Prehospital IV magnesium can bring about "dramatic" stroke recovery

By Martha Kerr

SAN ANTONIO (Reuters Health) – Administration of intravenous magnesium to acute stroke patients en route to the hospital resulted in what investigators say was a "dramatic" recovery in 25% of patients. The results of this preliminary trial also suggest that treatment was safe, regardless of stroke type.

Magnesium has demonstrated a neuroprotective action in animal studies, Dr. Jeffrey L. Saver of the UCLA Stroke Center told attendees of the American Stroke Association's 27th International Stroke Conference here Thursday. On the basis of those findings and some pilot studies, he and his colleagues undertook an open-label phase I trial of 20 patients with acute stroke as assessed by paramedics. The trial has been dubbed FAST-MAG.

Average time from arrival of the paramedics to needle time was as short as 23 minutes, Dr. Saver noted. Seventy percent of patients received IV magnesium within 2 hours of symptoms onset, while 25% were treated within 1 hour of symptom onset. "We accelerated treatment time by 2 hours," Dr. Saver told meeting participants.

Paramedics administered a 4 gm dose of IV magnesium in the ambulance, followed by 16 gm MgSO4 infused over the next 24 hours.

Symptoms improved markedly in 25% of patients. "All 25% of patients with dramatic recovery had ischemic strokes," Dr. Saver told Reuters Health, but there were no adverse effects of IV magnesium in any of the stroke patients.

"We're encouraged, but the numbers are too small to declare [a definitive] treatment effect," Dr. Saver commented. He reported that there have been no safety complications and no serious adverse effects. "It is now possible to start thinking about large clinical trials," he said. The UCLA stroke Center has received NINDS and NIH grants to undertake a trial of 1250 acute stroke patients randomized to prehospital IV magnesium or placebo.

"We're guessing that magnesium will be more beneficial for ischemic stroke patients, but it seems to have benefit in patients with hemorrhagic stroke," Dr. Saver told Reuters Health. If the treatment is safe for both types of stroke, then the need to get results of CT scans beforehand, as is required for thrombolytic therapy, is eliminated and treatment in the field can be initiated.

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