(Stroke. 1995;26:1183-1188.)
© 1995 American Heart Association, Inc.
Articles |
A Randomized, Double-Blind, Placebo-Controlled Pilot Trial of Intravenous Magnesium Sulfate in Acute Stroke
From the Acute Stroke Unit, University Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary, Glasgow, Scotland.
Correspondence to Dr Keith W. Muir, Acute Stroke Unit, University Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary, Glasgow G11 6NT, Scotland.
Background and Purpose Magnesium ions act as endogenous vasodilators of the cerebral circulation and act pharmacologically as noncompetitive antagonists of the N-methyl-D-aspartate receptor by virtue of their role as endogenous voltage-sensitive blockers of the ion channel. The preclinical efficacy of magnesium has been demonstrated in standard models of stroke.
Methods Sixty patients were randomized to magnesium sulfate (8 mmol IV over 15 minutes and 65 mmol over 24 hours) or placebo within 12 hours of clinically diagnosed middle cerebral artery stroke. Pulse, blood pressure, and serum magnesium levels were monitored. Primary outcome was death or significant functional impairment (Barthel Index score <60) at 3 months.
Results Magnesium was well tolerated, with no significant adverse effects and no change in blood pressure or pulse rate. Laboratory and electrocardiographic variables did not differ significantly between placebo- and magnesium-treated groups. Serum magnesium rose from 0.76 mmol/L to 1.42 mmol/L over 24 hours and remained significantly higher than in the placebo group at 48 hours. Thirty percent of magnesium-treated and 40% of placebo-treated patients were dead or disabled (Barthel Index score <60) at 3 months (P=.42). There was a decrease in the number of early deaths in the magnesium-treated group (P=.066, log-rank test).
Conclusions Magnesium sulfate is well tolerated after acute stroke and has no deleterious hemodynamic effects at this dose. Further trials are required to determine efficacy.
Key Words: clinical trials • magnesium • treatment outcome • neuroprotection
This article has been cited by other articles:
 |
|
 |
|
  B. P. Meloni, K. Campbell, H. Zhu, and N. W. Knuckey In Search of Clinical Neuroprotection After Brain Ischemia: The Case for Mild Hypothermia (35{degrees}C) and Magnesium Stroke, June 1, 2009; 40(6): 2236 - 2240. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. S. Kidwell, K. R. Lees, K. W. Muir, C. Chen, S. M. Davis, D. A. De Silva, C. J. Weir, S. Starkman, J. R. Alger, J. L. Saver, et al. Results of the MRI Substudy of the Intravenous Magnesium Efficacy in Stroke Trial Stroke, May 1, 2009; 40(5): 1704 - 1709. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. K. Bhudia, D. M. Cosgrove, R. I. Naugle, J. Rajeswaran, B.-K. Lam, E. Walton, J. Petrich, R. C. Palumbo, A. M. Gillinov, C. Apperson-Hansen, et al. Magnesium as a neuroprotectant in cardiac surgery: A randomized clinical trial J. Thorac. Cardiovasc. Surg., April 1, 2006; 131(4): 853 - 861. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Zausinger, K. Scholler, N. Plesnila, and R. Schmid-Elsaesser Combination Drug Therapy and Mild Hypothermia After Transient Focal Cerebral Ischemia in Rats Stroke, September 1, 2003; 34(9): 2246 - 2251. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, R. J. Adams, T. Brott, G. J. del Zoppo, A. Furlan, L. B. Goldstein, R. L. Grubb, R. Higashida, C. Kidwell, T. G. Kwiatkowski, et al. Guidelines for the Early Management of Patients With Ischemic Stroke: A Scientific Statement From the Stroke Council of the American Stroke Association Stroke, April 1, 2003; 34(4): 1056 - 1083. [Full Text] [PDF]
|
|
|
|
|
|
M. Fisher and T. G. Brott Emerging Therapies for Acute Ischemic Stroke: New Therapies on Trial Stroke, February 1, 2003; 34(2): 359 - 361. [Full Text] [PDF]
|
|
|
|
 |
|
 W. T. Longstreth Jr., C. E. Fahrenbruch, M. Olsufka, T. R. Walsh, M. K. Copass, and L. A. Cobb Randomized clinical trial of magnesium, diazepam, or both after out-of-hospital cardiac arrest Neurology, August 27, 2002; 59(4): 506 - 514. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Uchino, D. Billheimer, and S. C. Cramer Entry Criteria and Baseline Characteristics Predict Outcome in Acute Stroke Trials Stroke, April 1, 2001; 32(4): 909 - 916. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. P. Samsa and D. B. Matchar Have Randomized Controlled Trials of Neuroprotective Drugs Been Underpowered? : An Illustration of Three Statistical Principles Stroke, March 1, 2001; 32(3): 669 - 674. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Fisher and W. Schaebitz An Overview of Acute Stroke Therapy: Past, Present, and Future Arch Intern Med, November 27, 2000; 160(21): 3196 - 3206. [Full Text] [PDF]
|
|
|
|
 |
|
 T. E. Mayer, G. F. Hamann, J. Baranczyk, B. Rosengarten, E. Klotz, M. Wiesmann, U. Missler, G. Schulte-Altedorneburg, and H. J. Brueckmann Dynamic CT Perfusion Imaging of Acute Stroke AJNR Am. J. Neuroradiol., August 1, 2000; 21(8): 1441 - 1449. [Abstract] [Full Text]
|
|
|
|
|
|
P. W. Duncan, H. S. Jorgensen, and D. T. Wade Outcome Measures in Acute Stroke Trials : A Systematic Review and Some Recommendations to Improve Practice Stroke, June 1, 2000; 31(6): 1429 - 1438. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G DEVUYST and J BOGOUSSLAVSKY Recent progress in drug treatment for acute stroke J. Neurol. Neurosurg. Psychiatry, October 1, 1999; 67(4): 420 - 425. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Davis and D. Barer Neuroprotection in acute ischaemic stroke. II: Clinical potential Vascular Medicine, August 1, 1999; 4(3): 149 - 163. [Abstract] [PDF]
|
|
|
|
|
|
K. W. Muir and K. R. Lees Dose Optimization of Intravenous Magnesium Sulfate After Acute Stroke Stroke, May 1, 1998; 29(5): 918 - 923. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. G. Dyker and K. R. Lees Duration of Neuroprotective Treatment for Ischemic Stroke Stroke, February 1, 1998; 29(2): 535 - 542. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Dorman and P. A.G. Sandercock Considerations in the Design of Clinical Trials of Neuroprotective Therapy in Acute Stroke Stroke, September 1, 1996; 27(9): 1507 - 1515. [Full Text]
|
|