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Case Report

Progressive muscle cramps with pain as

atypical initial presentations of amyotrophic

lateral sclerosis: a case report

Cheng-Hui Liu, Chi Zhu, Fan Zeng, Heng Yang, Yan-Jiang Wang
Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, The Third Military Medical University,
Chongqing 400042, China.

A B S T R AC T
Amyotrophic lateral sclerosis (ALS) is the most common form of motor neuron disease and is a progressive and devastating
neurodegenerative disease that affects both lower and upper motor neurons. Muscle cramps, which are characterized by a sudden,
painful, involuntary contraction of muscles, are not rare in ALS patients. However, muscle cramps do not normally present early in
ALS and therefore not used for the initial diagnosis of ALS. In this paper the authors present a case of ALS with initial manifestation of
progressive painful muscle cramps in the absence of muscle weakness. This case might help people to recognize atypical foremost
presentations of ALS and therefore formulate effective therapies.
Key words: Muscular cramps; amyotrophic lateral sclerosis; motor neuron disease

INTRODUCTION (1-9%), axial onset with muscle weakness, muscle
[7,8]
atrophy and fasciculations. Muscle cramping with
Amyotrophic lateral sclerosis (ALS) is a rapidly pain presents in 7-12% of ALS patients. Muscle
[9]
progressive, fatal neurodegenerative disorder. [1,2] cramps, are not rare in ALS patients, but rarely act as
The worldwide incidence of ALS is around 1.7-2.3% initial symptom without muscle weakness of the ALS
per 100,000 population per year and the average age patients. Some studies reported that muscle cramps
of onset is 61.8 and 49.8 for Western countries and could appear during the early phase or prodromal
China individually. The occurrence rate of men is phase of ALS, and muscle cramps could help in the
higher than women. [3-6] The pathogenesis of motor early diagnosis of ALS. [10,11] In this paper we present
neuron disease (MND) remains largely unclear, a rare case with initial manifestation of progressive
genetic factors and various exogenous risk factors painful muscle cramps in the absence of obvious
are suggested to be associated with MND, including
rural residency, alcohol consumption, smoking, muscle weakness.
toxic substance, glutamate metabolism disorder and CASE REPORT
aberrant autoimmunity. [4-6]

A 56-year-old Chinese woman presented with
Typical clinical presentations of ALS include
asymmetric weakness of limbs (60-80%), bulbar progressive limb muscle cramps with pain and walk
symptoms (20%), respiratory muscle weakness (1-3%), difficulty for the last 7 months. She had no special
generalized weakness in limbs and bulbar muscles medical history before. At the beginning, the muscle
cramps started in her left lower limb, 4 months after
Corresponding Author: Dr. Yan-Jiang Wang, Department the onset, muscle cramps were aggravated, and slowly
of Neurology and Center for Clinical Neuroscience, Daping
Hospital, The Third Military Medical University, Chongqing This is an open access article distributed under the terms of the Creative
400042, China. E-mail: yanjiang_wang@tmmu.edu.cn Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows
others to remix, tweak, and build upon the work non-commercially, as long as the
Access this article online author is credited and the new creations are licensed under the identical terms.
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How to cite this article: Liu CH, Zhu C, Zeng F, Yang H, Wang YJ.
Progressive muscle cramps with pain as atypical initial presentations
of amyotrophic lateral sclerosis: a case report. Neuroimmunol
DOI: 10.20517/2347-8659.2015.49 Neuroinflammation 2016;3:170-2.
Received: 08-11-2015; Accepted: 30-03-2016
170 © 2016 Neuroimmunology and Neuroinflammation | Published by OAE Publishing Inc.