ALS From Both Sides, Care of an ALS Patient By Diane Huberty, Retired RN, Certified Neuro Nurse and ALS Patient

Muscle Cramping and Spasticity

There are four main "muscle things" that occur with ALS: Spasticity, cramping, fasciculations, and fibrillations.

Muscle Cramps

Muscle cramps are very common in ALS, probably due to muscle fatigue or irritability from screwed up nerve impulses. They can be terribly painful and can occur in any muscle; feet, legs, arms, abdomen, chest, back, and (my all time favorite for sheer pain!) the neck and jaw. They can be in small muscles or affect big ones—good old-fashioned charlie horses. As the muscles are affected by ALS, cramping is noted in that area. The cramping becomes less severe with time because the weakening muscles simply can't work up a good cramp anymore. Cramps tend to be repetitive. Once a muscle starts cramping up, it does so over and over for a miserable hour or so. They tend to occur more if you have overdone exercise, if the muscle is cold, or if circulation is decreased. Holding a book up to read in bed on a cool night will just about guarantee some whopping good hand cramps and result in interesting finger gestures!


Spasticity is an upper motor neuron problem and is present to some degree in ALS. For some patients, it is minimal, for others extreme. Spasticity can actually be helpful in maintaining function as the rigidity helps replace normal muscle strength, but it causes jerky, hard to control movements. Spasticity causes a tightening of muscles that results in a stiffening of that part of the body in an exaggerated reflex. It is actually triggering both the muscles to flex and the muscles to extend that part of the body at the same time. It can occur in any muscles—the arms, legs, back, abdomen, neck, or entire body at once. A simple touch can trigger it and it may last only a moment or persist indefinitely. Spasticity isn't always painful but it can be, especially if it triggers muscle cramps that add to the pain.


Fasciculations (muscle twitchings) are probably due to nerve irritability. They occur in smaller muscle bundles inside large muscle bundles and can be observed as well as felt. Fasciculations are not so much painful as irritating. It can feel as if someone is popping corn under your skin! They can be incredibly persistent and keep you from sleeping.I have not heard of any consistent success in reducing the fasciculations with any medication.


Fibrillations occur in single muscle fibers within a muscle. They cannot be felt but can be seen on EMG (Electromyogram). Fibrillations occur in conditions besides ALS.

Is it Spasticity or Cramping?

The first step in relieving these recurring pains is determining whether they are due to spasticity or cramping. Medications that work for spasticity don't necessarily work for muscle cramps and vice-versa.


Spasticity can usually be helped by medication but can be a very stubborn problem. One consideration in treating spasticity is to find a balance between relieving excessive and painful spasticity and maintaining a certain level of spasticity which can be helpful by replacing muscle strength.The meds for spasticity are primarily Baclofen, Dantrium and Zanaflex, tizanadine HCL.

The meds for cramping include:

There are other medications and home remedies to try. Retigabine (Trobalt) is mentioned as is a spoonful of French's mustard or pickle juice! Magnesium, potassium, calcium are just some things suggested but should be used as ordered by a doctor. Excesses of these can cause severe problems. More importantly, they are less likely to be effective to any definite degree unless your levels were low to begin with—and that is not usual in ALS. In ALS muscle cramping is caused by nerve irritability and/or muscle strain as muscles weaken.

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