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Magnesium untuk kekejangan otot rangka

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Abstract

Background

Skeletal muscle cramps are common and often presented to physicians in association with pregnancy, advanced age, exercise or disorders of the motor neuron (such as amyotrophic lateral sclerosis). Magnesium supplements are marketed for the prophylaxis of cramps but the efficacy of magnesium for this indication has never been evaluated by systematic review.

Objectives

To assess the effects of magnesium supplementation compared to no treatment, placebo control or other cramp therapies in people with skeletal muscle cramps.  

Search methods

We searched the Cochrane Neuromuscular Disease Group Specialized Register (11 October 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (2011, Issue 3), MEDLINE (January 1966 to September 2011), EMBASE (January 1980 to September 2011), LILACS (January 1982 to September 2011), CINAHL Plus (January 1937 to September 2011), AMED (January 1985 to October 2011) and SPORTDiscus (January 1975 to September 2011).

Selection criteria

Randomized controlled trials (RCTs) of magnesium supplementation (in any form) to prevent skeletal muscle cramps in any patient group (i.e. all clinical presentations of cramp). We considered comparisons of magnesium with no treatment, placebo control, or other therapy.

Data collection and analysis

Two authors independently selected trials for inclusion and extracted data. Two authors assessed risk of bias. We attempted to contact all study authors and obtained patient level data for three of the included trials, one of which was unpublished. All data on adverse effects were collected from the included RCTs.

Main results

We identified seven trials (five parallel, two cross‐over) enrolling a total of 406 individuals amongst whom 118 cross‐over participants additionally served as their own controls. Three trials enrolled women with pregnancy‐associated leg cramps (N = 202) and four trials enrolled idiopathic cramp sufferers (N = 322 including cross‐over controls). Magnesium was compared to placebo in six trials and to no treatment in one trial.

For idiopathic cramps (largely older adults presumed to have nocturnal leg cramps), differences in measures of cramp frequency, magnesium versus placebo, were small, not statistically significant, and without heterogeneity (I2 = 0%). This includes the primary endpoint, percentage change from baseline in the number of cramps per week at four weeks (‐3.93%, 95% confidence interval (CI) ‐21.12% to 13.26%, moderate quality evidence) and the difference in the number of cramps per week at four weeks (0.01 cramps/week, 95% CI ‐0.52 to 0.55, moderate quality evidence). The percentage of individuals experiencing a 25% or better reduction in cramp rate from baseline was also no different, being 8% lower in the magnesium group (95% CI ‐28% to 12%, moderate quality evidence). Similarly, no statistically significant difference was found at four weeks in measures of cramp intensity (moderate quality evidence) or cramp duration (low quality evidence).

Meta‐analysis was not possible for trials of pregnancy‐associated leg cramps. The single study comparing magnesium to no treatment failed to find statistically significant benefit on a three‐point ordinal scale of overall treatment efficacy. The two trials comparing magnesium to placebo differed in that one trial found no benefit on frequency or intensity measures while the other found benefit for both.

Withdrawals due to adverse events were not significantly different than placebo. While we could not determine the number of subjects with minor adverse events, studies of oral magnesium generally described potential side effects as similar in frequency to placebo.

Authors' conclusions

It is unlikely that magnesium supplementation provides clinically meaningful cramp prophylaxis to older adults experiencing skeletal muscle cramps. In contrast, for those experiencing pregnancy‐associated rest cramps the literature is conflicting and further research in this patient population is needed. We found no randomized controlled trials evaluating magnesium for exercise‐associated muscle cramps or disease state‐associated muscle cramps (for example amyotrophic lateral sclerosis/motor neuron disease).

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Ringkasan bahasa mudah

Magnesium untuk kekejangan otot

Kekejangan otot adalah perkara biasa dan boleh berlaku dalam pelbagai keadaan. Orang dewasa yang lebih tua dan wanita hamil biasanya mengadu kekejangan kaki semasa mereka sedang berehat, atlet boleh berkejangan apabila mereka menolak had ketahanan mereka, dan sesetengah orang mengalami kekejangan otot sebagai tanda keadaan perubatan yang lain. Salah satu rawatan yang berpotensi yang sudah dipasarkan untuk mengelakkan kekejangan otot adalah supplemen magnesium. Magnesium adalah mineral biasa dalam diet kita dan makanan tambahan mineral ini boleh didapati sama ada melalui Internet atau di kedai‐kedai makanan kesihatan dan farmasi (biasanya dalam bentuk pil atau serbuk untuk dilarutkan di dalam air). Kami mencari semua kajian berkualiti serta yang diterbitkan untuk menilai keberkesanan magnesium dalam mengelakkan kekejangan otot dan mendapati empat kajian di kalangan orang dewasa yang lebih tua dan tiga kajian di kalangan wanita hamil. Tidak terdapat kajian atas orang‐orang yang kekejangan semasa bersenam dan tiada kajian ke atas orang‐orang yang kekejangan disebabkan masalah perubatan. Empat kajian atas orang dewasa yang lebih tua (sebanyak 322 peserta termasuk kawalan dalam kajian rentas) bersama‐sama mencadangkan bahawa magnesium tidak mungkin memberi manfaat bermakna dalam mengurangkan kekerapan dan keterukan kekejangan dalam populasi itu. Kami menganggap bukti‐bukti sebagai berkualiti sederhana. Sebaliknya, kesemua tiga kajian wanita hamil (202 peserta) tiada berkesimpulan kerana satu kajian mendapati manfaat dalam mengurangkan kekerapan dan kesakitan kekejangan manakala dua lagi mendapati tiada manfaat. Lebih banyak penyelidikan berkenaan magnesium dalam kalangan wanita hamil itu diperlukan; Walau bagaimanapun, penghidap kekejangan orang dewasa lebih tua dijangka tidak mendapat manfaat daripada terapi ini. Walaupun kita tidak dapat menentukan kadar kesan‐kesan sampingan yang tidak diingini, kadar pengeluaran dalam kajian dan perbincangan peristiwa buruk mencadangkan rawatan ini senang diterima.