Magnesium Sulfate for Acute Traumatic Brain Injury

BackgroundThe purpose of this systematic review was to evaluate the effect of magnesium sulfate in the treatment of acute traumatic brain injury. Materials and MethodsA systematic search of ClinicalTrials.gov, the Cochrane Library database, EMBASE, MEDLINE, Web of Science, and the World Health Organization trial registry, plus manual searches of gray literature, was undertaken in April 2013. Two reviewers independently extracted the data with a predefined data extraction form. RevMan 5 software was used to synthesize data and calculate the risk ratio for mortality with the 95% confidence interval. For the Glasgow Outcome Scale and posttreatment Glasgow Coma Scale data, the weighted mean difference was calculated with the 95% confidence interval. ResultsA total of 8 randomized controlled trials with a total of 786 patients were included. Meta-analysis showed that there was no significant difference between the groups for mortality. The Glasgow Outcome Scale of the treatment group was higher than that of the control group, although the significance was borderline. The Glasgow Coma Scale score change posttreatment was significantly higher than that of the control. ConclusionsThe present meta-analysis of existing randomized controlled trials does not identify a significant beneficial effect in the mortality of traumatic brain injury patients; however, it suggests that magnesium sulfate shows a tendency to improve the Glasgow Outcome Scale and Glasgow Coma Scale scores, which is a promising result for traumatic brain injury therapy. Further effort is necessary to explore which subgroup of traumatic brain injury patients could benefit from magnesium sulfate.

[1]  A. Ahmadvand,et al.  Magnesium Sulfate Effect on the Clinical Course and GCS of Patients with a Severe Diffuse Axonal Injury , 2012 .

[2]  Y. Yanagawa.  Studying patients of severe traumatic brain injury with severe abdominal injury in Japan , 2011, Journal of emergencies, trauma, and shock.

[3]  M. Wald,et al.  Surveillance for traumatic brain injury-related deaths--United States, 1997-2007. , 2011, Morbidity and mortality weekly report. Surveillance summaries.

[4]  P. Vos,et al.  Clinical characteristics and pathophysiological mechanisms of focal and diffuse traumatic brain injury , 2010, Journal of cellular and molecular medicine.

[5]  B. Sharma,et al.  Randomized controlled trial of magnesium sulphate in severe closed traumatic brain injury , 2008, Indian Journal of Neurotrauma.

[6]  John W. Miller,et al.  When Basic Research Doesn't Translate to the Bedside—Lessons from the Magnesium Brain Trauma Study , 2007, Epilepsy currents.

[7]  S. Wisniewski,et al.  Serum and cerebrospinal fluid magnesium in severe traumatic brain injury outcome. , 2007, Journal of neurotrauma.

[8]  Ewout W Steyerberg,et al.  Prognosis and clinical trial design in traumatic brain injury: the IMPACT study. , 2007, Journal of neurotrauma.

[9]  Eiju Watanabe,et al.  [Acupuncture treatment for a patient with diffuse axonal injury]. , 2007, Masui. The Japanese journal of anesthesiology.

[10]  T. Lucas,et al.  Magnesium sulfate for neuroprotection after traumatic brain injury: a randomised controlled trial , 2007, The Lancet Neurology.

[11]  C. Ek,et al.  Changes in blood–brain barrier permeability to large and small molecules following traumatic brain injury in mice , 2007, The European journal of neuroscience.

[12]  M. Johnston,et al.  Pilot study to determine the hemodynamic safety and feasibility of magnesium sulfate infusion in children with severe traumatic brain injury* , 2007, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[13]  张赛,et al.  A study of the effect of extrinsic ionized magnesium treatment in the patients with severe traumatic brain injury , 2006 .

[14]  D. McArthur,et al.  Posttraumatic vasospasm: the epidemiology, severity, and time course of an underestimated phenomenon: a prospective study performed in 299 patients. , 2005, Journal of neurosurgery.

[15]  T. Enomoto,et al.  Pre-Injury magnesium treatment prevents traumatic brain injury-induced hippocampal ERK activation, neuronal loss, and cognitive dysfunction in the radial-arm maze test. , 2005, Journal of neurotrauma.

[16]  T. Sakamoto,et al.  Ionized magnesium in the cerebrospinal fluid of patients with head injuries. , 2005, The Journal of trauma.

[17]  R. Brewer,et al.  Analysis of the brain bioavailability of peripherally administered magnesium sulfate: A study in humans with acute brain injury undergoing prolonged induced hypermagnesemia* , 2005, Critical care medicine.

[18]  R. Vink,et al.  Magnesium Attenuates Post-Traumatic Depression/Anxiety Following Diffuse Traumatic Brain Injury in Rats , 2004, Journal of the American College of Nutrition.

[19]  R. Vink,et al.  The role of magnesium in traumatic brain injury. , 2004, Clinical calcium.

[20]  Young Hoon Kim,et al.  A molecular basis for the efficacy of magnesium treatment following traumatic brain injury in rats. , 2004, Journal of neurotrauma.

[21]  Thomas B Cole,et al.  Global road safety crisis remedy sought: 1.2 million killed, 50 million injured annually. , 2004, JAMA.

[22]  H. Bramlett,et al.  Pathophysiology of Cerebral Ischemia and Brain Trauma: Similarities and Differences , 2004, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[23]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[24]  T. Ozgurtas,et al.  Monitoring of serum ionized magnesium in neurosurgical intensive care unit: preliminary results. , 2003, Clinica chimica acta; international journal of clinical chemistry.

[25]  S. Canavero,et al.  Safety of magnesium-lidocaine combination for severe head injury: the Turin lidomag pilot study. , 2003, Surgical neurology.

[26]  J. Takala,et al.  Effects of cerebral perfusion pressure and increased fraction of inspired oxygen on brain tissue oxygen, lactate and glucose in patients with severe head injury , 2003, Acta Neurochirurgica.

[27]  R. Vink,et al.  Magnesium attenuates persistent functional deficits following diffuse traumatic brain injury in rats , 2003, Neuroscience Letters.

[28]  Guosheng Zhou,et al.  Effect of large dose of magnesium sulfate on patients with brain injury , 2001 .

[29]  R. Raghupathi,et al.  Postinjury treatment with magnesium chloride attenuates cortical damage after traumatic brain injury in rats. , 2000, Journal of neurotrauma.

[30]  S. Barbay,et al.  Large cortical lesions produce enduring forelimb placing deficits in un-treated rats and treatment with NMDA antagonists or anti-oxidant drugs induces behavioral recovery , 2000, Brain Research Bulletin.

[31]  R. Boet,et al.  Magnesium Sulfate in the Management of Patients with Fisher Grade 3 Subarachnoid Hemorrhage: A Pilot Study , 2000, Neurosurgery.

[32]  R. Vink,et al.  Brain free magnesium concentration is predictive of motor outcome following traumatic axonal brain injury in rats. , 1999, Magnesium research.

[33]  K A Dunn,et al.  Traumatic brain injury in the United States: A public health perspective. , 1999, The Journal of head trauma rehabilitation.

[34]  R. Vink,et al.  Concentration of brain free magnesium following severe brain injury correlates with neurologic motor outcome , 1999, Journal of Clinical Neuroscience.

[35]  J. K. Muir,et al.  Postinjury Magnesium Treatment Attenuates Traumatic Brain Injury-Induced Cortical Induction of p53 mRNA in Rats , 1999, Experimental Neurology.

[36]  M. Helfaer,et al.  Alterations in Ionized and Total Blood Magnesium After Experimental Traumatic Brain Injury , 1999, Journal of neurochemistry.

[37]  R. Vink,et al.  Optimization of magnesium therapy after severe diffuse axonal brain injury in rats. , 1999, The Journal of pharmacology and experimental therapeutics.

[38]  R. Vink,et al.  Improved motor outcome in response to magnesium therapy received up to 24 hours after traumatic diffuse axonal brain injury in rats. , 1999, Journal of neurosurgery.

[39]  T. Wieloch,et al.  Novel pharmacologic strategies in the treatment of experimental traumatic brain injury: 1998. , 1998, Journal of neurotrauma.

[40]  R. Vink,et al.  Neuroprotective effects of MgSO4 and MgCl2 in closed head injury: a comparative phosphorus NMR study. , 1998, Journal of neurotrauma.

[41]  T. Fuchs-Buder,et al.  Cerebrospinal fluid passage of intravenous magnesium sulfate in neurosurgical patients. , 1997, Journal of neurosurgical anesthesiology.

[42]  D. McArthur,et al.  Hemodynamically significant cerebral vasospasm and outcome after head injury: a prospective study. , 1997, Journal of neurosurgery.

[43]  Dr. Algirdas Kakarieka.  Traumatic Subarachnoid Haemorrhage , 1996, Springer Berlin Heidelberg.

[44]  J. Moodley,et al.  Randomised study assessing the effect of phenytoin and magnesium sulphate on maternal cerebral circulation in eclampsia using transcranial Doppler ultrasound , 1996, British journal of obstetrics and gynaecology.

[45]  A R Jadad,et al.  Assessing the quality of reports of randomized clinical trials: is blinding necessary? , 1996, Controlled clinical trials.

[46]  R. Cracco,et al.  Predictive value of serum ionized but not total magnesium levels in head injuries. , 1995, Scandinavian journal of clinical and laboratory investigation.

[47]  Douglas H. Smith,et al.  The Sodium Channel Blocker and Glutamate Release Inhibitor BW1003C87 and Magnesium Attenuate Regional Cerebral Edema Following Experimental Brain Injury in the Rat , 1995, Journal of neurochemistry.

[48]  Douglas H. Smith,et al.  Magnesium and ketamine attenuate cognitive dysfunction following experimental brain injury , 1993, Neuroscience Letters.

[49]  M. Sadeh,et al.  Action of magnesium sulfate in the treatment of preeclampsia-eclampsia. , 1989, Stroke.

[50]  M. Weiner,et al.  Decline in intracellular free Mg2+ is associated with irreversible tissue injury after brain trauma. , 1988, The Journal of biological chemistry.

[51]  B. Jennett,et al.  ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE A Practical Scale , 1975, The Lancet.

[52]  B. Jennett,et al.  Assessment of coma and impaired consciousness. A practical scale. , 1974, Lancet.

[53]  K. Barlow.  Traumatic brain injury. , 2013, Handbook of clinical neurology.

[54]  J. Mejia-Mantilla,et al.  Magnesium for acute traumatic brain injury. , 2006, The Cochrane database of systematic reviews.

[55]  Zhi Dashi.  A study of the effect of extrinsic ionized magnesium treatment in the patients with severe traumatic brain injury , 2006 .

[56]  R. Brewer,et al.  Magnesium neuroprotection is limited in humans with acute brain injury , 2005, Neurocritical care.

[57]  R. Bullock,et al.  Fluid percussion injury transiently increases then decreases brain oxygen consumption in the rat. , 2000, Journal of neurotrauma.

[58]  M. Grady,et al.  Regional patterns of blood-brain barrier breakdown following central and lateral fluid percussion injury in rodents. , 1993, Journal of neurotrauma.