June 15, 1998
New use of an old drug may help patients with serious head injuries
University of Washington (UW) physicians based at Harborview Medical
Center are evaluating the use of magnesium sulfate in preventing the
negative effects generally associated with severe head injuries. The study
is being conducted under the leadership of Dr. H. Richard Winn, UW
professor and chairman of neurological surgery.
A small Pennsylvania study has already demonstrated that, if administered
soon after head injury, 47 percent of patients given magnesium sulfate had
a good recovery as opposed to 23 percent in a group that received placebo
(inactive medication), according to Dr. Nancy Temkin, UW associate
professor of neurological surgery and biostatistics.
“There are indications that this very common, low-risk drug has the
potential of improving functioning as well as for preventing epilepsy
better than the anti-convulsants typically prescribed for individuals with
severe head injuries,” says Temkin.
Magnesium sulfate is a common compound that has been prescribed since the
1930s to prevent seizures in pregnant women with high blood pressure. In
head injuries, especially those occurring when the head is shaken
violently in a whiplash-like motion, the cells pull apart and are damaged,
resulting in cell death. The body’s reaction to this sort of injury
includes swelling, increased pressure on the brain and decreased oxygen
levels, which generally results in permanent disability, Temkin explains.
Magnesium sulfate appears to lessen this damage and prevent some seizures
associated with brain injury.
Side effects with magnesium sulfate are minimal. Studies have shown that
there may be a very small drop in blood pressure as well as a drop in
calcium levels, but there are no other significant health effects.
“This drug is only effective if given as soon as possible after a head
injury, probably no more than eight hours later,” says Temkin. “Since
almost all our patients are unconscious when they arrive and family
members are not always readily available, we want to be able to administer
this drug without consent if the patients family cant be reached quickly.”
Several individuals with severe head injuries have already received
magnesium sulfate, and the results have been very encouraging. “We had a
19-year-old who was thrown from a truck who we all feared was going to be
permanently disabled from his head injury,” says Pam Nelson, research
nurse. “We have seen this type of injury hundreds of times and the victim
usually winds up in a nursing home if he survives. The young man we
treated with magnesium sulfate is now driving and working. His speech and
some of his fine motor skills have been affected, but his recovery is
Investigators at Harborview have obtained funding from the National
Institutes of Health to perform a 400-patient clinical trial to determine
whether magnesium sulfate lives up to the promise suggested by individual
cases and the small Pennsylvania study. Patients will be given either
magnesium sulfate or a placebo in addition to standard treatment for head
Researchers are now seeking permission from the federal government to
enroll patients with serious injury without obtaining prior informed
consent if family members cannot be located quickly. Researchers believe
that the potential benefits of administering this drug outweigh the risk
of the minimal side effects. Investigators invite public comment on
enrolling patients without consent for this study. To comment, call (206)
521-1868, or write: Dr. Nancy Temkin, Harborview Medical Center, Box
359924, 325 Ninth Avenue, Seattle, WA 98104.