Persistent Leg Cramps in Elderly After Stroke: Seeking Solutions

Persistent leg cramps in the elderly?

After my mother suffered a thrombotic stroke, she has been experiencing persistent leg cramps, averaging a small cramp every ten minutes (tight cramps from the calf to the foot) and a larger cramp once an hour (with her body arching).
She has been on muscle relaxants, taking two pills three times a day for about a month, but there has been no improvement.
While on medication, she appears to be in a drowsy state, and the cramps have reduced to mild ones.
However, when the dosage is halved, the leg cramps return.
An EEG was performed, which showed no abnormal discharges indicative of seizures (the report indicated normal results), and her blood electrolyte levels were also normal, although there was some imbalance.
We have consulted various major hospitals in Taipei, but none have been able to provide relief.
We are at a loss as to what to do next.
Many doctors have suggested that the only solution for leg cramps is to continue using muscle relaxants.
I would like to ask a neurologist for professional advice or if there are any related cases that could provide guidance on how to help my mother alleviate her pain.
We would be very grateful for your assistance.

Xing Yu, 40~49 year old female. Ask Date: 2010/03/17

Dr. Gao Chunde reply Neurology

Although post-stroke patients are prone to seizures as a sequela, the characteristics you described seem to exhibit a regular periodicity.
Another common condition in the elderly is periodic limb movement disorder, which typically occurs during the onset of sleep or in light sleep.
This condition primarily involves flexion of the ankle and knee joints in the lower limbs, and in severe cases, the hip joint may also be affected.
The movements occur on average every fifteen to twenty seconds, lasting two to three seconds each time.
Some patients may have renal dysfunction, or deficiencies in iron or magnesium, but most do not show these abnormalities; rather, they exhibit brain degeneration.
In terms of treatment, once a diagnosis is confirmed, it is essential to address the specific issues.
There are several medication options available, but effective treatment can only be adjusted after a thorough examination of the patient’s response to medication.
Therefore, it is still recommended to consult a neurologist for evaluation, follow-up, and treatment to resolve the issues.

Reply Date: 2010/03/17

More Info

Persistent leg cramps in the elderly, especially following a stroke, can be a challenging and distressing issue for both the patient and their caregivers. In your case, your mother has been experiencing frequent leg cramps after suffering a stroke due to a blood clot. The cramps manifest as small contractions every ten minutes and more severe spasms that cause her body to arch, occurring approximately once an hour. Despite the use of muscle relaxants, there has been little improvement, and the side effects of these medications, such as drowsiness, are concerning.

Leg cramps, particularly in the elderly, can arise from various factors, including muscle fatigue, dehydration, electrolyte imbalances, and neurological issues related to the stroke. Given that your mother has undergone a thorough evaluation, including EEG and blood tests that returned normal results, it is essential to consider other potential causes and treatment options.

1. Physical Therapy: Engaging in physical therapy may help alleviate muscle cramps. A physical therapist can design a tailored exercise program that focuses on stretching and strengthening the muscles in the legs. Gentle stretching exercises before bed or during the day can help reduce the frequency and severity of cramps.

2. Hydration and Nutrition: Ensuring that your mother is adequately hydrated is crucial. Dehydration can contribute to muscle cramps. Additionally, while her electrolyte levels are reported as normal, it may be beneficial to review her diet to ensure she is receiving adequate amounts of potassium, magnesium, and calcium, which are essential for muscle function. Foods rich in these minerals include bananas, leafy greens, nuts, and dairy products.

3. Alternative Medications: If muscle relaxants are causing excessive drowsiness, it may be worth discussing with her physician the possibility of trying different medications. Some patients find relief with medications such as gabapentin or pregabalin, which are often used for neuropathic pain and may help with muscle spasms.

4. Topical Treatments: Applying heat or cold to the affected areas may provide temporary relief from cramps. Heat can help relax the muscles, while cold can reduce inflammation. Additionally, topical analgesics may help alleviate discomfort.

5. Regular Movement: Encouraging regular movement, even if it is limited, can help maintain muscle function and reduce the occurrence of cramps. Simple movements such as ankle pumps or gentle leg lifts can promote circulation and muscle relaxation.

6. Consultation with a Specialist: Since you have already seen multiple doctors without significant improvement, consider seeking a referral to a neurologist or a specialist in geriatric medicine who may have more experience with post-stroke complications. They may offer insights into less common causes of leg cramps or alternative treatment strategies.

7. Monitoring and Documentation: Keep a detailed log of your mother’s cramps, including their frequency, duration, and any potential triggers. This information can be invaluable for her healthcare providers in determining the best course of action.

In conclusion, while persistent leg cramps can be a common issue following a stroke, they can often be managed through a combination of physical therapy, dietary adjustments, alternative medications, and regular movement. It is essential to maintain open communication with her healthcare team to explore all available options and find the most effective treatment plan for her specific situation. Your dedication to seeking solutions for your mother’s discomfort is commendable, and with the right approach, there is hope for improvement in her quality of life.

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