Abstracts

Rationale: Rationale: Magnesium is a potential modulator of seizure activity because of its ability to antagonize excitation through the N-methyl-d-aspartate receptor. It has been shown that magnesium can control seizures in animal models.(1) Magnesium has been the mainstay treatment for eclampsia. (2) There is report of refractory status epilepticus seizures being controlled with magnesium supplementation.(3) It was shown to subside infantile spasms when combined with adrenorticotropic hormone (ACTH)(4). Recently a retrospective study reported decreased seizure frequency in patients who received magnesium oxide as add-on treatment(5). We hypothesise that magnesium supplementation can reduce seizures in people with epilepsy. Methods: This is an observational study of five patients with refractory epilepsy who received magnesium oxide 400 -800 mg daily as add-on to their baseline antiepileptic regimen(AED). The age of patients varied from 25 to 65 years old. There were three female and two male patients. The epilepsy syndrome was localization related epilepsy in all. The patients were followed for three months. Patients were given monthly seizure calendar to follow up their seizure frequency. Patients with renal failure were excluded. Results: The patients reported decreased seizure frequency as in table 1. The response to magnesium oxide treatment varied from being seizure free to 30 % seizure reduction compared to baseline. The patients did not report any side effects of being on magnesium oxide. Magnesium levels did not change after starting magnesium oxide supplement. Conclusions: Magnesium is important for many critical enzymatic processes in human physiology especially in central nervous system. This case series showed that magnesium supplement may have a potential role in decreasing seizure frequency in epilepsy patients. Serum magnesium levels may not reflect brain magnesium concentrations. It is possible that the detected effect is simply regression to the mean so further randomized controlled double blinded studies are needed to assess the effect of magnesium oxide in seizure control in epilepsy patients. References: 1.Anderson, W.W., Lewis, D.V., Swartzwelder, H.S., Wilson, W.A.,1986. Magnesium-free medium activates seizure-like events in the rat hippocampal slice. Brain Res. 398, 215—219. 2Chien, P.F., Khan, K.S., Arnott, N., 1996. Magnesium sulphate in the treatment of eclampsia and pre-eclampsia: an overview of the evidence from randomised trials. Br. J. Obstet. Gynaecol. 103, 1085—1091. 3.Pandey, M., Gupta, A., Baduni, N., Vijfdar, H., Sinha, S., Jain, A., 2010. Refractory status epilepticus—-magnesium as rescue therapy. Anaesth. Intensive Care 38, 962. 4.Zou, L.P., Wang, X., Dong, C.H., Chen, C.H., Zhao, W., Zhao, R.Y., 2010. Three-week combination treatment with ACTH + magnesium sulfate versus ACTH monotherapy for infantile spasms: a 24-week, randomized, open-label, follow-up study in China. Clin. Ther. 32, 692—700. 5.Abdelmalik PA, Politzer N, Carlen PL.Magnesium as an effective adjunct therapy for drug resistant seizures.Can J Neurol Sci. 2012 May;39(3):323-7