title: Systematic review: the treatment of muscle cramps in patients with cirrhosis.
abstract: BACKGROUND
  Up to 88% of patients with hepatic cirrhosis experience painful muscle cramps resulting in sleep deprivation and impaired quality of life. Management is often based on poor evidence with varying degrees of success in controlling the frequency and severity of muscle cramps in this group.
  
  
  OBJECTIVE
  To review systematically the treatment options for muscle cramps in cirrhosis.
  
  
  METHODS
  A systematic review of the relevant databases to identify treatments for muscle cramps in patients with hepatic cirrhosis was performed. Studies meeting the selection criteria were reviewed and quality of the papers was rated using a validated quality rating scale. The results for each treatment are reported.
  
  
  RESULTS
  Eighteen publications were identified as eligible for inclusion in this systematic review. The majority (n = 15) of these were treatment/intervention reports. Only three randomised-control studies were identified. A wide range of treatments were identified including zinc, 1-α-hydroxy vitamin D, vitamin E, branched chain amino acids, taurine, l-carnitine, nuiche-shen-qi-wen, eperisone hydrochloride, intravenous albumin and quinidine. There were some reported improvements in muscle cramps with most interventions with the exception of vitamin E but the evidence predominantly relies on case study reports. There is a lack of randomised-controlled clinical studies to support using these interventions.
  
  
  CONCLUSIONS
  There appear to be a number of promising treatments for muscle cramps in cirrhosis. However, there remains a need for further double-blinded, randomised, controlled clinical investigations to support routine use of these interventions to treat muscle cramps in patients with hepatic cirrhosis.
authors.affiliation: Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, Australia; Centenary Institute, University of Sydney, Sydney, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Vidot
authors.forename: S
authors.initials: S
authors.lastname: Carey
authors.forename: M
authors.initials: M
authors.lastname: Allman-Farinelli
authors.forename: N
authors.initials: N
authors.lastname: Shackel
mesh_terms: D000418:Albumins / Q000627:therapeutic use; D000597:Amino Acids, Branched-Chain / Q000627:therapeutic use; D002331:Carnitine / Q000627:therapeutic use; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy*; D009120:Muscle Cramp / Q000188:drug therapy* / Q000209:etiology; D011427:Propiophenones / Q000627:therapeutic use; D011802:Quinidine / Q000627:therapeutic use; D013654:Taurine / Q000627:therapeutic use; D014807:Vitamin D / Q000627:therapeutic use; D015032:Zinc / Q000627:therapeutic use
chemical_list: D000418:Albumins; D000597:Amino Acids, Branched-Chain; D011427:Propiophenones; D014807:Vitamin D; D013654:Taurine; C030848:eperisone; D011802:Quinidine; D015032:Zinc; D002331:Carnitine