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July2005 Vol.42 Issue:      2 Table of Contents
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Megnesium Sulphate in Management of Acute Ischemic Cerebral Stroke

Abd El-Haleem El-Tantawy, Shereen Zakarya, Maha Hazem Khalil, Ali Abou Elmaaty
Department of Neurology, Mansoura University

ABSTRACT

Objectives: This study aimed to clarify the role of magnesium sulphate (Mg So4) as a safe neuroprotective agent in acute phase of ischemic stroke. Subjects: Sixty-four patients of acute ischemic stroke in domain of middle cerebral artery (29 males and 35 females) with ages ranged from 28–88 years, the patients were selected from Stroke Unit of Emergency Hospital and Neurology Department of Mansoura University Hospital. Methods: The patients were divided into two equal groups, First group received Mg sulphate in addition to the usual measures, second group used as a comparison group, did not receive Mg sulphate. All patients were evaluated clinically, laboratory and radiologically, on admission and after 48 hours from the onset. NIHSS, Modified Rankim scale and Barthel index were done on admission, the 30th & 90th days from starting treatment. Results: There was statistically significant neurological improvement at day 30 versus admission & day 90 versus day 30 and on admission in patients who  received magnesium sulphate in comparison to the patients who did not receive it (P<0.006). The primary outcome of combined death and disability at day 90 was (37.5%) in patients who received MgSo4 and (71.8%) in patients who did not receive MgSO4. There was significant reduction in death and disability in patients received early (less than 6 hours) Mg sulphate in comparison in to that latter (6 - 12 h) received magnesium sulphate (p=0.043). Conclusion:  Magnesium Sulphate is safe, widely available effective neuroprotective therapy in management of acute ischemic cerebral stroke, especially when given early within the first 6 hours from the onset of stroke.

(Egypt J. Neurol. Psychiat. Neurosurg., 2005, 42(2): 429-440).

 




INTRODUCTION

 

                Stroke continues to be a major public health problem that rank in the top three causes of death in most countries and is responsible for a large proportion of the burden of neurological disorders, more often disabling than fatal. It is the first leading cause of severe neurological disability and results in enormous costs measured in both health-care dollars and lost productivity1.

                Early diagnosis and management of stroke is important for good prognosis2.  Many trials for reduction of death and disability in patients with ischemic stroke was done. One of these trials is the use of I.V. magnesium sulfate efficacy in acute stroke (IMAGES) trial3. Magnesium is believed to be important neuroprotective agent in acute ischemic stroke4 .

 

PATIENTS AND METHODS

 

Sixty four patients of acute ischaemic stroke in domain of middle cerebral artery randomly selected from stroke unit of emergency hospital and neurology section of Mansoura University Hospital in the period from December 2002 till May 2003 were classified into two groups:

1.     Magnesium sulfate group (32 patients): Group 1 

This group received magnesium sulfate in addition to low molecular weight heparin, vincamine, tonics and measures for treatment of any medical comorbidity. 6 patients received magnesium sulphate in first 6 hours from the onset of stroke while 26 patients received magnesium sulphate 6 – 12 hours from onset of stroke according to time of arrival to the hospital.

 

2.     Non magnesium sulfate group (32 patients): Group 2

Used as comparison group and received the same measures in the previous group apart from magnesium sulfate therapy.

 

The criteria for inclusion of patients in the  trial were:   

1.         Clinically diagnosed acute ischemic stroke with limb weakness.

2.         Patient presented at least one hour from disease onset and treatment initiation within 12 hours of onset.

3.         Age: 18 years or older.

4.         Previously independent activity of daily living.

5.         Ischemic stroke patients proved by C.T brain.

 

Exclusion Criteria :    

1.         Co-existing disease which is likely to prevent outcome assessment.

2.         Known chronic renal impairment (serum creatinine > 2.2mg/dl).

3.         Known intracerebral pathology other than ischemic stroke

4.         Comatosed patient.

5.         Pregnancy.

6.         Clear indication or contraindication for magnesium sulfate therapy.

 

These patients were diagnosed on clinical neurological examination confirmed by computed tomography (CT) head scanning.

 

Dose and route of administration:

Magnesium sulfate is used as add-on treatment in the studied group; the control group used the same regimen of treatment without magnesium sulfate.

 

BOLUS DOSE: 

One ampoule contains 10 ml solution of 50% magnesium sulfate (20 mmol or 5 gm). 16 mmol of magnesium sulfate is I.V infused over 15 minutes (8 ml of bolus added to 52 ml of 0.9% saline: i.e. 60 ml) using infusion pump at rate of 240 ml/hour3. 

 

MAINTENANCE DOSE:

Two ampoules each of them contain 20ml of 50% magnesium sulfate (40 mmol or 10 gm.). 65 mmol is given over 24 hours (add 32.5 ml  e.g. 65 mmol of the solution of the maintenance ampoule to 207.5 ml of 0.9% saline making the total volume of 240 ml, administer the whole amount at a rate of 10 ml/hour over 24 hour3.

Once the bolus has been given; change over to the maintenance dose infusion and continue for 24hours.

 

Patients were subjected to the following:  

1-     Thorough history taking & physical examination.

2-             Complete neurological examination.

3-             Scoring on:

*    National Institute of Health (NIH stroke Scale)

I = 1-5 mild NIHSS

II=6-15 moderate NIHSS.

III = 16-25 severe NIHSS.

IV=> 25 very severe NIHSS

*    Modified Rankin disability score

Patient with good functional status (independent) were those of grades 0, l, and 2 while patients with poor functional status (dependent) were  those of grade 3, 4 and 5.

*    Barthel index scale

      Score 60 or more indicate improvement, less than 60 indicate disability.

3.             Computed Topography (CT) head scan.

C.T. was done on admission and 48 hours from the onset to exclude hemorrhagic strokes.

4.             Laboratory investigation:

The following laboratory investigations were carried out for all patients on admission:

·       Liver function tests.

·       Serum creatinine.

·       Complete blood picture.

·       Coagulation profile (PT,INR & APTT).

·       Lipogram & uric acid in some patients.

 

The following laboratory investigations were done to the patients receiving magnesium sulfate in addition to the previous investigation.

 

·       Complete blood picture, at 24 h from start of the treatment.

·       Blood glucose level after 24 hours.

·       Coagulation profile after 24 hours.

·       Serum magnesium level.

-   Before treatment e.g. as base line.

-   After bolus dose infusion (15 min).

-   At 12, 24, 48 hours from starting of the maintenance dose.

5.             Electrocardiography:

         ECG was carried out for all patients before treatment and repeated to the patients receiving magnesium sulfate at 24, 48 hours from starting the treatment.

6.             Follow up:

At day 30 and day 90 from the onset of stroke (NIHSS, Modified Rankin scale, Barthel Index Score).

 

Statistical analysis:

                Data were analyzed using SPSS (statistical package for social science) version to:

                Qualitative data presented as number & %, Chi square or fisher exact test was used for comparison between groups. Qualitative data was tested for normality distribution by Kolmogorov-Smirnov test.

                Normality distributed data were presented as mean and standard deviation, unpaired student test was used for comparison between groups & paired test was used for before-after comparison. Non parametric data was presented as minimum-maximum-mean, standard deviation. Mann-Whitney test used for comparison between groups & Wilcoxon Signed Ranks test was used for before-after comparison. P<0.05 was considered to be statistically significant.

 

RESULTS

 

                The base line characteristics of the studied groups are shown in tables (1), (2) and (3). 

                The CT scans and ECG showed non significant difference between the two groups either on admission or 48 hours after the onset (Tables 4, 5). 

                There was significant progressive improvement of NIHSS in group 1 on day 30 and day 90 in comparison to group 2 which showed non significant change  (Tables 6, 7, 8).

                There was significant progressive improvement of NIHSS (Tables 6, 7, 8), Barthel index (Table 9) and Modified Rankin score (Tables 10, 11, 12) in group 1 at day 30 and day 90.

                Non significant effect of MgSO4 administration on metabolic or hematological parameters in the studied groups (Tables 13, 14). 

                There was significant reduction in death and disability rates on day 90 among group 1 versus group 2 according to modified Rankin score and Barthel index (Table 17).

                Table 18 showed that early administration of MgSO4 (within 6 hours from the onset of stroke) significantly improved the prognosis (death and disability) of patients when compared with later administration of MgSO4 (within 6-12 hours from the onset). 


 

 

Table 1. Sex distribution in cases treated with magnesium sulfate (group 1) and cases not treated with magnesium sulfate (group 2).

 

Sex

Group 1

Group 2

Significance test

Male & %

12 (37.5)

17 (53.1%)

X2 = 1.004

P = .316

Female & %

20 (62.5%)

15 (46.9%)

 

 

Table 2. Age distribution in cases treated with magnesium sulfate (group 1) and cases not treated with magnesium sulfate (group 2).

 

Age (years)

Group 1

Group 2

Significance test

Range

(48-87)

(28-88)

X2 = 1.004

P = .316

Mean

67.21

60.03

 

 

Table 3. Risk factors in both groups.

 

Group

Risk factors

Group 1

Group 2

- Hypertension

14 (43.7%)

13 (40.6%)

- D.M.

9(28.1%)

10(31.2%)

- Cardiac disease

9 (28.1%)

14 (40.6%)

- Previous TIAs

4(12.5%)

3(9.7%)

- Blood disease

1(3.1%)

-

- Hyperurecimia

2(6.2%)

-

- Hyperlipideamia

2(6.2%)

-

- No risk factor

4 (12.5%)

3 (9.7%)

 

 

Table 4. CT scan on admission and 48 hours from the onset.

 

Group

CT brain

Group 1

Group 2

Significance test

On admission

 

 

 

Normal

22(68.8%)

25 (78.1%)

X2 = 1.004

Infarction

10(31.2%)

7(21.9%)

P = 0.316

At 48 hours

 

 

 

Normal

2 (6.3%)

-

FET,

Infarction

30(93.7%)

32(100%)

P=0.492

FET = Fisher Exact Test

 

Table 5. ECG before treatment for all patients and at 24 & 48 hours after starting treatment in both groups:

 

Group

ECG

Group 1

Group 2

Significance test

Before Treatment

 

 

NAD VS.

 

 

 

+ve

 

 

 

finding

NAD

23 (71.9%)

19(59.4%)

X2=1.11

AF

8(25%)

7(21.9%)

P=0.29

IHD

1(3.1%)

5 (15.6%)

 

HB

-

1 (3.1%)

 

At 24 hours

 

 

NAD VS.

NAD

23 (71.9%)

19(59.4%)

+ve

AF

8(25%)

7(21.9%)

Fining

IHD

1(3.1%)

5(15.6%)

X2=1.11

HB

-

1 (3.1%)

P = 0.29

At 48 hours

 

 

NAD VS

NAD

23 (71.9%)

19 (59.4%)

+ve

AF

8(25%)

7(21.9%)

Finding

IHD

1(3.1%)

5(15.6%)

X2 = 1.11

HB

-

1(3.1%)

P=0.29

 

Table 6. NIHSS on admission, day 30 & day 90 in both groups (1) and (2).

 

Group

NIHSS degree

Group 1

Group 2

NIH on admission

 

 

Grade II

29 (90.6%)

31 (96.9%)

Grade III

3 (9.4%)

1 (3.1%)

NIH at day 30

 

 

Grade I

17 (60.7%)

2 (7.40%)

Grade II

11 (39.3%)

25 (92.5%)

NIH at day 90

 

 

Grade I

21 (84%)

3 (12.5%)

Grade II

4 (16%)

21(87.5%)

 

Table 7. NIHSS on admission, day 30 & day 90 in group (1).

 

Grade

Day

Grade I

Grade II & III

Admission Vs

day 30

Admission Vs

Day 90

Day 30 Vs

day 90

N

%

N

%

On admission

0

0

32

100

X2=27.1

P=0.000

X2=42.6

P=0.000

X2=3.5

P=0.06

at day 30

17

60.7

11

39.3

at day 90

21

84

4

16

Table 8. NIHSS on admission, day 30 & day 90 in group (2).

  

Grade

Day

Grade I

Grade II & III

Admission Vs

day 30

Admission Vs

Day 90

Day 30 Vs

day 90

N

%

N

%

On admission

0

0

32

100

FET,

P=0.21

FET,

P=0.037

FET

P=0.44

at day 30

2

7.4

25

92.5

at day 90

3

12.5

21

87.5

Table 9. Barthel index at day 30 & 90 in both groups.

  

Group

Barthel Index

Group 1

Group 2

- At day 30

 

 

Improvement

10 (35.7%)

8 (29.6%)

No improvement

18 (64.3%)

19 (70.4%)

- At day 90

 

 

Improvement

20 (80%)

9 (37.5%)

No improvement

5 (20%)

15 (62.5%)

X2

8.33

0.35

P

0.004

0.55

Table 10. Modified Rankin score at day 30 & 90 in group (1).

 

Score

Day 30

Day 90

30 Vs 90

0, 1, 2

10

20

X2 = 11.2

P=0.0008

3, 4, 5

18

5

 

 

 

Table (11): Modified Rankin score at day 30 & 90 in group (2).

 

Score

Day 30

Day 90

30 Vs 90

0, 1, 2

8

9

X2 = 0.35

P=0..55

3, 4, 5

19

15

 

Table12. Modified Rankin score at admission & day 30 & 90.

 

Group

Modified

Rankin Score

 

Group 1

 

Group 2

-At admission

Grade 3

Grade 4

Grade 5

 

2 (6.25%)

15 (46.9%)

15(46.9%)

 

1(3.1%)

16(50%)

15(46.9%)

-At day 30:

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

 

2(6.25%)

8(25%)

4(12.5%)

13(40.6%)

1(3.1%)

 

3(11.11%)

5(18.5%)

6(22.22%)

6(22.22%)

7(25.9%)

-At day 90:

Grade 0

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

 

3(9.4%)

9 (28.1%)

8 (25%)

1 (3.1%)

4 (12.5%)

-

 

-

7(29.1%)

2(8.3%)

10(41.6%)

4(16.6%)

1(4.16%)

 

 

 

Table 13. Effect of Mgso4 therapy on coagulation profile & blood glucose in comparison to non MgSO4 group.

 

Group

 

Laboratory

Investigations

Group 1

Group 2

Wilcoxon

Signal Test

Mean

S.D

Min

Max

Mean

S.D

Min

Max

Group 1

Group 2

P.T:

Before treatment

After 24 hours

 

13.57

13.7

 

1.9

1.9

 

12.0

12

 

20.0

19.8

 

12.4

13.2

 

0.97

1.7

 

12

12

 

17

22

 

T=0.837

P=0.402

 

T=3.99

P=0.00

INR:

Before Treatment

After 24 hours

 

 

1.28

1.29

 

0.37

0.36

 

1

1

 

2.6

2.5

 

1.4

1.9

 

0.36

0.37

 

1

1

 

2.9

3.2

 

T=0.750

P=0.453

 

T=3.99

P=0.006

APTT:

Before Treatment

After 24 hours

 

44.8

46.1

 

12.9

14.3

 

35.0

35.0

 

92.0

82.0

 

39.8

47.03

 

8.18

9.6

 

35.00

36.00

 

66.00

88.00

 

T=0.404

P=0.686

 

T=4.261

P=0.00

BI. Glucose:

Before Treatment

After 24 hours

 

150.8

154.2

 

62.1

45.4

 

79.0

85.0

 

336

2.56

 

187.3

153.9

 

112.6

58.7

 

40.0

100.0

 

493

360

 

T=0.720

P=0.472

 

T=1.954

P=0.51

Table 14. Effect of Magnesium sulfate treatment on CBCs.

 

Group

 

Laboratory

Investigations

Group 1

Group 2

Paired sample test

Mean

S.D

Mean

S.D

Group 1

Group 2

Platelets:

Before Treatment

After 24 hour

 

257.12

248.12

 

102.58

98.7

 

230.5

228.6

 

96.2

97.6

 

T=1.207

P=0.236

 

T=0.453

P=0.654

HB:

Before treatment

After 24 hours

 

12.04

11.77

 

1.84

1.83

 

12.6

12.5

 

1.54

1.53

 

T=1.574

P=0.126

 

T=1.042

P=0.306

RBCs:

Before treatment

After 24 hours

 

4.46

4.4

 

0.565

0.607

 

24.49

4.4

 

0.55

0.60

 

T=0.837

P=0.408

 

T=1.509

P=0.141

 

 

Table 15. Serum Mg level before & after 15 minutes, 12 hours, 24 & 48 hours from starting.

 

Mg serum level

Mean

S.D

Paired sample test before vs.

T

P

Before treatment

2.06

0.197

 

 

After 15 minutes

2.82

0.276

17.646

0.00

After 12 hours

3.26

0.281

29.335

0.00

After 24 hours

3.75

0.431

24.274

0.00

After 48 hour

3.14

0.279

21.587

0.00

 

 

Table 16. The most common sequelae in both groups.

 

Group

Sequels

Group 1

Group 2

-altered consciousness

-recurrent stroke

-D.V.T

-chest infection

3(9.7%)

3(9.7%)

7(21.8%)

7(21.8%)

5(15.6%)

6(18.7%)

6(18.7%)

6(18.7%)

 

 

Table 17. Prognosis of patients at day 90 in both groups.

 

Outcome at day 90

Group 1

Group 2

Significance test

Disability

Death

5(15.6%)

7(21.9%)

15(46.7%)

8(25%)

X²= 7.63

Total

12(37.5%)

23(71.8%)

P=0.006

 

 

Disability and death in both groups

 

 

Table 18. Correlation between starting treatment with magnesium sulfate and outcome.

 

Onset of stroke by hours

Number of patients

Death and disability at day 90 by Barthel index

FET

Less than 6 hours

Six hours or more

6

26

-

12

P=0.043

 

 

 


DISCUSSION

 

                Acute ischemic stroke result in neurochemical  and metabolic derangement that contribute to cell death in the ischemic penumbra surrounding an infarct core5. The evaluation of cerebral infarction is not predictable, particularly over the 1st hours. Progression of neurological symptoms is common  & may occur in 20% or more of patients during the 1st 24 hours6.

                Neuroprotective  drugs can be administered up to several hours after ischemic insult and reduction in infarct volume can be demonstrated7,8. The therapeutic benefit is probably greatest when the drug is administered early after onset of ischemia and then decays exponentially, so harm may be a constant negative factor or may even increase as time from stroke onset elapse9.

                Evaluation of the neuroprotective effect of magnesium and other novel agents are in progress10. Magnesium is an important neuroprotective agent in acute ischemic stroke11. Its use in brain focal ischemia increases the antioxidant system potential12, it rapidly penetrates the brain and has an excellent safety profile in elderly patients with cardiovascular disease. Its low price and simplicity mean that even a small benefit would be a highly cost effective. Also, its safety profile suggests that it could be readily administered by less experienced health care workers including paramedical staff13. Low serum magnesium level are associated with an increased risk of stroke14. Laurie and Gary concluded that a greater benefit had been expected in cortical and non cortical strokes14.

                In our study, thirty-two Egyptian patients with acute ischemic stroke in domain of middle cerebral artery, with ages more than 18 years were included. All of them had previously independent activity of daily living. Acute ischemic stroke was clinically diagnosed with limb weakness and symptoms present at least for one hour. Treatment was initiated within 12 hours of onset, adding MgSO4 to the usual measures. Thirty-two patients were used as a control group, and received the usual measures apart from MgSO4. All patients were evaluated clinically, laboratory and radiologically, on admission and 48 hours after the onset. NIHSS, Modified Rankin Scale and Barthel Index were done on admission, the 30th & 90th days from starting treatment.

                In the present study, conscious level was unchanged in 29 patients (90.6.6%), This is in agreement with Bradford and Lees3 who reported that the conscious level was unchanged in most cases (81%). Mostly, adverse events were related to cerebral complication of initial stroke. During 1st three months, three  patients (9.7%) in group (1) developed recurrent stroke while 6 patients (81.7%) did so in group (2).

                Cardiac disease comes next to hypertension as a risk factor and represent the higher risk factor in group (2) 14 patients (40.6%) & 9 patients (28.1%) in group (1). In the present study, diabetes mellitus is the 3rd frequent risk factor after hypertension and cardiac disease as 9 patients (28.1%) were diabetic in group (1) & 10 patients (31.2%) in group (2). No detectable risk factor in 4 patients (12.5%) in group (1) and 3 patients (9.7%) in group (2).

                Muir and Lees 199815 reported that rapid elevation of serum magnesium concentration to double the physiological level is well tolerated by patients with acute stroke, and the therapeutic index for magnesium is wide. Serum concentration of 4 to 6 mmol/I are necessary before symptomatic inhibition of neuromuscular transmission is encountered, also caution may be necessary in patients with renal impairment16. Although 6 patients (18.75%) experienced an adverse events  in the form of transient flushing and warmth in association with bolus dose, no serious adverse events that are fatal, life threatening, seriously disabling, or that require prolonged hospital stay was encountered.

                Most current large stroke trials use combination of scales in their protocols, so in our research, 3 scales were used for evaluation and follow up of all patients. The national institutes of health (NIH) stroke scale is one of the most sensitive impairment scales which are useful in classifying the initial severity of the patients condition, in order to evaluate whether treatment groups are sufficiently balanced at base line. Follow up with comparison with base line is a good indicator of clinical improvement.

                According to NIHSS, the clinical improvement was predominantly early in group one. At day 30, in comparison with day of admission, 17 patients (60.7%) were improved to mild degree while 11 patients (39.3%) remain the same as moderate degree, group (2) only 2 patients (7.40%) improved to mild degree of NIHSS and 25 patients (92.6%) remain the same as moderate degree. At day 90, in comparison with day 30, 21 patients (84%) with mild degree NIHSS and 4 patients (61%) with moderate degree of NIHSS in group one, in comparison to 3 patients (12.5%) and 21 patients (87.5%) respectively in group (2). Our results agreed with Muir et al.5, who reported that there was significant neurological improvement in the group that received magnesium sulfate therapy.

                Barthel index and modified Rankin scales are examples of disability scales which are useful as primary outcome parameters for evaluation of efficacy in large pivotal stroke trials , also generate information about the degree of death and disability .

                In this study, Barthel index was significantly higher in group (1) in comparison to group (2) at the day 30. This disagreed with Lampl et al.22, who reported that there was insignificant difference in the group who received magnesium sulfate therapy than the group who did not receive magnesium sulfate therapy.

                Modified Rankin score was significantly lowered in magnesium treated group in comparison to non magnesium treated group, this agreed with Lampl et al.22, who reported that there were significant neurological improvement in group received magnesium sulfate therapy than that not received magnesium sulfate  therapy.

                In our work, as regard one-month outcome for death and disability (Barthel Index < 60), four patients (12.5%) died and eighteen patients (64.3%) were disabled in group (1), while, five patients (15.6%) died and nineteen patients (70.4%) were disabled in group (2). Bradford and Lees 20003 found that one-month outcomes of death and disability in magnesium sulfate receiving patients were (15%) and (36%) respectively.

                Three-month outcome for death & disability (Barthel index < 60) were 7 patients (21.9%) & 5 patients (15.6%) respectively in group (1). As regard, group (2), 8 patients (25%) & 15 patients (46.7%) had three month outcome respectively our results go in hand with  Bradford and Lees 20003 who  found that, three month outcomes of death & disability in magnesium sulfate received patients were (20%) & (17%) respectively but Muir and Lees23, reported that no significant differences in the proportion of patients died or disabled at 3 months. The difference in early mortality between magnesium and placebo treated groups almost achieved significance.

                One of the most important observation in our work were statistically significant reduction in death and disability in patients received early (less than 6 hours) magnesium sulfate in comparison to that later (6-12 hours) received magnesium sulfate (p=0.043) so the earlier the treatment the better the prognosis.

 

REFERENCES

 

1.      Sacco.  RL:  Pathogenesis, classification and epidemiology of cerebrovascular disease in MERRITT'S neurology Rowland L.P. (ed) 2000, 35: 217-229.

2.      Rabie M.O.  El-Sayed Tag El-Din, S.A. Atlam. Evaluation of stroke in Tanta University Hospital: A retrospective study.  The Egyptian journal of Neuro., Psych. And Neurosurg., 2002; 39(1): 133-147.

3.      Andrew Bradford and Kennedy Lees: Design of intravenous magnesium efficacy in acute stroke (IMAGES) trial.  Curr control trials cardiovac. Med 2000; 1(3): 184-190.

4.      Karaszewski B.R., Dorosz, A., Lukasiak, J.W., Rozera G. and Nykia W.M.: The assessment of magnesium and potassium body components in patients with ischemic stroke: a pilot study in European journal of neurology, 2003; volume supplement C, P. 2017.

5.      Muir KW.: Magnesium for neuroprotection in ischemic stroke: rationale for use and evidence of effectiveness. CNS Drugs 2001; 15 (12): 921-930.

6.      Adams H.P, Jr. Brott G. Growell R: Guideline for management of patients with acute ischemic storke. Stroke 1994; 1901-1914.

7.      Davis SM, Lees KR, Albers GW, Diener HC, Markabi S, Karlsson G & Norris J, for the assist investigators selfotel in acute ischemic stroke. Possible neurotoxic effects of an NMDA antagonist. Stroke: 2000; 31: 347-354.

8.      Lees KR, Asplund K, caroli A, davis SM, diner H-C, Kaste M, Orgogozo J-M & Whitehead J, for the GAIN internatonal investigators. Glycine antagonist (gavestinel) in neuroprotection (GAIN international) in patients with acute stroke: a randomized controlled trial. Lancet, 2000; 355: 1949-1954.

9.      Bradford A,: FOR THE images STUDY GROUP: i.v. magnesium efficacy in stroke trial and MRI substudy (IMAGES & MR IMAGES & Cerebrovascular disease, 2000; 10, 80).

10.    Davenport R, Dennis M.: Neurology emergencies: acute stroke. J. Neurol Neurosurg Pychiatry 2000, 68:277-288.

11.    Karaszewski B.R., A. Dorosz, J.W. Lukasiak, G. Rozera and W.M. Nykia: The assessment of magnesium and potassium body components in patients with ischemic stroke: A pilot study in European journal of neurology, 2003, volume supplement C, P. 2017.

12.    Shcharbina N. Yu., Nechipureneko N.I: pro-and antioxidant balance in the treatment of cerebral ischemia by magnesium sulfate in: European journal of neurology, 2003; 10: 122-154.

13.    Lees KR, Lavelle JR, Cunha L, Diener Hc, Sandrs EACM, Tack P, Wester P for the GAIN phase II European study group. Glycine antagonist (GV50526) in acute stroke: A double-blind, placebo-controlled phase II trial.  Cerebrovascular disease, 2001; 11: 20-29.

14.    Laurie B, Gary d: Magnesium may benefit about lacunar infarctions but not other stroke : Lacet. 2004; 363: 414-415,439-445.

15.    Muir KW, Lees KR,: Dose optimization of i.v. magnesium sulfate after acute stroke. Stroke, 1998; 92(5): 918-23.

16.    Wood KL, Fletcher S, Roffe C, Haider Y : intravenous magnesium sulfate in suspected myocardial infarction: result of the second Leicester intravenous magnesium intervention trial (L1M1T2) Lancet 1992; 339: 1553-1558.

17.    Brott T, Adams HP Olinger CP, et al. Measurements of acute cerebral infarction: a clinical examination scale . Stroke 1989; 20: 864-870.

18.    Collin C, Wade D, Davies S, Horne V. The Barthel ADL index; a reliability study. Int Disabil studies 1988; 10: 61-63.

19.    Granger CV, Albrecht GL, Hamilton BB. Outcome of comprehensive medical rehabilitation. Measurement by PULSES profile and the Barthel index . Arch Phys Med Rehabil 1979; 60: 145-154 .

20.    Van swieten JC KP , Visser MC, Schouten HJA, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients . Stroke 1988;19:604-607 .

21.    Bamford J, sandercock P, Warlow C, Slattery J. Interobserver agreement for the assessment of handicap in stroke patients . Stroke 1989; 20: 828-831.

22.    Lmp1 Y, Gilad R, Geva D, Eshel Y, Sadeh M: i.v administration of magnesium sulfate in acute stroke: A randomized double-blind study. Clinical, Neuropharmacol., 2000; 24(1): 11-15.

23.    Muir K.W,MD,MRCP; Lees; Kennedy R., MD, FRCP: A randomized, Double-blind, placebo-controlled pilot trial of Intravenous Magnesium Sulfate After Acute Stroke, stroke, 1995; 26: 1183-1188.


 

المخلص العربي

 

دراسة تأثير سلفات الماغنسيوم في علاج الاحتشاء المخي الحاد

 

الهدف من هذا البحث هو دراسة تأثير سلفات الماغنسيوم كعقار آمن ومتوفر في علاج الاحتشاء المخي الحاد مبكراً في الفترة من (1 : 12 ساعة) من بداية الجلطة وتقييم دورة بالمتابعة والفحص الإكلينيكي حتى يوم 90 من بداية العلاج.

في هذا البحث تمت دراسة 64 مريض من مرضى الاحتشاء المخي الحاد وقد تم تقسيمهم إلى مجموعتين :

المجموعة الأولي وتشمل : المرضى الذين تناولوا عقار سلفات الماغنسيوم بالإضافة إلى العلاج المعتاد في حالات الجلطات وعددهم 32 مريض (12 ذكر + 20 أنثى).

المجموعة الثانية وتشمل : المرضى الذين لم يتناولوا عقار سلفات الماغنسيوم ولكنهم تناولوا نفس العلاج المستخدم في حالات الجلطات وتستخدم هذه المجموعة كمجموعة مقارنة وعددهم 32 مريض (17 ذكر + 15 أنثى).

وقد أسفر هذا البحث عن النتائج التالية :

-     تميزت المجموعة الأولى بالتحسن الواضح في نسبة العجز عند مقارنة الفحص عند اليوم 30 بالفحص عند الدخول والتحسن الملحوظ عند اليوم 90 عند مقارنته بوقت الدخول واليوم 30 وأن هذا التحسن بدا قليلاً في المجموعة الثانية.

-     بلغت نسبة الوفاة والعجز في المجموعة الأولى 37.5 % عند اليوم 90 ينما وصلت إلى 71.8% في المجموعة الثانية عند اليوم 90.

-     تناول عقار سلفات الماغنسيوم المبكر في أول 6 ساعات أعطى معدل تحسن واضح عند مقارنته بالحالات التي تناولت العقار متأخراً (6 – 12 ساعة).

-     تستنبط من هذا البحث أن تناول عقار سلفات الماغنسيوم في مرض الاحتشاء المخي الحاد وخصوصاً إذا أعطى مبكراً في أول 6 ساعات، من بداية الجلطة يقلل نسبة العجز والوفاة في هؤلاء المرضى.



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