The Role of Magnesium in the Management of Cerebral Vasospasm

Table 2

Clinical data regarding the use of magnesium therapy in CVS.

Author/; date	Study; type	Mg^2+ administration; type	N treatment/; placebo	Major results
Mees et al., 2012 [40]	RCT	64 mMol/day (IV) of MgSO4 for 20 days	606/597	Outcomes assessed by the modified Rankin Scale were similar in the treatment and placebo groups.
Wong et al., 2010 [41]	RCT	20 mMol bolus followed by 80 mMol/day (IV) for 14 days	169/158	(i) Outcome measured by GOS was the same at six months after treatment; (ii) Incidence of CVS was similar in both groups
Westermaieret al., 2010 [42]	RCT	16 mMol bolus of MgSO4  followed by  8 mMol/hour continuous infusion for 10 days	55/55	(i) Lower incidence of CVS in Mg^2+ group; (ii) Lower incidence of delayed ischemic infarction in Mg^2+ group; (iii) DIND nonsignificantly reduced in Mg^2+ group, though fewer patients with DIND expressed delayed ischemic infarction
Shah et al., 2009 [43]	Retrospective case series	8–32 mMol (IA) via super-select catheterization	14	(i) No long-term outcomes reported; (ii) No cerebral infarction in 12/14 patients
Mori et al., 2009 [44]	Prospective case series	15 mMol/L MgSO4 at 20 mL/hour (intracisternal) for 20 days	10	(i) Five patients had good recovery; (ii) One patient exhibited moderate disability; (iii) One patient exhibited severe disability; (iv) Two patients progressed to a vegetative state; (v) One patient died
Muroi et al., 2008 [45]	RCT	16 mMol bolus in 150 mL  followed by 64 mMol continuous infusion for 12 days	31/27	(i) Magnesium treatment had to be discontinued in 52% of patients due to adverse side effects; (ii) Trend towards improved outcome observed
Dorhout Mees et al., 2007 [21]	Retrospective case series	64 mMol/day for 20 days	155/194	(i) Risk of DCI was lower in patients with higher serum magnesium concentrations when compared to the lowest quartile; (ii) No effect on incidence of poor outcome
Schmid-Elsaesser et al., 2006 [46]	RCT	10 mg/kg bolus  followed by 30 mg/kg (IV) infusion of MgSO4 for 7 days	53/51	(i) No difference in outcome measured by GOS after 12 months; (ii) Similar incidence of CVS in both groups; (iii) Rate of cerebral infarction similar in both groups.
Wong et al., (2006) [47]	RCT	20 mMol bolus  followed by  80 mMol/day (IV) for 14 days	30/30	(i) CVS incidence decreased, but not statistically significant; (ii) Vasospasm detected via TCD shorter in duration; (iii) No difference in outcome measured by GOS at 6 months
Prevedello et al., 2006 [48]	RCT	20 mMol bolus of MgSO4  followed by  120–150 mMol/day	48 treated with nimodipine, Triple-H therapy, bed rest/; 24 treated with MgSO4 adjunct	(i) Incidence of vasospasm was reported to be equal in both groups.; (ii) Vasospasm occurring in the nimodipine-only group was correlated with longer hospital stays, when compared to the MgSO4 adjunct group
Stippler et al., 2006 [49]	Retrospective; historically controlled.	100 mMol MgSO4/day continuous infusion	38/38	(i) Incidence of vasospasm in the Mg^2+ adjunct group decreased by 18%; (ii) Outcome not changed in Mg^2+ group (𝑃>0.05)
Yahia et al., (2005) [50]	Prospective pilot study	100 mMol/hour MgSO4 for 10 days	19	(i) No adverse effects from continuous magnesium infusion; (ii) Lower incidence of both angiographic and clinical CVS observed than the literature values
van den Bergh, 2005 [51]	RCT	64 mMol (IV) MgSO4 for 14 days	139/144	Suggested benefit for reduction of DCI, though results were inconclusive
Venya et al., 2002 [52]	RCT	6 g bolus followed by  2 g/hour MgSO4 for 10 days	20/20	(i) No significant reduction in incidence of CVS; (ii) Trend toward improved neurological outcome measured by GOS at 3 months
Chia et al., 2002 [53]	Retrospective; case series	24–52 mMol/day continuous infusion MgSO4	13/10	(i) Significant reduction in the incidence of CVS; (ii) Neurologic outcome was similar in both groups
Wong et al., 2011 [54]	Meta-analysis	—	441	(i) Lowered odds ratio for incidence of CVS and DCI in the magnesium treatment groups; (ii) Increased odds ratio for favorable outcomes
Wong et al., 2010 [41]	Meta-analysis	—	875	(i) No benefit from magnesium infusion on the incidence of cerebral infarction; (ii) Nonsignificant increase for odds ratio of favorable outcome at 3 and 6 months.
Chen and Carter, 2011 [55]	Meta-analysis	—	936	(i) Decreased risk of poor outcome at 3–6 months in the magnesium treatment groups; (ii) Risk of mortality after SAH was unaffected
Ma et al., 2010 [22]	Meta-analysis	—	699	(i) Magnesium infusion reduced the risk for DCI and poor outcome after SAH; (ii) Serum levels need to be monitored closely to prevent adverse side effects