Causes And Treatment Of Muscle Seizures, Spasms, Cramps

A muscle spasm, or muscle cramp, is an involuntary contraction of a muscle. Muscle spasms occur suddenly, usually must be  resolved quickly, and are often painful.

A muscle spasm is different from a muscle twitch. A muscle twitch, or fasciculation, is an uncontrolled fine movement of a small segment of a larger muscle that can be seen under the skin.

Spasms may affect many different types of muscles in the body, leading to many different symptoms.

Spasms of skeletal muscles are most common and are often due to overuse, dehydration, and electrolyte abnormalities. The spasm occurs abruptly, is painful, and is usually short-lived. It may be relieved by gently stretching the muscle.

If muscle spasms are especially painful, if they do not resolve or if they recur, medical care should be accessed to look for possible underlying causes.

Smooth muscles that are within the walls of hollow organs (like the colon) can go into spasm, causing significant pain. Often this pain is colicky, meaning that it comes and goes. Examples include the pain associated with menstrual cramps, diarrhea, gallbladder pain, and passing a kidney stone.

Possible Causes of Muscle Seizures, Cramps

There are a variety of causes of muscle spasms, and each depends upon predisposing factors, the part of the body involved, and the environment that the body is in.

1. Spasms may occur when a muscle is overused and tired, particularly if it is overstretched or if it has been held in the same position for a prolonged period of time. In effect, the muscle cell runs out of energy and fluid and becomes hyperexcitable, resulting in a forceful contraction. This spasm may involve part of a muscle, the whole muscle, or even adjacent muscles.
2. Overuse as a cause of skeletal muscle spasm is often seen in athletes who are doing strenuous exercise in a hot environment. 
3. This is also an occupational issue with construction workers or others working in a hot environment. Usually, the spasms will occur in the large muscles that are being asked to do the work. When this occurs associated with heat exposure, the condition is also known as heat cramps.
4. Overuse can also occur with routine daily activities like shoveling snow, or mowing or raking grass, causing muscle spasms of the neck, shoulder, and back.  
5. Unfamiliar exercise activities can also cause muscle spasms to occur. Abdominal spasms can occur when a person decides to begin working their abdominal muscles by doing sit-ups and does too many too quickly.
6. Writer's cramps of the hand and fingers are similarly caused by prolonged use of the small muscles in the hand.
7. It is commonly thought that dehydration and depletion of electrolytes will lead to muscle spasm and cramping. Muscle cells require enough water, glucose, sodium, potassium, calcium, and magnesium to allow the proteins within them to develop an organized contraction. Abnormal supply of these elements can cause the muscle to become irritable and develop spasm.
8. Atherosclerosis or narrowing of the arteries (peripheral artery disease) may also lead to muscle spasm and cramps, again because an inadequate blood supply and nutrients are delivered to the muscle. Peripheral artery disease can decrease the flow of blood to the legs, causing pain in the legs with activity. There may also be associated muscle cramps.
9. Leg spasms are often seen related to exercise, but cramps may also be seen at night involving calf and toe muscles. Nocturnal leg cramps and restless legs syndrome are considered a type of sleep disturbance. Their prevalence increases with age and often a precise cause is not found.
10. Chronic neck and back pain can lead to recurrent muscles spasms. Large muscle groups make up the trunk, including the neck, chest wall, upper back, lower back, arms, and legs. Spasms in these muscles can be a result of an injury or they may develop over time because of arthritic changes in the spine. Systemic illnesses like diabetes, anemia (low red blood cell count), kidney disease, and thyroid and other hormone issues are also potential causes of muscle spasms.
11. Diseases of the nervous system, such as amyotrophic lateral sclerosis, multiple sclerosis, or spinal cord injury, can be associated with muscle spasm.
12. Smooth muscle can also go into spasm. When a hollow structure filled with air or fluid is squeezed by the muscle spasm, significant pain may occur, since the fluid or air cannot be compressed. For example, smooth muscle in the intestinal wall can go into spasm, causing waves of pain called colic. Colicky pain which tends to come and go may also occur within the bile duct that empties the gallbladder and may develop after eating.
13. When kidney stones try to pass through the urinary tract, the smooth muscles that are in the walls of the ureter (that connects the kidney to the bladder) may spasm rhythmically and cause significant pain. Often this type of pain is associated with nausea and vomiting and is called renal colic.
14. Muscles that surround the esophagus can go into spasm when irritation occurs with reflux esophagitis or GERD.
15. Diarrhea can be associated with colicky pain, where the muscles within the colon wall spasm just before a watery bowel movement.
16. Menstrual cramps occur when the walls of the uterus contract forcefully.
17. The coronary arteries that supply the heart muscle with blood also have smooth muscle within their walls that may go into spasm. This can cause chest pain that may be indistinguishable from the pain of coronary artery disease (where plaque has accumulated and narrowed the arteries). Coronary artery spasm often occurs in smokers or those who have high cholesterol blood levels. Coronary artery spasm may be triggered by stress, alcohol withdrawal, stimulant drug abuse or medications that can constrict or narrow blood vessels. Coronary artery spasm is also known as Prinzmetal's angina.
18. Dystonias are movement disorders where groups of muscles forcefully contract and cause twisting. Uncontrolled repetitive movements and the inability to maintain normal posture may be the result of this type of muscle spasm and cramping. The symptoms may be very mild initially but gradually progress to become more frequent and aggressive. Occasionally, there is no progression. Examples of this type of muscle spasm include torticollis (where the neck muscles spasm and cause the head to turn to one side), blepharospasm (where there is uncontrolled blinking of the eyes), and laryngeal dystonia that affects the muscles that control speech. Dystonias may be caused by abnormally functioning neurotransmitter chemicals within part of the brain called the basal ganglia. These chemicals (serotonin, dopamine, acetylcholine, and GABA) are required to properly send messages between brain cells that begin muscle contraction. Dystonia symptoms may occur as a complication of stroke.

Summary; 

• Poor blood circulation in the legs
• Overexertion of the calf muscles while exercising
• Insufficient stretching before exercise
• Exercising in the heat
• Muscle fatigue
• Dehydration
• Magnesium and/or potassium deficiency
• Calcium deficiency in pregnant women
• Malfunctioning nerves, which could be caused by a problem such as a spinal cord injury or pinched nerve in the neck or back

Medications that can cause muscle cramps include:

• Lasix (furosemide), Microzide (hydrochlorothiazide), and other diuretics ("water pills") used to remove fluid from the body
• Aricept (donepezil), used to treat Alzheimer's disease
• Prostigmine (neostigmine), used for myasthenia gravis
• Procardia (nifedipine), a treatment for angina and high blood pressure
• Evista (raloxifene), an osteoporosis treatment
• Brethine (terbutaline), Proventil and Ventolin (albuterol), asthma medications
• Tasmar (tolcapone), a medication used to treat Parkinson's disease
• Statin medications for cholesterol such as Crestor (rosuvastatin),Lescol (fluvastatin), Lipitor (atorvastatin), Mevacor (lovastatin),Pravachol (pravastatin), or Zocor (simvastatin)

What are risk factors for muscle spasms?

Most people are at risk for developing a muscle spasm at one time. The risks differ depending upon the person's past medical history, their occupation, and level of physical activity. Examples include the following:

Construction and factory workers who work in hot environments are at risk for becoming dehydrated and developing heat cramps. This same situation can occur in athletes, both elite and recreational.
Patients with peripheral artery disease can develop nocturnal leg cramps. Risk factors are the same as for stroke and heart attack: high blood pressure, high cholesterol, diabetes, and smoking.
Patients who have underlying neurologic disorders are at risk for developing muscle spasms.
What are the symptoms and signs of muscle spasms?

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The symptoms of muscle spasm depend upon the muscle involved and the circumstances leading up to the spasm.

Skeletal muscle spasm usually involves muscles that are being asked to do excessive work. There is acute onset of pain as the muscle contracts. A bulging, tight muscle may be seen or felt underneath the skin where the muscle is located. Most often, the spasm resolves spontaneously after a few seconds though it may last many minutes or longer. Usually, those affected will feel the need to stretch the muscle involved, thus relieving the spasm and resolving the episode. With heat cramps, the muscle spasm may occur after the activity is completed.

A muscle fasciculation or twitch may last just a few seconds or may be a recurrent event. Usually, it's just a momentary repetitive contraction of just a few muscle fibers of a larger muscle in a localized area served by one nerve fiber. This often involves the eyelid, calf, thigh, or thumb. The fasciculations often come and go and may be related to stress or anxiety. Ingestion of stimulants like caffeine and pseudoephedrine or phenylephrine found in over-the-counter cold medications may also cause the twitch. Medications such as albuterol (Ventolin, Proventil, AccuNeb, VoSpire, ProAir) used for the treatment of asthma and medications used to treat attention deficit disorder (Adderall) may be associated with twitching. These twitches are considered harmless and are referred to as benign fasciculations.

However, muscle twitching may also be associated with neurologic disorders such as muscular dystrophy, amyotrophic lateral sclerosis, and myopathy (a primary muscle illness). With these diseases, associated symptoms include weakness, muscle wasting with loss of muscle size, and change in sensation.

Smooth muscle spasm will cause colicky pain that comes and goes. The symptoms will depend upon the organ involved.


Treatment of a Muscle Spasm

Prevention is the key to most skeletal muscle spasm episodes.

Since they are often associated with dehydration and electrolyte disturbances, it is important to keep the body well hydrated. If the fluid loss is due to an illness with fever or vomiting and diarrhea, controlling the symptoms will help limit fluid loss and prevent spasms. Similarly, for those who work or exercise in a hot environment, drinking enough fluids to keep hydrated is very important. It is often helpful as well to hydrate prior to activities in warm environments.

Muscles should also be prepared for the activity that they are expected to do. Just as athletes stretch and warm up before the game, nonathletes should warm up before heavy labor, including jobs like raking, mowing, and shoveling snow.

Should a large skeletal muscle go into spasm (often referred to as a charley horse), the initial treatment is to gently stretch the muscle back to length to break the spasm cycle and resolve the acute situation.

Further treatment will depend upon the underlying cause of the muscle spasms. For muscles that have been damaged or strained, medications may be required for short-term pain relief, including anti-inflammatories (ibuprofen [Advil, Motrin]), narcotics, and muscle relaxants.

The treatment of smooth muscle spasm, such as bowel spasm, also depends upon the underlying cause.

Nocturnal leg cramps are difficult to control and treat. Historically, quinine has been prescribed to help with the muscle spasms, but this drug can have side effects including abnormal bleeding problems. Other medications, including B-complex vitamins, gabapentin and diltiazem, may be helpful.

Many possible treatments are available for the dystonias. The decision as to which medication to use depends upon the individual situation. It may take trial and error to find the right medication in the right dose to control symptoms.

Anti-Parkinsonism drugs, like trihexyphenidyl HCl (Artane) and benztropine mesylate (Cogentin), decrease acetylcholine levels.
Muscle relaxants like diazepam (Valium) and baclofen (Lioresal) affect GABA receptors.
Levodopa (Sinemet) and reserpine (Harmonyl) affect dopamine levels.
Carbamazepine (Tegretol), a seizure-control drug, may be useful in some patients.
Botulinum toxin type A (Botox) may be injected into a specific muscle to paralyze it and relieve the muscle spasm of dystonia, such as for blepharospasms.
What is the prognosis for muscle spasms?

Most people experience infrequent muscle spasms and do well with prevention (keeping well hydrated and not overusing their body).

However, those who have an underlying medical condition as a cause of muscle spasms often need to treat the original medical problem to help control the muscle spasms. This is especially true for those with peripheral artery disease or movement disorders.

You could be out for a run or drifting off to sleep when it happens: The muscles of your calf or foot suddenly become hard, tight, and extremely painful. You are having a muscle cramp.

Sometimes called charley horses -- particularly when they are in thecalf muscles -- cramps are caused by muscle spasms, involuntarycontractions of one or more muscles. In addition to the foot and calf muscles, other muscles prone to spasms include the front and back of the thigh, the hands, arms, abdomen, and muscles along the rib cage.

Almost everyone experiences muscle cramps, which come without warning. What causes them, and what can you do to relieve them?

1. When muscle cramps occur, there are several things you can do to help ease them, such as massaging, stretching, or icing the muscle, warming the muscle, or taking a bath with Epsom salt.
2. For a charley horse in the calf or a cramp in the back of the thigh [hamstring], try putting your weight on the affected leg and bending your knee slightly, or sit or lie down with your leg out straight and pull the top of your foot toward your head. 
3. For a cramp in the front of the thigh (quadriceps), hold onto a chair to steady yourself and pull your foot back toward your buttock.