[The state of muscle cramp disease]

A 65-year-old man presented with daily, almost continuous muscle cramps and painless muscle contractions eight years after being diagnosed as having rheumatoid arthritis. Both cramps and contractions were present at rest, were accentuated by stress and disappeared during sleep. By night-fall the patient was plunged into an extremely disabling condition due to the continuous cramps present in the orofacial, trunk, neck and limb musculature. He even had difficulty speaking. EMG studies demonstrated that both cramps and painless contractions appeared synchronously in muscles innervated by different peripheral nerves. A state of central hyperexcitability is the probable cause of this clinical picture which has remained unchanged over the last six years.