Value of magnesium sulfate in prevention of eclamptic seizure - adapted from the New England Journal of Medicine, July 27, 1995 - Tips from Other Journals

Although magnesium sulfate has been used to obstruct eclamptic seizures for nearly 90 years, not many well-controlled clinical trials have been convoyed In the United Kingdom and in one centers in the United States, conventional antiepileptic put drugs intos such as phenytoin, are used. Lucas and colleagues compared the efficacy of phenytoin and magnesium sulfate in women with pregnancy-induced hypertension.

The trial included 2138 women who were admitted for delivery with a systolic relations pressure 6f at least 140 mm Hg and a diastolic life-current pressure of at least 90 mm Hg Women in the magnesium sulfate cluster received an intramuscular 10-g loading dose followed through a maintenance dose of 5 g each four hours until 24 hours after delivery. An additional 4-g intravenous loading dose was given to women with relentless preeclampsia (diagnosed by the air of one or more of these criteria: a diastolic kin pressure of at least 110 mm Hg a systolic kindred pressure of at least 160 mm Hg proteinuria of 3+ in succession dipstick testing, or symptoms including headaches, visual changes or upper abdominal pain). Women in the phenytoin collection received a 1,000-mg loading dose from one side of to the other one hour, followed by a 500-mg extended-release capsule 10 hours later. For one as well as the other groups, anti-hypertensive therapy with 5 to 10 mg of intravenous hydralazine was given each 15 to 20 minutes if diastolic kin pressure was over 110 mg Hg

None of the 1049 women randomly assigned to the magnesium sulfate regimen had eclamptic convulsions, compared with 10 of the 1089 women treated with phenytoin. Maternal and infant issues were similar in both groups

The authors gather that magnesium sulfate therapy is significantly more effective than phenytoin in the prevention of eclamptic seizures.

In a related editorial, Roberts hypothesizes that magnesium's influential vasodilatory effects, especially in the brain, may be protective against seizure in this subset of patients. In addition, magnesium shelters against endothelial cell damage and may have direct anticonvulsant properties. He notes that treating all women with house pressures over 140 mm Hg/90 mm Hg may terminate in substantial overtreatment, although markers of the like kind as proteinuria and central nervous order symptoms do not identify all women who subsequently have seizures. Roberts also points not at home that in most centers, intravenous administration of magnesium has replaced the more painful intramuscular way of administration. (New England Journal of Medicine, July 27 1995 vol 333 pp 201 250)

COPYRIGHT 1995 American Academy of Family Physicians

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