Evidence map›Paper›PMID 40545904›Full record

Trial reportMuscle & nerve2025

Placebo-Controlled, Randomized Double-Blind N-Of-1 Trial to Study Safety and Potential Efficacy of TJ-68 for Improving Muscle Cramps in Patients With Amyotrophic Lateral Sclerosis: A Pilot Study.

Hiroshi Mitsumoto, Ken Cheung, Björn Oskarsson, Grace E Jang, Howard F Andrews, Stephen Johnson, Jaimin S Shah, Joseph Americo Fernandes, Jinsy A Andrews, Maya Rao and 1 more

Abstract readRandomized Controlled TrialMulticenter Study
In one paragraph

Trial report in Muscle & nerve, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Trial
  2. Metabolomic analyses of amyotrophic lateral sclerosis, muscle cramps, and TJ-68 treatment.Metabolomics : Official journal of the Metabolomic Society · 2026
    Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Hiroshi MitsumotoDepartment of Neurology, Columbia University Irving Medical Center, New York, New York, USA.ORCID https://orcid.org/0000-0001-6259-8923
Ken CheungDepartment of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA.
Björn OskarssonDepartment of Neurology, Mayo Clinic Jacksonville, Jacksonville, Florida, USA.ORCID https://orcid.org/0000-0002-1725-9866
Grace E JangDepartment of Neurology, Columbia University Irving Medical Center, New York, New York, USA.
Howard F AndrewsData Coordinating Center (DCC), Department of Biostatistics, Mailman School of Public Health, Columbia University Mailman School of Public Health and New York State Psychiatric Institute, New York, New York, USA.
Stephen JohnsonDepartment of Neurology, Mayo Clinic Arizona, Scottsdale, Arizona, USA.ORCID https://orcid.org/0000-0002-9058-4331
Jaimin S ShahDepartment of Neurology, Mayo Clinic, Jacksonville, Florida, USA.
Joseph Americo FernandesDepartment of Neurology, University of Nebraska, Omaha, Nebraska, USA.
Jinsy A AndrewsDepartment of Neurology, Columbia University Irving Medical Center, New York, New York, USA.
Maya RaoDepartment of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA.
Martin McElhineyDepartment of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

INTRODUCTION/

aimsMuscle cramps are a common symptom in amyotrophic lateral sclerosis (ALS). Ameliorating muscle cramps may improve quality of life in devastating diseases like ALS. A traditional Japanese medicine (Kampo, TJ-68) is widely prescribed in Japan for muscle cramps. However, it is not available in the USA. This study evaluated the safety, tolerability, and efficacy of TJ-68 in ALS.

methodsThis study was a double-blind, randomized, placebo-controlled crossover trial, consisting of four periods, conducted at three centers in the USA. Safety was evaluated using multiple measures. The primary efficacy outcome was the Visual Analog Scale for Muscle Cramps Affecting Overall Daily Activity (item #5 of the Muscle Cramp Scale (MCS)). The secondary outcomes included the remaining items of the MCS and the Clinical Global Impression of Changes (CGIC), among others. The study was planned to enroll 22 participants with ALS within 2 years.

resultsThe enrollment was slow and was completed with 11 participants. There were no serious safety issues and TJ-68 was well tolerated. Although the primary outcome measure did not reach statistical significance (p = 0.35), several secondary measures showed significant results: MCS #1 triggering of cramps (p = 0.01), MCS #2 cramp frequency (p = 0.03), MCS Additional 1 change of motor behaviors (p = 0.02), and CGIC assessed by the evaluator (p = 0.009). Other outcome measures did not reach statistical significance. DISCUSSION: The study revealed that N-of-1 trial design can detect changes in a small sample size, and TJ-68 appeared to be safe. Larger studies are needed to confirm the efficacy of TJ-68.

Indexed as

Amyotrophic Lateral SclerosisMuscle CrampAdultAgedCross-Over StudiesDouble-Blind MethodFemaleHumansMaleMiddle AgedPilot ProjectsSingle-Case Studies as TopicTreatment OutcomeALSmuscle crampsmuscle cramp scale (MCS)N‐of‐1 trialsTJ‐68 (Shakuyakukanzoto)

Identifiers

PMID40545904
PMCPMC12338019

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.