapy of magnesium deficiency in pregnancy
In the study to determine serum magnesium(Mg)-levels in 67 pregnant women in late pregnancy. 42 gravidae complained of nightly muscle cramps; 21 of them received 1.8 g monomagnesiumaspartate twice daily per mouth for 4 weeks, found that serum Mg-levels were lower in pregnant women as compared to a control group of non pregnant women. Gravidae complaining of muscle cramps had significantly lower serum Mg-levels than women without muscle cramps. The administration of Mg was associated with a significant rise in serum Mg-levels as early as 2 weeks after the initiation of therapy.The Our study indicates that nightly muscle cramps during pregnancy might be a sign of a latent magnesium deficiency which can be influenced by oral magnesium(4).

5. Serum magnesium level in preterm labour
Preterm labour, (PTL) defined as labour after 28 weeks but before 37 completed week of gestation, is an ill omen for our country as the incidence is 5-10% leading to 70-80% of perinatal deaths. According to the study by the  Indira Gandhi Institute of Medical Sciences, varied hypomagnesemia was observed in Preterm labour cases (1.47 mg/dl +/- 0.22 S.D.), normal value of serum magnesium was found in normal non-pregnant ladies and slightly low value were observed in pregnant ladies of same gestational age. Age and parity had no significant effect on serum magnesium level in our study. As far as socio-economic study is concerned, it was found to be higher in high socio-economic group and low in lower group. Thus from this study it can be concluded that estimation of serum magnesium in pregnancy may prove to be a valuable tool in predicting preterm onset of labour(5).

6. Relationship between hypermagnesaemia in preterm labour and adverse health outcomes in babies
In the study of the Magnesium and Neurologic Endpoints Trial (the so-called MagNET Trial) undertaken to establish whether the antenatal usage of magnesium sulphate could protect neonates from having adverse neurologic outcomes, showed that unfortunately, the trial was suspended after 15 months of enrolment because of excess total paediatric mortality among those exposed to magnesium sulphate. Following our original report and contrary to the original hypotheses, additional analyses of our data have actually shown a statistically significant increase in the risk of neonatal intraventricular hemorrhage, as well as total adverse paediatric outcomes, among those with higher levels of ionized magnesium at delivery. Nonetheless, it has been postulated, but not established, that anions of magnesium other than sulphate could have a more benign, or even beneficial, effect on health outcomes in the neonate(6).

7. Nocturnal leg cramps
Up to 60 percent of adults report that they have had nocturnal leg cramps. The recurrent, painful tightening usually occurs in the calf muscles and can cause severe insomnia. According to the study by the St. Mark's Family Medicine Residency, nocturnal leg cramps are associated with vascular disease, lumbar canal stenosis, cirrhosis, hemodialysis, pregnancy, and other medical conditions. Medications that are strongly associated with leg cramps include intravenous iron sucrose, conjugated estrogens, raloxifene, naproxen, and teriparatide. A history and physical examination are usually sufficient to differentiate nocturnal leg cramps from other conditions, such as restless legs syndrome, claudication, myositis, and peripheral neuropathy. Laboratory evaluation and specialized testing usually are unnecessary to confirm the diagnosis. Limited evidence supports treating nocturnal leg cramps with exercise and stretching, or with medications such as magnesium, calcium channel blockers, carisoprodol, or vitamin B(12). Quinine is no longer recommended to treat leg cramps(7).

8. Stretching before sleep reduces the frequency and severity of nocturnal leg cramps in older adults
According to the study by the Hanze University of Applied Sciences, in the study of nighty adults aged over 55 years with nocturnal leg cramps who were not being treated with quinine, with the experimental group performed stretches of the calf and hamstring muscles nightly, immediately before going to sleep, for six weeks. The control group performed no specific stretching exercises. Both groups continued other usual activities, showed that nightly stretching before going to sleep reduces the frequency and severity of nocturnal leg cramps in older adults(8).

9. The effect of magnesium infusion on rest cramps
Rest cramps (also known as nocturnal leg cramps) are very common in a geriatric population. In a double blind, placebo controlled randomized controlled trial conducted on 46 community-dwelling older adult (69.3 ± 7.7 years) rest cramp sufferers to determine whether 5 consecutive days infusion of 20-mmol (5 g) magnesium sulfate would reduce the frequency of leg cramps per week in the 30 days immediately pre and post infusions and whether the response to treatment varied with the extent to which infused magnesium was retained (as measured by 24-hour urinary magnesium excretion), found that intravenous magnesium infusion did not reduce the frequency of leg cramps in a group of older adult rest cramp sufferers regardless of the extent to which infused magnesium was retained. Although oral magnesium is widely marketed to older adults for the prophylaxis of leg cramps, our data suggest that magnesium therapy is not indicated for the treatment of rest cramps in a geriatric population(9).

10. Muscle cramps--differential diagnosis and therapy
Calf cramps are sudden, involuntary, painful contractions of part of or the entire calf muscle that are visible, persist for seconds to minutes and then spontaneously resolve. According to the study by Kompetenzzentrum für Bewegungsstörungen, Paracelsusklinik Zwickau, Muscle cramps can occur with no identifiable cause, and are then referred to as common calf cramps. They may also be symptoms associated with diseases of the peripheral and central nervous system and muscle diseases. They also occur in association with metabolic disorders. In such cases the cramps are more extensive, intense and persist for longer. Cramp-fasciculation-myalgia syndrome additionally involves paresthesias and other signs of hyperexcitability of peripheral nerves. The recommended treatment for patients with frequent calf cramps causing significant impairment of well-being is oral administration of quinidine and/or botulinum toxin treatment of the calf muscles. During pregnancy both products are contraindicated, while probatory administration of magnesium is indicated(10).
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/22972143
(2) http://www.ncbi.nlm.nih.gov/pubmed/6553557
(3) http://www.ncbi.nlm.nih.gov/pubmed/7631676
(4) http://www.ncbi.nlm.nih.gov/pubmed/6891868
(5) http://www.ncbi.nlm.nih.gov/pubmed/15022938
(6) http://www.ncbi.nlm.nih.gov/pubmed/12635881
(7) http://www.ncbi.nlm.nih.gov/pubmed/22963024
(8) http://www.ncbi.nlm.nih.gov/pubmed/22341378
(9) http://www.ncbi.nlm.nih.gov/pubmed/21289017
(10) http://www.ncbi.nlm.nih.gov/pubmed/19402333