Therapeutic potential of magnesium in the treatment of acute stroke

Keith W. Muir, MD, MRCP, Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland

Abstract

Magnesium is a key cation in multiple biological processes, including membrane excitability, protein synthesis, and cellular bioenergetics. Parenterally administered magnesium crosses the blood-brain barrier, raises brain concentrations to supraphysiological levels, and is neuroprotective in preclinical models of cerebral and spinal cord ischemia, excitotoxic injury, and head trauma. Neuronal and vascular effects of therapeutic magnesium may be pertinent, including inhibition of presynaptic release of excitatory neurotransmitters, presynaptic potentiation of adenosine, blockade of the N-methyl D-aspartate receptor, block of voltage-gated calcium channels, relaxation of vascular smooth muscle with vasodilatation of large and small vessel vascular beds causing increased cerebral blood flow, antagonism of endothelin-1 and other vasoconstrictors, enhanced postischemic recovery of tissue adenosine triphosphate, buffering of intracellular calcium ions (especially antagonism of mitochondrial calcium entry), and inhibition of deleterious ion shifts in white matter. Wide clinical experience in obstetrics and myocardial infarction confirms safety and tolerability as a therapeutic agent. Clinical trials in stroke are ongoing following encouraging results of pilot studies.http://www.sciencedirect.com/science/article/pii/S1052305700700474


Therapeutic potential of magnesium in the treatment of acute stroke
www.strokejournal.org
Journal of Stroke & Cerebrovascular Diseases, Volume 9, Issue 6, Pages 257-267, November 2000, Authors:Keith W. Muir, MD, MRCP