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В январьском номере The Lancet Neurology 2007 опубликовали результаты рандомизированного контролируемого исследования по магнезии в качестве нейропротектора при ЧМТ. Включали пациентов с "серьезной" ЧМТ (необходимо хирургическое вмешательство; Glasgow coma scale 3 - 12; интубированных с GCS моторной шкалой 1 - 5). Всего включено 499 пациентов. Магнезия назначалась в первые 8 часов и вводилась в течение 5 суток до достижения концентрации в крови 1.25 - 2.5 ммоль/л (n=118), однако в последующем из-за проблем с АД и тенденции к повышению смертности целевой диапазон был снижен до 1.0 - 1.85 ммоль/л (нормальные значения 0.75–1.0 ммоль/л). Исход оценивали через 6 месяцев (комбинированная оценка: смертность, судорожный синдром, нейропсихологические тесты, функциональный исход). В результате магнезия не показала нейропротективного эффекта и даже могла оказывать отрицательный эффект. Так что, как и при инсульте (IMAGES) - увы...
На картинке ниже исход по Glasgow outcome scale через 6 месяцев (1=death; 2=vegetative state; 3=lower severe disability; 4=upper severe disability; 5=lower moderate disability; 6=upper moderate disability; 7=lower good recovery; 8=upper good recovery).

Temkin NR, Anderson GD, Winn HR, Ellenbogen RG, Britz GW, Schuster J, Lucas T, Newell DW, Mansfield PN, Machamer JE, Barber J, Dikmen SS. Magnesium sulfate for neuroprotection after traumatic brain injury: a randomised controlled trial. Lancet Neurol. 2007 Jan;6(1):29-38.

Department of Neurological Surgery, University of Washington, Seattle, USA. [Ссылки доступны только зарегистрированным пользователям ]

BACKGROUND: Traumatic brain injuries represent an important and costly health problem. Supplemental magnesium positively affects many of the processes involved in secondary injury after traumatic brain injury and consistently improves outcome in animal models. We aimed to test whether treatment with magnesium favourably affects outcome in head-injured patients. METHODS: In a double-blind trial, 499 patients aged 14 years or older admitted to a level 1 regional trauma centre between August, 1998, and October, 2004, with moderate or severe traumatic brain injury were randomly assigned one of two doses of magnesium or placebo within 8 h of injury and continuing for 5 days. Magnesium doses were targeted to achieve serum magnesium ranges of 1.0-1.85 mmol/L or 1.25-2.5 mmol/L. The primary outcome was a composite of mortality, seizures, functional measures, and neuropsychological tests assessed up to 6 months after injury. Analyses were done according to the intention-to-treat principle. This trial is registered with , number . FINDINGS: Magnesium showed no significant positive effect on the composite primary outcome measure at the higher dose (mean=55 average percentile ranking on magnesium vs 52 on placebo, 95% CI for difference -7 to 14; p=0.70). Those randomly assigned magnesium at the lower dose did significantly worse than those assigned placebo (48 vs 54, 95% CI -10.5 to -2; p=0.007). Furthermore, there was higher mortality with the higher magnesium dose than with placebo. Other major medical complications were similar between groups, except for a slight excess of pulmonary oedema and respiratory failure in the lower magnesium target group. No subgroups were identified in which magnesium had a significantly positive effect. INTERPRETATION: Continuous infusions of magnesium for 5 days given to patients within 8 h of moderate or severe traumatic brain injury were not neuroprotective and might even have a negative effect in the treatment of significant head injury.