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Introduction: Muscle cramping is a common symptom in amyotrophic lateral sclerosis (ALS) that lacks efficacious treatment. The natural history of this symptom is unknown, which hampers efforts to design optimal clinical trials., Methods: We surveyed early stage ALS patients about their experience with cramps each month by phone for up to 21 months., Results: Cramps developed in 95% of patients over the course of their disease. The number of cramps experienced by an individual varied widely from month-to-month and trended lower after the first year of illness (P = 0.26). Those with limb-onset and age >60 years had more cramps than bulbar-onset (P < 0.0001) and younger patients (P < 0.0001)., Conclusions: The high variability of the number of cramps experienced suggests that clinical trials will need to use crossover designs or large numbers of participants, even when the treatment effect is substantial., (© 2015 Wiley Periodicals, Inc.)

Introduction: High-resolution ultrasound has been used to evaluate several neuromuscular conditions, but it has only been used on a limited basis in amyotrophic lateral sclerosis (ALS) patients. It has not been used to assess their peripheral nerves. This study was designed to use neuromuscular ultrasound to investigate nerve cross-sectional area and muscle thickness in ALS., Methods: Twenty individuals with ALS and 20 matched controls underwent neuromuscular ultrasound to measure the cross-sectional area of their median and sural nerves and the thickness of their biceps/brachialis muscle complex., Results: The cross-sectional area of the median nerve in the mid-arm was smaller in the ALS group than in controls (10.5 mm(2) vs. 12.7 mm(2) , P = 0.0023), but no difference was seen in the sural nerve (4.5 mm(2) vs. 5.0 mm(2) , P = 0.1927). The ALS group also had thinner biceps/brachialis than controls (2.1 cm vs. 2.9 cm, P = 0.0007)., Conclusions: Neuromuscular ultrasound demonstrates nerve and muscle atrophy in ALS and should be further explored as a disease biomarker., (Copyright © 2011 Wiley Periodicals, Inc.)