How effective is botulinum toxin-A for treating cramps in diabetic nerve disease?

The aim of this study was to investigate the safety and effectiveness of botulinum toxin A (BTX-A) injections for treating muscle cramps in diabetic neuropathy (nerve disease). The main finding of this study was that this treatment was safe and effective in treating muscle cramps in diabetic neuropathy.

Diabetic neuropathy (DN) is a complication of diabetes. In DN, nerves (mainly in the feet and legs) become damaged. This can cause muscle cramps. Muscle cramps occur in greater than 50% of patients with diabetes and reduce their quality of life. Currently, there is no effective treatment for these cramps.

Botulinum toxin type A (BTX-A), more commonly known as “botox”, is used effectively in the treatment of cramps in other nerve conditions. It is unknown whether BTX-A could effectively treat muscle cramps in DN.

This study included 50 patients with DN who were randomly signed to one of two groups. One group had BTX-A and the second group had saline (salt water). Both treatments were injected into their calf or foot muscles. Changes in pain intensity and cramp frequency were evaluated over 20 weeks after the injections. In 19 of the 20 patients who responded to treatment, BTX-A was repeated after 5 months.

Cramping pain intensity and the number of cramp episodes improved significantly in patients who received BTX-A compared to those who received saline. These changes occurred from the first week after injection and lasted until 14 weeks after the first injection. 56% of patients experienced a 50% reduction in pain intensity from week 1. 48% of patients still had greater than 50% pain reduction by week 12. After BTX-A, 20% of patients had pain reduction of less than 50%.

The only side effect experienced was pain at the injection site. This disappeared after 2-3 days and was sees in 4 patients.

The authors concluded that BTX-A is a safe and effective treatment for muscle cramps in DN.

The study size was very small. Larger studies are needed.

If you have concerns about DN and its treatment, discuss this with your doctor.