title: Seasonal effects on the occurrence of nocturnal leg cramps: a prospective cohort study.
abstract: BACKGROUND
  It has been anecdotally reported that nocturnal leg cramps in pregnant women are worse in summer. We analyzed population-level data to determine whether the symptom burden of nocturnal leg cramps is seasonal in the general population.
  
  
  METHODS
  We examined time-series data for 2 independent measures of the symptom burden of leg cramps: (a) new quinine prescriptions (reflecting new or escalating treatment of leg cramps) from December 2001 to October 2007 among adults aged 50 years and older, which were obtained from linked health care databases that contain the prescribing information for the 4.2 million residents of British Columbia, Canada; and (b) the Internet search volume from February 2004 to March 2012 for the term "leg cramps" (reflecting public interest), which we obtained from Google Trends data and geographically limited to the United States and Australia. We assessed seasonality by determining how well a least-squares sinusoidal model predicted variability in the outcomes.
  
  
  RESULTS
  New quinine prescriptions and Internet searches related to leg cramps were both seasonal, with highs in mid-summer and lows in mid-winter, and a peak-to-peak variability that was about two-thirds of the mean. Seasonality accounted for 88% of the observed monthly variability in new quinine prescriptions (p < 0.001) and 70% of the observed variability in Internet searches related to leg cramps (p < 0.001).
  
  
  CONCLUSIONS
  New quinine prescriptions and Internet searches related to leg cramps were seasonal and roughly doubled between the winter lows and summer highs. Why a disorder of peripheral motor neurons displays such strong seasonality warrants exploration.
authors.affiliation: Faculty of Medicine (Garrison), University of Alberta, Edmonton, Alta.; Centre for Hip Health and Mobility (Garrison, Khan), University of British Columbia; Therapeutics Initiative (Dormuth, Morrow, Carney), University of British Columbia; Pharmacology and Therapeutics, Department of Anesthesiology (Dormuth), University of British Columbia, Vancouver, BC; Aspetar Orthopaedic and Sports Medicine Hospital (Khan), Doha, Qatar. scott.garrison@ualberta.ca.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Garrison
authors.affiliation: Faculty of Medicine (Garrison), University of Alberta, Edmonton, Alta.; Centre for Hip Health and Mobility (Garrison, Khan), University of British Columbia; Therapeutics Initiative (Dormuth, Morrow, Carney), University of British Columbia; Pharmacology and Therapeutics, Department of Anesthesiology (Dormuth), University of British Columbia, Vancouver, BC; Aspetar Orthopaedic and Sports Medicine Hospital (Khan), Doha, Qatar.
authors.forename: Colin R
authors.initials: CR
authors.lastname: Dormuth
authors.affiliation: Faculty of Medicine (Garrison), University of Alberta, Edmonton, Alta.; Centre for Hip Health and Mobility (Garrison, Khan), University of British Columbia; Therapeutics Initiative (Dormuth, Morrow, Carney), University of British Columbia; Pharmacology and Therapeutics, Department of Anesthesiology (Dormuth), University of British Columbia, Vancouver, BC; Aspetar Orthopaedic and Sports Medicine Hospital (Khan), Doha, Qatar.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Morrow
authors.affiliation: Faculty of Medicine (Garrison), University of Alberta, Edmonton, Alta.; Centre for Hip Health and Mobility (Garrison, Khan), University of British Columbia; Therapeutics Initiative (Dormuth, Morrow, Carney), University of British Columbia; Pharmacology and Therapeutics, Department of Anesthesiology (Dormuth), University of British Columbia, Vancouver, BC; Aspetar Orthopaedic and Sports Medicine Hospital (Khan), Doha, Qatar.
authors.forename: Greg A
authors.initials: GA
authors.lastname: Carney
authors.affiliation: Faculty of Medicine (Garrison), University of Alberta, Edmonton, Alta.; Centre for Hip Health and Mobility (Garrison, Khan), University of British Columbia; Therapeutics Initiative (Dormuth, Morrow, Carney), University of British Columbia; Pharmacology and Therapeutics, Department of Anesthesiology (Dormuth), University of British Columbia, Vancouver, BC; Aspetar Orthopaedic and Sports Medicine Hospital (Khan), Doha, Qatar.
authors.forename: Karim M
authors.initials: KM
authors.lastname: Khan
mesh_terms: D000368:Aged; D001955:British Columbia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000627:therapeutic use*; D011446:Prospective Studies; D011803:Quinine / Q000627:therapeutic use*; D012621:Seasons; D020922:Sleep-Wake Transition Disorders / Q000188:drug therapy* / Q000453:epidemiology*; D011795:Surveys and Questionnaires
chemical_list: D009125:Muscle Relaxants, Central; D011803:Quinine