Research Article
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Investigation of the Effects of Magnesium Sulfate Therapy on Recovery in Traumatic Brain Injury

Year 2018, Volume: 25 Issue: 3, 293 - 297, 01.09.2018
https://doi.org/10.17343/sdutfd.422320

Abstract

Aim

The  incidence of disability and mortality in traumatic brain injuries is high. However there are no proven pharmacologic therapies to prevent these injury. Magnesium plays central pathophysiological  role in trumatic brain injuries. It has been shown that reduced magnesium levels were associated with these injuries. In this study, we investigate the effects of magnesium sulphate in traumatic brain injuries.

Material and Methods

60  traumatic brain injury patients admitted to Antalya Eğitim ve Araştırma Hospital between November 2008 and November2016 were retrospectively analysed.

Results.

60 patients were included in this study (mean age  35.6±17.6 years, 53 male, 7 female). GCS scores were 5 at admission, 7 at the time of discharge in Magnesium Sulphate and control groups, and at the end of two months it was 12 in Magnesium Sulphate group and 9 in control group (P<0.05). Duration in intensive care unit stay was 7 days in both groups. Surgical decompression was performed in 6 (20%) of the Magnesium Sulfate and in 8 of the control group (26.6%). Magnesium administered patients showed a significant positive effect on recovery after 2 months (P<0.05). Mortality after discharge within 1 month was 1 patient (3.33%) in Magnesium Sulfate group and 3 (10%) patients with control group.

 

Conclusion

The results indicate that administration og magnesium sulphate within 12 hours of traumatic brain injury may have neuroprotecitve effects.

References

  • 1. Kızılcık N ÇE, Keleştemur T, Köner Ö, İş M, Bilgen S, Çeçen A, Yılmaz B. Comparing effects of intraventricular hypertonic saline and magnesiım sulfate application on diffuse brain injury in rats. J Turk Soc Intens Care 2017;15:34-8.
  • 2. Li W BY, Li YJ, Liu KG, Wang MD, Xu GZ, Shang HL, Li YF. Magnesium sulfate for acute traumatic brain injury. J Craniofac Surg 2015;26(2):393-8.
  • 3. McIntosh TK. Novel pharmacologic therapies in the treatment of experimental traumatic brain injury: a review. J Neurotrauma. 1993;10(3):215-61.
  • 4. Temkin NR AG, Winn HR, Ellenbogen RG, Britz GW, Schuster J, Lucas T, Newell DW, Mansfield PN, Machamer JE, Barber J, Dikmen SS. Magnesium sulfate for neuroprotection after traumatic brain injury: a randomised controlled trial. . Lancet Neurol 2007;6(1):29-38.
  • 5. Memon ZI AB, Benjamin JL, Cracco RQ, Altura BM. Predictive value of serum ionized but not total magnesium levels in head injuries. . Scand J Clin Lab Invest. 1995;55:671-7.
  • 6. Vink R MT, Demediuk P, Weiner MW, Faden AI. Decline in intracellular free Mg2+ is associated with irreversible tissue injury after brain trauma. J Biol Chem. 1988;263(2):757-61.
  • 7. Vink R MT, Demediuk P, Faden AI. Decrease in total and free magnesium concen- tration following traumatic brain injury in rats. Biochem Biophys Res Commun 1987;149:594-9.
  • 8. Cernak I, Radosevic P, Malicevic Z, Savic J. Experimental magnesium depletion in adult rabbits caused by blast overpressure. Magnes Res. 1995;8(3):249-59.
  • 9. Heath DL, Vink R. Traumatic brain axonal injury produces sustained decline in intracellular free magnesium concentration. Brain Res. 1996;738(1):150-3.
  • 10. Smith DA, Connick JH, Stone TW. Effect of changing extracellular levels of magnesium on spontaneous activity and glutamate release in the mouse neocortical slice. Br J Pharmacol. 1989;97(2):475-82.
  • 11. Suzuki M, Nishina M, Endo M, Matsushita K, Tetsuka M, Shima K, et al. Decrease in cerebral free magnesium concentration following closed head injury and effects of VA-045 in rats. Gen Pharmacol. 1997;28(1):119-21.
  • 12. Heath DL, Vink R. Delayed therapy with magnesium upto 24h following traumatic brain injury improves motor outcome. . J Neurosurg 1999;90(3):504-9.
  • 13. Sen AP, Gulati A. Use of magnesium in traumatic brain injury. Neurotherapeutics. 2010;7(1):91-9.
  • 14. Salehpour F SM, Ahmadvand A, Vafaee R, Jafari R, Safaiyan A. Magnesium sulfate effect on the clinical course and GCS of patients with a severe diffuse axonal injury. J Paramed Sci 2012;3(4):2-6.
  • 15. SS Dhandapani AG, S Vivekanandhan, BS Sharma, AK Mahapatra. Randomized controlled trial of magnesium sulphate in severe closed traumatic brain injury. . Indian J Neurotrauma. 2008;5(1):27-33.
  • 16. Zhang S LJ, Zhi DS, et al. . A study of the effect of extrinsic ionized magnesium treatment in the patients with severe traumatic brain injury. Chin J Neurosurg 2006;2:76-9.
  • 17. Canavero S, Bonicalzi V, Narcisi P. Safety of magnesium-lidocaine combination for severe head injury: the Turin lidomag pilot study. Surg Neurol. 2003;60(2):165-9; discussion 9.

Travmatik Beyin Yaralanmasıda Magnezyum Sülfat Tedavisinin İyileşme Üzerine Etkisinin Araştırılması

Year 2018, Volume: 25 Issue: 3, 293 - 297, 01.09.2018
https://doi.org/10.17343/sdutfd.422320

Abstract

Amaç

 Travmatik beyin yaralanmalarına bağlı sakat kalma ve ölüm oranı yüksektir. Ancak bu yaralanmaların zararlı sonuçlarına karşı koruma sağlamak için kesin olarak kanıtlanmış farmakolojik tedaviler bulunmamaktadır. Magnezyumun travmatik beyin yaralanmasının patofizyolojisinde merkezi bir rol oynamaktadır. Bu yaralanmalarda magnezyum sülfat seviyelerinde düşme olduğu gösterilmiştir. Bu araştırmada travmatik beyin yaralanmalarında Magnezyum Sülfat tedavisinin etkinliğinin değerlendirilmesi amaçlanmıştır.

Yöntem ve Gereçler

 Kasım 2008 ve Kasım 2016 arasında Antalya Eğitim ve Araştırma Hastanesi yoğun bakım ünitesine kabul edilen travmatik beyin yaralanması olan 18 yaş ve üzeri 60 hasta geriye dönük olarak incelendi. 

Bulgular

Çalışmaya 60 hasta alındı. (ortalama yaş 35.6±17.6, 53 erkek, 7 kadın).  GKS skorları Magnezyum Sülfat grubu ve kontrol grubunda başvuruda 5, taburculuk sırasında 7, iki ayın sonunda Magnezyum Sülfat grubunda 12, kontrol grubunda 9 tespit edildi (P<0.05). Hastaların yoğun bakımda kalış süresi her iki grupta da ortalama 7 gündü. Magnezyum Sülfat alan hastaların 6’ sına (%20), kontrol grubu hastaların ise 8’inin (%26,6) cerrahi olarak dekompresyon yapıldı. Magnezyum sülfat verilen hastalarda 2 ay sonunda iyileşme üzerine anlamlı etki saptandı(p<0.05). Magnezyum Sülfat alan 1 (%3.33) hastanın ve kontrol grubu olan 3 (%10) hastanın  taburcu olduktan sonra takipleri sırasında öldüğü tespit edildi. 

Tartışma ve Sonuç

 Travmatik beyin yaralanmasını takiben 12 saat içerisinde başlanan ve idame ettirilen Magnezyum Sülfat verilmesinin nöroprotektif etki oluştuduğu görüşündeyiz.

References

  • 1. Kızılcık N ÇE, Keleştemur T, Köner Ö, İş M, Bilgen S, Çeçen A, Yılmaz B. Comparing effects of intraventricular hypertonic saline and magnesiım sulfate application on diffuse brain injury in rats. J Turk Soc Intens Care 2017;15:34-8.
  • 2. Li W BY, Li YJ, Liu KG, Wang MD, Xu GZ, Shang HL, Li YF. Magnesium sulfate for acute traumatic brain injury. J Craniofac Surg 2015;26(2):393-8.
  • 3. McIntosh TK. Novel pharmacologic therapies in the treatment of experimental traumatic brain injury: a review. J Neurotrauma. 1993;10(3):215-61.
  • 4. Temkin NR AG, Winn HR, Ellenbogen RG, Britz GW, Schuster J, Lucas T, Newell DW, Mansfield PN, Machamer JE, Barber J, Dikmen SS. Magnesium sulfate for neuroprotection after traumatic brain injury: a randomised controlled trial. . Lancet Neurol 2007;6(1):29-38.
  • 5. Memon ZI AB, Benjamin JL, Cracco RQ, Altura BM. Predictive value of serum ionized but not total magnesium levels in head injuries. . Scand J Clin Lab Invest. 1995;55:671-7.
  • 6. Vink R MT, Demediuk P, Weiner MW, Faden AI. Decline in intracellular free Mg2+ is associated with irreversible tissue injury after brain trauma. J Biol Chem. 1988;263(2):757-61.
  • 7. Vink R MT, Demediuk P, Faden AI. Decrease in total and free magnesium concen- tration following traumatic brain injury in rats. Biochem Biophys Res Commun 1987;149:594-9.
  • 8. Cernak I, Radosevic P, Malicevic Z, Savic J. Experimental magnesium depletion in adult rabbits caused by blast overpressure. Magnes Res. 1995;8(3):249-59.
  • 9. Heath DL, Vink R. Traumatic brain axonal injury produces sustained decline in intracellular free magnesium concentration. Brain Res. 1996;738(1):150-3.
  • 10. Smith DA, Connick JH, Stone TW. Effect of changing extracellular levels of magnesium on spontaneous activity and glutamate release in the mouse neocortical slice. Br J Pharmacol. 1989;97(2):475-82.
  • 11. Suzuki M, Nishina M, Endo M, Matsushita K, Tetsuka M, Shima K, et al. Decrease in cerebral free magnesium concentration following closed head injury and effects of VA-045 in rats. Gen Pharmacol. 1997;28(1):119-21.
  • 12. Heath DL, Vink R. Delayed therapy with magnesium upto 24h following traumatic brain injury improves motor outcome. . J Neurosurg 1999;90(3):504-9.
  • 13. Sen AP, Gulati A. Use of magnesium in traumatic brain injury. Neurotherapeutics. 2010;7(1):91-9.
  • 14. Salehpour F SM, Ahmadvand A, Vafaee R, Jafari R, Safaiyan A. Magnesium sulfate effect on the clinical course and GCS of patients with a severe diffuse axonal injury. J Paramed Sci 2012;3(4):2-6.
  • 15. SS Dhandapani AG, S Vivekanandhan, BS Sharma, AK Mahapatra. Randomized controlled trial of magnesium sulphate in severe closed traumatic brain injury. . Indian J Neurotrauma. 2008;5(1):27-33.
  • 16. Zhang S LJ, Zhi DS, et al. . A study of the effect of extrinsic ionized magnesium treatment in the patients with severe traumatic brain injury. Chin J Neurosurg 2006;2:76-9.
  • 17. Canavero S, Bonicalzi V, Narcisi P. Safety of magnesium-lidocaine combination for severe head injury: the Turin lidomag pilot study. Surg Neurol. 2003;60(2):165-9; discussion 9.
There are 17 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Articles
Authors

Çağatay Özdöl

Publication Date September 1, 2018
Submission Date May 9, 2018
Acceptance Date June 12, 2018
Published in Issue Year 2018 Volume: 25 Issue: 3

Cite

Vancouver Özdöl Ç. Travmatik Beyin Yaralanmasıda Magnezyum Sülfat Tedavisinin İyileşme Üzerine Etkisinin Araştırılması. Med J SDU. 2018;25(3):293-7.

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